Care of the Secondary Patient in Family Practice

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Original Research

Care of the Secondary Patient in Family Practice

J Fam Pract. 2001 February;50(2):113-114

References

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Although our study does not provide data to identify the reasons that secondary care was provided, it is interesting to speculate that access to care might be involved. Access issues related to the clinician or practice might include the ease of scheduling a visit or phone contact.²⁰ Access issues related to the patient might include transportation, work responsibilities, or child or elder care.²⁰ For example, when the secondary patient was aged 65 years or older, follow-up was the service more likely to occur. Perhaps this represents an accommodation to this age group, thereby possibly obviating the arrangement of transportation for another visit. Transportation, or the lack thereof, might explain why secondary care occurred more often in rural settings. The finding that secondary care tended to be provided more often by older clinicians might be explained by their more comprehensive knowledge of the patient and family. Although the proportion of women was higher for both primary and secondary patients, the finding that the secondary patient was less likely to be a woman is consistent with previous research demonstrating the central role of women in accessing medical care for the family.^21,22

Future research should examine the reasons why secondary care is provided, from the perspectives of the physician and primary and secondary patients. In addition, the effects of other factors on the frequency and content of secondary care, such as health insurance, employment, access to care, and family structure must be elucidated. Such studies would provide useful information on the extent to which secondary care is an expression of barriers to access of care or an added value of family practice responding rationally to competing opportunities.^23,24 Also, studies need to assess whether the quality of care including the clinical outcomes, patient satisfaction, and cost of care for both primary and secondary patients is affected by the substitution of secondary care for a separate visit.

Conclusions

A physician’s care of a secondary patient includes the provision of potentially time-consuming and complex services that are largely not reimbursed or recognized by current measures of primary care. This provision of secondary care seems to facilitate access to care and represents an added value provided by family physicians.

Related Resources

American Academy of Family Physicians www.aafp.org
Center for Research in Family Practice and Primary Care http://mediswww.cwru.edu/dept/crfppc