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  1. Is gatekeeping better than traditional care ? A survey of physicians'attitudes.

    Article - En anglais

    Context. - Nearly all managed care plans rely on a physician « gatekeeper » to control use of specialty, hospital, and other expensive services.

    Gatekeeping is intended to reduce costs while maintaining or improving quality of care by increasing coordination and prevention and reducing duplicative or inappropriate care.

    Whether gatekeeping achieves these goals remains largely unproven.

    Objective

    - To assess physicians'attitudes about the effects of gatekeeping compared with traditional care on administrative work, quality of patient care, appropriateness of resource use, and cost.

    Design

    - Cross-sectional survey of primary care physicians Setting. - Outpatient facilities in metropolitan Boston, Mass.

    Participants

    - All physicians who served as both primary care gatekeepers and traditional Blue Cross/Blue Shield providers for the employees of Massachusetts General Hospital, Boston.

    Of the 330 physicians surveyed, 202 (61%) responded.

    Outcomes Measures

    - Physician ratings of the effects of gatekeeping on 21 aspects of care, including administrative work, physician-patient interactions, decision making, appropriateness of resource use, cost, and quality of care.

    Results

    - Physicians reported that gatekeeping (compared with traditional care) had a positive effect on control of costs, frequency, and appropriateness of preventive services and knowledge of a patient's overall care (P<. 001). (...)

    Mots-clés Pascal : Soin santé primaire, Médecin, Enquête opinion, Organisation santé, Soin intégré, Homme, Etats Unis, Amérique du Nord, Amérique

    Mots-clés Pascal anglais : Primary health care, Physician, Opinion inquiry, Public health organization, Managed care, Human, United States, North America, America

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 98-0033425

    Code Inist : 002B30A05. Création : 17/04/1998.