Policymakers, managed care organizations, medical educators, and the general public are showing an increasing interest in the amount and quality of care provided by generalists and subspecialists.
This article reviews studies comparing the knowledge base of and quality of care provided by these 2 groups of physicians.
English-language articles were identified through MEDLINE (1966-present) using the following keywords : generalist, generalism, (sub) specialist, (sub) specialty, (sub) specialization, consultation, referral, and quality of care, and through the bibliographies of these citations.
All studies were evaluated.
With respect to quality of care, only American studies were chosen.
Data quality was assessed by me.
Evidence is strongest that the knowledge base and quality of care provided by specialists exceeds those of generalists for certain conditions such as myocardial infarction, depression, and acquired immunodeficiency syndrome.
Differences in many other areas are multifactorial, and often a function of study design or patient selection.
The differences, however, are not as striking or important to the health of the public at large as those deficiencies in disease management, preventive care, and health maintenance that are common to all physicians.
Furthermore, overuse of diagnostic and therapeutic modalities by certain specialists leads to increased costs with either no benefit or added risks to patients. (...)
Mots-clés Pascal : Médecin généraliste, Médecin, Spécialité médicale, Qualité, Soin, Etude comparative, Traitement, Homme, Article synthèse, Revue bibliographique
Mots-clés Pascal anglais : General practitioner, Physician, Medical specialty, Quality, Care, Comparative study, Treatment, Human, Review, Bibliographic review
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0387917
Code Inist : 002B30A04A. Création : 25/01/1999.