The rapid expansion of managed care in the United States has increased debate regarding the appropriate mix of generalist and specialist involvement in medical care.
To compare the quality of medical care when generalists and cardiologists work separately or together in the management of patients with acute myocardial infarction (AMI).
We reviewed the charts of 1716 patients with AMI treated at 22 Minnesota hospitals between 1992 and 1993.
Patients eligible for thrombolytic aspirin, bêta-blockers, and lidocaine therapy were identified using criteria from the 1991 American College of Cardiology guidelines for the management of AMI.
We compared the use of these drugs among eligible patients whose attending physician was a generalist with no cardiologist input, a generalist with a cardiologist consultation, and a cardiologist alone.
Patients cared for by a cardiologist alone were younger, presented earlier to the hospital, were more likely to be male, had less severe comorbidity, and were more likely to have an ST elevation of 1 mm or more than generalists'patients.
Controlling for these differences, there was no variation in the use of effective agents between patients cared for by a cardiologist attending physician and a generalist with a consultation by a cardiologist. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Soin intégré, Qualité, Etude comparative, Médecin généraliste, Cardiologie, Stratégie, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Organisation santé
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Managed care, Quality, Comparative study, General practitioner, Cardiology, Strategy, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0431711
Code Inist : 002B12A05. Création : 25/01/1999.