Patients, doctors have different opinions on high-quality care

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Ideally, a good family doctor will not only be able to see you when you're sick, but make you feel better. At the least, you'll get a chance to thoroughly discuss what's ailing.

Lately, most of the nation's top associations of family docs have embraced the notion of a patient-centered medical home. The idea is that each patient should have a team of doctors, nurses and technicians looking out for them, but work mainly with one doctor to quarterback the care.

Yet two recent studies done by different research teams at the University of Michigan illustrate how professional and patient standards may not entirely mesh.

In a study published online in the journal Health Service Research, a team led by Dr. John Hollingsworth reported that 46 percent of the nation's physician practices don't meet the national standards to qualify as a medical home.

Researchers determined this by plotting outpatient care data gathered by the federal government against standards for medical homes set by a national accrediting organization.

General-ly speaking, solo or small groups of physicians can't meet the medical home standards because they don't have the staff or infrastructure to fully monitor and coordinate patient care. That was what the Michigan group found -- that nine of 10 Americans get care from doctors who practice in smaller, single-specialty groups.

"Ideally, medical homes will keep patients with chronic diseases from getting lost in the shuffle of our complex, fragmented health care system, yet a growing number of patients do not have access to them," Hollingsworth said.

The medical home concept is part of a larger trend in health care to aggregate medical practices and pay those teams for each episode of care -- and for positive results -- rather than procedure by procedure. The change is being pushed by employers and insurance companies as well as through the federal health care reform law.

Hollingsworth and his colleagues say smaller practices need more incentives and help to meet the new care standards, particularly in rural and underserved urban areas.

Another study that analyzed data from an online survey website about physicians, DrScore.com, found that most patients seem satisfied with their doctors and the care they receive.

Between 2004 and 2010, 14,984 patients ranked their most recent visit on a 10-point scale, with 10 the top number. Only doctors with at least 10 on-line ratings were included in the study and the site only allowed a patient the opportunity to rate a particular doctor once every three months, to prevent skewing.

Fewer than 2 percent of all the ratings were a 1 or less. And 70 percent of all the scores were a 10; another 15 percent were a 9.

Rajesh Balkrishnan, the study's lead author and an associate professor in the school of public health and pharmacy, said even most patients who reported spending only "average" waiting times and appointment times with their doctor "seem to be giving full marks to their physician in terms of visit satisfaction."

He said older patients, those who had shorter waiting times and spent the most time with their doctors gave higher scores; younger patients with longer waits and shorter visits (less than five minutes) gave lower scores.

Despite these rosy reports, patients are actually making fewer visits to their regular doctors.

Two October studies presented to the American College of Emergency Physicians showed that most patients who come to an emergency room with minor complaints have a regular doctor, and that many, if not most, visited the ER because their regular doctor sent them or told them they could not get a timely appointment.

A study published by RAND Corp. in November found that the number of people using retail medical clinics in pharmacies and other shops was 10 times greater in 2009 than in 2007 among people enrolled in one insurance plan.

Out of 13.3 million in the insurance plan, 3.8 million used a retail clinic at least once during the two years.

Researchers found no evidence that most people using the clinics lacked a regular doctor. Most said they used the clinics as a convenience for getting treatment of a simple problem such as a sore throat or earache.

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