A Comparison of Outcomes Resulting From Generalist vs Specialist Care for a Single Discrete Medical Condition

Abstract

Background: Studies of clinical outcomes for generalist vs specialist care for diagnoses within a specialist's narrow domain have tended to favor specialty care.

Disentangling the Linkage of Primary Care Features to Patient Outcomes: A Review of Current Literature, Data Sources, and Measurement Needs

“…Figure 1 illustrates the context in which primary care may be provided for patients. As depicted, the patient and the primary care team are influenced by available resources and infrastructure at their practice site, by the larger practice organization of which the practice may be a part, the affiliated provider networks of specialists and hospitals, 96 and local market-and community-level factors and resources. [97][98][99] In this complex environment, there are a variety of structures and care processes 4,100,101 to support the primary care elements.…”

Family Medicine Outpatient Encounters are More Complex Than Those of Cardiology and Psychiatry

“…23 In fact, in a systematic review of the generalist-specialist quality of care literature, studies favoring specialist care were less likely to control for 4 key potential confounders: (1) physician volume or experience, (2) information technology support, (3) care management programs, and (4) practice size and integration into delivery systems. 24 If we accept that these generalist-specialist differences are real, what is the explanation? Because those entering primary care residencies have similar scores on standardized examinations as those entering other residencies, 25 differences in quality of care provided must have a cause other than differences in intelligence.…”

Reforming primary care: innovation or destruction?

“…Many studies have demonstrated that, for specific diseases, specialists are capable of achieving better standards of care than generalists, 5 and some proposals for reform have focused on improving access to specialist medicine as a means of improving health outcomes. Conversely, specialist care is recognised as being more expensive than generalist care, and there is a good deal of evidence to show that strong primary care is associated with better health outcomes at lower cost for the healthcare system overall.…”

“…14,15 This raises the question of the very nature of primary care, its professional content, and organisational structure to pursue this function. That primary care is essential may well be beyond doubt, 1,5 but it is less well understood which of its characteristics 4 determine its effectiveness. This hampers the translation of the principles of primary care into a coherent primary care-led healthcare system.…”