Doctor shopping by overweight and obese patients is associated with increased healthcare utilization

Gudzune, Kimberly A.; Bleich, Sara N.; Richards, Thomas M.; Weiner, Jonathan P.; Hodges, Krista A.; Clark, Jeanne M.

doi:10.1002/oby.20189

Cited by 35 publications

(42 citation statements)

References 30 publications

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“…We only included patients who were actively engaged in primary care, so our population excludes patients who may not be engaged in care due to dissatisfaction or lack of trust in the healthcare system. A prior study found that overweight and obese patients were more likely to “doctor shop” (27), so our results may underestimate the prevalence of patient-perceived weight-related judgment by providers.…”

Section: Discussionmentioning

confidence: 67%

Patients who feel judged about their weight have lower trust in their primary care providers

Gudzune¹,

Bennett²,

Cooper³

et al. 2014

Patient Education and Counseling

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Objective To evaluate whether overweight and obese patients have less trust in their primary care providers (PCPs) if they feel judged about their weight by these PCPs. Methods We conducted a national internet-based survey of 600 adults engaged in primary care with a BMI≥25kg/m2 in 2012. Our dependent variable was high patient trust in their PCP (score≥8/10). Our independent variable was “feeling judged about my weight by my PCP” dichotomized as “often/sometimes” versus “never.” We conducted a multivariate logistic regression model adjusted for patient and PCP factors using survey weights. Results Overall, 21% felt that their PCP judged them about their weight. Respondents who perceived judgment were significantly less likely to report high trust in their PCP [OR 0.55, 95%CI 0.31-0.98]. Conclusion While only a fifth of overweight and obese patients perceived weight-related judgment from their PCPs, these patients were significantly less likely to report high trust in these providers. Given patients’ decreased trust in providers who convey weight-related judgment, our results raise concerns about potential effects on the doctor-patient relationship and patient outcomes. Practice Implications Addressing provider stigma towards patients with obesity could help build trust in these patient-provider relationships and improve quality of care.

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Section: Discussionmentioning

confidence: 67%

Patients who feel judged about their weight have lower trust in their primary care providers

Gudzune¹,

Bennett²,

Cooper³

et al. 2014

Patient Education and Counseling

Self Cite

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“…This suggests that the small percentage of patients who see surgery as their best hope may gravitate to surgeons who are more likely to offer it. So-called ''doctor shopping'' has been studied in other fields and has been associated with decreased patient satisfaction and with opioid addiction [9,13]. Future research should focus on factors associated with seeking a second opinion in the field of hand surgery and the influence on final patient symptoms and disability.…”

Section: Discussionmentioning

confidence: 99%

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Becker

Teunis

Blauth

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There are substantial variations in medical services that are difficult to explain based on differences in pathophysiology alone. The scale of variation and the number of people affected suggest substantial potential to lower healthcare costs with the reduction of practice variation. Our study assessed practice variation across three affiliated urban sites in one city in the United States and related healthcare costs following the diagnosis of hand osteoarthritis (OA) in patients. Questions/purposes (1) What are the factors associated with increased costs and surgery in the first year after diagnosis of hand OA? (2) How much practice variation exists among hand surgeons in terms of the number of patient visits, use of imaging tests, use of injections, occupational therapy use, and surgery? (3) What proportion of total cost is accounted for by patients who consult with an additional provider? Methods Patients receiving a new diagnosis of primary hand OA between January 1, 2007, and December 31, 2011, were identified from the research database of three affiliated urban hospitals in a single city in the United States. We included 2814 patients (69%, 1929 women) treated by six hand surgeons. We recorded all visits, imaging tests, injections, occupational therapy visits, and surgical procedures in the first year after that diagnosis. Costs were extracted from the Medicare Physician Fee Schedule. Reliability of the database was assessed by manual checking of 120 patient charts (4.3% of all data); reliability was determined to be 94% (113 of 120) for diagnoses, 97% (116 of 120) correct surgeon, 100% (120 of 120) second surgeon, 99% (278 of 282) visits, 99% (132 of 134) imaging procedures, 92% (11 of 12) injections, 95% (21 of 22) surgical procedures, and 85% (102 of 120) prescribing occupational therapy.One of the authors (SJEB) is supported by Dutch research grants from Anna Foundation|NOREF (less than USD 10,000) (Oegstgeest, The Netherlands), Genootschap Noorthey (less than USD 10,000) (Bussum, The Netherlands), Stichting Fonds Doctor Catharine van Tussenbroek (less than USD 10,000) (Amsterdam, The Netherlands), and Stichting Vreedefonds (less than USD 10,000) (Amsterdam, The Netherlands). One of the authors (TT) received research grants from the Prince Bernhard Culture Fund & Kuitse Fung (less than USD 10,000) (Amsterdam, The Netherlands) and Fundatie van de Vrijvrouwe van Renswoude te's-Gravenhage (less than USD 10,000) (The Hague, The Netherlans). One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from Wright Medical (less than USD 10,000) (Memphis, TN, USA); Skeletal Dynamics (less than USD 10,000) (Miami, FL, USA); Biomet (less than USD 10,000) (Warsaw, IN, USA); AO North America (less than USD 10,000) (Paoli, PA, USA); and AO International (less than USD 10,000) (Dubendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and boa...

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“…It may also result from the GPs’ general qualities such as organizational skills, communication abilities, or empathic attitudes. It has been suggested that such patterns may result from patients’ negative interactions with healthcare providers, so that, for instance, obese patients search for “obese friendly” physicians [25]. Patients could also make use of informal conversations (word-of-mouth) with family, friends, or colleagues that recommend one GP or another, which seems to have a greater effect on the choice of GP than public information disclosure [20].…”

Section: Discussionmentioning

confidence: 99%

“…Interaction between chronically ill patients and their GPs has not been given specific attention in previous literature, but a previous study of obese patients may contain clues for generalizable results: reportedly, obese patients avoided physicians they perceived as sources of stigma and searched for providers who were “obese friendly” [25]. …”

Section: Introductionmentioning

confidence: 99%

Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data

Mokienko

Wangen

2016

BMC Fam Pract

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BackgroundNorwegian general practitioners (GPs) consult on a variety of conditions with a mix of patient types. Patients with chronic diseases benefit from appropriate continuity of care and generally visit their GPs more often than the average patient. Our aim was to study disenrollment patterns among patients with chronic diseases in Norway, because such patterns could indicate otherwise unobserved GP quality. For instance, higher quality GPs could have both a greater share of patients with chronic diseases and lower disenrollment rates.MethodsData on 384,947 chronic patients and 3,974 GPs for the years 2009–2011 were obtained from national registers, including patient and GP characteristics, disenrollment data, and patient list composition. The birth cohorts from 1940 and 1970 (146,906 patients) were included for comparison. Patient and GP characteristics, comorbidity, and patient list composition were analyzed using descriptive statistics. Patients’ voluntary disenrollment was analyzed using logistic regression models.ResultsThe GPs’ proportion of patients with a given chronic disease varied more than expected when the allocation was purely random. The proportions of patients with different chronic diseases were positively correlated, partly due to comorbidity. Patients tended to have lower disenrollment rates from GPs who had higher shares of patients with the same chronic disease. Disenrollment rates were generally lower from GPs with higher shares of patients with arthritis or depression, and higher from GPs who had higher shares of patients with diabetes type 1 and schizophrenia. This was the same in the comparison group.ConclusionPatients with a chronic disease appeared to prefer GPs who have higher shares of patients with the same disease. High shares of patients with some diseases were also negatively associated with disenrollment for all patient groups, while other diseases were positively associated. These findings may reflect the GPs’ general quality, but could alternatively result from the GPs’ specialization in particular diseases. The supportive findings for the comparison group make it more plausible that high shares of chronic patients could indicate GP quality.

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Doctor shopping by overweight and obese patients is associated with increased healthcare utilization

Cited by 35 publications

References 30 publications

Patients who feel judged about their weight have lower trust in their primary care providers

Patients who feel judged about their weight have lower trust in their primary care providers

Medical Services and Associated Costs Vary Widely Among Surgeons Treating Patients With Hand Osteoarthritis

Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data

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