| Titre : | Resolving the gatekeeper conundrum : What patients value in primary care and referrals to specialists. (1999) |
| Auteurs : | K. GRUMBACH ; A.B. BINDMAN ; C. DAMBERG ; C.J.R. QUESENBERRY ; J.V. SELBY ; A. TRUMAN ; C. URATSU ; Center for California Health Workforce Studies. University of California. San Francisco. USA ; Division of Research. Kaiser Permanente Medical Care Program of Northern California. Oakland. USA ; Primary Care Research Center. University of California. San Francisco. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 282, n° 3, 1999) |
| Pagination : | 261-266 |
| Langues: | Anglais |
| Mots-clés : | Soins intégrés ; Soins santé primaire ; Etats Unis ; Amérique ; Perception ; Malade ; Rôle du professionnel ; Médecin généraliste ; Evaluation ; Relation médecin malade ; Adulte ; Homme ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST pQ3R0x3p. Diffusion soumise à autorisation]. Context Few data are available regarding how patients view the role of primary care physicians as "gatekeepers'in managed care systems. Objective To determine the extent to which patients value the role of their primary care physicians as first-contact care providers and coordinators of referrals, whether patients perceive that their primary care physicians impede access to specialists, and whether problems in gaining access to specialists are associated with a reduction in patients'trust and confidence in their primary care physicians. Design, Setting, and Patients Cross-sectional survey mailed in the fall of 1997 to 12 707 adult patients who were members of managed care plans and received care from 10 large physician groups in California. The response rate among eligible patients was 71%. A total of 7718 patients (mean age, 66.7 years ; 32% female) were eligible for analysis. Main Outcome Measures Questionnaire items addressed 3 main topics : (1) patient attitudes toward the first-contact and coordinating role of their primary care physicians, (2) patients'ratings of their primary care physicians (trust and confidence in and satisfaction with), and (3) patient perceptions of barriers to specialty referrals. Referral barriers were analyzed as predictors of patients'ratings of their physicians. Results Almost all patients valued the role of a primary care physician as a source of first-contact care (94%) and coordinator of referrals (89%). (...) |
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