Physician communication in managed care organizations: opinions of primary care physicians.
BACKGROUND
One method of achieving appropriate patient treatment and continuity of care is to ensure good communication between primary care physicians and specialist physicians. We undertook an exploratory study designed to assess primary care physicians' opinions regarding communication patterns between primary care physicians and specialist physicians participating in fee-for-service and managed care health insurance plans.


METHODS
A 26-question survey instrument was mailed to 110 general internists on the clinical faculty of a university hospital. Each question solicited a response for "managed care plans" and "nonmanaged care plans," with responses scored on a 5-point Likert scale ranging from 1 = never to 5 = always. Results were analyzed using the Wilcoxon signed-ranks test of the difference between responses for managed care and nonmanaged care settings.


RESULTS
Eighty-four physicians (76%) responded to the survey. Forty-one of these physicians participated in both managed and nonmanaged care plans and thus were eligible for the analysis. These primary care physicians reported that patients were referred more often to an unknown specialist for managed care (MC) plans than for nonmanaged care (NMC) plans (MC mean = 2.8, NMC mean = 1.4; P < .01). They also reported that when referring patients in managed care plans to a specialist, they spoke personally with specialists less often (MC mean = 2.8, NMC mean = 3.5; P < .01) and sent a written summary to specialists less often (MC mean = 2.6, NMC mean = 2.9; P < .05). Primary care physicians in this study perceived that patients in managed care plans charged primary care providers much more frequently than did those in nonmanaged care plans (MC mean = 3.8, NMC mean = 2.2; P < .01).


CONCLUSIONS
In this exploratory study, we found that communication between primary care and specialist physicians may be impaired when multiple health insurance plans with restricted panels of participating physicians are implemented in communities. Further research is required to confirm these findings and to assess how patient-related communication is managed.
Roulidis
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Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC 20007.
Schulman
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D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D004219:District of Columbia; D005251:Fees, Medical; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007388:Internal Medicine; D007400:Interprofessional Relations; D008297:Male; D008511:Medicine; D008875:Middle Aged; D010820:Physicians; D012017:Referral and Consultation; D013038:Specialization