Care of the secondary patient in family practice. A report from the Ambulatory Sentinel Practice Network.
BACKGROUND
Care of a secondary patient (an individual other than the primary patient for an outpatient visit) is common in family practice, but the content of care of this type of patient has not been described.


METHODS
In a cross-sectional study, 170 volunteer primary care clinicians in 50 practices in the Ambulatory Sentinel Practice Network reported all occurrences of care of a secondary patient during 1 week of practice. These clinicians reported the characteristics of the primary patient and the secondary patient and the content of care provided to the secondary patient. Content of care was placed in 6 categories (advice, providing a prescription, assessment or explanation of symptoms, follow-up of a previous episode of care, making or authorizing a referral, and general discussion of a health condition).


RESULTS
Physicians reported providing care to secondary patients during 6% of their office visits. This care involved more than one category of service for the majority of visits involving care of a secondary patient. Advice was provided during more than half the visits. A prescription, assessment or explanation of symptoms, or a general discussion of condition were provided during approximately 30% of the secondary care visits. Secondary care was judged to have substituted for a separate visit 60% of the time, added an average of 5 minutes to the visit, and yielded no reimbursement for 95% of visits.


CONCLUSIONS
Care of a secondary patient reflects the provision of potentially intensive and complex services that require additional time and are largely not reimbursed or recognized by current measures of primary care. This provision of secondary care may facilitate access to care and represent an added value provided by family physicians.
Orzano
A J
AJ
Department of Family Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey  08903-0019, USA. orzanoaj@umdnj.edu
Gregory
P M
PM
Nutting
P A
PA
Werner
J J
JJ
Flocke
S A
SA
Stange
K C
KC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration*; D002170:Canada; D003430:Cross-Sectional Studies; D005190:Family; D005192:Family Health; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D016526:Workload