A descriptive study of managed-care hassles in 26 practices.
OBJECTIVE
To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem.


METHODS
16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship.


RESULTS
Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both.


CONCLUSIONS
The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.
Internal Medicine Residency Program, St Mary's Medical Center, San Francisco, CA 94117-1079, USA. lsommers@chw.edu
L S
LS
Sommers
T W
TW
Hacker
D M
DM
Schneider
P A
PA
Pugno
J B
JB
Garrett
D001291:Attitude of Health Personnel; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States