title: GERD-related health care utilization, therapy, and reasons for transfer of GERD patients between primary care providers and gastroenterologists in a US managed care setting.
abstract: OBJECTIVE
  Patient flow between primary care physicians and gastroenterologists in the continuum of gastroesophageal reflux disease (GERD) care is poorly understood. Using administrative claims data from a large US health plan linked with data abstracted from medical records, we examined: health care resource utilization for GERD subjects treated by primary care physicians (PCPs) and gastroenterologists (GEs), determinants of GERD subject transfer between these physician types, and reasons for GERD therapy change.
  
  
  RESULTS
  Within a sample of 169,884 patients, 211,043 PCP-based episodes of care and 40,304 GE-based episodes of care were developed. In unadjusted comparisons, GE episodes were characterized by more endoscopic procedures, on average (50.5/100 episodes), compared with PCP episodes (6.3/100, P < 0.001). Multivariate analysis showed that patients with esophagitis had 57.3% higher odds (P < 0.01) of transfer from PCP to GE compared with patients without esophagitis; patients with esophageal stricture had 98.6% higher odds (P < 0.01) of PCP-GE transfer. Patients with endoscopy during a first GE episode had 32.2% higher odds of transfer to a PCP (P < 0.01). The principal reasons for change in GERD therapy were no change or worsening of symptoms (51.7% of PCP charts; 9.5% of GE charts) and lack of response to therapy (51.7% of PCP charts, 26.2% of GE charts).
  
  
  CONCLUSIONS
  Resource utilization varies greatly based on the physician's specialty. We infer that timely transfer of GERD patients to gastroenterologists when empiric treatment is insufficient may lead to more efficient clinical management.
authors.affiliation: Health Economics and Outcomes Research, i3 Innovus, Eden Prairie, MN, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Halpern
authors.forename: Smita
authors.initials: S
authors.lastname: Kothari
authors.forename: Mahesh
authors.initials: M
authors.lastname: Fuldeore
authors.forename: Victoria
authors.initials: V
authors.lastname: Zarotsky
authors.forename: Victoria
authors.initials: V
authors.lastname: Porter
authors.forename: Omar
authors.initials: O
authors.lastname: Dabbous
authors.forename: Jay L
authors.initials: JL
authors.lastname: Goldstein
mesh_terms: D002983:Clinical Competence; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology; D005764:Gastroesophageal Reflux / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000458:organization & administration*; D010821:Physicians, Family; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States; D000078329:Workforce
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