Physicians' preferences for specialty involvement in the care of patients with neurological conditions

BACKGROUND. Recent changes in the US health care system have produced questions about the appropriate roles and responsibilities of generalist and specialist physicians within a primary care-centered health care delivery system. OBJECTIVES. To determine neurologists' and primary care physicians' preferences for specialist involvement in the management of common neurologic conditions and the factors influencing these preferences. RESEARCH DESIGN AND SUBJECTS. A self administered questionnaire was developed with the assistance of a multispecialty Advisory Board and sent to a stratified probability sample of 608 family physicians, 624 general internists, and 492 neurologists. MEASURES. The questionnaire contained three clinical scenarios, each followed by questions regarding respondent preferences for the primary care physician to manage alone, curb-side, or refer to a specialist. The questionnaire also contained knowledge questions corresponding to each scenario and physician and practice characteristics questions. RESULTS. Response rate was 60%. For all three scenarios, primary care physicians' preferences to involve a specialist differed substantially from neurologists' preferences, with nearly all neurologists preferring involvement of a specialist. Primary care physicians with less knowledge were more likely to prefer assistance from a neurologist. Physician age and practice setting influenced the type of assistance preferred (curbside vs. referral). Utilization management techniques and financial incentives had little influence on physician preferences to involve a specialist. CONCLUSIONS. The extensive disagreement between primary care physicians' and specialists' preferences for specialty involvement represents cause for considerable concern, supporting further efforts to identify where inappropriate referral processes are occurring and to implement mechanisms for improving the coordination and quality of primary and specialty care.