The involvement of primary care physicians during the last years of life may play a critical role in the health and well-being of the elderly.
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care recently completed a study that suggested primary care physicians play a vital role in the continuity of care and the duration of hospital stays for Medicare part B recipients, the American Academy of Family Physicians reported.
The study, which was published in the Annals of Family Medicine's January/February issue, concluded that patients who received more primary care involvement were less likely to require intensive care at the end of their lives. In fact, an average stay in the intensive care unit was reduced by almost a day and a half for those in regions with better primary care involvement.
The authors of the study were careful to point out that this study is simply evidence that more research is needed into the roles that primary care providers play in the final days of patient care.
Drawing data from the 1.1 million Medicare Part B recipients who had been diagnosed with a chronic illness and were treated in one of 306 Hospital Referral Regions, the researchers said that even though the evidence in favor of primary care physician involvement is strong, the data cannot be used to draw definitive conclusions. The study pointed out that there remains a great deal of accessibility differences between patient experience in major metropolitan areas vs. rural areas.
The influence that this research is likely to have on public policy is unknown, but there is strong evidence that increasing access to primary care physicians could decrease the cost of care for the Medicare Part B program. Using estimates that the authors said were “conservative,” the findings include a financial difference of $3,870 per patient. Those patients with the most primary care involvement during the final two years of their life resulted in a total Medicare spending of $65,160 vs. those with the least involvement from their primary care physician who cost the program $69,030.
Enrollment into hospice programs was also markedly lower for patients in the regions with the most primary care physician involvement in end-of-life treatment. However, researchers were hesitant to determine causation of those findings suggesting that the physician patient relationship may play a role in the determination.
Alternatively, the growth of hospice care in some regions might be a reflection of the lack of available primary care physicians. More research will be needed to study the effects that primary care physician involvement has on end-of-life care for all patients.
