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Patient perception of quality of care provided by specialists and generalists

Behavioral Science Research Program, Frontier Science & Technology Research Foundation, Inc., Chestnut Hill, Massachusetts, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Sally Brotman

Behavioral Science Research Program, Frontier Science & Technology Research Foundation, Inc., Chestnut Hill, Massachusetts

Nicholas LaRocca

Health Services Research Program, National Multiple Sclerosis Society, New York, NY, MS Comprehensive Care Center, St. Agnes Hospital, White Plains, NY

Hang Lee

Department of Psychiatry, Massachusetts Mental Health Center, Harvard Medical School, Boston, Massachusetts, USA

Efforts to control medical care costs have focused on reducing the number of specialists directing patient care. This cross-sectional survey evaluated multiple sclerosis patient perceptions of the quality of care across three patterns of care: primary care (n=156), single specialty care (n=338), and comprehensive care (n=75). The pattern of medical care received by the patient was defined by: (1) whether the MS provider was a primary care physician or (2) a neurologist; (3) whether the patient reported using other specialty services, such as psychological, rehabilitation, or social work services. Process indicators of quality of care were measured by subscales for interpersonal aspects of care, access to care, and perceived action plan. The MSQOL-54 was used to measure health-related quality of life. Pattern of care was not related to the Interpersonal or Access dimensions of care, after adjusting for health status and sociodemographic characteristics. Patients in the Single Specialty and Comprehensive Care patterns of care were, however, more likely to report their MS provider having and implementing an action plan. We conclude that MS patients who receive Single Specialty and Comprehensive Care are more likely to get diagnostic and treatment-related tests, as well as immunotherapeutic and experimental treatments.

Key Words: multiple sclerosis • quality of care • specialists • generalists

Multiple Sclerosis, Vol. 4, No. 5, 426-432 (1998)
DOI: 10.1177/135245859800400505


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