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PCPs Often Give In to Patient Requests That Raise Healthcare Expenses

October 13th, 2016

GALVESTON, TX – Are primary care physicians too agreeable with patient requests, even if those increase healthcare expenses?

A study published recently in the American Journal of Managed Care finds that might be the case.

The University of Texas Medical Branch at Galveston study says that more than half of primary care providers reported “unnecessary” referrals to a specialist simply because patients asked them. In addition, many physicians agreed to prescribe brand-name drugs when patients requested them, even when less expensive generics were available.

Background information in the articles notes that 30% of U.S. healthcare expenses each year are believed to be unnecessary. The researchers sought to determine how physicians balance cost-saving expectations when confronted with specific patient requests.

For the study, researchers employed data from a survey of a nationally representative sample of 840 primary care physicians in 2009: 274 in family practice, 257 in internal medicine, and 309 in pediatrics.

The survey reported that, in response to patient requests, 52% of the respondents said they had made what they considered unnecessary referrals for a specialist and 39% prescribed brand-name drugs despite generic alternatives.

Results indicate that family physicians and internal medicine physicians were more likely than pediatricians to respond to those patient requests. Physicians also were more likely to give in to patient requests if they had more interactions with drug/device representatives, more years of clinical experience, treated fewer underinsured patients, and practiced in groups with only one or two physicians.

“PCPs may lack the time to effectively manage patient requests. Therefore, providing physicians with real-time support to effectively manage unnecessary requests can cause desirable outcomes,” study authors wrote. “Certain PCPs (i.e., family and internal medicine physicians) may require additional support to change their response to patient requests for unnecessary medical services. More experienced physicians in solo practices could benefit from guidance on how to appropriately incorporate patient preferences into patient-centered care, without engaging in unnecessary care.”

"Unnecessary medical practices may cause unneeded emotional and financial stress for patients and their loved ones," lead author Sapna Kaul, PhD, added in a University of Texas press release. "Both physician and patient-level strategies are required to limit wastage of medical resources. Efforts to reduce unnecessary practices could include educating physicians about the benefits that result from avoidance of over/under use of medical services and implementing incentives to create a system of value-seeking patients."