A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition: a systematic review and methodologic critique
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Medical Subject Headings
Clinical Competence; *Family Practice; Humans; *Medicine; Quality of Health Care; Reproducibility of Results; *Specialization
Health Services Research | Primary Care
BACKGROUND: Studies of clinical outcomes for generalist vs specialist care for diagnoses within a specialist's narrow domain have tended to favor specialty care.
METHODS: A MEDLINE search from January 1, 1980, through April 1, 2005, and a hand search of retrieved bibliographies of English-language studies that compared generalist vs specialist care for individual patients with a single discrete medical condition were performed. Two reviewers determined eligibility for each study and abstracted data onto a standardized instrument.
RESULTS: A total of 49 articles met our inclusion criteria: 24 studies favored specialty care, 13 found no difference in outcomes, 7 varied by individual outcome, 1 depended on physician experience, and 4 favored generalist care. Only 8 studies reported integration into health delivery systems, 4 considered physician experience, 3 documented information technology support, and 2 considered the impact of care management programs. Selection bias was adequately addressed in 58% of studies that favored specialty care and in 71% of studies that found no difference or favored generalist care (P = .52). Studies that favored specialty care were less likely to consider 4 key, potentially confounding physician or practice characteristics compared with studies that found no difference or favored generalist care (3% vs 15% of potential instances, respectively; P = .009).
CONCLUSIONS: The literature regarding the influence of generalist vs specialist care on outcomes for patients with a single discrete condition suffers from important methodologic shortcomings. Further research is needed to inform health care policy as it pertains to the optimal role of generalists and specialists in the physician marketplace.
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Citation: Arch Intern Med. 2007 Jan 8;167(1):10-20. Link to article on publisher's site
Smetana, Gerald W.; Landon, Bruce E.; Bindman, Andrew B.; Burstin, Helen; Davis, Roger B.; Tjia, Jennifer; and Rich, Eugene C., "A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition: a systematic review and methodologic critique" (2007). Meyers Primary Care Institute Publications and Presentations. 407.