When a primary care physician is the predominant provider near the end of a patient's life, patients tend to receive less intensive, lower cost palliative care, according to a recent study published by the Annals of Family Medicine.
The study examines the ratio of primary care physician to specialist visits in the last six months of patients' lives in 306 hospital referral regions. Researchers compared this ratio to the rate of hospital deaths, hospital and intensive care use at the end of life, the percentage of patients being seen by more than 10 physicians and Medicare spending during the last 2 years of patients' lives.
They found patients who resided in regions with the most primary care involvement accrued roughly $4,000 less in Medicare spending in their last two years of life, spent nearly 1.4 fewer days in the intensive care unit in their last six months of life and were less likely to be enrolled in hospice.
The study highlights its paradoxical finding that lower spending is associated with less hospice use for patients with highly involved primary care physicians. The researchers note this aspect of the study warrants further investigation. They suggest it may be due to slower hospice growth in areas with strong primary care involvement, or possibly that primary care physicians with long-standing patient relationships may hesitate to end relationships by sending patients to hospice.
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