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A prospective study of principal care among Colorado neurologists

Departments of Neurology (Drs. Franklin and Ringel), Preventive Medicine and Biometrics (Drs. Franklin and Baron), and Psychiatry (Dr. Baron), University of Colorado School of Medicine, Denver; and the Rocky Mountain Multiple Sclerosis Center (Dr. Franklin and Ms. Jones), Englewood, CO.

We initially surveyed the practice patterns of 24 private sector neurologists in Colorado between June and September, 1985, having chosen representative practices from each of 4 practice types (solo [6], nonsolo single discipline [11], nonsolo multispecialty [4], and nonsolo HMO [3]) and from both urban (14) and rural (10) practice locations. Among 2,373 consecutive new patient visits initially surveyed, we reexamined 2,359 (99%) charts 1 year later to investigate patterns of principal care. We defined principal care as 2 or more follow-up visits in the year following the initial office visit. One-fifth of initial visits received principal care, and the mean number of follow-up visits per year among those receiving principal care was 4 (range, 2 to 32 visits). The best indicators of principal care were Medicare coverage, a classic neurologic diagnosis (seizure, stroke), rural practice location, and solo neurology practice. The best indicators of consultative care were self-pay coverage, a diagnosis of musculoskeletal, psychiatric, or pain disorder, urban practice location, and HMO neurology practice. Age, sex, race, and type of referring physician were unimportant in determining subsequent principal care. Projections of future manpower needs must reflect both consultative as well as principal care services provided by neurologists, as well as the cost-effectiveness of such care.

Address correspondence and reprint requests to Dr. Gary M. Franklin, Department of Environmental Health, SC-34, University of Washington School of Public Health and Community Medicine, Seattle, WA 98195.

Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.

Received August 22, 1989. Accepted for publication in final form September 27, 1989.

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