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Allen J. Dietrich, MD; Eugene C. Nelson, DSc; John W. Kirk, MD; Michael Zubkoff, PhD; Gerald T. O'Connor, PhD, DSc

JAMA. 1988;259(21):3145-3149.

Abstract
In what proportion of a patient's total health care is the primary physician involved? By means of calendar diaries and telephone interviews, 211 primary care patients from community practices of the Dartmouth Primary Care Cooperative Information Project were followed prospectively for one year. We found that a substantial proportion of care was managed (that is, either actually provided or coordinated in advance) by the patient's primary physician. Specifically, criteria for a primary physician's role in management were met by 75% of 1379 ambulatory visits to physicians, 33% of 786 visits to nonphysician health care providers, 81% of 26 nonemergency hospitalizations, and 78% of 2769 prescriptions. Primary physicians in these settings appear to function as case managers even when they are not participating in formal managed-care systems.

(JAMA 1988;259:3145-3149)

Author Affiliations
From the Departments of Community and Family Medicine (Drs Dietrich, Nelson, Kirk, and Zubkoff) and Medicine (Dr O'Connor), Dartmouth Medical School, Hanover, NH.

Footnotes
Preliminary results of this study were presented at the annual Robert Wood Johnson Clinical Scholars Meeting, Scottsdale, Ariz, Nov 2 through 6,1985.

Reprint requests to the Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03756 (Dr Dietrich).

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