EFFECT OF PHYSICIAN SPECIALTY ON USE OF NECESSARY CORONARY ANGIOGRAPHY

Objectives. This study sought to determine whether having a cardiologi st as a regular source of care influences likelihood of undergoing nec essary coronary angiography. Background. An important element of the c urrent health policy debate is the respective roles of primary care an d specialist physicians. However, there are few data on interspecialty differences in quality of care for patients with ischemic heart disea se. Methods. We contacted 243 patients by telephone (response rate 72% ) who had positive (or very positive) exercise stress test results and met additional clinical criteria for necessary coronary angiography. Study patients were randomly sampled from those undergoing exercise st ress testing at one university and three public hospitals in Los Angel es between January 1, 1990 and June 30, 1991. Patients were asked whet her they had a regular source of care during the time after their exer cise stress test and, if so, whether that provider was a cardiologist or cardiology clinic. Results. Among survey responders, 47% underwent necessary coronary angiography within 3 months of exercise testing and 61% within 12 months. After adjustment for sociodemographics and clin ical presentation, patients with a cardiologist as a regular source of care were more likely than all other patients to have undergone neces sary angiography within 3 months (52% vs. 38%, p = 0.05) and within 12 months (74% vs. 44%, p = 0.0001) of the exercise test. At 3 months, t here was a trend toward a more pronounced effect of ongoing cardiologi c care within the public hospitals compared with the private hospital (p = 0.09 for interaction between hospital types). Conclusions. Patien ts ffith a cardiologist as a regular source of care were more likely t han all other patients to undergo clinically necessary coronary angiog raphy within both 3 and 12 months of exercise stress testing.