Care of the secondary patient in family practice - A report from the Ambulatory Sentinel Practice Network

BACKGROUND Care of a secondary patient (an individual other than the primar y patient for an outpatient visit) is common in family practice, but the co ntent of care of this type of patient has not been described. METHODS In a cross-sectional study, 170 volunteer primary care clinicians i n 50 practices in the Ambulatory Sentinel Practice Network reported all occ urrences of care of a secondary patient during 1 week of practice. These cl inicians reported the characteristics of the primary patient and the second ary patient and the content of care provided to the secondary patient. Cont ent of care was placed in 6 categories (advice, providing a prescription, a ssessment or explanation of symptoms, follow-up of a previous episode of ca re, making or authorizing a referral, and general discussion of a health co ndition). RESULTS Physicians reported providing care to secondary patients during 6% of their office visits. This care involved more than one category of servic e for the majority of visits involving care of a secondary patient. Advice was provided during more than half the visits. A prescription, assessment o r explanation of symptoms, or a general discussion of condition were provid ed during approximately 30% of the secondary care visits. Secondary care wa s judged to have substituted for a separate visit 60% of the time, added an average of 5 minutes to the visit, and yielded no reimbursement for 95% of visits. CONCLUSIONS Care of a secondary patient reflects the provision of potential ly intensive and complex services that require additional time and are larg ely not reimbursed or recognized by current measures of primary care. This provision of secondary care may facilitate access to care and represent an added value provided by family physicians.