A descriptive study of managed-care hassles in 26 practices

Objectives To explore the nature of managed-care hassles in primary care ph ysicians' offices and to determine the feasibility of practice-based resear ch methods to study the problem. Methods 16 internists and 10 family physic ians volunteered to collect data about managed-care hassles during or short ly after the office visit for 15 consecutive patients using preprinted data cards. Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship. Results Physicians adapted easily to using data cards. Before the pilot study, part icipants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits g enerated 1 or more hassles. On average, a physician who saw 22 patients dai ly experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both. Conclusions The high hassle rate, in addition to the interference of hassles with quality of care and the doctor -patient relationship, suggests the need for further investigation into man aged-care hassles using practice-based research methods.