Staying With One Doc Improves Preventive Care

Urgent Care Centers Aren't Set Up for Long-Term Preventive Medicine

By Jeanie Lerche Davis
WebMD Health News

July 20, 2004 -- Urgent care " doc-in-the-box" centers are everywhere. But what's the downside?

A new study shows that adults who regularly visit the same doctor -- or the same clinic -- are more likely to get better preventive medicine. Continuity of care is the important ingredient.

In today's managed care world, few studies have examined this issue -- how patients fare based on the type of health care service they choose, writes researcher Mark P. Doescher, MD, MSPH, a professor in family medicine at the University of Washington School of Medicine. His paper appears in this month's issue of the Journal of General Internal Medicine.

The last such study was done in 1987, in the early days of managed care, he writes. Those researchers found that -- whether patients chose one primary doctor or a clinic or HMO -- they all got the same preventive medicine in terms of mammograms, Pap smears, breast exams, vaccinations, etc.

Medical Care Battles It Out

His study looks at more recent data from a 1996-1997 nationwide telephone survey of nearly 43,000 adults. Doescher and his colleagues asked about each family's health care service -- whether they used urgent care centers or hospital emergency rooms for health problems, if they relied on an HMO clinic, or if they saw just one primary care doctor.

Researchers also tracked whether family members got yearly flu shots, mammograms, and advice on stopping smoking -- a few measures of preventive medicine.

The "one-doctor-only group"got the highest level of preventive health care, reports Doescher. These people may be already health-focused: Primary care doctors certainly have placed a progressively greater emphasis on health promotion, he adds.

Among those that received their care only from urgent care centers:

38% of people 55 and over got flu shots, 36% of women got mammograms, and 40% of adult smokers got stop-smoking advice.

The HMO clinic group did better:

They were 10% more likely to get flu shots, 13% more likely to get mammograms, and 6% more likely to get stop-smoking advice than the urgent care group.

In addition patients that stuck with the same doctor fared even better than the HMO group. These patients were 6% more likely to get flu shots and mammograms than the HMO group. Stop-smoking advice was about the same as in the HMO group.

Clinics Are Fine

Lizabeth Riley, MD, associate medical director of the Baylor Family Medicine Clinic in Houston, offered her view. In her clinic, Riley is essentially a primary care doctor.

The advantage of having one primary doctor: "You don't spend time relearning every patient with every visit, so you can use that time to see if they're due for a screening -- a colonoscopy or even something as simple as a flu shot. You're not looking at their past history, trying to figure them out."

But another clinic doctor can pinch-hit easily, with today's electronic medical record systems, she adds. That alone gives patients the continuity of care that keeps them satisfied. "As long as a patient goes to the same clinic -- versus going to an urgent care center over and over -- they can come in with a sore throat, but the records will show they're also due for a diabetes check."

Urgent care centers simply don't offer that big picture of a patient's health care, Riley points out. "If a patient had three sinus infections and lots of allergy problems in the past three months -- and just went to an urgent care center -- they lose continuity of care."

They don't get the problem solved, and they don't have a doctor providing overall preventive medicine.

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