Education, Research Should Move to Ambulatory Setting

Article excerpt

DURBAN, SOUTH AFRICA -- A landmark study provides new fuel for those who wish to see the bulk of medical education and research relocated from tertiary academic medical centers to ambulatory settings.

"The locus for medical education, research, and quality assurance in the U.S. health care delivery system is not consistent with the number of patients served and the volume of care provided by setting," George E. Fryer Jr., Ph.D., said at WONCA 2001, the conference of the World Organization of Family Doctors.

His study, which received the Outstanding Free Paper Award at the meeting, used data from a variety of nationally representative sources to document where Americans obtain their health care.

More specifically, the study offers a snapshot of the health care utilization patterns of 1,000 representative noninstitutionalized Americans, including children, during a 1-month period in 1996.

During this month-long interval, roughly one-third of Americans considered seeking medical care for symptoms that they were experiencing; two-thirds of these individuals actually did so. (See chart.)

More than 11% of Americans visited a primary care physician in an office setting. Another 6.5% sought care from a practitioner of complementary and alternative medicine, according to the study, which was scheduled to appear in the New England Journal of Medicine in late June.

In contrast, just 2.1% utilized a hospital based outpatient clinic, 1.3% were treated in a hospital emergency department, and 0.8% had an inpatient hospital stay. And fewer than 1 in 1,000 Americans were admitted to an academic medical center.

Yet it is in these hospital-based settings--rather than in the predominant-care settings--where most contemporary physician training and medical research takes place, noted Dr. Fryer of the American Academy of Family Physicians' Robert Graham Center, Washington.

This study follows by exactly 40 years the publication of an earlier look at where Americans got their health care, an article entitled "The Ecology of Medical Care." The seminal 40-year-old study utilized data from as far back as 1928 and from sources far less sophisticated than those available today.

The new study used far more reliable data sources, including the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey, the National Ambulatory Medical Care Survey the American Hospital Association database, and a national Gallup poll conducted specifically for the study

The results of the two studies were quite similar despite the 4-decade gap, although the new study incorporates children, minorities, and the use of complementary and alternative medicine. …