Most interesting was the information obtained on a follow-up survey conducted two years later. During this time, 29% of patients changed their primary care provider and 15% of patients changed their main arthritis doctor (who was not necessarily a rheumatologist). The most common reasons for this were the patient or provider moved (29%), the patient was not happy with the provider (13%), or because of insurance restrictions (10%). What consequences these changes might have had on coordination of care, treatment plans, or health outcomes was not studied.
Given that the patients studied had medical insurance, these results may be somewhat biased toward a more favorable assessment than exists in the population as a whole. Patients without insurance or those with public insurance may have less access to specialists and greater fragmentation of care than the patients who were studied. This study does not describe the nature of the care provided during visits or link the process of care to patient outcomes. The study also does not attempt to describe what types of care are appropriate or inappropriate, or useful or wasteful, but highlights the diversity of sources of care that characterize current clinical practice.
