Intuitively, it would seem that increased access to primary care would reduce the need for expensive medical interventions later on. But recent research shows that this assumption may not hold true.

Medical researchers studied 1,396 in-patients in nine veterans' hospitals with chronic illnesses that require frequent rehospitalization and emergency care diabetes mellitus, obstructive pulmonary disease and congestive heart failure. Some patients were given six months of intensive follow-up care by primary care physicians and nurses after discharge, while others received normal follow-up care.

The enhanced care included a visit by the primary care physician two days before discharge, a follow-up telephone call from a nurse within two days after discharge, an examination in a clinic within one week after discharge and an updated treatment plan.

The study found that, compared to patients with the same conditions and severity of illness who received normal follow-up care:

• The group given more intensive follow-up care from a primary care physician had significantly higher rates of readmission to the hospital and more days of rehospitalization.

• After six months their quality of life was no better than those given normal follow-up care.

• Mortality rates were actually higher in the group of patients given intensive follow-up care.

• However, patients given more intensive care did express greater satisfaction with the quality of care they were given.

Physicians suggest that the enhanced use of primary care was ineffective because doctors who saw patients more frequently performed more diagnostic tests and proposed more therapeutic interventions. These patients were also more exposed to the risks associated with treatment and hospitalization.

Other studies have found little or no benefit in such preventive measures as detecting and treating early-stage prostate cancer and such follow-up interventions as surveillance to detect recurrence in patients with breast cancer.

Sources: Morris Weinberger et al., "Does Increased Access to Primary Care Reduce Hospital Readmissions?" and H. Gilbert Welch, "Questions About the Value of Early Intervention," New England Journal of Medicine, Vol. 334, No. 22, May 30, 1996.