The handful of studies looking at physician specialty differences within an HMO setting have focused on other medical conditions. Assessing the Appropriateness of Care for Heart Attack Survivors

Our study compares the use of three specific pharmacological treatments among Medicare heart attack survivors who saw cardiologists regularly and those who did not. Usage rates for aspirin were much higher but still below recommended levels. Medicare HMO Enrollees Who See a Cardiologist Regularly Are More Likely to Report Taking Cholesterol-Lowering Drugs and Beta-Blockers

Approximately 2 years after their heart attack, 41 percent of our sample reported that they saw a cardiologist regularly. We found clear differences in the use of cholesterol-lowering drugs and beta-blockers—and a smaller difference in aspirin usage—between patients under the regular care of a cardiologist and all others. As table 1 shows, both cholesterol-lowering drugs and beta-blockers were taken 50-percent more often by respondents who routinely saw a cardiologist compared to those without regular cardiology appointments. Healthier Patients Are More Likely to Report Taking Cholesterol- Lowering Drugs, Beta-Blockers, and Aspirin

In general, we found that healthier patients were more likely to take all three types of drugs, although the specific predictive factors varied among the drug categories. Regular cardiology care was not associated with gender, educational attainment, current income, the presence of comorbidities, or self-reported health status. Observations

On the whole, our conclusion that patients under the regular care of a cardiologist are more likely to take recommended medications parallels the findings of other studies of physician specialty differences in the United States. Our results also reinforce the findings of the small number of other studies specifically concerned with HMO members. Our sample, however, was limited to heart attack survivors enrolled in Medicare HMOs who remained enrolled for the roughly 2-year period from their heart attack until we interviewed them. Those respondents were coded as not having a cardiologist. Patients with regular cardiology appointments Patients with occasional cardiology appointments Patients with no cardiology appointments Patients who did not see a cardiologist or saw one only occasionally (B+C)
Our main analysis compared group A with group D (see table 1); this analysis compares group A with group B to make inferences about group C. If, as suggested by the alternative explanation, the principal determinant of drug use is the regularity of physician appointments regardless of the physician’s specialization, then one would expect the same proportion of patients who did not see a cardiologist to receive these drugs depending on whether they saw any other physician regularly or not. All of the figures we used in the above calculations reflect the responses provided by the particular sample HCFA drew from the population of Medicare heart attack survivors in HMOs. Multivariate Analyses for Cholesterol- Lowering Drugs, Beta-Blockers, Aspirin, and Regular Cardiology Appointments

For our major analyses, we compared the usage rates of cholesterol-lowering drugs, beta-blockers, and aspirin for respondents who had regularly scheduled cardiology visits with the rates for those who do not see a cardiologist regularly. U.S. General Accounting Office P.O.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the potential differences in treatment patterns for health maintenance organizations (HMO) patients treated by specialists and those treated by generalist physicians, focusing on: (1) the proportion of Medicare heart attack survivors enrolled in HMOs who take cholesterol-lowering drugs, beta-blockers, and aspirin; and (2) whether Medicare heart attack survivors in HMOs regularly treated by a cardiologist are more likely to take cholesterol-lowering drugs, beta-blockers, and aspirin than those who do not have regular cardiology appointments.

What GAO Found

GAO noted that: (1) the ongoing use of cholesterol-lowering drugs and beta-blockers reported by Medicare heart attack survivors enrolled in HMOs generally parallels the patterns for heart attack survivors in the U.S. health care system overall; (2) as others have found for the general patient population, GAO found a much smaller proportion of respondents reported taking cholesterol-lowering drugs (36 percent) or beta-blockers (40 percent) than would be expected if everyone who would benefit from using these drugs were taking them; (3) Medicare HMO heart attack survivors with regular cardiology care--40 percent of GAO's survey respondents--were more likely to take the recommended drugs than those without regular appointments with a cardiologist; (4) enrollees who saw cardiologists regularly for their cardiac care were approximately 50 percent more likely to take cholesterol-lowering drugs and beta-blockers--a finding consistent with other comparisons of care provided by cardiologists and generalists; (5) although factors such as age, education, self-reported health status, and the presence of other illnesses also influenced who took cholesterol-lowering drugs and beta-blockers, they did not account for the higher use levels observed among patients who had routine cardiology appointments; (6) still, even patients of cardiologists often did not take one or both of these drugs; (7) by contrast, the overall use of aspirin was much higher--71 percent--and while regular patients of cardiologists were still more likely to take aspirin, the difference between them and other patients was smaller and not statistically significant (75 percent versus 68 percent); (8) on the whole, GAO's results for heart attack survivors treated by cardiologists and generalist physicians in Medicare HMOs are consistent with those of other studies of physician specialty differences in the United States; and (9) GAO's finding that patients under the regular care of cardiologists are more likely to take recommended medications reinforces the findings of the small number of other studies of physician specialty differences that are specifically concerned with HMO members and extends those findings to an older population and to a different medical condition.