[The participation of primary care physicians in integrated health services network: United States experiences]

Abstract

Background: Reforms of care and services have affected primary care physicians, but very little attention has been devoted to their actual participation in Integrated Health Services Network (IHSN).

Methods: From a literature review of articles published from January 1985 to December 2006, we selected 24 studies on physicians' participation in IHSN and their perceptions on practices.

Results: This literature review suggests that physicians' perceptions of IHSN are linked to their actual level of participation. Physicians who participated fully perceived improvements in all practice dimensions. Physicians who participated partially were dissatisfied with physician-patient relationships, perceived a loss of professional autonomy and increased gate-keeping constraints. They had however a positive perception of the overall quality of care. When physicians received capitation payments, they were overall dissatisfied.

Conclusions: In order to improve primary care physicians' participation in IHSN, quality of care should be reinforced, capitation payment avoided and gate-keeping should be transformed into coordination of care.