Do elderly Medicare recipients contact physicians appropriately?

OBJECTIVES This research identified characteristics of persons and their illness episodes that predict appropriate and inappropriate decisions to seek medical care. METHODS This study analyzes 1,292 health care decisions of 885 elderly members of an HMO in Los Angeles. Illness episodes are divided into three categories based on the expertise of a panel of 22 geriatricians, using a formal mathematical analysis derived from anthropological consensus theory. These categories are physician visit not recommended, physician visit recommended, and physician visit mandatory. Physician contact is regressed on a list of variables derived from Andersen's behavioral model separately for each group of episodes. RESULTS Although the variables indicating perceived seriousness and duration of the episode consistently predict the decision to contact a physician, regardless of whether that contact is considered appropriate by the geriatrician panel, the variables indicating other illness responses and predisposing personal attributes have less consistent patterns of significance. DISCUSSION The category of episodes (visit recommended) for which predisposing personal attributes figure most strongly in the treatment decision is the one for which there are no clear cultural directives to action. Implications for health education and policy are drawn from the findings.