Role of specialty care for chronic diseases: A report from an ad hoc committee of the american college of rheumatology

An ad hoc committee of health-services researchers and clinicians of the American College of Rheumatology observed that the rush to capitated, integrated health-care systems has assumed that systems should be built around primary care and gatekeeping to specialty consultation. This assumption is untested. For persons with chronic rheumatic and musculoskeletal diseases, the evidence suggests that outcomes, coordination, and patient satisfaction are superior when specialists have a central role. The same situation may be true for patients with other chronic diseases.