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Defining and understanding "co-management" care.

Comparisons of the care delivered by specialists versus generalists suffers from several methodological problems that have not been resolved. These problems, which have persisted in the absence of sustained interest coupled with lack of funding for studies of specialty care, have made such comparisons difficult to perform and to interpret. Defining and understanding “ co-management” is one of these vexing issues. A single consultation with a specialist could have a major impact on an outcome. Having more percent time or having “principal” care delivered by one provider may not be the most influential factors in improving outcomes of chronic disease care. The recommendations by the provider, the intensity of follow-up when treatment is changed, the timeliness of appropriate elements of care and of consultations, the level of interpersonal care, and even the relationship between the generalist and the specialist may be far more important than the actual time spent or the number of visits made to one or the other type of doctor.

Probably the most problematic issue in specialist/generalist comparisons is that of assessing the severity or complexity of the condition and the relevant comorbidities. Specialists have more experience, skill, and knowledge in the care for patients who have diseases in their area of expertise—the more difficult the management, the higher the degree of complexity of the conditions, the more obscure the …