Murphy J, Rogers WH, Chang H, Montgomery J, Safran DG; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Julia Murphy, M.D., Senior Research Associate, The Health Institute, New England Medical Center, 750 Washington Street, Box 345, Boston, MA 02111. Tel: 617-636-5656; Fax: 617-636-8351; email: jmurphy@lifespan.org
Research Objective: In a health care environment increasingly driven by market pressures, primary care physicians are challenged to be maximally productive, continuously attentive to expenditures, and responsive to the needs and expectations of their patients. Against this backdrop, the present study evaluates changes in the quality of doctor-patient relationships in primary care over a 3-year study period (1996 to 1999). Study Design: Data derive from a longitudinal observational study of insured adults (1996-1999). Study participants completed a self-administered questionnaire at baseline (68.5% response rate) and at follow-up (69.4% response rate). Both the baseline and follow-up questionnaires included 4 measures of the primary care relationship quality (patient trust, doctor's knowledge of the patient, communication quality, interpersonal treatment) from the Primary Care Assessment Survey (PCAS). Analyses were restricted to patients who remained with one primary care physician throughout the 3-year study period. For each scale, we computed the average change in scores between 1996 and 1999, controlling for the duration of the primary care relationship. To allow comparison across scales, we computed a standardized effect size (i.e., the difference score as a percentage of the standard deviation [SD] of the scale). Categorical indicators of improvement or decline, defined as individual-level change exceeding 1.4-SEM (standard error of measurement), were also computed.Population Studied: Adults employed by the Commonwealth of Massachusetts at baseline, who completed the baseline and follow-up questionnaires, and who remained with one primary care physician throughout the study period (n=2383). Principal Findings: Results reveal significant downward trends in three of four relationship scales: communication (-.095 SD), interpersonal treatment (-.115 SD), and trust (-.046 SD). Improvement was observed in one scale: doctor's knowledge of the patient (.052 SD). Categorical indicators of change (better, same, worse) revealed a large percentage of patients experiencing a decline in the quality of their primary care relationship. Trust declined more than 1.4-SEM for 21.5% of patients. The quality of communication declined more than 1.4-SEM for 31.1% of patients. Ordered logistic regression results reveal that changes in the amount of time spent face-to-face with patients during office visits over the study period significantly predict the observed changes in relationship quality (p<.01).Conclusion: Findings from this longitudinal study indicate significant declines in three of four elements of the doctor-patient relationship over a 3-year period. Decreasing time spent face-to-face with patients during office visits appears to be a significant contributor to the observed trend.Implications for Policy, Delivery and Practice: Both public and private sector-driven health care reforms urge an expanded role of primary care in our delivery system. Yet in the context of current delivery system changes, a marked decline in the quality of primary care relationships is observed. Given the desire to strengthen primary care, and given established links between primary care relationship quality and outcomes of care, the downward trajectory demands attention and interventions that will redirect this course.Primary Funding Source: Agency for Healthcare Quality and Research; Robert Wood Johnson Foundation.
Publication Types:
Keywords:
- Adult
- Communication
- Delivery of Health Care
- Health Services Research
- Humans
- Insurance, Health
- Longitudinal Studies
- Massachusetts
- Office Visits
- Physicians, Family
- Primary Health Care
- Quality of Health Care
- Questionnaires
- Research
- Research Design
- Trust
- economics
- trends
- hsrmtgs
Other ID:
UI: 102272282
From Meeting Abstracts