Health Care Quality/Patient Safety

Quality of the primary care doctor-patient relationship has eroded, even for a doctor's long-time patients

More than three-fourths of U.S. adults have one physician whom they consider to be their primary physician, despite recent changes in the nation's health care delivery systems. Unfortunately, surveys of primary care patients over the past 15 years reveal that despite long-term primary care relationships, the ideals of whole-person, integrated care are largely unmet in their experiences. Furthermore, the quality of the primary care doctor-patient relationship has eroded over the past several years. These findings are from two longitudinal studies in which researchers administered the Primary Care Assessment Survey (PCAS). The studies were supported in part by the Agency for Healthcare Research and Quality (HS08841 and HS09622).

In one study, researchers administered the PCAS in 1996 and 1999 to a panel of adults sampled from 12 Massachusetts commercial health plans. In the other study, researchers administered the survey annually from 1998 to 2000 to Medicare HMO and fee-for-service beneficiaries in 13 States.

The PCAS measures seven features of primary care through 11 summary scales: access, continuity, comprehensiveness, integration of care, quality of the clinician-patient interaction, interpersonal treatment, and patient trust. Whole-person care was a weak link in primary care performance, according to Dana Gelb Safran, Sc.D., of Tufts-New England Medical Center. It ranked lowest among five PCAS measures of interpersonal care.

Despite the fact that three-quarters of adults surveyed had gone to their PCPs for 3 years or more, the majority rated their doctor's knowledge about them and their life circumstances as less than excellent. Three-fourths of patients in practices that relied on teams of clinicians rated the other clinicians' whole-person knowledge about them unfavorably, nearly two-thirds rated their knowledge of their medical history unfavorably, and half rated their communication skills unfavorably. Finally, there was a decline in the quality of physician-patient interaction (communication quality, interpersonal treatment, and thoroughness of physical examinations).

See "Defining the future of primary care: What can we learn from patients?" by Dr. Safran, in the February 4, 2003, Annals of Internal Medicine 138, pp. 248-255.

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