Outcomes/Effectiveness Research

Patients who are connected to their doctors tend to receive care that adheres to guidelines

Patients shown to have a close connection to their doctors visited their doctors more often and had better outcomes than patients who merely reported an association with a medical practice, a recent study finds. Of the 155,590 patients seen at 13 Boston medical practices, 59.3 percent were connected to a primary care physician (PCP) compared with 34.5 percent who were connected only to a medical practice. This doctor-patient connection often resulted in receiving care that adhered to established screening guidelines. For example, 78.1 percent of PCP-connected women received mammograms compared with 65.9 percent of women who reported a connection to a medical practice.

Screenings for colorectal cancer were 77.1 percent for PCP-connected patients compared with 69.6 percent for practice-connected patients. Timothy G. Ferris, M.D., M.P.H., of Harvard Medical School, and colleagues found that patients who did not have close relationships with their physicians were less likely to undergo tests for preventive or chronic care. This lack of a connection may affect doctors who participate in pay-for-performance systems, which reward physicians for high scores on performance measures. These systems, the authors suggest, may penalize physicians who provide care to populations that are disinclined to connect to their physicians, potentially through no fault of the physician.

Black and Hispanic patients were less likely than whites to have a PCP connection; thus, these patients were less likely to receive care that adhered to guidelines. The authors suggest that disparities in care may be mediated in part by improving patients' relationships with their PCPs. This study was funded in part by the Agency for Healthcare Research and Quality (HS15002). See "Patient-physician connectedness and quality of primary care," by Steven J. Atlas, M.D., M.P.H., Richard W. Grant, M.D., M.P.H., Dr. Ferris, and others in the March 3, 2009 Annals of Internal Medicine 150(5), pp. 325-335.

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