The quality of physician-patient relationships. Patients' experiences 1996-1999.
BACKGROUND
Our objective was to examine how patients of primary care physicians are responding to a changing health care environment. The quality of their relationship with their primary care physicians and their experience with organizational features of care were monitored over a 3-year period.


METHODS
This was a longitudinal observational study (1996-1999). Participants completed a self-administered questionnaire at baseline and at follow-up. The questionnaires included measures of primary care quality from the Primary Care Assessment Survey (PCAS). We included insured adults employed by the Commonwealth of Massachusetts who remained with one primary care physician throughout the study period (n=2383). The outcomes were unadjusted mean scale score changes in each of the 8 PCAS over the 3 years and associated standardized difference scores (effect sizes). The 8 PCAS scales measured relationship quality (4 scales: communication, interpersonal treatment, physician's knowledge of the patient, patient trust) and organizational features of care (4 scales: financial access, organizational access, visit-based continuity, integration of care).


RESULTS
There were significant declines in 3 of the 4 relationship scales: communication (effect size [ES] = -0.095), interpersonal treatment (ES = -0.115), and trust (ES = -0.046). Improvement was observed in physician's knowledge of the patient (ES = 0.051). There was a significant decline in organizational access (ES = -0.165) and an increase in visit-based continuity (ES = 0.060). There were no significant changes in financial access and integration of care indexes.


CONCLUSIONS
The declines in access and 3 of the 4 indexes of physician-patient relationship quality are of concern, especially if they signify a trend.
Murphy
J
J
The Health Institute, Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts 02111, USA. jmurphy@lifespan.org
Chang
H
H
Montgomery
J E
JE
Rogers
W H
WH
Safran
D G
DG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000458:organization & administration* / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires