Are better ratings of the patient-provider relationship associated with higher quality care for depression?
BACKGROUND
The interpersonal patient-provider relationship (PPR) is an essential part of health care quality, particularly for patients with depression, yet little is known neither about how to measure this relationship nor about its association with quality of care.


OBJECTIVE
To evaluate properties of patient rating measures, understand the relation between 2 types of ratings, and determine the association of ratings with quality depression care.


METHODS
1,104 patients with current depressive symptoms and lifetime or 12-month disorder identified through screening 27,332 consecutive primary care visitors in 6 managed care organizations participating in Partners in Care (PIC).


METHODS
Cross-sectional analysis of 18-month data (collected in 1998) after the start of PIC depression quality improvement (QI) interventions (in which clinics were randomized to 1 of 2 QI interventions or usual care).


METHODS
Patient ratings of the interpersonal relationship with the primary care provider and satisfaction with health care, and quality of depression care indicators.


METHODS
Factor analysis and multitrait scaling to evaluate the psychometric properties of multiitem constructs and analysis of covariance to evaluate associations between patient ratings and quality.


RESULTS
Patient ratings had high internal consistency and met criteria for discriminant validity tapping unique aspects of care. Patients receiving quality care, especially for medication use, had significantly higher ratings of the interpersonal relationship (by 22% to 27% of a SD) and were more satisfied (by 26% to 34% of a SD) than patients who did not receive quality care.


CONCLUSIONS
Ratings of the interpersonal relationship and satisfaction measure distinct aspects of care and are positively associated with quality care for depression.
Meredith
L S
LS
RAND (Research, Analysis, and Development), Santa Monica, California 90407, USA. lisa_meredith@rand.org
Orlando
M
M
Humphrey
N
N
Camp
P
P
Sherbourne
C D
CD
D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D003863:Depression / Q000628:therapy*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011594:Psychometrics; D011787:Quality of Health Care; D011795:Surveys and Questionnaires