title: Intention to discontinue care among primary care patients: influence of physician behavior and process of care.
abstract: BACKGROUND
  Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in outpatient settings caring for patients with diverse types of insurance coverage.
  
  
  OBJECTIVE
  To examine whether physician behavior and process of care affect patients' intention to return to their usual health care practice.
  
  
  METHODS
  Cross-sectional patient survey and medical record review.
  
  
  METHODS
  Eleven academically affiliated primary care medicine practices in the Boston area.
  
  
  METHODS
  2,782 patients with at least one visit in the preceding year.
  
  
  METHODS
  Unwillingness to return to the usual health care practice.
  
  
  RESULTS
  Of the 2,782 patients interviewed, 160 (5.8%) indicated they would not be willing to return. Two variables correlated significantly with unwillingness to return after adjustment for demographics, health status, health care utilization, satisfaction with physician's technical skill, site of care, and clustering of patients by provider: dissatisfaction with visit duration (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and patient reports that the physician did not listen to what the patient had to say (OR, 8.8; 95% CI, 2.5 to 30.7). In subgroup analysis, patients who were prescribed medications at their last visit but who did not receive an explanation of the purpose of the medication were more likely to be unwilling to return (OR, 4.9; 95% CI, 1.8 to 13.3).
  
  
  CONCLUSIONS
  Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Federman
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips
authors.forename: A L
authors.initials: AL
authors.lastname: Puopolo
authors.forename: J S
authors.initials: JS
authors.lastname: Haas
authors.forename: T A
authors.initials: TA
authors.lastname: Brennan
authors.forename: H R
authors.initials: HR
authors.lastname: Burstin
mesh_terms: D001900:Boston; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations