Beyond the examination room: primary care performance and the patient-physician relationship for low-income women.
OBJECTIVE
To assess whether primary care performance of low-income women's primary care delivery sites is associated with the strength of their relationships with their physicians.


METHODS
Random-digit-dial and targeted household telephone survey of a population-based sample.


METHODS
Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold.


METHODS
Women over age 40 (N=1,205), 82% of whom were African American.


RESULTS
The response rate was 85%. Primary care performance was assessed using women's ratings of their systems' accessibility (organizational, geographic, and financial), continuity, comprehensiveness, and coordination. Respondents' ratings of trust in their physicians, communication with their physicians, and compassion shown by their physicians were used to operationalize the patient-physician relationship. Controlling for population and insurance characteristics, 4 primary care features were positively associated with women's trust in and communication with their physicians: continuity with a single clinician, organizational accessibility of the practice, comprehensive care, and coordination of specialty care services. Better organizational access, but not geographic or financial access, was associated with greater levels of trust, compassion, and communication (odds ratios [ORs], 3.2, 7.4, and 6.9, respectively; P < or =.01). Women who rated highest their doctor's ability to take care of all of their health care needs (highest level of comprehensiveness) had 11 times the odds of trusting their physician (P < or =.01) and 6 times the odds of finding their physicians compassionate and communicative (P < or =.01), compared to those with the lowest level of comprehensiveness.


CONCLUSIONS
Primary care delivery sites organized to be more accessible, to link patients with the same clinician for their visits, to provide for all of a woman's health care needs, and to coordinate specialty care services are associated with stronger relationships between low-income women and their physicians. Primary care systems that fail to emphasize these features of primary care may jeopardize the clinician-patient relationship and indirectly the quality of care and health outcomes.
O'Malley
Ann S
AS
Georgetown University Medical Center, Cancer Control Program, Lombardi Cancer Center, Washington, DC, USA. omalleya@gunet.georgetown.edu
Forrest
Christopher B
CB
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004219:District of Columbia; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011203:Poverty; D011320:Primary Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D012494:Sampling Studies; D012959:Socioeconomic Factors; D014932:Women's Health Services / Q000592:standards*