Leaving the practice: effects of primary care physician departure on patient care.
BACKGROUND
Recent changes in the organization of health care services, coupled with rising rates of primary care physician (PCP) turnover, pose threats to the maintenance of a continuous patient-physician relationship. Little is known, however, about how PCP departure may affect patients' quality of health care.


METHODS
Participants were adult patients whose PCPs left a large, multispecialty group practice from July 1, 1994, to June 30, 1996 (n = 3931), and adult patients of a set of matched PCPs who remained in the practice at least 2 years beyond the index PCPs departure dates (n = 8009). We compared the following measures of quality of care: adherence to recommended screening guidelines, adequacy of blood pressure and glycemic control in patients with hypertension and/or diabetes mellitus, and use of urgent care and emergency department services.


RESULTS
Among the women who received a mammogram in the 2-year baseline period, a higher proportion of those whose PCP departed did not continue to receive mammograms, although the difference did not reach statistical significance (8.4% vs 5.1%; P =.08). For patients who had screening Papanicolaou smears or fecal occult blood testing during the baseline period, there was no significant difference between study and control groups in the likelihood that patients discontinued screening during the follow-up period (10.9% vs 10.7%; P =.93 and 28.8% vs 25.3%; P =.93, respectively). Similarly, diabetic patients of departed PCPs did not have higher risk of worsening glycemic control (31.7% vs 28.9%; P =.46); and hypertensive patients of departed PCPs actually had lower risks of worsening blood pressure control (16.5% vs 22.5%; P =.02). There was no difference in use of urgent care or emergency department services between patient groups.


CONCLUSIONS
In this multispecialty group practice, patients of departed PCPs experienced little or no decrease in quality of care measures for routine screening, management of chronic disease, and use of urgent care and emergency department services.
Pereira
Anne G
AG
Center for Ethics in Managed Care and the Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Mass 02446, USA.
Kleinman
Ken P
KP
Pearson
Steven D
SD
D003266:Continuity of Patient Care / Q000592:standards*; D003920:Diabetes Mellitus / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy; D009819:Office Visits / Q000706:statistics & numerical data; D005791:Patient Care / Q000592:standards*; D010563:Personnel Turnover; D010821:Physicians, Family; D011314:Preventive Health Services / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies