The patient-physician relationship, primary care attributes, and preventive services.
BACKGROUND
The importance of a sustained relationship between patients and physicians is a defining characteristic of family medicine. This study examined whether there is an association among the length of the patient-physician relationship, various attributes of primary care, and the delivery of clinical preventive services to Medicare beneficiaries.


METHODS
The data source for this study was the 1993 Medicare Current Beneficiary Survey. Primary care attribute scales were developed by conducting a factor analysis of 17 survey questions. Three clinical preventive services were measured as outcomes: influenza vaccination, mammography, and an eye examination for diabetics. Path analyses were used to test the relationships between length of relationship, primary care attributes, and delivery of clinical preventive services.


RESULTS
As the length of the relationship increased, scores on communication, accumulated knowledge of the patient by the physician, and trust all improved. Length of relationship and communication predicted accumulated knowledge of the patient by the physician, accumulated knowledge predicted trust, and trust predicted delivery of preventive services.


CONCLUSIONS
Among elderly Medicare beneficiaries, the ability to develop a sustained relationship with a provider is related to the realization of other important attributes of primary care. Trust was associated with delivery of important clinical preventive services. Efforts should be made to protect the ability of patients and physicians to sustain a relationship over time.
Parchman
Michael L
ML
Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA. parchman@uthscsa.edu
Burge
Sandra K
SK
D000368:Aged; D003266:Continuity of Patient Care; D005194:Family Practice; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States