title: Voluntary physician switching by human immunodeficiency virus-infected individuals: a national study of patient, physician, and organizational factors.
abstract: OBJECTIVE
  We sought to assess which patient, physician, and organizational factors are related to voluntary physician switching among human immunodeficiency virus (HIV)-infected patients.
  
  
  METHODS
  We analyzed the results from a 3-wave survey of patients conducted by the HIV Cost and Services Utilization Study (HCSUS), a longitudinal study of a nationally representative sample of noninstitutionalized HIV-infected individuals receiving care in the contiguous United States. Physicians providing care and care site directors were surveyed once. Relationships of interpersonal aspects of care, access and continuity, technical quality of care, and physician and site characteristics to voluntary switching were analyzed using multilevel logistic regression models that nested repeated observations within patients, patients within clinicians, and clinicians within region.
  
  
  RESULTS
  Approximately 15% of patients voluntarily changed their usual clinicians during the 2-year study period. In a multivariate model, lower voluntary switching was predicted by patient trust (odds ratio [OR]=0.74; 95% confidence interval [95% CI]=0.61-0.90), physician antiretroviral knowledge (OR=0.26; 95% CI 0.13-0.53), moderate (rather than low or high) HIV patient volume at a care site (OR=0.09; 95% CI=0.03-0.31), and Ryan White Care Act funding (OR=0.27, 95% CI=0.14-0.52).
  
  
  CONCLUSIONS
  Patients with chronic illnesses may use several markers of specialization and technical quality to make decisions about their care. These results challenge the notion that patients cannot assess the quality of care they receive.
authors.affiliation: Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Landon
authors.forename: Peter V
authors.initials: PV
authors.lastname: Marsden
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration; D003657:Decision Making; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008511:Medicine / Q000458:organization & administration; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians; D011787:Quality of Health Care / Q000458:organization & administration*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013038:Specialization; D035502:Trust