The effects of primary care physician visit continuity on patients' experiences with care.
BACKGROUND
Visit continuity is important to patients and valued by physicians. However, it is virtually impossible for primary care physicians (PCPs) to provide care during every paneled patient visit. It remains unclear whether PCP visit discontinuity can be planned in a way that is least disruptive to patients' experiences with care.


OBJECTIVE
This study aims to clarify whether visit continuity affects patients' experiences with primary care equally for all patients.


METHODS
From January 2004 through March 2005, a large multispecialty practice in Massachusetts administered the Ambulatory Care Experience Survey (ACES) monthly to a random sample of patients visiting each of 145 PCPs. The analytic sample includes 14,835 patients with 2 or more primary care visits over the 6 months before being surveyed. Usual Provider Continuity (UPC), an administratively based measure of PCP visit continuity, was calculated for all respondents. Multilevel regression models that accounted for the clustering of patients within physicians modeled the relationship between UPC and each ACES measure. Interaction effects between UPC and gender, education, self-rated health, and PCP-patient relationship duration were tested.


RESULTS
Physician-patient interaction quality, including physician communication, knowledge of the patient, health promotion support, and organizational access were more strongly influenced by visit continuity among respondents in early stages of a PCP-patient relationship (P < 0.01) and with worse self-rated health (P < 0.01).


CONCLUSIONS
Improvements in physician-patient relationship quality can be achieved by targeting visit continuity improvement efforts to patients who benefit most, particularly those in early stages of a PCP-patient relationship and/or perceive their health as poor.
Rodriguez
Hector P
HP
Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, 750 Washington Street, Box 345, Boston, MA 02111, USA. hrodriguez@tufts-nemc.org
Rogers
William H
WH
Marshall
Richard E
RE
Safran
Dana Gelb
DG
D000328:Adult; D001294:Attitude to Health; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008404:Massachusetts; D009819:Office Visits; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care