title: The closure of a medical practice forces older patients to make difficult decisions: a qualitative study of a natural experiment.
abstract: OBJECTIVE
  The closure of a primary care practice and the relocation of the physicians and staff to a new office forced patients to decide whether to follow their primary care physicians (PCP) or to transfer their care elsewhere. This study explores the perspectives of the older patients affected by this change.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  Two lists of patients older than 60 years from the original office were generated: (1) those who had followed their PCPs to the further practice and (2) those who chose new PCPs at an affiliated nearby clinic. One hundred forty patients from each of the two lists were randomly selected for study.
  
  
  METHODS
  Eight months after the clinic's closure, patients responded to an open-ended question asking patients to describe the transition. Using content analysis, two investigators independently coded all of the written responses.
  
  
  RESULTS
  Over 85% of patients in both groups had been with their original PCP for longer than 2 years. Patients that elected to transition their care to a new PCP within their community were older (75 vs 70 years) and more likely to be living alone (38% vs 18%), both p < 0.01. There was still considerable frustration associated with the clinic's closure. Patients from both groups had variable levels of satisfaction with their new primary care arrangements. Patients who moved to the near clinic, now seeing a new physician, commented on being satisfied with the proximity of the site. On the other hand, these patients also expressed longing for the previous arrangement (the building, the staff, and especially their prior physician). Patients who transferred their care to the further clinic indicated a profound loyalty to their PCP and an appreciation of the added features at the new site. Yet, many patients still described being upset with the difficulties associated with the further distance.
  
  
  CONCLUSIONS
  The closing of this practice was difficult for this cohort of older patients. Patients' decisions were considerably influenced by whether they imagined that convenience or their established relationship with their PCP was of a higher priority to them.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
authors.forename: Mary Anne J
authors.initials: MA
authors.lastname: Nidiry
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carrese
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D005194:Family Practice / Q000379:methods / Q000639:trends; D005260:Female; D006271:Health Facility Closure / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D009819:Office Visits / Q000639:trends; D010817:Physician-Patient Relations / Q000941:ethics; D010865:Pilot Projects; D011216:Practice Management, Medical / Q000639:trends; D036301:Qualitative Research