title: Satisfaction with patient-doctor relationships in inflammatory bowel diseases: examining patient-initiated change of specialist.
abstract: OBJECTIVE
  To assess the reasons for, and factors associated with, patient-initiated changes in treating specialist in inflammatory bowel diseases (IBD).
  
  
  METHODS
  Prospectively identified IBD patients (n = 256) with ≥ 1 encounter at a metropolitan hospital were surveyed, including whether they had changed treating specialist and why. Negative reasons included loss of confidence, disagreement, and/or personality clash with the specialist.
  
  
  RESULTS
  Of 162 respondents, 70 (43%) had ever changed specialists; 30/70 (43%) for negative reasons, 52/70 (74%) in the preceding year. Patients with negative reasons for changing (n = 30) were younger (median, 35.2 years vs 45.3 years), had higher IBD knowledge (median, 5.0 years vs 4.0 years), yet had lower medication adherence and satisfaction scores (median, 19.0 years vs 22.0 years, 14.0 years vs 16.0 years respectively, Mann-Whitney tests, all P < 0.05), compared to all other responders (n = 132). Patients with a recent change (for any reason) were more likely to have Crohn's disease, currently active disease, previous bowel resection and recent hospitalization [OR 2.6, 95% CI (1.3-5.4), 2.2 (1.0-4.7), 5.56 (1.92-16.67), 2.0 (1.3-3.0), each P < 0.05].
  
  
  CONCLUSIONS
  Changing specialist appears associated with patient- related (age, nonadherence) and contemporaneous disease-related factors (recent relapse) which, where modifiable, may enhance patient-doctor relationships and therefore quality of care.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, School of Medicine, University of Adelaide, South Australia 5000, Australia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: van Langenberg
authors.forename: Jane M
authors.initials: JM
authors.lastname: Andrews
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D013505:Digestive System Surgical Procedures; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D010361:Patients / Q000523:psychology*; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012008:Recurrence; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D013021:South Australia; D011795:Surveys and Questionnaires