title: Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.
abstract: To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care.
  
  
  
  Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression.
  
  
  
  Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists.
  
  
  
  The quality of the family physician-patient relationship is not independently associated with frequent attendance.
  
  
  
  Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: a.dinkel@tum.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Dinkel
authors.affiliation: Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: antonius.schneider@tum.de.
authors.forename: Antonius
authors.initials: A
authors.lastname: Schneider
authors.affiliation: Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany. Electronic address: gabriele.schmutzer@medizin.uni-leipzig.de.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schmutzer
authors.affiliation: Department of Medical Psychology and Medical Sociology, Universität Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg Universität Mainz, Mainz, Germany. Electronic address: elmar.braehler@medizin.uni-leipzig.de.
authors.forename: Elmar
authors.initials: E
authors.lastname: Brähler
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany. Electronic address: whaeuser@klinikum-saarbruecken.de.
authors.forename: Winfried
authors.initials: W
authors.lastname: Häuser
mesh_terms: D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D005858:Germany; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Family medicine; Family physician; Frequent attenders; General population; Health-care utilization; Medical specialists; Physician–patient relationship