The Quality of Physician-Patient Relationships

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Original Research

The Quality of Physician-Patient Relationships

J Fam Pract. 2001 February;50(2):123-129

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Limitations

Our study population included employed, insured, and generally healthy adults and was not representative of more vulnerable groups. This effect is further accentuated because the nonrespondents are more likely to be from a more vulnerable population. Since the research literature suggests that minority status and low income have an adverse impact on physician-patient interaction,^37-39 it is likely our findings would have been demonstrated more strongly with the inclusion of data from this section of the population.

Our inclusion criteria create selection biases, which reduce generalizability for some scales. Visit-based continuity is most likely to be optimized in this group of patients who have named a regular physician and have stayed with them during the study period.

The observed changes in primary care performance, though statistically significant, are small. But they occur within a reported (ie, observed) range of scores that is approximately one third the size of the range of possible scores. The movement within this range represents a larger shift than the same shift in a more extensive range. In addition to allowing comparisons across scales, the standardized effect size also helps address this issue by representing the data as a proportion of the standard deviation. The usual Cohen classification of effect size is not as pertinent to these results, because it was not developed and described for population studies.⁴⁰ Thus, the changes we observed (1) reflect declines where increases would be expected, (2) reflect the shift of a population, and (3) may reflect an ongoing trend continuing beyond our study period.

We have viewed declines primarily as a result of a change in the patients’ experiences in contrast to a change in the patients. Patient attributes not considered may include: declines in levels of societal trust, raised patient expectations with increasing patient consumerism, and patient education influenced by the rapidly increasing patient access to information on the Internet during the study period. Our scale measures are specific to a domain and should not be as affected by external factors.

Conclusions

Declines in primary care performance indicators were demonstrated by our study.
These declines have been reported in an environment of change.
Further research to examine the factors driving this decline in primary care quality is needed. The distractions of organizational restructuring, mergers, and departures from the market region, and pressures to increase productivity without compromising standards of care may be contributing factors.
If quality of primary care performance continues to fall, the previously hoped for goals of health care reform through the advancement of primary care are at risk for being undermined.

Acknowledgments

Our research was supported by grant number R01 HS08841 from the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) and by grant number 035321 from the Robert Wood Johnson Foundation. We are indebted to Dolores Mitchell, the executive director of the Massachusetts Group Insurance Commission, whose commitment to this research and participation in it made the study possible. We also gratefully acknowledge Brian Clarridge, PhD, and his colleagues at The Center for Survey Research, University of Massachusetts, for their technical expertise and commitment to excellence in obtaining the data for our study.

Related resources:

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