Continuity of Primary Care: To Whom Does It Matter and When?

Nutting, Paul A.

doi:10.1370/afm.63

Cited by 256 publications

(236 citation statements)

References 24 publications

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“…7,14 However, because continuity of care between a patient and a provider or even the more general construct of patient perception of having a personal physician in the nonrandomized 'real world' is intertwined with a variety of other variables like health insurance, a patient's desire for continuity, a matching of the health beliefs of the patient and the physician, or even the patient's age or gender, the possibility of confounding with an outcome must be considered. [15][16][17][18] The current study showed a strong consistent bivariate association between having a personal physician and a positive health behavior among obese individuals in the face of conflicting health risk information. An adjusted relationship was demonstrated for screening tests for hypertension but not hypercholesterolemia.…”

Section: Discussionmentioning

confidence: 64%

Having a regular physician and attempted weight loss after screening for hypertension or hypercholesterolemia

et al. 2004

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OBJECTIVE: To examine the relationship between having a regular physician, results of screening tests for cardiovascular risk (hypertension, hypercholesterolemia) and efforts to lose weight among obese adults. DESIGN: Analysis of a population-based telephone survey (2002 Behavioral Risk Factor Surveillance System). SETTING: Four states (Iowa, South Carolina, South Dakota, Virginia) in the US. PARTICIPANTS: Adults (Z18 y old) who were obese (body mass index Z30 kg/m 2 ) (unweighted n ¼ 1735). MAIN OUTCOME MEASURES: Currently attempting to lose weight; changes in diet or exercise as strategies to lose weight. RESULTS: Obese individuals with a personal physician were more likely to report attempts to lose weight in the face of screening normal for hypertension or hypercholesterolemia than those without a personal physician (75.6 vs 60.5% for hypercholesterolemia, P ¼ 0.03; 74.6 vs 57.7% for hypertension, P ¼ 0.01). In adjusted models, obese individuals screening normal for hypertension but having a personal physician were significantly more likely to attempt to lose weight than individuals without a personal physician (OR 1.71, 95% CI 1.12-2.60). CONCLUSIONS: Having a regular physician is associated with a higher likelihood of attempted weight loss among obese individuals who believe that they do not have hypertension or hypercholesterolemia, than their counterparts with no regular physician. This suggests a previously unrecognized benefit of having a personal physician.

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Section: Discussionmentioning

confidence: 64%

Having a regular physician and attempted weight loss after screening for hypertension or hypercholesterolemia

et al. 2004

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“…The direct association comes from the clinical FTE, care continuity, 28,30 access to care, 29,31 and other practice characteristics. The indirect association comes through continuity of care and access to care.…”

Section: Conceptual Modelmentioning

confidence: 99%

“…Patients who see their own provider are more likely to report higher satisfaction. 30 Access to Care. The third next-available appointment measures a PCP's average number of days until the third nextavailable appointment.…”

Section: Variable Definitionsmentioning

confidence: 99%

“…A common limitation is the use of an arbitrary discrete cutoff to define part-time versus full-time, 16,17,21 with cutoffs ranging from 20 clinical hours/week 17 to 40 h/week of self-reported work. 16 No study has yet controlled for either continuity of care or access, which have both been associated with patient satisfaction, [28][29][30][31] or accounted for their potential mediating relationship, since continuity of care and access are also likely to be affected by a physician's work hours.…”

Section: Introductionmentioning

confidence: 99%

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Patients Report Better Satisfaction with Part-Time Primary Care Physicians, Despite Less Continuity of Care and Access

et al. 2014

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BACKGROUND:The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. OBJECTIVE: We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. DESIGN: We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. PARTICIPANTS: The study included family medicine (n=104) and internal medicine (n=101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n=12,688). MAIN MEASURES: Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third nextavailable appointment. KEY RESULTS: Physician FTE was directly associated with better continuity of care received (0.172 % per FTE, p<0.001), better continuity of care provided (0.108 % per FTE, p<0.001), and better access to care (−0.033 days per FTE, p<0.01), but worse patient satisfaction scores (−0.080 % per FTE, p=0.03). The continuity of care provided was a significant mediator (0.016 % per FTE, p<0.01) of the relationship between FTE and patient satisfaction; but overall, reduced clinical work hours were associated with better patient satisfaction (−0.053 % per FTE, p=0.03). CONCLUSIONS: These results suggest that PCPs who choose to work fewer clinical hours may have worse continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of parttime PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.KEY WORDS: part-time work; continuity of care; access to care; patient satisfaction.

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“…Alternative destinations to traditional ED care have been shown to have many potential benefits for patients and the general healthcare system, and to reduce the burden on the ED as well (Nutting, Goodwin, Flocke, Zyzanski, & Stange, 2003; Olshaker, 2009; Snooks et al, 1998; Weinick, Burns, & Mehrotra, 2010). It seems reasonable to assume that alternative destinations in general shorten both transport and waiting times (Nutting et al, 2003; Snooks et al, 1998). …”

Section: Introductionmentioning

confidence: 99%

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

Boysen

Nyström

Christensson

et al. 2017

International Journal of Qualitative Studies on Health and Well

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Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre.Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden.Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of the lifeworld” enables the patient to feel trust.Conclusion: Trust in the early chain of healthcare entails caregivers’ ability to pay attention to both medical and existential issues in compliance with the patient’s information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

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Continuity of Primary Care: To Whom Does It Matter and When?

Cited by 256 publications

References 24 publications

Having a regular physician and attempted weight loss after screening for hypertension or hypercholesterolemia

Having a regular physician and attempted weight loss after screening for hypertension or hypercholesterolemia

Patients Report Better Satisfaction with Part-Time Primary Care Physicians, Despite Less Continuity of Care and Access

Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

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