Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Abstract

PURPOSE We wanted to review the medical literature regarding the relationship between interpersonal continuity of care and patient satisfaction and suggest future strategies for research on this topic.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted to fi nd articles focusing on interpersonal continuity of patient care. The resulting articles were screened to select those focusing on the relationship between interpersonal continuity in the doctor-patient relationship and patient satisfaction. These articles were systematically reviewed and analyzed for study method, measurement technique, and the quality of evidence.RESULTS Thirty articles were found that addressed the relationship between interpersonal continuity and patient satisfaction with medical care. Twenty-two of these articles were reports of original research. Nineteen of the 22, including 4 clinical trials, reported signifi cantly higher satisfaction when interpersonal continuity was present.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, a consistent and signifi cant positive relationship exists between interpersonal continuity of care and patient satisfaction. Future research in this area should address whether the same is true for all patients or only for those who seek ongoing relationships with physicians in primary care. INTRODUCTIONC ontinuity of care is considered to be a core principle of family medicine 1,2 and primary care, 3 but conclusive proof regarding its value has eluded primary care and health policy researchers. The fi rst step in establishing this proof requires a specifi c defi nition of the most important elements of continuity. Previous authors have addressed different aspects of continuity and have proposed defi nitions with multiple dimensions. 1,[4][5][6][7][8][9][10] Recently, 3 of these dimensions were organized into a hierarchy ranging from the availability of accurate information from one health care encounter to another (informational continuity), through a pattern of health care utilization at a particular site of care (longitudinal continuity), to a personal doctor-patient relationship characterized by loyalty and trust (interpersonal continuity).11 For family physicians the concept of interpersonal continuity holds particular importance. 12 Interpersonal continuity refers to a special type of longitudinal continuity in which an ongoing personal relationship between the patient and clinician is characterized by personal trust and responsibility.11 Changes in the American health care system during the past decade have made it increasingly diffi cult to establish such long-term trusting relationships between physicians and patients. [13][14][15][16][17][18][19] Some authors have questioned whether a personal model of care is feasible, as health plans increasingly have required provider changes for economic reasons. 20 As these changes occur, health policy planners are looking for evidence supporting the value of interpersonal continuity...

The Impact of Hospitalist Discontinuity on Hospital Cost, Readmissions, and Patient Satisfaction

“…In the outpatient setting, greater continuity has been associated with better hypertensive control, lower risk of hospitalization, fewer emergency department visits, higher patient satisfaction, and higher physician satisfaction. [1][2][3][4] Achieving continuity is difficult in the inpatient setting, where care must be provided continuously. Fletcher et al showed that between 1996 and 2006, Medicare patients experienced declining levels of physician continuity during their hospitalizations.…”

Does Having a Personal Physician Improve Quality of Care in Diabetes?

“…In a review of studies examining the value of interpersonal continuity, some found consistent evidence that personal continuity is associated with increased patient satisfaction and improved adherence to preventive services. 11,12 The current study did not assess patient satisfaction but did examine some preventive services (pneumococcal and influenza vaccination) and found greater adherence with influenza recommendations among patients with a personal physician.…”

Primary Care Physician Visit Continuity: A Comparison of Patient-reported and Administratively Derived Measures

“…Over the past 2 decades, several studies have demonstrated the benefits of visit continuity. Patients who see their PCP for a high proportion of their primary care office visits are more likely to be satisfied with their care [6][7][8] , maintain relationships with their physician over time 9,10 , and have more appropriate utilization of emergency and hospital services 11,12 . Some of the evidence base, however, relies on patient-reported measures of visit continuity [13][14][15] , which might be subject to response bias.…”