Patient Dismissal by Primary Care Practices

O’Malley, Ann S.; Swankoski, Kaylyn; Peikes, Deborah; Crosson, Jesse C.; Duda, Nancy; Day, Timothy; Heitkamp, Shannon

doi:10.1001/jamainternmed.2017.1309

Cited by 11 publications

(11 citation statements)

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“…Many primary care practices, under pressure to implement these guidelines, started discharging patients with chronic pain who were taking opioids (O'Malley et al, 2017). Within 2 years, it was evident that opioid prescriptions were cut by more than one third (Bohnert, Guy, & Losby, 2018); however, opioid overdose deaths reached record high levels (Scholl, Seth, Kariisa, Wilson, & Baldwin, 2018).…”

Section: Shifting Focusmentioning

confidence: 99%

Shifting Focus: From the Opioid Crisis to Quality Pain Management

Arnstein

Herr

2019

J Gerontol Nurs

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Section: Shifting Focusmentioning

confidence: 99%

Shifting Focus: From the Opioid Crisis to Quality Pain Management

Arnstein

Herr

2019

J Gerontol Nurs

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“…Unfortunately, on occasion, PCPs and clinics who face challenges and strains in patient-provider relationships resort to terminating patients. [5][6][7][8][9] This practice-at times referred to as "firing" patients-is a source of distress for patients, providers, and practices and warrants efforts to better understand and prevent such breakdowns. [10][11][12][13] Given often disruptive and stressful circumstances that patient terminations represent, better understanding their occurrence and causes may prove valuable for mitigating and preventing the harm and friction from which they stem.…”

Section: Introductionmentioning

confidence: 99%

“…[24][25][26][27][28] In several previous studies, surveys have been sent to primary care doctors or their practice administrators to explore this topic. [5][6][7][8][9] These surveys reported that patients were most commonly terminated from primary care due to inappropriate, abusive, or threatening behavior. [5][6][7][8][9] The few qualitative studies that have been done have shown that there is often a disconnect between providers' and patients' experiences with the dismissal process and that research is needed to better understand where and how these relationships break down.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9] These surveys reported that patients were most commonly terminated from primary care due to inappropriate, abusive, or threatening behavior. [5][6][7][8][9] The few qualitative studies that have been done have shown that there is often a disconnect between providers' and patients' experiences with the dismissal process and that research is needed to better understand where and how these relationships break down. 10,11,13,29 The aim of this study was to better understand the extent and nature of formal termination of patients in primary care, examine documentation and communication related to such terminations, and, where possible, assess whether patients were able to establish a new primary care provider after termination.…”

Section: Introductionmentioning

confidence: 99%

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Terminations in Primary Care: a Retrospective Observational Study of 16 Primary Care Clinics

et al. 2021

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BACKGROUND:The relationship between clinician and patient is the cornerstone of primary care. Breakdown and termination of this relationship are understudied yet important, undesirable outcomes. OBJECTIVE: To better understand the nature and extent of provider and clinic termination of the primary care relationship. DESIGN: Retrospective observational case-control study. SUBJECTS: Adult patients in Eastern Massachusetts who received primary care at hospital-and communitybased clinics and health centers participating in a practice-based research network between January 2013 and June 2017. MAIN MEASURES: Formal termination by primary care physician (PCP), reasons for termination, independent predictors of termination based on mixed-effects logistic regression, and documentation of a new PCP after termination. KEY RESULTS: We identified 158,192 patients who received primary care from 182 PCPs across 16 clinics. We found 536 cases of formal termination. Clinics ranged from 4 to 119 terminations per 10,000 patients (intraclass correlation coefficient [ICC]=0.21; 95% CI: 0.18-0.24). Patient age, race/ethnicity, educational attainment, relationship status, employment status, and insurance type were independent predictors of termination (e.g., compared to patients employed full-time, patients unemployed due to disability were more likely to be terminated [adjusted OR:9.26;). The most common cause for termination (38%) was appointment "no-shows" with some PCPs/ clinics found to enforce a policy of dismissal following three no-shows. At the time of chart review, 201 patients (38%) had no documentation of a new PCP. Among patients who re-established care within the network, 134 (25%) had a primary care visit within 6 months of termination.CONCLUSIONS: Detailed chart review found that, unlike previous survey-based studies, dismissal was often for missed appointments based on enforcement of no-show policies. Many sociodemographic factors were associated with termination. Variability among clinics highlights the need for further research to better understand circumstances surrounding terminations, with the principal goals of improving patient-provider relationships and providing equitable care.

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“…However, in a recent survey of 794 primary care practices, 90% reported discharging patients in the previous two years, often for opioid-related issues. 1 Disruptive or inappropriate behavior was the most common reason for discharge (81%), but 78% reported dismissing patients for violations of a chronic pain or controlled substance agreement. We find this practice worrisome, particularly since many controlled substance agreements use coercive and stigmatizing language that patients may reluctantly sign or have trouble understanding.…”

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confidence: 99%