When Do Older Patients Change Primary Care Physicians?

Abstract

Background: Concerns have been raised about changes in the health care system that may disrupt continuity of care and thereby reduce the quality of that care. The purpose of this study was to look at the reasons that older patients give for changing primary care physicians (PCPs) and to look at relationships between the duration of the PCP-patient relationship and the perceived quality of primary care received.Methods: We analyzed data collected during the first 2 years of a longitudinal study of primary care patients 65 years of age and older. Variables included sociodemographic characteristics, duration of relationship with current PCP, reasons for leaving last PCP, estimated numbers of visits to PCP, other clinics, and emergency departments, and admissions to hospitals and nursing homes in the last year, self-rated health, 2 measures of health-related quality of life, and the Components of Primary Care Index (CPCI).Results: 799 patients of 23 PCPs were enrolled in year 1 of the longitudinal study, and 579 were reevaluated in year 2. The mean and median PCP-patient relationship durations were 10.27 and 8 years, respectively. Duration of the PCP-patient relationship was associated with greater patient age, income, level of education, and frequency of visits to the PCP. Longer relationship duration was also associated with higher scores on all 8 CPCI subscales. The distribution of reasons for changing PCP was associated with duration of relationship; those with a longer relationship were more likely to change involuntarily. Insurance-related reasons for changing PCP were more common in those who had changed more recently. One hundred and fourteen (14%) changed PCP during the first year of the study. Three CPCI subscale scores predicted PCP change, accumulated knowledge, communication, and family orientation. Eighty-seven percent changed involuntarily, 44% for insurance-related reasons and 40% because their doctors had moved, retired, or died.Conclusions: Older patients, particularly those who are older and have more education and income, tend to stay with their PCPs until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive.

Does Patient Assessment of the Quality of the Primary Care They Receive Predict Subsequent Outcomes?: An Oklahoma Physicians Resource/Research Network (OKPRN) Study

“…In fact, in a previous analysis of OKLAHOMA studies data, the accumulated knowledge, communication, and family orientation subscale scores did predict change in PCP. 11 This is the first study to attempt to determine whether the CPCI can discriminate between better or worse primary care. Only a few other published studies have reported the results of analyses of associations between patient assessments of the quality of their primary care and outcomes.…”

“…Previous publications have described the methodology used to obtain this data in somewhat greater detail. 11,12 The study was reviewed and approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center, and all subjects consented to participate, first by telephone and then by signing a written consent form.…”

Do Older People Benefit from Having a Confidant? An Oklahoma Physicians Resource/Research Network (OKPRN) Study

“…Previous publications have described in greater detail the methodology used to obtain this data. 7,8 This study was reviewed and approved by the institutional review board of the University of Oklahoma Health Sciences Center, and all participants consented to take part, first by phone and then by signing a written consent form.…”

The Closure of a Medical Practice Forces Older Patients to Make Difficult Decisions: A Qualitative Study of a Natural Experiment

“…Older patients are thought to be more loyal to their PCP and less likely to switch away from a PCP voluntarily. [17][18][19] This study sheds light on the subject of how older patients balance the priorities of convenience and continuity in relation to their medical care. Our findings suggest that when a change in care is forced upon patients (e.g., having to choose a new practice location or physician), thoughtful interventions to help with the transition are warranted.…”