LINKING PRIMARY-CARE PERFORMANCE TO OUTCOMES OF CARE

BACKGROUND. Substantial research links many of the defining characteri stics of primary care to important outcomes; yet little is known about the relative importance of each characteristic, and several character istics have not been examined. These analyses evaluate the relationshi p between seven defining elements of primary care (accessibility, cont inuity, comprehensiveness, integration, clinical interaction, interper sonal treatment, and trust) and three outcomes (adherence to physician 's advice, patient satisfaction, and improved health status). METHODS. Data were derived from a cross-sectional observational study of adult s employed by the Commonwealth of Massachusetts (N=7204). All patients completed a validated questionnaire, the Primary Care Assessment Surv ey. Regression methods were used to examine the association between ea ch primary care characteristic (11 summary scales measuring 7 elements of care) and each outcome. RESULTS. Physicians' comprehensive (''whol e person'') knowledge of patients and patients' trust in their physici an were the variables most strongly associated with adherence, and tru st was the variable most strongly associated with patients' satisfacti on with their physician. With other factors equal, adherence rates wer e 2.6 times higher among patients with whole-person knowledge scores i n the 95th percentile compared with the 5th percentile (44.0% adherenc e vs 16.8% adherence, P < .001). The likelihood of complete satisfacti on was 87.5% for those with 95th percentile trust scores compared with 0.4% for patients with 5th percentile trust scores (P < .001). The le ading correlates of self-reported health improvements were integration of care, thoroughness of physical examinations, communication, compre hensive knowledge of patients, and trust (P < .001). CONCLUSIONS. Pati ents' trust in their physician and physicians' knowledge of patients a re leading correlates of three important outcomes of care. The results are noteworthy in the context of pervasive changes in our nation's he alth care system that are widely viewed as threatening to the quality of physician-patient relationships.