The quality of physician-patient relationships - Patients' experiences 1996-1999

BACKGROUND Our objective was to examine how patients of primary care physic ians are responding to a changing health care environment. The quality of t heir relationship with their primary care physicians and their experience w ith organizational features of care were monitored over a 3-year period. METHODS This was a longitudinal observational study (1996-1999). Participan ts completed a self-administered questionnaire at baseline and at follow-up . The questionnaires included measures of primary care quality from the Pri mary Care Assessment Survey (PCAS). We included insured adults employed by the Commonwealth of Massachusetts wh o remained with one primary care physician throughout the study period (n=2 383). The outcomes were unadjusted mean scale score changes in each of the 8 PCAS over the 3 years and associated standardized difference scores (effect siz es). The 8 PCAS scales measured relationship quality (4 scales: communicati on, interpersonal treatment, physician's knowledge of the patient, patient trust) and organizational features of care (4 scales: financial access, org anizational access, visit-based continuity, integration of care). RESULTS There were significant declines in 3 of the 4 relationship scales: communication (effect size [ES] = -0.095), interpersonal treatment (ES = -0 .115), and trust (ES = -0.046). Improvement was observed in physician's kno wledge of the patient (ES = -0.051). There was a significant decline in org anizational access (ES = -0.165) and an increase in visit-based continuity (ES = 0.060). There were no significant changes in financial access and int egration of care indexes. CONCLUSIONS The declines in access and 3 of the 4 indexes of physician-pati ent relationship quality are of concern, especially if they signify a trend .