Switching doctors: Predictors of voluntary disenrollment from a primary physician's practice

BACKGROUND Our objective was to evaluate 8 interpersonal and structural fea tures of care as predictors of patient's voluntary disenrollment from their primary care physician's practice. METHODS We performed a longitudinal observational study in which participan ts completed a validated questionnaire at baseline (1996) and follow-up (19 99). The questionnaire measured 4 elements of the quality of physician-pati ent relations (communication, interpersonal treatment, physician's knowledg e of the patient, and patient trust) and 4 structural features of care (acc ess, visit-based continuity, relationship duration, and integration of care ). Study participants were insured adults who report ed having a regular pe rsonal physician at baseline and who completed both baseline and follow-up questionnaires (n=4108). The outcome measured was voluntary disenrollment f rom the primary physician's practice between baseline and follow-up. RESULTS One fifth of the patients voluntarily left their primary physician' s practice during the study period. When tested independently, all 8 scales significantly predicted voluntary disenrollment (P <.001), with somewhat l arger effects associated with the 4 relationship quality measures. In multi variable models, a composite relationship quality factor most strongly pred icted voluntary disenrollment (odds ratio [OR]=1.6; P <.001), and the 2 con tinuity scales also significantly predicted disenrollment (OR=1.1; P <.05). Access and integration did not significantly predict disenrollment in the presence of these variables. CONCLUSIONS These findings highlight the importance of relationship quality in determining patients loyalty to a physician's practice. They suggest th at in the race to the bottom line medical practices and health plans cannot afford to ignore that the essence of medical care involves the interaction of one human being with another.