Loyalty to the regular care provider: patients' and physicians' views

Background. Changes in the organization of primary care practices are likel y to have repercussions on the manner in which patients and physicians perc eive loyalty to a regular source of care. A better understanding of their v iews will contribute to conceptual reflections on this poorly documented to pic and, where needed, will reinforce efforts to adapt services to patient expectations. Objectives. The aims of this study are to document and compare the views th at patients and GPs have of loyalty to the regular care provider. Methods. This exploratory study uses the focus group technique. In 1997, we set up three groups of patients and three groups of physicians practising in Montreal. A total of 23 patients and 14 physicians participated in the s tudy. The meetings investigated the participants' points of view on various aspects of the notion of loyalty. Analysis was based on transcripts of the meetings. The emerging themes were identified and the viewpoints were code d independently and then revised (when necessary) in order to obtain a cons ensus. Results. Patients and physicians have a relatively congruent vision of the notion of loyalty. This tendency to use the regular source of care over tim e appears to be rooted in a formal or informal contract between patients an d their physicians and implies a sustained partnership and a strong interpe rsonal relationship. The relationship established is neither exclusive nor permanent. Patients periodically reconsider it by evaluating their physicia n's technical and interpersonal skills. Conclusions. This study highlights the dynamic and multidimensional nature of the notion of loyalty. It shows that patients clearly identify with a pa rticular physician rather than a clinic. The results challenge the prevaili ng methods of assessing longitudinality of care.