Intention to discontinue care among primary care patients - Influence of physician behavior and process of care

BACKGROUND: Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in o utpatient settings caring for patients with diverse types of insurance cove rage. OBJECTIVE: To examine whether physician behavior and process of care affect patients' intention to return to their usual health care practice. DESIGN. Cross-sectional patient survey and medical record review. SETTING: Eleven academically affiliated primary care medicine practices in the Boston area. PATIENTS: 2,782 patients with at least one visit in the preceding year. MEASUREMENT: Unwillingness to return to the usual health care practice. RESULTS: Of the 2,782 patients Interviewed, 160 (5.8%) indicated they would not be willing to return. Two variables correlated significantly with unwi llingness to return after adjustment for demographics, health status, healt h care utilization, satisfaction with physician's technical skill, site of care, and clustering of patients by provider: dissatisfaction with visit du ration (odds ratio [OR], 3.2; 95% confidence Interval [CI], 1.4 to 7.4) and patient reports that the physician did not listen to what the patient had to say (OR, 8.8; 95% Cl, 2.5 to 30.7). In subgroup analysis, patients who w ere prescribed medications at their last visit but who did not receive an e xplanation of the purpose of the medication were more likely to be unwillin g to return (OR, 4.9; 95% Cl, 1.8 to 13.3). CONCLUSION: Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribut e to patients' decisions to discontinue care at their usual site of care.