Measuring the impact of primary care provider and patient relationships on health outcomes.

摘要

The core of primary care is long-term, personal, trusting relationships in which the patient and provider make decisions together. A better understanding of the factors influencing the patient-provider relationship that impact health outcomes has implications for provider training and the organization of health care systems. The study objectives were to investigate whether patients who are empaneled to a primary care provider (PCP) perceive that a relationship with a PCP is important to improving their health outcomes; to evaluate, from the perspective of the patients who are empaneled to a PCP, the quality of the relationship with this PCP; and to measure the impact of patient and provider factors on the quality of the patient-provider relationship and on health outcomes. Data were collected from a convenience sample of 2,126 patients over the age of 18 and empaneled to one of 41 PCPs from 7 primary care clinics operated by Southcentral Foundation, a nonprofit health care system in Anchorage, Alaska. The standard CARE measure with additional survey questions was utilized in addition to patient and provider demographics, satisfaction, health care system utilization, and health outcomes to conduct a multilevel regression analysis. Various patient and PCP factors impacting the relationship were investigated. The study results indicate that patients empaneled to a PCP perceive that a relationship with a provider is important to improve health outcomes with the only significant patient factor being increased time empaneled. Patients empaneled to a PCP reported having a relationship, and there were several patient and provider factors of significance. Patients who reported having a relationship with their chosen PCP had a higher self-reported health rating. Unlike previous research on patient-provider relationships, the continuity factor/match rate did not result in significant improvement to health outcomes. Retention, onboarding, and training of PCPs must be designed to foster the creation and maintenance of relationships. Further research should include a longitudinal design to address the long-term impacts of relationship and health outcomes from the perspective of the patient, and a comparative study design to examine any potential differences across patient populations.