Patient-Physician Shared Experiences and Value Patients Place on Continuity of Care

INTRODUCTION

Continuity of care plays a central role in the patient-physician relationship and has been shown to be associated with a variety of positive outcomes, including patient satisfaction,¹ likelihood of hospitalization and emergency department use,^2,3 and control of chronic disease.⁴ Consequently, from a health policy perspective continuity of care has been encouraged for many years.⁵

It is unclear what creates a patient’s desire for continuity of care.¹ For example, patients with asthma have a greater desire than the general population to maintain continuity with their physician, even when the visit is not for asthma.⁶ Asthmatic patients have frequent contacts with their physician, but they may also link successful resolution of an exacerbation to the skill of the physician. The purpose of this study is to examine the independent and interactive impact of longitudinal physician continuity and shared experiences of patients and physicians on patients’ desires for continuity of care.

METHODS

RESULTS

The demographics of the patient and physician samples have been previously described.⁷ The results of the 2-way analysis of variance testing the effects of duration of relationship with the physician and experiences shared between patients and physicians on the degree to which patients value continuity are displayed in Table 1⇓. A significant interaction was found between duration of relationship and experiences shared between patients and physicians. The effect of experiences shared with the physician on the degree to which patients value continuity is dependent on the length of the patient’s relationship with the physician, and vice versa.

This complex relationship between duration of relationship, experiences shared between patient and physician, and the degree to which patients value continuity can be better understood by examining the mean value of continuity within each of the cells of the independent variables, as displayed in Table 2⇓. For all lengths of relationship with the physician, the patients’ value of continuity increased when patients had a shared experience with the physician. Also, for all 3 categories of key event, the patient’s value of continuity was higher when the patient had been with the physician for more than 4 years than when the patient had been with the physician for less than 2 years. Magnitude of difference, however, was not the same for all levels of key event. For patients who responded that they did not have a shared experience with the physician, the difference in value of continuity by length of relationship appeared to be greater than for patients that agreed or responded neutrally.

DISCUSSION

The results of this study point to the importance of the patient-physician relationship in a patient’s desire for continuity with his or her regular doctor. Just seeing the same physician over time does not guarantee a personal relationship or loyalty on the part of the patient.

This finding dovetails with previous discussions suggesting that the construct of continuity of care needs to be conceptualized in a way that distinguishes contact between patient and physician from the development of personal relationships.¹ The personal relationship has been argued to be more important than simply having exposure to the same physician. Some physicians develop relationships within a short period, whereas others may see patients for years and still not have developed a strong patient-physician relationship. The developing relationship may be tied, however, to the successful management of important medical problems. The data support past research that suggests patients who have medical problems requiring substantial intervention on the part of the physician are more likely to exhibit a desire for continuity.⁶

The results of this study must be evaluated in light of several limitations. First, the data are all based on self-reports and thereby could be influenced by recall bias or social desirability. Even so, many of the measures have been previously validated and used successfully in other studies. Second, the data may be somewhat dated because they derive from surveys conducted in 1994 and 1995. It is possible that the relationships may not represent current attitudes, although it seems unlikely that this process of developing relationships between patients and physicians would have changed substantially in the recent past. Third, the analysis is cross-sectional and thereby limits our ability to demonstrate causal pathways between the constructs of experiences shared between patients and physicians and how patients value continuity.

In conclusion, the present findings point to the importance of experiences shared between patients and physicians. The longitudinal relationship that can build between patients and physicians is enhanced by these shared experiences. Future research might elucidate the types of shared experiences that encourage a desire for continuity of care.