Table 1.

Interpersonal Continuity and Patient Satisfaction

Study Method, Study, and Publication DateSettingFindings*Quality of Evidence
* Techniques of measuring interpersonal continuity described previously.11
Clinical trial
Wasson et al, 198450Randomly assigned 776 men >55 y at a Veterans Administration (VA) clinic to either a continuity clinic or an outpatient clinic without continuityFor 18-month period, both continuity scores and patient satisfaction were significantly higher in experimental group. Continuity measured by usual provider continuity index (UPC), sequential continuity index (SECON), and the ability of patients to name their provider7.5
Becker et al, 197448; Becker et al, 197449Randomly assigned 125 low-income pediatric patients to either a clinic with continuity or a walk-in clinic. Both clinic staff and mothers were blinded to study designAfter 1 y, patients receiving care in continuity clinic were significantly more satisfied with care and rated care quality and quality of staff-patient interactions more highly than control patients. Continuity was not measured in either group, but the experimental clinic was designed to provide continuity of provider7.0
Alpert et al, 197057; Alpert et al, 197647Randomly assigned 931 low-income children from 750 families to receive care in a comprehensive pediatric clinic (252 families), a no-contact control group (257 families), and a control group that was interviewed along with the experimental group every 6 mo(261 families)Mothers in experimental group were more satisfied with several aspects of care, including relationship with providers, even though satisfaction with care was similar at start of study. Continuity was measured by determining number of mothers who could name their provider, 69% of experimental group and 33% of controls after 4 y6.5
Rowley et al, 199558Randomly assigned 405 pregnant Australian women to receive care from a continuity clinic staffed by 6 midwives and 409 women to a university teaching clinic without continuityWomen assigned to the continuity team were significantly more satisfied with care. Patients not blinded to the study design, and continuity not measured in the 2 groups4.5
Cohort, prospective
Smith, 1995463 interdisciplinary care teams consisting of internal medicine faculty, residents, midlevel providers, pharmacists, and clinic staff were organized in a VA outpatient department. Approximately 2,500 patients were enrolled with each team. Satisfaction was measured before and after the changePatient satisfaction improved significantly with the change. Continuity with assigned team was measured by chart review and improved from 47% to 69%, but was measured only for 30 “high-utilization” patients7
Shortell et al, 197742106 patients with hypertension, 50 in private practices and 56 in a group model health maintenance organization (HMO) were studied to compare care settings for 2 yHigher continuity scores correlated with increased patient satisfaction in both study groups. Continuity measured by number of providers seen (NOP)3.5
Breslau & Haug, 197653Children from 63 families receiving care from 2 pediatricians were evaluated before and after their physicians moved from a private office to a university clinicContinuity of care as measured by UPC worsened significantly after the move. 23 families were lost to follow-up after the move. Patient satisfaction did not change significantly3.0
Cohort, retrospective
Shear et al, 19835259 pregnant women receiving perinatal care in a family practice clinic were compared with101 women receiving care in an obstetric clinic. Continuity of care and patient satisfaction were measured and compared in both groupsContinuity was significantly better in the family practice group as measured by SECON, the NOP seen, and the ability to identify their usual provider. There was no significant difference in satisfaction. Patients were not randomly assigned and the care models were different in ways other than interpersonal continuity6.5
Breslau & Mortimer, 198137Home interviews of 370 mothers of children with cystic fibrosis, cerebral palsy, myelodysplasia, or multiple handicaps to determine correlation between continuity of care and patient satisfaction. Study encompassed 2 comprehensive and 3 specialty clinics in Cleveland, Ohio.Continuity of care as measured by patient report of seeing a usual provider accounted for the largest portion of the association between source of care and satisfaction. This was true in both comprehensive care and specialty care clinics8.5
Weyrauch, 199643Survey of 1,146 patient visits in an urban HMO to determine correlation between choice of provider, continuity of provider, and satisfactionBoth choosing one’s physician and seeing one’s own physician for the evaluated visit correlated significantly with satisfaction with care7.5
Love et al, 200041Survey of 1,726 Kentucky medicaid patients, 404 of which had a diagnosis of asthma, examining correlation between continuity of care and satisfaction with provider communication and patient influence over treatment decisionsContinuity as rated by patients on a Likert scale was significantly correlated with satisfaction in both groups, but was particularly important for the group with asthma7.5
Hjortdahl & Laerum, 199240Survey of 3,918 Norwegian patients to examine relationship between continuity of care and patient satisfaction with their office visitA personal doctor-patient relationship increased satisfaction sevenfold and the duration of that relationship had a weak, but significant association with satisfaction7.0
Kingston, 198359Survey of 292 residents of a senior citizen apartment complex in Michigan examining determinants of loyalty to providerPatients with higher self-rated continuity were less likely to express interest in finding a new provider6.5
Breslau, 198244Home interviews of 369 families of children with cystic fibrosis, cerebral palsy, myelodysplasia, or multiple handicaps compared with 459 families of nondisabled children. Study was done to determine whether continuity of care is more important for the disabled groupContinuity was significantly better in the non-disabled group, which also included families with lower average income, less education, and a higher proportion of nonwhite race. Continuity of care correlated significantly more strongly with 3 elements of patient satisfaction in the disabled group. Continuity was evaluated by patient rating of degree to which patients saw their usual provider6.5
Mainous et al, 200155Survey of 418 US patients and 650 UK patients examining correlates with patients’ trust in their physiciansTrust was related to the length of the doctor-patient relationship, but not to measures of continuity. Continuity was measured by the patients’ ability to identify a usual provider and by UPC. US patients valued continuity more highly than UK patients6.0
Roland et al, 198645128 patients in 4 general practices in Bristol, England, were followed for 2 y. Two practices had patients assigned to the clinic, and in2 the patients were assigned to individual providersPatients assigned to individual providers had significantly higher continuity as measured by the most frequent provider continuity index. They were also more likely to request their own doctor, more willing to wait for an appointment, and more likely to view their doctor as a friend5.0
Baker, 199660Survey of 75 patients from 126 British general practitioners in 39 practices to determine correlates of patient satisfactionSmaller practices and use of personal list assignments were associated with higher satisfaction. Continuity was not measured other than recording whether partial or complete personal assignment lists were used5.0
Freeman & Richards, 199339Home interviews with 111 patients from 3 general practices in England to determine patient values regarding personal continuity and to compare the responses from patients in practices with personal assignment lists vs combined listsMost patients prefer to see the same doctor, but patients in personal list practices value this more. Patients in combined list practices were less willing to wait to see their usual provider. Continuity as measured by UPC increased with patient age in both groups4.5
Flynn, 198538Survey of 61 prenatal patients at a university family practice residency in Missouri to determine association between provider continuity and pregnancy outcomeContinuity as measured by the continuity of care index and presence of assigned physician at delivery ranked 8th of 10 attributes in importance to patients and did not significantly correlate with satisfaction4.0
Kearley et al, 200054Survey of 996 adult patients from 18 British general practices to determine when patients most value having a personal doctor-patient relationshipContinuity relationships were highly valued as very important or extremely important by 64% of patients and most valued when serious illness, psychosocial problems, and family issues were present3.5