Intention to discontinue care among primary care patients: influence of physician behavior and process of care

Abstract

Background: Specific elements of health care process and physician behavior have been shown to influence disenrollment decisions in HMOs, but not in outpatient settings caring for patients with diverse types of insurance coverage.

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 unwillingness to return after adjustment for demographics, health status, health care utilization, satisfaction with physician's technical skill, site of care, and clustering of patients by provider: dissatisfaction with visit duration (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% CI, 2.5 to 30.7). In subgroup analysis, patients who were prescribed medications at their last visit but who did not receive an explanation of the purpose of the medication were more likely to be unwilling to return (OR, 4.9; 95% CI, 1.8 to 13.3).

Conclusion: Failure of physicians to acknowledge patient concerns, provide explanations of care, and spend sufficient time with patients may contribute to patients' decisions to discontinue care at their usual site of care.