Patient choice. A randomized controlled trial of provider selection

Abstract

Objective: To evaluate the impact of an intervention designed to help patients choose a new primary care provider (PCP) compared with the usual method of assigning patients to a new PCP.

Design: Randomized controlled trial conducted between November 1998 and June 2000.

Intervention: Provision of telephone or web-based provider-specific information to aid in the selection of a provider.

Setting: Medical center within a large HMO.

Patients: One thousand and ninety patients who were >/=30 years old, whose previous PCP had retired and who responded to a mailed questionnaire 1 year after linkage with a new PCP.

Measurements and main results: The questionnaire assessed perceptions of choice, satisfaction, trust, and retention of the PCP. During the intervention period, 85% of subjects obtained a new PCP. Intervention subjects were more likely to perceive that they chose their PCP (78% vs 22%; P <.001), to retain their PCP at 1 year (93% vs 69%; P <.001), and to report greater overall satisfaction with the PCP (67% vs 57%; P <.01), compared to control subjects who were assigned to a PCP. The intervention subjects also reported greater trust in their PCP on most measures, but these differences did not remain statistically significant after adjustments for patient age, gender, ethnicity, education, and health status.

Conclusions: Encouraging patients to choose their PCP can result in mutually beneficial outcomes for both patients and providers, such as greater overall satisfaction and duration of the relationship. Further research is needed to identify the types of information most useful in making this choice and to understand the relevant underlying patient expectations.

FIGURE 1

Trial flow diagram. ^*There were 232 subjects who left the health plan, died, or for whom we could not find correct contact information during the study period. We randomly sampled 50% of the remaining control subjects to decrease costs.