Matching patients and practitioners based on beliefs about care: results of a randomized controlled trial

Abstract

Objective: To determine whether an intervention designed to inform and guide patients in choosing a primary care provider (PCP) could increase satisfaction and trust.

Design: A randomized controlled trial conducted at the Santa Clara Medical Center of the Kaiser Permanente Medical Care Program in Northern California.

Patients and methods: Patients needing a PCP were randomly assigned to Informed Choice (provider-level information offered), Guided Choice (PCP names provided based on the similarity of patients' and practitioners' patient-centered beliefs, and patients then chose), or Usual Care. One year later, mailed questionnaires asked about patients' trust and satisfaction, perceptions of the choice process, and trust and satisfaction with Kaiser Permanente. More than 5000 adult patients were linked with a PCP as part of the project, and completed surveys were returned by 2437 patients.

Results: Neither intervention arm generated better matches on patient-practitioner beliefs than Usual Care; however, trust and satisfaction were higher among Guided Choice patients. Across study arms, patient-practitioner belief discrepancy showed a consistent positive association with trust, satisfaction, and attitudes toward Kaiser Permanente.

Conclusions: The discrepancy between patient and practitioner beliefs about care is an important determinant of trust and satisfaction, and involving patients in the selection of their PCP can have an independent positive effect. It should be possible to build on the experience of this project to develop programs that better match patients and practitioners within managed care plans.