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Observational Study
. 2020 Sep;18(5):422-429.
doi: 10.1370/afm.2554.

Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health

R Henry Olaisen  1   2 , Mark D Schluchter  3 , Susan A Flocke  4 , Kathleen A Smyth  3 , Siran M Koroukian  3 , Kurt C Stange  3   2
Affiliations
Observational Study

Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health

R Henry Olaisen et al. Ann Fam Med. 2020 Sep.

Abstract

Purpose: Access to a usual source of care is associated with improved health outcomes, but research on how the physician-patient relationship affects a patient's health, particularly long-term, is limited. The aim of this study was to investigate the longitudinal effect of changes in the physician-patient relationship on functional health.

Methods: We conducted a prospective cohort study using the Medical Expenditure Panel Survey (MEPS, 2015-2016). The outcome was 1-year change in functional health (12-Item Short-Form Survey). The predictors were quality of physician-patient relationship, and changes in this relationship, operationalized with the MEPS Primary Care (MEPS-PC) Relationship subscale, a composite measure with preliminary evidence of reliability and validity. Confounders included age, sex, race/ethnicity, educational attainment, insurance status, US region, and multimorbidity. We conducted analyses with survey-weighted, covariate-adjusted, predicted marginal means, used to calculate Cohen effect estimates. We tested differences in trajectories with multiple pairwise comparisons with Tukey contrasts.

Results: Improved physician-patient relationships were associated with improved functional health, whereas worsened physician-patient relationships were associated with worsened functional health, with 1-year effect estimates ranging from 0.05 (95% CI, 0-0.10) to 0.08 (95% CI, 0.02-0.13) compared with -0.16 (95% CI, -0.35 to -0.03) to -0.33 (95% CI, -0.47 to -0.02), respectively.

Conclusion: The quality of the physician-patient relationship is positively associated with functional health. These findings could inform health care strategies and health policy aimed at improving patient-centered health outcomes.

Keywords: Medical Expenditure Panel Survey; United States; functional health; impact; primary care; relationship.

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Figures

Figure 1
Figure 1
Construction of a prospective cohort study of US adults who had office-based physician visits in 2 consecutive years. Data from MEPS, 2015-2016. HC = MEPS Household Component; MEPS-PC = Medical Expenditure Panel Survey Primary Care measure. Note: Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey (MEPS Panel 20 Longitudinal Data File [HC-193, 2015-2016] and Medical Conditions File [HC-190, 2015]).
Figure 2
Figure 2
Directed acyclic graph of the hypothesized mechanism for how physician-patient relationship advances functional health. HAVEUS2 = does person have USC provider-R2; MEPS-PC = Medical Expenditure Panel Survey Primary Care measure; N = no; SF-12 = 12-Item Short-Form Survey; Y = yes. Note: Functional health operationalized with the SF-12 instrument. Physician-patient relationship operationalized with the MEPS-PC Relationship composite subscale. Usual source of care operationalized as having a particular doctor’s office, clinic, health center, or other place usually visited when sick or seeking advice about their health, operationalized with the MEPS HAVEUS2 indicator.
See this image and copyright information in PMC

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