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When do older patients change primary care physicians?

James W Mold1, George E Fryer, A Michelle Roberts

  • 1Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA. james-mold@ouhsc.edu

The Journal of the American Board of Family Practice
|December 3, 2004
PubMed
Summary

Older patients value long-term relationships with primary care physicians (PCPs). Longer PCP relationships correlate with higher perceived quality of care, but system changes may force involuntary changes.

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Area of Science:

  • Geriatric Medicine
  • Health Services Research
  • Primary Care

Background:

  • Healthcare system changes may disrupt care continuity and quality.
  • Understanding reasons for primary care physician (PCP) changes is crucial for older adults.
  • Long-term PCP-patient relationships are linked to perceived quality of care.

Purpose of the Study:

  • Investigate reasons older patients (65+) change PCPs.
  • Examine the association between PCP-patient relationship duration and perceived primary care quality.

Main Methods:

  • Longitudinal study of 799 patients aged 65+ over 2 years.
  • Data collected on sociodemographics, PCP relationship duration, reasons for change, healthcare utilization, and quality of care (CPCI).

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Main Results:

  • Mean PCP relationship duration was 10.27 years; longer duration associated with older age, higher income/education, and more frequent visits.
  • Longer PCP relationships correlated with higher scores on all 8 Components of Primary Care Index (CPCI) subscales.
  • 14% of patients changed PCPs; involuntary changes (87%) were common, often due to insurance (44%) or physician relocation/retirement/death (40%).

Conclusions:

  • Older, more educated, and higher-income patients tend to maintain long-term PCP relationships.
  • Extended PCP-patient relationships are associated with improved perceived primary care quality.
  • Healthcare system changes may be increasing involuntary PCP transitions for older adults.