Qualitative study of high-cost patients in an urban primary care centre

We examined patient accounts of illness and care among primary care patients whose medical services costs were high in order to illuminate factors associated with high cost.

Thirty-three primary care patients with multiple chronic illnesses in an urban clinic serving a resource poor neighbourhood were selected from a range of high medical cost patients. Participants were interviewed with open-ended questions to investigate experiences of illnesses and care; their responses were examined for prominent themes using qualitative analysis methodology.

Patients sorted themselves into two categories based on the dominant focus of the roles of the care givers: one termed 'professional', in which the focus was on the competence and effectiveness of the care giver; and the second, 'personal', in which the focus was on the interpersonal relationship.

We examine similarities with other recent studies, suggest factors influencing these two different types of relationships such as intensity of involvement in the healthcare system as well as personality characteristics, and explore the challenge for healthcare programme development. We also noted that these two ways of conceptualizing the doctor-patient relationship may have adaptive or maladaptive consequences depending on the match between physician and patient.