Patients' relationship with primary care physician improves health care quality: Study

Patients who report having a regular doctor either at a community health center or at the physician's office report receiving better quality health care, and have a better health care experience, than patients who have a regular place of care, but lack an established physician relationship. The findings are part of a study published in the May Journal of Health Care for the Poor and Underserved, and authored by Anne Beal, MD, MPH, head of the Aetna Foundation, and Susan Hernandez, MPA, formerly of The Commonwealth Fund.

“Our analyses show lack of having a regular doctor, which is more common among community health center patients, has a greater impact on poor quality in community health center settings than all of the patient sociodemographic characteristics known to be associated with poor health outcomes.”

"At a time when the new health reform legislation is expanding access to primary care for millions more people, the number of primary care physicians in this country is dwindling at an alarming rate. We don't know the full impact of their declining numbers on health outcomes," Beal said. "This study demonstrates the importance of the primary care relationship for giving patients high quality care. It underscores the urgent need to encourage more physicians to pursue careers in primary care through more competitive public and private program reimbursement, expanded testing, study and implementation of medical homes, and increased support for primary care training programs."

The study was based on a sample of respondents to The Commonwealth Fund's 2006 Health Care Quality Survey. The study sample included nearly 3,000 adults who said they had a regular place of care - either a community health center or a physician's office - but not necessarily a regular primary care doctor. The study researchers analyzed the respondents' views on the quality of care they received, as defined by receiving preventive care and their personal experiences with care.

"Some indicators showed that community health centers do not perform as well as other types of health care institutions, or as well as private physician practices, in patients' reports of quality," Beal said. "However, our analysis showed that when community health center patients have a regular doctor, their care is significantly improved and they are as likely as others to report receiving preventive care and having positive patient experiences. So the problems with quality in community health centers were eliminated when patients had a personal physician."

As the study authors note, "Our analyses show lack of having a regular doctor, which is more common among community health center patients, has a greater impact on poor quality in community health center settings than all of the patient sociodemographic characteristics known to be associated with poor health outcomes."

Presently, the American College of Physicians estimates that only one third of physicians in the United States practice primary care, and the US Department of Health and Human Services estimated in 2009 that more than 16,000 primary care physicians are needed to meet the current needs of the US population.

According to the 2010 National Resident Matching Program, which matches graduate medical students with residency programs, the number of U.S. medical students choosing internal medicine residencies was up about 3 percent in 2009, but not enough to impact the shortage of primary care physicians. Some 2,722 seniors at US medical schools enrolled in an internal medicine residency program, which is down dramatically from the 3,884 who did so in 1985. And among those who choose internal medicine residency programs, an estimated 25 percent will ultimately choose a subspecialty, such as cardiology, over primary care.

"This is an important study, and one that highlights a particular aspect of the 'primary care workforce issue,' " said Richard Baron, M.D., whose recent article in the New England Journal of Medicine reported that primary care physicians spend many hours coordinating care for their patients providing non-visit based care in addition to direct face-to-face contact. "Given the expansion that will be happening for Community Health Centers and the newly insured populations that will be accessing care there, it is particularly important for policy makers to understand the need for primary care doctors who can create relationships with patients leading to higher quality outcomes across the delivery system."