Continuity of Care and the Physician-Patient Relationship
The Importance of Continuity for Adult Patients with Asthma
BACKGROUND: We assessed the role and importance of continuity of care in predicting the perceptions of the physician-patient relationship held by patients with asthma.
METHODS: We analyzed the 1997 statewide probability survey of adult Kentucky Medicaid recipients. The participants included 1726 respondents with 2 or more visits to a physician’s office, clinic, or emergency department in the previous 12 months. Of these, 404 reported having asthma. The respondents used 5-point single-item scales to rate continuity of care, provider communication, and patient influence over treatment.
RESULTS: Multivariate linear regression analyses were used to assess the contribution of continuity of care to provider communication and patient influence in the presence of control variables. Those variables included age, sex, education, race, number of visits, general health, health improvement, and life satisfaction. For persons with asthma, continuity of care was the only variable that significantly contributed to the provider communication model (P=.01) and the only variable other than life satisfaction that contributed to the patient influence model (P <.05 for each). For patients who did not have asthma, continuity of care was one of several variables contributing significantly (P <.05) to the provider communication and patient influence models.
CONCLUSIONS: Particularly for patients with asthma, continuity of care was linked to patient evaluations of their interaction with the physician. Because of this, changes in health care systems that promote discontinuity with individual physicians may be particularly disruptive for patients with chronic diseases.
Continuity of care has been shown to be associated with a variety of positive outcomes including patient satisfaction,1 compliance with medication regimens,2 and health services utilization.3 High continuity of physician care is also associated with a decreased likelihood of future hospitalization.4,5 One explanation for this finding is that continuity leads to increased knowledge and trust between the patient and the physician.6 This increased knowledge and trust may make it easier for the physician to manage medical problems in the office or over the phone and thereby avoid hospitalizing the patient. Similarly, having care continuity with a specific physician is significantly associated with a decreased likelihood of emergency department (ED) use.7
Although data are continually accumulating indicating that continuity between a patient and a clinician has positive benefits, it is clear that it is not always easy to achieve high continuity in practice.8 This is increasingly the case as physicians work in larger groups where there is likely to be less continuity with an individual provider.9 According to data from the 1987 National Medical Expenditure Survey, only half of all patients have high continuity with a physician.8 This situation may be worsening as more Americans are enrolled in managed health care plans that frequently change their panel of approved physicians.10 As a result, patients may be forced to change their physician on multiple occasions, which could have negative consequences on the management of their medical problems.
Since continuity between a patient and a physician has positive health benefits in the general population, it makes intuitive sense that these benefits would be greatest for persons with chronic conditions. Asthma is a common chronic disease affecting 14 to 15 million people in the United States and is the most common chronic disease of childhood, affecting nearly 5 million children in the United States.11 Asthma accounts for more than 470,000 hospitalizations and more than 5000 deaths annually.12 Rates of hospitalization for asthma have been increasing and reflect that it is the most common discharge diagnosis among children.13 In addition to the morbidity and mortality associated with this disease, some treatments have possible adverse effects.14 Thus, the benefits that could accrue from improved health care delivery are considerable.
Patients with asthma have a greater desire than the general population to maintain continuity with a physician, even when the visit is not for asthma.15 A possible reason continuity of care may be important is that the management of chronic conditions requires ongoing monitoring and decisions about when changes in therapy are appropriate. When a patient is seen by the same physician, that provider is more likely to know when tests and treatment changes are indicated. Effective physician-patient interaction is an important component of health care delivery. For patients with chronic illnesses, interaction processes that include the physician giving more information and the patient having greater control during the visit are associated with better health.15 Physician and patient roles in managing asthma differ across physician-patient relationships,16 but the relation between continuity of care and the physician-patient relationship has not been specified for patients with asthma.
It is important to determine the role and importance of continuity in the delivery of health care to patients with asthma. The purpose of our study was to examine the relationship between continuity of care and physician-patient interaction among patients with and without asthma.
