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Patient-doctor bond linked to better quality care

E-mail | Print | Comments () Posted by Elizabeth Cooney March 2, 2009 05:00 PM

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Patients who are directly connected to their primary care physicians are more likely to get preventive screenings according to a Boston study that examines the relationship from the physician's as well as the patient's point of view. Its conclusions may add to the debate on how doctors are paid.

Having regular access to health care has long been linked to quality, but researchers from Massachusetts General Hospital and Harvard Medical School explored the importance of patients having their own personal physicians.

Looking at the medical records of more than 155,000 patients at nine physician practices and four community health centers in the hospital's primary care network, they found that patients who not only named their own doctors but whose doctors also identified them as "my patient" were more likely to get screenings for cancer, diabetes, and coronary artery disease compared to patients not linked to a personal physician. These patients saw different doctors in a practice or health center.

Although the patient-physician connection was more common among people who are white, speak English, and have health insurance, the bond with a personal physician was a bigger factor than race or ethnicity in whether a patient got guideline-recommended preventive care. Being insured was also not as important as being connected, according to the study, which was completed before Massachusetts passed its healthcare law mandating near-universal coverage.

"We need to understand why certain patients are connected to personal physicians and why others aren't," Dr. Steven J. Atlas said in an interview.

Atlas and his co-authors, who report on their study in the Annals of Internal Medicine, were surprised by the variation in connectedness that they found across the 13 practices, ranging from 46 percent to 71 percent of patients. The different settings share clinical and administrative systems, including electronic health records, and have the same management structure.

"That's a huge difference," Atlas said. "That has important health policy implications if you think about paying physicians or practices based on the quality of care they provide."

Physicians have objected to pay-for-performance programs that compensate them based on how many of their patients get recommended care. Last year the Massachusetts Medical Society sued the state's Group Insurance Commission alleging its ranking of physicians based on cost and quality measures hurt physicians and patients because it was based on a flawed methodology. Physicians were sometimes punished for the cost of care for patients they did not treat, the suit alleged.

The willingness or ability of patients to establish a relationship with their doctors may play a role in connectedness, too, Atlas said, in which case holding the physician or practice accountable may not work. Patients facing socioeconomic or language barriers as they navigate the healthcare system may be less likely to connect with their physicians.

"The doctor may be doing a great job, but it may be a much more challenging population," Atlas said.

In an editorial, Dr. Andrew B. Bindman of the University of California, San Francisco, says the measure of patient-physician connectedness would be more valuable if it included not just screening for certain diseases but also improved health and lower costs.

"Clearly, we need to learn more about the role that patient preferences and provider behavior play in forming (or undermining) productive health care relationships," he writes.

Atlas said what they have learned about connectedness can affect how healthcare is delivered.

"If patients can't come in during 9 to 5, we have to figure out a new way. The face-to-face office visit is just one model of care," he said. "We are using this information to understand where we are doing well and where we can do better."

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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