Attitudes and satisfactions of low-income families receiving comprehensive pediatric care.

Alpert, Joel J.; Kosa, John; Haggerty, Robert J.; Robertson, Leon S.; Heagarty, Margaret C.

doi:10.2105/ajph.60.3.499

Cited by 78 publications

(16 citation statements)

References 6 publications

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“…21,37,45,57,58 In 7 of the studies, including 6 of the 7 clinical trials, patients were assigned either to a clinic designed to deliver clinician continuity or to a clinic with no physician continuity. [22][23][24][25][26]29,40,70 Unfortunately, the quality of evidence in these studies is compromised, because in only 1 study was continuity actually measured in either study group. 33 Supplemental Table 3 (http://www.annfammed.org/ cgi/content/full/3/2/159/DC1) summarizes the 20 studies examining the association between interpersonal continuity and the cost of health care.…”

Section: Resultsmentioning

confidence: 99%

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Saultz

Lochner

2005

The Annals of Family Medicine

492

389

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PURPOSE We wanted to undertake a critical review of the medical literature regarding the relationships between interpersonal continuity of care and the outcomes and cost of health care.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted by the primary author to fi nd original English language articles focusing on interpersonal continuity of patient care. The articles were then screened to select those articles focusing on the relationship between interpersonal continuity and the outcome or cost of care. These articles were systematically reviewed and analyzed by both authors for study method, measurement technique, and quality of evidence.RESULTS Forty-one research articles reporting the results of 40 studies were identifi ed that addressed the relationship between interpersonal continuity and care outcome. A total of 81 separate care outcomes were reported in these articles. Fifty-one outcomes were signifi cantly improved and only 2 were signifi cantly worse in association with interpersonal continuity. Twenty-two articles reported the results of 20 studies of the relationship between interpersonal continuity and cost. These studies reported signifi cantly lower cost or utilization for 35 of 41 cost variables in association with interpersonal continuity.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, it is likely that a signifi cant association exists between interpersonal continuity and improved preventive care and reduced hospitalization. Future research in this area should address more specifi c and measurable outcomes and more direct costs and should seek to defi ne and measure interpersonal continuity more explicitly. Ann Fam Med INTRODUCTIONC ontinuity of care traditionally is considered one of the core principles of family medicine, 1,2 and it is a core element of the Institute of Medicine defi nition of primary care. 3 Recently there has been a resurgence of interest in this subject, and the Annals of Family Medicine has devoted a theme issue to the topic. 4 This resurgence has occurred in part because of the growing sophistication of research in family medicine and because of changes in American health care that many believe have undermined continuity in the relationship between physicians and their patients.5-11 A central question facing the future of family medicine is the degree to which we will provide personal health care based on the individual doctor-patient relationship, or whether we will seek to provide a medical home for patients based on an interdisciplinary team with less emphasis on personal care. 12Continuity has proved to be a diffi cult variable to defi ne and measure. Several previous reviews of this subject have noted major limitations to its research foundation because of inconsistent defi nitions and complex methodologic challenges. [13][14][15][16][17][18] In early 2002, we undertook a comprehensive review of the medical literature to examine one aspect of continuity 160INTERPERSONAL CONTINUITY AND...

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Section: Resultsmentioning

confidence: 99%

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Saultz

Lochner

2005

The Annals of Family Medicine

492

389

View full text Add to dashboard Cite

show abstract

“…All 4 found aspects of improved patient satisfaction in study groups with higher continuity of care. In the 1960s, Alpert and colleagues 47,57 randomly assigned 931 low-income children to receive care in a comprehensive pediatric clinic or in a traditional pediatric walk-in clinic in Boston. The care of these 2 groups was compared at 2 and 4 years.…”

Section: Resultsmentioning

confidence: 99%

“…48,49,58 Although the intervention groups were assigned to receive care in clinics that were designed to deliver care in an interpersonal continuity model, there is no evidence in these reports that the continuity was in fact better in these clinics. In the remaining 2 trials by Alpert et al 47,57 and Wasson et al, 50 interpersonal continuity was measured by the percentage of patients who could name their physicians. Wasson et al also reported the usual provider continuity index (UPC) and the sequential continuity index (SECON) to show higher continuity scores in the intervention group.…”

Section: Resultsmentioning

confidence: 99%

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Saultz¹

2004

The Annals of Family Medicine

383

305

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PURPOSE We wanted to review the medical literature regarding the relationship between interpersonal continuity of care and patient satisfaction and suggest future strategies for research on this topic.METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted to fi nd articles focusing on interpersonal continuity of patient care. The resulting articles were screened to select those focusing on the relationship between interpersonal continuity in the doctor-patient relationship and patient satisfaction. These articles were systematically reviewed and analyzed for study method, measurement technique, and the quality of evidence.RESULTS Thirty articles were found that addressed the relationship between interpersonal continuity and patient satisfaction with medical care. Twenty-two of these articles were reports of original research. Nineteen of the 22, including 4 clinical trials, reported signifi cantly higher satisfaction when interpersonal continuity was present.CONCLUSIONS Although the available literature refl ects persistent methodologic problems, a consistent and signifi cant positive relationship exists between interpersonal continuity of care and patient satisfaction. Future research in this area should address whether the same is true for all patients or only for those who seek ongoing relationships with physicians in primary care. INTRODUCTIONC ontinuity of care is considered to be a core principle of family medicine 1,2 and primary care, 3 but conclusive proof regarding its value has eluded primary care and health policy researchers. The fi rst step in establishing this proof requires a specifi c defi nition of the most important elements of continuity. Previous authors have addressed different aspects of continuity and have proposed defi nitions with multiple dimensions. 1,[4][5][6][7][8][9][10] Recently, 3 of these dimensions were organized into a hierarchy ranging from the availability of accurate information from one health care encounter to another (informational continuity), through a pattern of health care utilization at a particular site of care (longitudinal continuity), to a personal doctor-patient relationship characterized by loyalty and trust (interpersonal continuity).11 For family physicians the concept of interpersonal continuity holds particular importance. 12 Interpersonal continuity refers to a special type of longitudinal continuity in which an ongoing personal relationship between the patient and clinician is characterized by personal trust and responsibility.11 Changes in the American health care system during the past decade have made it increasingly diffi cult to establish such long-term trusting relationships between physicians and patients. [13][14][15][16][17][18][19] Some authors have questioned whether a personal model of care is feasible, as health plans increasingly have required provider changes for economic reasons. 20 As these changes occur, health policy planners are looking for evidence supporting the value of interpersonal continuity...

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“…Starfield 27 stated that longitudinality is an essential element of good primary care, and Hjortdahl and Laerum 28 described continuity as a cornerstone of the relationship. The benefits of continuity have been described: enhanced satisfaction for parents of children with chronic illnesses 29 ; improved understanding of the need for and results of a consultation 30 ; improved appointment compliance with longitudinal care 31,32 ; improved medication compliance 31,33,34 ; and reduced hospitalization rates, episodes of illness, and number of laboratory tests performed. 35 Mothers have been found to be more likely to disclose behavioral problems 31,34 ; previously addressed problems are more likely to be addressed again 17 ; and visit satisfaction is greater with the same provider.…”

Section: Discussionmentioning

confidence: 99%

Multisite Survey of Pediatric Residents' Continuity Experiences: Their Perceptions of the Clinical and Educational Opportunities

Serwint

2001

Pediatrics

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ABSTRACT. Objectives. To survey a large group of residents from different institutions to delineate whether there are significant perceptive differences pertaining to the clinical and educational strengths and weaknesses of their continuity experiences by the 3 types of continuity sites.Background. The residency review committee requires a 3-year continuity experience for pediatric residents. Residents receive this experience at a variety of practice sites: hospital-based sites (HBS), community health centers (CHC), and private practices (PP)/health maintenance organizations (HMOs).Design/Methods. Continuity clinic directors who attended the Ambulatory Pediatric Association Continuity Clinic Special Interest Group at the 1999 annual Pediatric Academic Societies Meeting were invited to participate in this cross-sectional study. Thirty-six agreed and distributed a 60-item questionnaire to their residents at the end of the academic year. The questionnaire addressed quality and quantity of the educational and patient care experiences, overall satisfaction, and future career plans.Results. Of the 1167 categorical residents (71%) who returned the questionnaire, 28% were postgraduate level (PL)-1s, 34% were PL-2s, and 37% were PL-3s. Ninetyfour percent of the 36 programs had residents in HBS (n ‫؍‬ 807 residents), 58% in CHC (n ‫؍‬ 106), and 69% in PP/HMO (n ‫؍‬ 254). Compared with other groups, residents in HBS were more likely to report having seen patients more than once, being involved during patients' hospitalizations, taking phone calls from patients, and perceiving that the parents identified them as the primary care provider. HBS and CHC residents felt more autonomous and were more likely to believe that they were advocates for their patients, compared with PP/ HMO residents. The number of patients seen per session was greater in PP/HMO, whereas residents in PP/HMO were more likely to perceive that they had received the right amount of exposure to practice management and billing issues and the appropriate amount of nursing and office support. Although numbers of newborn visits were reported as adequate across sites, residents in HBS and CHC believed that they did not see enough adolescents. The majority of residents at all sites agreed that their preceptor was a good role model, was available for questions, and delivered the appropriate amount of teaching and feedback. Approximately two thirds of residents from all sites were satisfied with their experience and believed that it was preparing them for their future career.Conclusions T he continuity experience in its present form became a mandatory part of pediatric residency training in 1990. Guidelines were further defined in 1997 regarding numbers of patient encounters and resident patient panels. The residency review committee (RRC) is a committee of the Accreditation Council of Graduate Medical Education that makes recommendations to the Accreditation Council of Graduate Medical Education who then provide a standard of governance for all residency training p...

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Attitudes and satisfactions of low-income families receiving comprehensive pediatric care.

Cited by 78 publications

References 6 publications

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Interpersonal Continuity of Care and Care Outcomes: A Critical Review

Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

Multisite Survey of Pediatric Residents' Continuity Experiences: Their Perceptions of the Clinical and Educational Opportunities

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