Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms

Abstract

Background:If a patient presents for an acute care visit and sees their assigned primary care provider (PCP), they may be more likely to receive preventive and other services than a patient not seeing their assigned PCP.Methods:After exclusion of 2 visits with insufficient information, we reviewed 98 consecutive, outpatient internal medicine 15-minute acute care visits comparing patients seeing their assigned PCP with those seeing a non-PCP provider. The primary outcome, preventive service ordering, was measured in 2 ways: percentage of patient visits with any preventive service ordered and the total number of preventive services ordered as a proportion of all preventive service items due for each entire cohort. The secondary outcome of other work completed was assessed by comparing tests and consults ordered, and by counting the number of physical examination elements and discrete medical diagnoses documented.Results:The PCPs were significantly more likely than non-PCPs to order any preventive service 45% versus 17% (P = .005; odds ratio [OR]: 4.16, 95% confidence interval [CI]: 1.45-12.0). The PCP cohort ordered a higher proportion of the total number of preventive services due compared with the non-PCP cohort (30% vs 11%; P = .002; OR: 3.4, CI: 1.5-7.7). The PCPs also addressed more medical diagnoses (2.3 vs 1.4; P = .008) and more frequently ordered tests outside the reason for that visit (40% vs 13%; P = .003; OR: 4.27, CI: 1.5-11.8).Conclusion:Patients seeing their assigned PCP in brief, acute visits have higher rates of preventive and other service ordering compared to those not seeing their assigned PCP.

Exploring the therapeutic alliance in Belgian family medicine and its association with doctor–patient characteristics: a cross-sectional survey study

“…The number of contacts is representative of provider continuity and continuity of care. Multiple studies have shown that a higher continuity in family medicine is associated with better outcomes—through improved preventive healthcare27 and more adequate cancer screening28—and lower total healthcare costs 29 30. Our own study has found that patients who see their doctor more frequently had a higher measure of therapeutic alliance, but there was no correlation with the length of time the patient had known their doctor.…”

General practice and patient characteristics associated with personal continuity: a mixed-methods study

“…Personal continuity implies familiarity and mutual confidence between patient and doctor that can and usually do arise from repeated contacts over time (6). Reported benefits include a better patient-doctor relationship (7,8), better preventive care (9), fewer emergency department visits (10), greater patient and doctor satisfaction (8,11,12), fewer hospital admissions (13), reduced health care costs (14), better medication compliance and prescription (9,(15)(16)(17)(18)(19) and reduced mortality rates (20,21). Adverse effects of personal continuity include frustrated or difficult patient-doctor relationships and delayed diagnosis or referrals (22).…”

Patient Provider Continuity and Prostate Specific Antigen Testing: Impact of Continuity on Receipt of a Non-recommended Test

“…Several studies have indicated that having higher continuity is associated with greater treatment adherence in terms of medication use ( 5 – 7 ). There is even some evidence that continuity with a regular physician is associated with receipt of preventive services ( 8 , 9 ).…”