When do older patients change primary care physicians?

James W. Mold, MD, MPH; George E. Fryer, PhD; A. Michelle Roberts, BA.

BACKGROUND: Concerns have been raised about changes in the health care system that may disrupt continuity of care and thereby reduce the quality of that care. The purpose of this study was to look at the reasons older patients say they last changed primary care physicians (PCP), and to look at relationships between the duration of the PCP-patient relationship and the perceived quality of primary care received. METHODS: We analyzed data collected during the first two years of a longitudinal study of primary care patients 65 years of age and older. Variables included socio-demographic characteristics, duration of relationship with current PCP, reasons for leaving last PCP, estimated numbers of visits to PCP, other clinics, emergency departments, and admissions to hospitals and nursing homes in the last year, self-rated health and two measures of health-related quality of life, and the Components of Primary Care Index (CPCI). RESULTS: 799 patients of 23 PCPs were enrolled in year one of the longitudinal study, and 579 were re-evaluated in year two. The mean and median PCP-patient relationship duration were 10.27 and 8 years. Duration of the PCP-patient relationship was associated with greater patient age, income, level of education, and number of visits to the PCP. Longer relationship duration was also associated with higher scores on all eight CPCI subscales. The distribution of reasons for changing PCP was associated with duration of relationship, those with a longer relationship being more likely to change involuntarily. Insurance-related reasons for changing PCP were more common in those who had changed more recently. One hundred and fourteen (14%) changed their PCP during the first year of the study. Three CPCI subscale scores predicted PCP change, accumulated knowledge, communication, and family orientation. Eighty-seven percent changed involuntarily, forty-four percent for insurance related reasons and 40% because their doctor moved, retired, or died. CONCLUSIONS: Older patients, and particularly those who are older and have more education and income, tend to stay with their PCP until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP.

Mold JW, Fryer GE, Roberts M. When do older patients change primary care physicians? J Am Board Fam Med 2004;17:453-60.