Patient-physician connection results in closer adherence to guidelines

NEW YORK (Reuters Health) - Patients who feel a connectedness with their personal physician feel they are receiving a higher quality of care and that the medical care is more consistent with approved guidelines than patients who feel like a "number" in the healthcare system.

A study of nine primary care practices and four community health centers connected with Massachusetts General Hospital, involving a total of 181 physicians in the Boston area, was conducted by Dr. Steven J. Atlas and colleagues "to determine whether patient-physician connectedness affects measures of clinical performance."

The study involved 155,590 adults who made one or more visits to one of the practices between 2003 and 2005. Dr. Atlas' team looked at screening for breast, cervical and colorectal cancer in eligible patients; hemoglobin A1c measurement in patients with diabetes; and low-density lipoprotein (LDL) cholesterol measurement in patients with or at risk of coronary artery disease.

The researchers found that 59.3% of the patients were connected to a specific physician, 34.5% were connected only to a specific practice, and 6.2% could not be connected to a physician or a practice.

The researchers report in the March issue of the Annals of Internal Medicine that "physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care."

Mammography rates were 78.1% for physician-connected patients and 65.9% for practice-connected patients. Hemoglobin A1c measurement rate was 90.3% for physician-connected diabetics and 74.9% for practice-connected diabetics.

"Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity," they found.

"We try to connect a patient with a primary care physician, but the medical education system is not sufficient to sustain this. The number of primary care physicians is at an all-time low, and unless the pipeline changes, the situation is not going to change," Dr. Atlas said in an interview with Reuters Health.

"We need to change the locus from the office-based visit to something else, such as by phone or email...The whole reimbursement system is based on the office visit," Dr. Atlas said.

"We need to change our outreach, by having more early morning or late evening hours and more weekend hours," he added. ""We need a patient-centered home model, where the system makes it easier for the patient than for the physician."

In an accompanying editorial, Dr. Andrew B. Bindman of the University of California at San Francisco echoed Dr. Atlas' point about the medical education system.

"Although there are demonstrable benefits associated with patients having a personal physician, this goal has been undermined in recent years by the shrinking number of physicians entering into practice in one of the primary care specialties of family medicine, general internal medicine, or pediatrics," Dr. Bindman told Reuters Health.

"Several steps are needed to reverse this trend, beginning with a reform of the payment formulas in Medicare and other health insurance plans that reward specialists and the performance of procedures to a disproportionate degree over the diagnostic, education, and coordination functions of primary care physicians in their roles as communicators with patients."

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.