Continuity of Care and Other Determinants of Patient Satisfaction with Primary Care

Authors

  • Vincent S. Fan MD, MPH,

    1. Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Medicine, University of Washington, Seattle, WA, USA.
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  • Marcia Burman MD, MPH,

    1. Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Medicine, University of Washington, Seattle, WA, USA.
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  • Mary B. McDonell MS,

    1. Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA
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  • Stephan D. Fihn MD, MPH

    1. Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA
    2. Department of Medicine, University of Washington, Seattle, WA, USA.
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  • There are no conflicts of interest to disclose, and there are no financial or personal relationships among the authors that would affect the results of this study..

Address correspondence and requests for reprints to Dr. Fan: Health Services Research and Development (152), 1660 S. Columbian Way, Seattle, WA 98108-1597 (e-mail: vfan@u.washington.edu).

Abstract

Objective: The patient-clinician relationship is a central feature of primary care, and recent developments in the delivery of health care have tended to limit continuity of care. The objective of this study was to evaluate the extent to which continuity of care and other factors are related to patient satisfaction.

Design: Cross-sectional, mailed questionnaire study.

Setting: Primary care clinics at 7 Veterans Affairs medical centers.

Patients/Participants: Patients (N=21,689) participating in the Ambulatory Care Quality Improvement Project who returned the baseline Seattle Outpatient Satisfaction Questionnaire (SOSQ).

Measurements and Main Results: We evaluated the association between self-reported continuity and satisfaction, after adjusting for characteristics of patients, clinics, and providers. The humanistic scale of the SOSQ measures patient satisfaction with communication skills and humanistic qualities of providers, whereas the organizational scale measures satisfaction with delivery of health care services. The mean adjusted humanistic score for patients who reported always seeing the same provider was 17.3 (95% confidence interval [CI], 15.5 to 19.1) points higher than for those who rarely saw the same provider. Similarly, the mean adjusted organizational score was 16.3 (95% CI, 14.5 to 18.1) points higher for patients who always saw the same provider compared to rarely. Demographic factors, socioeconomic status, health status, clinic site, and patient utilization of services were all associated with both the adjusted humanistic and organizational scores of the SOSQ.

Conclusions: Self-reported continuity of care is strongly associated with higher patient satisfaction. This suggests that improving continuity of care may improve patient satisfaction with providers as well as with their health care organization.

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