AIM: Heart patient care enhanced by close relationship with PCP

Healthcare in the United States is often fragmented and uncoordinated and it is common for patients to receive episodic care from different physicians. A study in the March 3 issue of the Annals of Internal Medicine finds that patients who are connected to a primary care physician are more likely to receive guideline-consistent care than those who are connected to a practice but not a physician.

Researchers examined 155,590 adults in a primary care network to determine which patients received most of their care from a specific physician, practice or neither.

They found that patients who were not connected to a particular physician were less likely to receive recommended care. In addition, these patients were less likely to complete recommended testing for preventive and chronic illness care. Performance measures included breast, cervical and colorectal cancer screening; hemoglobin A1c measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease.

"This study provides strong evidence for the value of having a regular doctor," said the study's lead author Steven Atlas, MD, director of primary care quality improvement at Massachusetts General Hospital in Boston.

Investigators also found that patients who were connected to a physician were more likely to have health insurance, speak English and be non-Hispanic white. However, connectedness was associated with larger disparities in screening rates than was race or ethnicity.

"The process of establishing a strong relationship with a specific physician may represent an important key to understanding disparities in care," Atlas said. "Greater insight into the role of patient- provider- or practice-level barriers to establishing a closely connected primary care relationship may lead to improved quality of care for vulnerable patients."

But according to researchers, continuity of care is a shared responsibility between physicians and patients. Even if physicians or practices treated all patients similarly, patients vary in their ability and willingness to adhere to recommendations.

Atlas noted that this study has healthcare policy implications.

"Pay-for-performance [P4P] initiatives hinge on the ability to accurately assign performance measures to those practitioners who have some control over the outcome. Our study results suggest that physicians with a relatively low percentage of connected patients are likely to receive lower scores on performance measures when compared to physicians with a higher proportion of connected patients," said Atlas.