Abstract
Objective
The closure of a primary care practice and the relocation of the physicians and staff to a new office forced patients to decide whether to follow their primary care physicians (PCP) or to transfer their care elsewhere. This study explores the perspectives of the older patients affected by this change.
Design
Qualitative study.
Setting and Participants
Two lists of patients older than 60 years from the original office were generated: (1) those who had followed their PCPs to the further practice and (2) those who chose new PCPs at an affiliated nearby clinic. One hundred forty patients from each of the two lists were randomly selected for study.
Measurement
Eight months after the clinic’s closure, patients responded to an open-ended question asking patients to describe the transition. Using content analysis, two investigators independently coded all of the written responses.
Results
Over 85% of patients in both groups had been with their original PCP for longer than 2 years. Patients that elected to transition their care to a new PCP within their community were older (75 vs 70 years) and more likely to be living alone (38% vs 18%), both p < 0.01. There was still considerable frustration associated with the clinic’s closure. Patients from both groups had variable levels of satisfaction with their new primary care arrangements. Patients who moved to the near clinic, now seeing a new physician, commented on being satisfied with the proximity of the site. On the other hand, these patients also expressed longing for the previous arrangement (the building, the staff, and especially their prior physician). Patients who transferred their care to the further clinic indicated a profound loyalty to their PCP and an appreciation of the added features at the new site. Yet, many patients still described being upset with the difficulties associated with the further distance.
Conclusion
The closing of this practice was difficult for this cohort of older patients. Patients’ decisions were considerably influenced by whether they imagined that convenience or their established relationship with their PCP was of a higher priority to them.
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References
Institute of Medicine. Primary Care: America’s Health in a New Era. Primary Care: America’s Health in a New Era. Washington DC: National Academy Press; 1996.
Safran DG. Defining the future of primary care: what can we learn from patients? Arch Intern Med. 2003;138:248–255.
Parchman M, Burge S. The patient-physician relationship, primary care attributes and preventive care services. Fam Med. 2004;36122–27.
Shi L, Forrest C, von Schrader S, Ng J. Vulnerability and the patient-practitioner relationship: the roles of gatekeeping and primary care performance. Am J Pub Health. 2003;93:138–144.
Fiscella K, Meldrum S. Franks P, et al. Patient Trust: Is it related to patient-centered behavior of primary care physicians? Medical Care. 2004;42111049–1055.
Starfield B. Primary Care: Balancing Health Needs, Services and Technology. New York, NY: Oxford University Press; 1998:143.
Periera A, Kleinman K, Pearson S. Leaving the practice: effects of primary care physician departure on patient care. Arch Intern Med. 2003;163:2733–2736.
Buchbinder SB, Wilson M, Melick CF, Powe NR. Primary care physician job satisfaction and turnover. Am J Manag Care. 2001;7:701–713.
Pham H, Ginsburg P. Unhealthy trends: the future of physician services. Health Affairs. 2007;2661586–1598.
Hurley R, Pham H, Claxton G. A Widening Rift in Access And Quality: Growing Evidence of Economic Disparities. Health Affairs Web Exclusive, 6 December 2005. Accessed at http://www.healthaffairs.org/WebExclusives.php on 6/24/2008.
Heeb J, Gmel G, et al. Changes in alcohol consumption following a reduction in the price of spirits: a natural experiment in Switzerland. Addicition. 2003;98:1433–1446.
Costello E, Comptom S, Keeler G, Angold A. Relationship between poverty and psychopathology: a natural experiment. JAMA. 2003;290152023–2029.
Crabtree BF, Miller WL. Doing qualitative research, 2nd ed. London: Sage; 1999.
Flocke SA. Measuringe Attributes of Primary Care: Development of a new instrument. J Fam Pract. 1997;45164–74.
American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home. March 2007. Accessed at http://www.medicalhomeinfo.org/Joint%20Statement.pdf on 6/24/2008.
Casalino LP, Kelly DJ, et al. Benefits and barriers to large medical group practice in the United States. Arch Int Med. 2003;163:1958–1964.
Safran DG, Montgonery J, Chang H, et al. Switching doctors: predictors of voluntary disenrollment for a primary physician’s practice. J Fam Pract. 2001;502130–136.
Donahue K, Ashkin E, Pathman D. Length of patient-physician relationship and patients’ satisfaction and preventive service use in the rural south: a cross-sectional telephone study. BMC Fam Pract. 2005;6(40).
Mold J, Fryer G, Roberts A. When do older patients change primary care physicians? JABFP. 2004;176453–460.
Ubel PA, Loewenstein G, Schwarz N, Smith D. Misimagining the unimaginable: the disability paradox and health care decision making. Health Psychol. 2005;244 SupplS57–S62.
Pereira A, Pearson S. Patient attitudes towards continuity of care. Arch Intern. 2003;1638909–912.
Nutting P, Goodwin M, Flocke S, Zyzanski S, Stange K. Continuity of primary care: to whom does it matter and when? Ann Fam Med. 2003;1:149–155.
Acknowledgments
Dr. Wright is an Arnold P. Gold Foundation Associate Professor of Medicine, and he is a Miller-Coulson Family Scholar. The authors are also grateful for the support from The Osler Center for Clinical Excellence within Johns Hopkins University School of Medicine.
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Nidiry, M.A.J., Gozu, A., Carrese, J.A. et al. The Closure of a Medical Practice Forces Older Patients to Make Difficult Decisions: A Qualitative Study of a Natural Experiment. J GEN INTERN MED 23, 1576–1580 (2008). https://doi.org/10.1007/s11606-008-0718-6
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DOI: https://doi.org/10.1007/s11606-008-0718-6