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Does improved continuity of primary care affect clinician-patient communication in VA?
Journal article   Open access   Peer reviewed

Does improved continuity of primary care affect clinician-patient communication in VA?

David A Katz, Kim McCoy and Mary Vaughan Sarrazin
Journal of general internal medicine : JGIM, Vol.29 Suppl 2(S2), pp.S682-688
07/2014
DOI: 10.1007/s11606-013-2633-8
PMCID: PMC4070228
PMID: 24072718
url
https://doi.org/10.1007/s11606-013-2633-8View
Published (Version of record) Open Access

Abstract

Recent changes in health care delivery may reduce continuity with the patient's primary care provider (PCP). Little is known about the association between continuity and quality of communication during ongoing efforts to redesign primary care in the Veterans Administration (VA). To evaluate the association between longitudinal continuity of care (COC) with the same PCP and ratings of patient-provider communication during the Patient Aligned Care Team (PACT) initiative. Cross-sectional survey. Four thousand three hundred ninety-three VA outpatients who were assigned to a PCP, had at least three primary care visits to physicians or physician extenders during Fiscal Years 2009 and 2010 (combined), and who completed the Survey of Healthcare Experiences of Patients (SHEP) following a primary care visit in Fiscal Year (FY)2011. Usual Provider of Continuity (UPC), Modified Modified Continuity Index (MMCI), and duration of PCP care were calculated for each primary care patient. UPC and MMCI values were categorized as follows: 1.0 (perfect), 0.75-0.99 (high), 0.50-0.74 (intermediate), and < 0.50 (low). Quality of communication was measured using the four-item Consumer Assessment of Healthcare Providers and Systems-Health Plan program (CAHPS-HP) communication subscale and a two-item measure of shared decision-making (SDM). Excellent care was defined using an "all-or-none" scoring strategy (i.e., when all items within a scale were rated "always"). UPC and MMCI continuity remained high (0.81) during the early phase of PACT implementation. In multivariable models, low MMCI continuity was associated with decreased odds of excellent communication (OR = 0.74, 95 % CI = 0.58-0.95) and SDM (OR = 0.70, 95 % CI = 0.49, 0.99). Abbreviated duration of PCP care (< 1 year) was also associated with decreased odds of excellent communication (OR = 0.35, 95 % CI = 0.18, 0.71). Reduced PCP continuity may significantly decrease the quality of patient-provider communication in VA primary care. By improving longitudinal continuity with the assigned PCP, while redesigning team-based roles, the PACT initiative has the potential to improve patient-provider communication.
 United States Primary Health Care - methods United States Department of Veterans Affairs - standards Cross-Sectional Studies Humans Middle Aged Male Physician-Patient Relations Primary Health Care - standards Aged, 80 and over Female Aged Retrospective Studies Continuity of Patient Care - standards Longitudinal Studies Cohort Studies

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