Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health

R. Henry Olaisen, MPH, PhD; Mark D. Schluchter, PhD; Susan A. Flocke, MA, PhD; Kathleen A. Smyth, PhD; Siran M. Koroukian, MHA, PhD; Kurt C. Stange, MD, PhD

Disclosures

Ann Fam Med. 2020;18(5):422-429. 

In This Article

Abstract and Introduction

Abstract

Purpose: Access to a usual source of care is associated with improved health outcomes, but research on how the physician-patient relationship affects a patient's health, particularly long-term, is limited. The aim of this study was to investigate the longitudinal effect of changes in the physician-patient relationship on functional health.

Methods: We conducted a prospective cohort study using the Medical Expenditure Panel Survey (MEPS, 2015–2016). The outcome was 1-year change in functional health (12-Item Short-Form Survey). The predictors were quality of physician-patient relationship, and changes in this relationship, operationalized with the MEPS Primary Care (MEPS-PC) Relationship subscale, a composite measure with preliminary evidence of reliability and validity. Confounders included age, sex, race/ethnicity, educational attainment, insurance status, US region, and multimorbidity. We conducted analyses with survey-weighted, covariate-adjusted, predicted marginal means, used to calculate Cohen effect estimates. We tested differences in trajectories with multiple pairwise comparisons with Tukey contrasts.

Results: Improved physician-patient relationships were associated with improved functional health, whereas worsened physician-patient relationships were associated with worsened functional health, with 1-year effect estimates ranging from 0.05 (95% CI, 0–0.10) to 0.08 (95% CI, 0.02–0.13) compared with −0.16 (95% CI, −0.35 to −0.03) to −0.33 (95% CI, −0.47 to −0.02), respectively.

Conclusion: The quality of the physician-patient relationship is positively associated with functional health. These findings could inform health care strategies and health policy aimed at improving patient-centered health outcomes.

Introduction

Ecologic studies have shown that primary care is associated with better health, improved health care quality, improved access, and lower cost—virtually the definition of value.[1–4] Having a usual source of care, defined as access to a regular facility or primary care provider when one is sick or needs medical advice, has been associated with improved health outcomes.[5,6] Whereas consistent access to a provider is important, the quality of each clinical encounter is equally important in shaping a patient's experience and overall health outcomes. Specifically, the quality of the physician-patient relationship warrants closer research. The physician-patient relationship is a valued primary care process on which other primary care processes depend.[7–10] A strong physician-patient relationship involves good interpersonal communication, the development of a shared understanding that allows for reliance and trust, and ease of obtaining care, facilitated by the physician serving as a patient advocate.[11,12]

Despite these promising findings, we currently do not fully understand the underlying processes by which primary care exerts its beneficial effects.[13,14] Moreover, whereas the quality of the physician-patient relationship is a known mechanism for improving patient outcomes,[15–17] studies have not yet clarified how changes in this fundamental relationship over time affect functional health outcomes.

Primary care research poses challenges, in part due to a shortage of robust measurements capturing unique primary care processes thought to benefit patients.[13,15] Efforts to elucidate the protective effect of primary care found that ecologic studies using individual-level data showed mixed results. Robust pragmatic trials aimed at improving functional health outcomes among patients with multimorbidity—a high-risk, high-cost, high-priority primary care population—also showed mixed results.[16] Well-designed cohort studies have the potential to provide empirical evidence at a fraction of the cost of randomized trials by tapping readily available, nationally representative data to guide decision making. Whereas reliable physician-patient relationship instruments exist,[18–21] until recently no such measure had been specified using the nationally representative Medical Expenditure Panel Survey (MEPS), which provides a rich array of process and outcome data for health services research.[22]

We recently identified, specified, and validated the primary care composite measure (MEPS-PC)—comprising 3 subscales, each capturing distinct primary care processes—using items from MEPS.[23,24] The availability of this measure has made possible the present study and might also inform future research in this critical area of health care inquiry. The aim of this observational study was to investigate the longitudinal effect of changes in the physician-patient relationship on functional health.

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