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Anne G. Pereira, MD, MPH; Steven D. Pearson, MD, MSc

Arch Intern Med. 2003;163:909-912.

Background  Concern has been raised about managed care's effects on continuity of patient care, but little is known about how much value patients place on continuity.

Methods  We surveyed 2500 adult patients of a large New England health maintenance organization about their attitudes toward continuity and their willingness to spend additional time or money to maintain continuity with their primary care physician (PCP).

Results  Among the 1171 (46.8%) of patients responding, 460 (39.6%) of 1162 patients had had more than one PCP in the previous 5 years. Nearly all patients (1068 [91.5%] of 1167) rated continuity as very important or important; only 26 (2.2%) rated continuity as unimportant or very unimportant. However, only 256 (22.2%) of 1152 patients were willing to drive more than 60 minutes to maintain continuity with their PCP, and only 200 (18.2%) of 1096 would be willing to spend an additional $20 to $40 per month to maintain it. In multivariable analyses, patients were more willing to drive if they were nonwhite (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.4-3.6), older than 50 years (OR, 1.7; 95% CI, 1.2-2.4), or had less than a college education (OR, 1.6; 95% CI, 1.2-2.2). Patients who had been forced to change PCPs when their physician moved away were less willing to drive (OR, 0.5; 95% CI, 0.3-0.8) or spend more money (OR, 0.7; 95% CI, 0.5-1.0) to maintain continuity.

Conclusions  Most patients in this sample indicated that continuity of care was important to them, but reported being unwilling to spend much additional personal time or money to maintain continuity with their current PCP. Nevertheless, an important subset of older and more vulnerable patients reported being more willing to pay to maintain continuity.

From the Center for Ethics in Managed Care (Dr Pearson) and the Department of Ambulatory Care and Prevention (Drs Pereira and Pearson), Harvard Medical School and Harvard Pilgrim Health Care (Drs Pereira and Pearson), Boston, Mass. The authors have no relevant financial interest in this article.

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