Continuity can be measured in a number of ways. When measured as the length of the patient-physician relationship, we find continuity varies with patient demographics and with elements of satisfaction. Over half of adults of this study's 150 rural communities report seeing the same physician for more than five years. Those who saw the same physician for less than five years tended to be nonwhite, without health insurance, less educated, more often report income of less than $25,000 and more often report fair to poor health status. This group was also less likely to be satisfied with their overall health care and its quality and with components of the doctor-patient relationship.
Patients and their physicians value continuity [28–31]; in this study of rural participants, satisfaction appears associated with length of the continuity relationship, as similarly noted in other studies [11, 18, 32]. The elements of greater satisfaction found in persons with longer relationships with their physicians lend credence to the importance of the continuity relationship to patient outcomes. However, in this study, there appears to be a threshold effect at one or two years of continuity beyond which satisfaction does not rise significantly further.
Even a relationship length of two years is becoming difficult to maintain in the current U.S. healthcare system, especially in urban areas, with the pressures of competitive managed care plans which encourage patients and their employers to change health plans, and the growth of urgent care centers . In the 1996–97 Community Tracking Study household survey, 17% of privately insured persons changed their health plan during the year prior to the survey . Of those changing health plans, a little over half cited changes in their insurance as the reason for also changing their source of care. Increases in insurance premiums could contribute to further health provider switching.
Satisfaction, as an indicator of quality of care , has been found to affect other outcomes, including patient adherence to their physicians' recommendations . Mothers are more likely to follow a physician's treatment recommendations for their child if she feels the physician is friendly and understands the complaint . Patients with hypertension are more likely to adhere to treatment and have their blood pressure under control when the physician considers the patient an active participant in treatment .
Previous studies note the importance of having a usual source of care versus no source to the timely receipt of preventive services for younger adults [38, 39]. However no differences in preventive care services were observed for older Americans in long-term relationships . In our study preventive services outcomes did not differ significantly by length of continuity as well. For preventive services, it appears that having a usual source of care is important but no additional benefit comes with having a longer-term relationship with that source of care.
Respondents with one year or less continuity, interestingly, were more likely to report receiving nutrition counseling than those in the five-year or more continuity category. Possibly more patients are asking about nutrition issues in the first year or are specifically changing doctors to discuss nutrition. Another possibility is that the developing familiarity with the patient in a long term relationship may be associated with less vigilance by the physician or less counseling in areas in which the patient may have initially shown resistance .