Abstract
BackgroundContinuity of care by the same personal physician is a key factor in an effective and efficient health care system. Studies that support the association between high adherence and better outcomes were done in settings where allocation to the same physician was a long-term policy.ObjectivesTo evaluate the influence that changing organizational policy from the free choice of a primary care physician to a mandatory continuity of care by the same physician has on adherence to a personal physician.MethodsA cross-sectional study based on electronic databases; comparison of adherence and demographic characteristics (sex, age, and socio-economic status) of 208,286 Leumit enrollees who met the inclusion criteria, according to change in the adherence to a personal physician. To evaluate adherence, we used the Usual Provider of Care (UPC) index, which measures the number of visits made to the personal doctor out of the total primary care physician visits over the same period. The patients were divided into groups according to their UPC level.ResultsThe data shows that 54.5% of the patients were high adherers even before the organizational change; these rates are similar to those published by various organizations worldwide, years after mandating continuity of care by the same physician.In the year following the intervention, only 34.5% of the patients changed the level of their adherence group. Of these, 64% made a shift to a higher adherence group.Before the intervention, the high adherers were older (mean age 57.8 vs. 49.3 years in the low adherers group) and from a higher SES (mean SES status 9.32 vs. 8.71). After the intervention, a higher proportion of older patients and patients from a higher SES changed their adherence to a higher group.Sex distribution was similar over all the adherence level groups and did not change after the intervention.Conclusions and policy implicationsA policy change that encouraged adherence to an allocated primary care physician managed to improve adherence only in specific groups.Health organizations need to examine the potential for change and the groups they want to influence and direct their investment wisely.Trial registrationretrospectively registered.
Highlights
Continuity of care by the same personal physician is a key factor in an effective and efficient health care system
The results show that 54.5% (CI 95%, 54.9–55.1) of the patients were high adherers before the organizational change
In the year following the intervention, all groups showed significantly increased adherence to their personal physician, while the number of high adherers increased by 9.5% (p < 0.001)
Summary
Continuity of care by the same personal physician is a key factor in an effective and efficient health care system. Studies that support the association between high adherence and better outcomes were done in settings where allocation to the same physician was a long-term policy. Among the outcomes that are influenced are better adherence to diagnostic tests and treatments offered as preventive medicine [11], decreased hospitalizations [11,12,13,14], reduced over-use of healthcare resources [ 15–18], better-controlled chronic diseases (including psychiatric conditions) [ 19–24], reduced mortality [9, 16, 25] and improved communication and trust between the physician and the patient [5,6,7]. Other studies support the findings that continuity of care contributes to increased patient satisfaction [ 21, 26–29], and physician satisfaction [ 30]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
