Abstract
Background: Continuity of care with a regular physician has been associated with treatment adherence but it is unclear if continuity of care may lead to inappropriate treatments. We assessed the relationship between the receipt of prostate-specific antigen (PSA) screening, a non-recommended test, and having continuity with a single personal doctor.Methods: We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). Responses from men aged 40 and older with no symptoms or family history of prostate cancer were analyzed (unweighted n = 232,548, representing 36,919,766 individuals). Continuity with one doctor was analyzed in relation to discussions of advantages and disadvantages of PSA tests, provider recommendation to receive a test and receipt of a PSA test.Results: 39.5% of men received PSA screening during the time that the test was not recommended. Having a single personal doctor was associated with discussion of both advantages (53.3 vs. 29.7%, p < 0.001) and disadvantages (24.2 vs. 13.5%, p < 0.001) of PSA tests but also a recommendation to receive a PSA test (45.3 vs. 29.3%, p < 0.001). The adjusted odds of receiving a PSA test was higher among those with a single personal doctor compared to those without (OR 2.31; 95% CI, 2.17–2.46).Conclusion: In a nationally representative sample during the time when PSA screening was not recommended by the US Preventive Services Taskforce, having a single personal doctor was associated with both recommendations for the test and receipt of the test. These findings emphasize the importance of the patient physician relationship and the need for evidence-based care.
Highlights
Interpersonal continuity of care is the ongoing relationship between a patient and an individual physician
The continuity between a patient and a physician is assumed to increase trust in the physician. This trust in the physician should yield greater treatment adherence to treatments suggested by the physician
This study demonstrated that patients who received a nonrecommended, low value preventive service (PSA testing) was strongly linked to patients having one person they think of as their personal doctor or health care provider
Summary
Interpersonal continuity of care is the ongoing relationship between a patient and an individual physician. This patient physician dyad and the concomitant patient-physician relationship is a hallmark of primary care. The continuity between a patient and a physician is assumed to increase trust in the physician. This trust in the physician should yield greater treatment adherence to treatments suggested by the physician. There is even some evidence that continuity with a regular physician is associated with receipt of preventive services [8, 9]. We assessed the relationship between the receipt of prostate-specific antigen (PSA) screening, a non-recommended test, and having continuity with a single personal doctor
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