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APHA Scientific Session and Event Listing

Recorded presentation

Karen Swanson, PhD, ScM, Office of Planning, Data Quality and Analysis, Los Angeles County Department of Health Services, 313 N. Figueroa St., Ste. 704, Los Angeles, CA 90012, 213/240-8267, kswanson@ladhs.org, Roshan Bastani, PhD, Department of Health Services, University of California, Los Angeles, School of Public Health, Box 951722, Los Angeles, CA 90095, and Lisa V. Rubenstein, MD, MSPH, VA Greater Los Angeles, UCLA , & RAND, P.O. Box 2138, Santa Monica, CA 90407.

Background: Little is known about whether patient satisfaction is associated with provider switching, nor whether provider switching predicts subsequent patient satisfaction. Even less is known about provider switching for patients with major depression or the effects of patient gender on switching.

Conceptual Model: The model posits that organizational characteristics combined with patient characteristics, such as predisposing, enabling and need variables, influence processes and outcomes of care. More specifically, this model posits that baseline satisfaction will be associated with provider switching at month six and this will be moderated by gender. It further posits that provider switching will be associated with a change in satisfaction between baseline and six month.

Methods: The data for this research are from the Quality Improvement for Depression study, a large national 4-study collaborative of 1,481 patients diagnosed with current major depression in managed care settings. Each of these projects sought to maximize scientific discovery about care for depression in primary care settings by evaluating quality improvement interventions for depression based on the AHRQ practice guidelines. The intervention for all four QID studies changed the structure of care by implementing some or all of the following components of a collaborative care model: a focus on patient self-management, case management, provider education, and mental health-primary care collaboration. One-hundred and eight managed care and mixed-model clinics were randomly assigned to receive the intervention versus care-as-usual for depression. The patient longitudinal cohort aspect of the QID collected information on patient health processes and outcomes every six months for a period of two years (1996-1998). The sample was 1,317 patients who answered both the baseline and month six questionnaires. The analyses were performed using multiple logistic regression and multiple linear regression.

Results: Baseline satisfaction had a protective effect on provider switching (OR= 0.43; p<0.05). Gender was not a moderator of this relationship. Provider switching had a significant negative effect on change in satisfaction (ß= -0.17; p<0.05). Patients satisfied with care had a lower odds of switching providers between baseline and six months, and switching providers predicted a lower likelihood of satisfaction at follow up.

Conclusion: Contrary to expectations, gender made no difference in the effect of provider switching on patient satisfaction. Furthermore, the negative effect of provider switching on patient satisfaction was contrary to our hypothesis. More information on reasons why patients switch providers is needed, such as whether they do it voluntarily or involuntarily.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Describe the association of patient satisfaction with provider switching for patients with depression.
• Articulate whether gender moderates the patient satisfaction and provider switching relationship.
• Describe whether provider switching is associated with subsequent patient satisfaction.

Keywords: Mental Health Care, Patient Satisfaction

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation