Relationships between factors affecting physician patient relationship and quality of care in primary care

Background Primary care plays an important role in the delivery of quality health care. As the structure of healthcare organizations changes, this leads to development of significant factors affecting the primary care physicians' ability to provide quality primary care services. Objective This study investigated the relationships among factors for providing quality primary care, including physician-patient interaction, patient context, information technology use, and financial incentives. Methods This study utilized secondary data collected through the Community Tracking Study (CTS) Physician Survey. The primary care physician sample for this study came from the 2004-2005 CTS Physician Survey; 1,871 primary care physicians were selected. The ability to provide quality care, physician-patient interaction (measured by having a long-term relationship with patients, freedom to make clinical decisions in the patients' best interests, and spending enough time with patients), patient context (condition severity, proportion of patients with chronic conditions, and communication difficulty due to language difference), physicians' use of health information technology (six activities related to medical care), and physicians' personal financial incentives (increasing or reducing medical services) were included in the research model . Relationships among these variables to improve quality of care in primary care settings were investigated using path analysis. Results The path model shows a decent fit with the data (χ2= 16.3, p=0.038, GFI=0.999, AGFI=0.983, CFI=0.998, RMR=0.003, RMSEA=0.024). Results showed statistically significant and positive relationships between physician-patient interaction and the ability to provide quality care. Primary care physicians believe it is difficult to provide quality care if they have too many chronic patients, or patients with severe conditions. The impacts of information technology use were not uniform. Physicians knew which activities with information technology (writing prescription and obtaining drug interaction) can help them to improve quality of care and physician-patient interactions. Finally, financial incentives that encourage physicians to reduce medical services were negatively associated with physician-patient interaction. Discussion/Conclusion Results from this study highlight physician-patient interaction as a critical factor in providing high quality care by primary care physicians. Although managers and administrators often focus on business viability and performance, it is important to recognize that physicians may prevent achieving these objectives if they perceive implementation of information technology, altered financial incentives, and other changes in the practice environment as barriers to providing quality patient care.