Patient centered practice climate, information technology functionality, and primary care physicians' confidence in providing high quality primary care

Background: Primary care is a driving force in accomplishing the goals of Affordable Care Act, higher quality care while controlling cost. Several studies show that patient centeredness in primary care is associated with higher quality, care outcomes, and lower costs. Information technology (IT) is a critical component of primary care delivery. It is important to evaluate how IT functionality affects physicians' confidence in providing quality health care together with the patient-centered practice climate in an analytic scheme. Change spurred by focusing on patient centeredness and IT use will more significantly affect salaried primary care physicians who need to accommodate system changes in their practice of medicine. Objectives: to evaluate associations of patient-centered perceived practice climate and IT functionality with salaried primary care physicians' confidence in providing high quality care.

Data: 1,733 salaried primary care physicians, specialized in internal medicine, pediatrics, and family medicine, were selected from Community Tracking Study 2004-2005 Physician Survey for this analysis. A multiple logistic regression was conducted. A survey item was used for the confidence in providing quality care and recoded into a binary variable (highly confident and all others) to serves as a dependent variable. Patient-centered practice climate is defined with four survey items. Three types of IT functionality were defined; clinical information access (five items), e-prescription (two items), and communication (three items). For above variables, composite scores were generated and included in the analysis. Control variables include physician and practice characteristics, financial incentives, quality restrictions imposed by practices.

Findings: Patient-centered practice climate was positively associated with higher confidence in providing quality primary care among salaried primary care physicians (OR=3.92, 95% CI=3.22-4.78). Higher IT functionality for clinical information access is positively associated with higher confidence (OR=1.21, 95% CI=1.07-1.37). However, e-prescription functionality was negatively associated (OR=0.78, 95% CI=0.63-0.95). No significance was found for communication IT functionality.

Conclusion: Results support that patient-centered practice climate makes salaried primary care physicians more confident in their ability to provide higher quality care. Salaried physicians seem to use IT for a functionality that helps their practice of medicine such as accessing treatment information. However, the negative association of the e-prescription IT functionality may indicate that either a technical barrier or lack of successful workflow changes. Not significant association of IT functionality for communication with hospitals, other physicians, and patients in their confidence in providing quality care may indicate that they don't use IT for coordinated care around patients.