Objectives:To use a natural experiment to identify patient factors associated with the decision to follow one's primary care provider (PCP) to a more distant location after the closure of a medical practice. Study Design: Case-control study. Methods: Eight months after the closure of a practice in Dundalk, Maryland, we randomly selected 140 patients older than 60 years from each of the following groups: those who followed their PCP (continuity group) and those who transferred to a closer clinic (proximity group). We designed a survey instrument to collect information about demographics, duration of the patient-PCP elationship, transportation, self-assessed driving proficiency, and patients' estimates of the distance in miles and the driving time in minutes from their homes to both practices. x 2Tests and logistic regression analyses were used to determine differences between the groups. Results:The response rate to the survey was 64%. More than 85% of patients in both groups had been with their original PCP for longer than 2 years. In multivariate analysis, the following 3 factors were associated with being a patient in the proximity group: living alone (adjusted odds ratio [OR], 3.14; 95% confidence interval [CI], 1.35-7.26), having greater physical disability (physical component summary score ≤40; OR, 2.14; 95% CI, 1.04-4.39), and perceiving that travel time from home to the farther clinic would require at least 10 minutes longer than the MapQuest estimate (OR, 4.08; 95% CI, 1.97-8.43). Conclusion: Older patients who live alone and are weaker seem to be more likely to forgo continuity with their PCP for the sake of convenience when a barrier to access occurs such as relocation of the physician to a more distant office.
|Original language||English (US)|
|Number of pages||6|
|Journal||American Journal of Managed Care|
|State||Published - Mar 1 2009|
ASJC Scopus subject areas
- Health Policy