Ongoing relationship with care provider key for patients with a chronic condition

Appearing in the current issue of Medical Care, the study is the first in Canada to investigate the links between having a regular primary healthcare provider and patient activation, a growing direction in healthcare that aims to increase people's skills, confidence and knowledge so they can better manage their own health.

Primary care refers to the first level of contact with healthcare for individuals. These include clinical services from doctors, nurses or nurse practitioners as well as health promotion activities.

"The idea is that we need to do the best we can with our current healthcare dollars to provide sustained quality care for individuals who in some cases are living with one or more chronic conditions," says Assoc. Prof. Sabrina Wong, lead author and a researcher in the School of Nursing and Centre for Health Services and Policy Research.

"What we're seeing across North America is a policy direction that links patient-reported outcome measures such as patient activation to the quality of services and care provided by primary healthcare, especially in chronic disease management," says Wong.

Previous U.S.-based studies have shown that having a strong primary healthcare system in place pays dividends for patients, and ultimately the taxpayer. For example, individuals with one or more chronic conditions experience reduced risk, and reduced duration and effects, of acute and episodic conditions. As well, they report reduced risk and effects of continuing health conditions,

For their study, Wong and the research team looked at relationships between patient activation and multiple dimensions of primary healthcare in B.C. including access, utilization, responsiveness, interpersonal communication and satisfaction for patients, both with and without a chronic condition.

Taking part in the study were 504 B.C. residents with an average age of 46. Fourteen per cent of participants reported their health as being fair or poor, and 44 per cent reported having at least one chronic condition such as arthritis, high blood pressure or diabetes.

"The results suggest there is a strong relationship between patients' ability to self-manage their health and having a positive relationship with at least one PHC provider," says Wong.

With the typical primary care visit lasting between 10 and 12 minutes, one aspect of care especially important to those with a chronic condition was having enough time to talk with their family physician or nurse practitioner.

Other aspects of care such as communication, patient-centered decision-making and being treated as a whole person also appear especially important for those with a chronic condition.

Findings also show that for patients with a chronic condition, high quality PHC was more about a strong connection with the place of care than whether it was delivered through group practice, solo practice or a walk-in clinic.

What was most important, however, for physically healthy adults -- who may visit doctors or clinics less frequently -- was the quality of the interpersonal interaction.