Respondents were predominantly in their early to mid sixties (). Most were married with at least a high school education and held private insurance. The majority had longstanding relationships with their usual place and provider of over five years. Hypertension, joint pain and arthritis were common conditions. Diabetes, cancer, coronary artery disease and stroke were less common conditions present in the sample. Over half of the respondents were taking at least one prescription medication regularly. Less than 20%, however, had other chronic conditions that interfered quite a bit or greatly with their daily lives. The majority of respondents were deliberators and therefore preferred discussion of treatment options with their physician.
Descriptive characteristics (N=6,827)
Variation existed in the extent to which patients felt unsafe were they to experience discontinuity. shows the percentage distribution of this variation; 67% of the sample agreed or strongly agreed that they would feel safe visiting someone other than their own doctor (N=4,555), 21% were neutral (N=1,404) and 12% disagreed or strongly disagreed with this statement (N=868).
Distribution of perceptions of safety if interpersonal continuity were to be disrupted
indicates characteristics of individuals who felt unsafe (N=868) as opposed to safe (N=4,555) about visiting another doctor or clinic. Patients who feel unsafe were more likely to be female (Odds Ratio=1.65; 95% Confidence Interval: 1.35−2.01). Age, education, marital status and insurance type were not significantly associated with feeling unsafe.
Adjusted odds ratios and 95% confidence intervals (CI) for the relationship between patient characteristics and feeling unsafe about interpersonal continuity disruption (N=5,741)
The length of relationship with a provider but not a place was significantly associated with feeling unsafe versus safe with a break in interpersonal continuity. As compared to those who had been with their provider 0−4 years, those who had been with their provider for 5−9 years had 53% increased odds of feeling unsafe (95% CI: 1.11−2.10), those who had been with their provider10−14 years had 41% increased odds of feeling unsafe (95% CI: 1.02−1.95) and those who had been with their provider 15 or more years had 62% increased odds of feeling unsafe (95% CI: 1.20−2.17).
While having an increasing number of chronic conditions that interfered with life was significantly associated with feeling unsafe with a break in interpersonal continuity (OR=1.27; 95% CI: 1.08−1.50), only one specific chronic condition, coronary artery disease, was significantly associated with feeling unsafe (OR=1.49, 95% CI 1.18−1.88). As a sensitivity analysis, we repeated analyses with a variable that indicated the presence of any chronic condition. This variable was not significantly associated with feeling unsafe. Taking more medications, decision making preference type and personality type also were not significantly associated with safety.
Individuals who felt safe or unsafe about seeing someone other than their own physician varied in trusting their physician's deliberation. Of those who felt safe about seeing someone else, 49% perceived high trust, 22% were neutral and 29% had low trust (data not shown). Conversely, of those who felt unsafe about seeing someone else, 55% perceived high trust, 15% were neutral and 30% perceived low trust. There was a borderline statistically significant interaction between decision making preference and trust (p < 0.06), suggesting that the effect of decision making preference on feeling unsafe about a break in continuity might differ for patients who had weak versus high trust in their physician. As indicated in , among those with high trust in their physician, deliberative autonomists (the most active preference type) were more likely to feel unsafe if there were to experience discontinuity when compared to non-deliberative delegators (the least active preference type) (OR 1.63; 95% CI 1.10−2.41). A similar result was shown for deliberative delegators (OR 1.50; 95% CI 0.97−2.32) although this result was only borderline statistically significant.
Adjusted odds ratios (OR) and 95% confidence intervals (CI) for the relationship between decision making preference and feeling unsafe without interpersonal continuity, by trust in physician deliberation (N=5,696)