Patient -centered primary care: Patient and physician perceptions

The patient-centered model for medical care is increasingly becoming integrated into primary care. Research has demonstrated that this model of care has significant benefits for both physicians and patients. The objective of the current study was to examine patient-centered care in a primary care setting and to incorporate both patient and physician samples. The study took place in a family medicine residency clinic at a large teaching hospital in Arizona. The samples included 15 first- and third-year resident physicians and 195 of their patients who presented at the clinic for a medical exam. Before their medical exam, patients completed measures of patient expectations for patient-centered primary care and health locus of control. After the medical exam, both physicians and patients completed the primary outcome measures, which included patient satisfaction, patient enablement, patient perceptions of patient-centeredness, and physician perceptions of patient-centeredness. As the data were clustered by physician, hierarchical linear modeling procedures were utilized to assess those dependent variables with significant between-cluster variance, while standard statistical procedures were used to assess the non-clustered dependent variables. The results indicated that patient perceptions of patient-centeredness were positively related to both patient satisfaction and patient enablement, while physician perceptions of patient-centeredness were not related to these outcome variables. Patients who attributed control of their health to their physicians/powerful others or chance had significantly higher expectations for patient-centered care than did those who did not make this attribution. Also, both depth of physician training in patient-centeredness, defined by residency year, and patient expectations for patient-centered care significantly predicted patient enablement. Patients of first-year residents reported significantly higher levels of patient enablement than did patients of third-year residents. Given the strong influence of patient-centered care on patient enablement, these results have implications for counseling psychologists in medical care settings who can assist in the continued effort to incorporate patient-centered training into medical care. There are further practical implications stemming from these results for family practice physicians interested in incorporating patient-centered values into practice.