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Noteworthy Publications

The impact of primary care turnover


A VA study found that turnover in primary care providers has minimal impact on quality of care, but does affect how patients rate their experience.
A VA study found that turnover in primary care providers has minimal impact on quality of care, but does affect how patients rate their experience. (Photo: ©iStock/Yuri)

A VA study found that turnover in primary care providers has minimal impact on quality of care, but does affect how patients rate their experience. (Photo: ©iStock/Yuri)

Several studies have linked the ability of patients to continue to see the same primary care provider over a period of time with higher patient satisfaction, improvement in the quality of ambulatory care they receive, and lower rates of hospitalization.

Primary care provider turnover is increasing, however. According to a 2012 study by the Urban Institute, 30 percent of primary care providers aged 35 to 49 plan to leave their practice within five years, and that number increases to up to 50 percent for those over age 50.

A team led by Dr. Ashok Reddy of the Philadelphia VA Medical Center and the University of Pennsylvania studied the impact of primary care provider turnover on patient care experience and ambulatory quality of care.

They looked at more than 500,000 patients enrolled in primary care in VA between 2010 and 2012, and divided them into two groups: those who received care from the same primary care provider, and those whose provider left VA during the time period. They found that 9 percent of patients in their sample experienced a turnover in their primary care provider during the study period.

The researchers used VA's Survey of Healthcare Experiences of Patients (SHEP) results to measure five composite areas involving patients' care experience, including how well their VA physicians and nurses were able to communicate with them; how highly they rated their personal doctors and nurses; how well they were able to receive needed care, and how quickly they were able to receive that care; and their overall rating of VA health care.

The team also looked at 11 measures of ambulatory quality of care measured in VA's External Peer Review Program (EPRP).

According to the investigators, turnover was associated with a worse rating in each domain of patient care experience—but it was not associated with lower quality of care, except for a slightly lower likelihood of controlling blood pressure. The researchers therefore concluded that primary care provider turnover was associated with worse patient experiences of care, but that it did not have a major effect on ambulatory care quality. The study was published in the July 2015 issue of JAMA Internal Medicine.


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