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Title: Patient-doctor longitudinal care, depth of relationship and detection of patient psychological distress by general practitioners
Author: Ridd, Matthew John
ISNI:       0000 0001 3820 8569
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2009
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Continuity of patient care is often described as a core value in general practice yet changes in primary care in the United Kingdom have eroded the traditional model of the patient seeing the same doctor and developing a relationship with them over time. Such patient-doctor continuity is especially valued by patients and GPs when, among other situations, the problem is psychological. However, evidence that continuity benefits patient care is limited, possibly because research has focused on its longitudinal rather than its interpersonal characteristics. Using a previously described model of patient-doctor continuity, two hypotheses were tested. First, that longitudinal care and depth of relationship would be associated. Second, that patient-doctor continuity (in particular depth of relationship) would be associated with GP detection of patient psychological distress. A novel measure of patient-doctor depth of relationship was developed and psychometrically evaluated through ten pre-pilot interviews and two pilot rounds involving 529 participants. This measure was then used in a cross-sectional study of routine GP consultations. Of the 643 eligible patients who attended the 31 participating GPs, 541 (84.1%) returned a questionnaire and 490 (76.2%) gave permission to review their medical records. An association between the number of encounters between patient and study GP and the probability of having a deep relationship appeared to be curvilinear, with an average odds ratio of 1.5 (95% CI 1.2 to 1.8). However, neither depth of relationship nor longitudinal care were associated with GP detection of psychologically distressed patients, as defined by the General Health Questionnaire (GHQ). Indeed, patient-doctor continuity appeared to be associated with GP over-reporting of psychological distress. The causality of the association between patient-doctor longitudinal care and depth of relationship, and the value of depth of relationship to patients with psychological problems, warrants further investigation.
Supervisor: Salisbury, Chris Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available