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Quality of Care

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Better ratings of the patient-provider relationship are associated with higher quality of care for depression

The interpersonal patient-provider relationship (PPR) is a critical element of health care quality, especially for patients suffering from depression. Depressed patients are more likely to disclose concerns and details about their illness when the doctor asks them about specific problems such as depression, shows empathy, discusses treatment choice, and listens well, all elements of quality PPR. RAND researchers used data from the Partners in Care (PIC) Study to examine the relationship between patient ratings of interpersonal PPR and both satisfaction with health care and technical quality of care among a sample of depressed primary care patients.

This study, supported by the Agency for Healthcare Research and Quality (HS08349) and the Robert Wood Johnson Foundation, involved 1,104 depressed patients who visited providers at six managed care organizations. The correlation between satisfaction and interpersonal PPR was moderate, implying they are distinct but related elements. Ratings of satisfaction and PPR tended to be high overall, while technical quality scores were low to moderate. Thus, satisfaction and PPR ratings also reflect something other than technical quality. In routine monitoring of care, therefore, such measures may convey a broader consumer perspective that technical quality measures do not capture.

Patients receiving higher technical quality of care for depression, especially appropriate medication use, had significantly higher ratings of the PPR and were more satisfied with their care than patients who received lower technical quality of care. The researchers point out that additional research is needed to determine whether patient ratings are causally linked to quality of care over time and clarify their relationship to health plan enrollment and disenrollment decisions.

More details are in "Are better ratings of the patient-provider relationship associated with higher quality care for depression?" by Lisa S. Meredith, Ph.D., Maria Orlando, Ph.D., Nicole Humphrey, M.H.S.A., and others, in the April 2001 Medical Care 39(4), pp. 349-360.

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