Objective: To determine if patients vary in perceptions of safety if interpersonal continuity were to be disrupted. If so, which characteristics are associated with feeling unsafe?
Background: The extent to which patients' preference for continuity with a personal physician is due to perceptions of safety is unclear.
Design: Observational study (Wisconsin Longitudinal Study Graduate and Sibling Survey).
Setting and participants: A total of 6827 respondents (most aged 63-66 years) who completed the 2003-06 survey round.
Main variables studied: Age, gender, marital status, education, health insurance type, illnesses, medications, length of relationship with provider and place, personality type, decision-making preference and trust in physician deliberation.
Main outcome measures: Safety perception when visiting another doctor or clinic if own doctor were not available.
Results: Twelve percent of respondents felt unsafe. After adjustment, as compared to those who felt safe, those who felt unsafe were more likely to be women (Odds ratio=1.65, 95% confidence interval=1.35-2.01), have more chronic conditions (1.27, 1.08-1.50) and have a longer relationship with a usual provider: 5-9 years (1.53, 1.11-2.10) 10-14 years (1.41, 1.02-1.95) and 15 or more years (1.62, 1.20-2.17) compared to 0-4 years. Those who preferred active participation in decision making and had trust in their physician were less likely to feel safe (1.63, 1.10-2.41).
Conclusions: Certain older adults perceive being unsafe if not seeing their usual physician. Further research should investigate reasons for perceptions of safety if continuity were disrupted and any implications for care.