Good Patient-Provider Relationship Proves to Boost Outcomes

A good patient-provider relationship has long been understood as the foundation of a high patient satisfaction score, but new evidence suggests these relationships can have greater impacts. A study in the Annals of Family Medicine has found that a better patient-provider relationship can mean better patient health outcomes.

The pursuit of a good patient-provider relationship is not exactly new, the researchers acknowledged. Positive relationships can help improve patient satisfaction and yield patient loyalty. And when a patient has a regular source of healthcare, data has shown health outcomes can improve, the researchers reported.

But patient-provider relationships may go beyond improving the patient experience, the researchers said.

“Whereas consistent access to a provider is important, the quality of each clinical encounter is equally important in shaping a patient’s experience and overall health outcomes,” the investigators, hailing from Case Western Reserve University, explained. “Specifically, the quality of the physician-patient relationship warrants closer research. The physician-patient relationship is a valued primary care process on which other primary care processes depend.”

Using 2015 and 2016 data from the Medical Expenditure Panel Survey (MEPS), the researchers measured both improvements in patient-provider relationships and functional health status over the course of the year.

The team defined a positive patient-provider relationship was on that centers on patient trust, a shared understanding of health-related goals, and seamless patient access to care. Notably, a good patient-provider relationship also highlights the provider as a patient advocate, the researchers said.

The research team measured relationship quality by asking adult patients whether they perceived their provider as listening to them and whether their provider explained concepts in an understandable way. In total, the researchers used 14 questions to assess relationship quality, and then looked at whether relationship quality and functional health status improved at the start and end of the study.

Unsurprisingly, good patient-provider relationships were positively associated with functional health status by a correlation coefficient of 0.2.

However, looking at the trajectory of patient-provider relationships — whether relationships improved over the course of the study period — was perhaps more telling.

When patient-provider relationships improved, functional health status also improved by a correlation coefficient of between 0.05 and 0.08. Conversely, when patient-provider relationships deteriorated, as did functional health status.

Like most other health phenomena, these results affected certain patients more than others. Patients with five or more comorbidities, for example, were more likely to experience a poor patient-provider relationship than their counterparts.

“This discrepancy might reflect unmet physician-patient relationship needs among adults bearing multimorbidity burdens and therefore signal an opportunity for intervention,” the researchers said.

“Relationship-centered care might be especially important among aging adults with a disproportionate burden of chronic diseases, who represent a growing subpopulation in the United States,” they added.

These findings, which the researchers said are the first of their kind, open the door for further research into the patient-provider relationship. What qualities in the relationship are most important to improving self-reported health outcomes? What qualities lead to patient-provider relationship improvements? Do patient-provider relationships and their importance change based on subspecialty or type of visit?

Researchers may consider these questions as a part of overall efforts to improve the patient-provider relationship, and with it, health outcomes.

Other studies have already begun to look into the factors that constitute a positive patient-provider relationship. In January, researchers from Stanford University listed the five best practices that comprise a good patient-provider relationship.

Through a literature review of 73 studies about interpersonal connection conducted between 1997 and 2017, the researchers were able to identify five factors that could define a good relationship between patient and provider.

Those best practices include:

• Prepare with intention: Clinicians should become familiar with the patient they are about to meet and create a set plan for each clinical encounter.
• Listen intently and completely: Clinicians should display active listening skills such as leaning forward when the patient is speaking and sitting down. Clinicians should avoid interrupting the patient.
• Agree on what matters most: Clinicians should ask the patient about her healthcare goals and values and be sure to integrate those priorities into their care plans.
• Connect with the patient’s story: Clinicians may put their clinical protocol into the context of a patient’s everyday life and personal background. This will help the provider understand the factors that influence the individual patient’s health and wellness.
• Explore emotional cues: Looking out for body language that might convey a certain emotion from the patient will help cue the provider to display empathy. Clinicians should name and validate patient emotions at the point of care.

“We were looking for practices that would improve the experience of patients and lead to better care for them, but would also improve the experience of clinicians and help them to rediscover the joy of medicine,” Donna Zulman, MD, an assistant professor of medicine and the director of Stanford Presence 5, one of several interdisciplinary Presence initiatives at Stanford, said in a statement.

“As physicians, we are privileged to work with people in their most vulnerable moments,” she added. “And in today’s climate, particularly in primary care, it’s easy to lose sight of that with all of the administrative demands, time pressures and technology distractions.”