Table 2

Summary of study aims, participants, and key findings.

StudyAimsParticipantsaKey findingsa
Brown et al22 (Appendix 3)‘What factors contribute to patients' long-term attendance at a family practice teaching unit?’: to explore the ideas, opinions, feelings, and experiences of patients attending the centre and to examine their reasons for continued attendance42 patients (unknown sex, 31–84 years old, unknown ethnicity). Patients were purposefully selected to have received care primarily from a staff physician, a resident, or both. They had been affiliated with one of three practices for ≥15 yearsFour key themes were identified as the primary factors contributing to long-term attendance: the relationship context (patient as a person; relationship-building processes; and relationships with specific team members), the team concept, professional responsibility, and attitudes, and comprehensive and convenient care
Gabel et al23 (Appendix 4)‘What characteristics of physicians and practices promote long-term care relationships with patients?’: to gain insight into the meaning patients attach to continuity of care60 patients (unknown sex, ≥35 years unknown ethnicity). Recruited 15 patients per physician, who had seen the same family physician for a minimum of 15 consecutive years and who were ≥35 years.The main factors identified as contributing to long-term relationships were: patient familiarity with the physician (including knowing what to expect with them), physician knowledge of the patient (accumulated knowledge about the patient's medical history, work, lifestyle, habits and stresses, and the patient's family), and patient confidence in the physician (‘that resulted from satisfactory scare received over many years’)
Goold and Klipp25 (Appendix 5)To explore consumer expectations and experiences in managed health plans. The report however ‘focuses on the role of trust in members' perceptions and experiences of managed care, a topic that participants spontaneously raised during the study’26 male and 14 female, 25–71 years, 20 white, 12 African-American, 3 Hispanic, 2 Indian, 2 Arab,1 mixed. Selectively sampled through area employers (11), community-based in organisations (14), personal contacts (11), via other interviewees (3), and unknownGoold and Klipp distinguish between experientially based trust in a specific doctor (trust in my physician) and trust physicians in general. Trust in my physician: the two major themes were history and communication. Other themes were: competence/positive outcomes, advocacy, vulnerability, caring/compassion, and respect. Trust in physicians in general: comments were based less on relationships and more on ethics (distrust expressed as the consequence of bad experience; and trust based on beliefs and assumptions about doctors)
Gore and Ogden16 (Appendix 6)To examine patients' views of the process of creating a relationship with their GP9 men and 18 women, 30–79 years old, ‘mixed’ ethnicity. Recruited from four practices. Patients had to have been registered for 2 years and to have attended at least six times per year during this periodDescribes the relationship in terms of development, validation, and consolidation stages. They conclude that each consultation is not an isolated event and that patients are active agents in their relationship with their doctors
Lings et al17 (Appendix 7)To describe, conceptualise and explain patients' and doctors' experiences and behaviour with regard to the therapeutic relationship24 females and 10 males, unknown ages, 12 from ‘ethnic minorities’. ‘Randomly sampled’ from family medicine centreThey describe three key factors in patient–doctor relationships: ‘asymmetrical’ communication; the importance on both sides of ‘liking’; and the value set by both parties on development of trust. Continuity of relationships may promote the development of trust and liking, and make patients more tolerant of a doctor's mistakes
Pandhi et al21 (Appendix 8)To examine how patients perceive a continuity of patient–doctor relationship in a family medicine setting, from its development through to its consequences8 females and 6 males, 25–62 years old, unknown ethnicity. Theoretically selected from random sample of 40 eligible patients of a family medicine residency. Poor–excellent healthRather than describing ongoing patient–doctor relationships in terms of ‘continuity of care’ per se, Pandhi et al found that patients talked about the importance of establishing and maintaining a comfortable relationship
Roberge et al24 (Appendix 9)‘To define the notion of loyalty to the attending physician’: to document and compare the vision that patients and physicians in the Montreal region have of loyalty to the regular care provider16 females and 7 males, 27–72 years old, unknown ethnicity. Recruited through advertisementPatient–doctor loyalty may be viewed as a contract, agreement, or commitment. It primarily depends upon patient trust, and it means that the patient sees the same doctor for the majority of their health needs. However, patient loyalty is neither exclusive nor permanent. Patient loyalty was firstly to the doctor, not the clinic
Tarrant et al19 (Appendix 10)To explore patients' perceptions of the features of personal care and how far these are shared by healthcare providers; whether a continuing relationship between a health professional and a patient is essential for personal care; and the circumstances in which a continuing relationship is important25 females and 15 males, aged ≥18 years, 29 white, 9 Asian, 2 African-Caribbean; 25 had chronic or multiple health problems. Recruited from six general practicesPersonal care was described in terms of: human communication, individualised treatment or management, and whole-person care (treatment in the context of the patient's life and family history). Whatever the context, human communication and individualised care are important in making care personal. A continuing provider-patient relationship promotes, but does not guarantee, personal care
Thom and Campbell26 (Appendix 11)To gain an understanding of how patients perceive trust of a physician and how patients relate physicians' behaviours to their perceptions of trust20 female and 9 male, 23–72 years old. Recruited from a university-based family practice (6 long-time patients, 10 recruited from a list of 43 randomly sampled patients who had visited the office within the previous 6 months), a family practice residency clinic (4 recruited froma random sample of 54 English-speaking Hispanic patients who had visited within the last 56 months), and the remainder by flyersposted in a publicly supported medical clinicThree global factors that influence patient trust were described: physician behaviours, predisposing factors, and structural/staffing factors. Patients seem to distinguish between physician behaviours that are primarily interpersonal and those that are technical. There may be a discernible difference in patient's minds between trust in, and satisfaction with, a physician
Von Bültzingslowen et al20 (Appendix 12)To acquire a comprehensive understanding of the core values of having a personal doctor in a continuing patient–doctor relationship in primary care among patients with a long-term chronic illness9 female and 5 male, 33–79 years old, unknown ethnicity. Recruited from three primary healthcare centres. Patients had to have: visited the healthcare centre for at least 5 years; have any long-term chronic disease (such as diabetes, rheumatoid arthritis, coronary heart disease, depression, or lower back pain); and have experienced personal and short-term locum doctorsMany patients described the impact of having a personal doctor in terms of a core sense of security. The basis of this security was: coherence, confidence in care, a trusting relationship, and accessibility. The authors suggest that personal care is promoted by, but not always dependent on, a continuing provider-patient relationship
Wiles and Higgins18 (Appendix 13)To examine how private patients interpret and understand their relationships with their doctors. In particular, ‘whether patients understand the relationship with their consultants to be a consumerist one, in which they hold the power, one of mutuality, or the more traditional paternalistic one’35 female and 25 male. Majority aged 25–50 years and in social classes I, II, or III. 30 paid for their stays through private health insurance provided or subsided by their employers. Recruited from 8 private hospitals and pay beds in 3 NHS hospitalsSome patients thought that the direct or indirect exchange of money influenced the nature of the relationship in some cases, for example ‘buying time’ with their consultants. Many patients characterised their relationships as one of friendship, which they attributed to the greater frequency with which they saw the same doctor, or the length of time over which contacts had occurred. Others thought the ‘congenial surroundings and positive atmosphere’ of the private hospitals enhanced communication
  • a Where informants other than patients were recruited, characteristics of patient participants and findings attributed to patients only are summarised.