Satisfaction with health care providers and preventive care adherence: A national study

BACKGROUND:: Prior studies demonstrating associations between patient satisfaction with health care providers and preventive adherence were cross-sectional, limiting causal inferences. In cross-sectional and prospective analyses, we explored 3 hypotheses previously invoked to explain associations between satisfaction with providers and preventive adherence: (1) receiving preventive care increases satisfaction; (2) enhancing satisfaction increases preventive care; (3) satisfaction and adherence reflect patient characteristics, incompletely adjusted for in previous studies. METHODS:: We conducted 3 sets of logistic regression analyses employing 2000-2010 Medical Expenditure Panel Survey data: 1 cross-sectional and 2 prospective (baseline preventive care/follow-up year satisfaction, and baseline satisfaction/follow-up year preventive care), each set cumulatively adjusting for patient demographics, socioeconomics, morbidity, health care access, and medical skepticism. Consumer Assessment of Health Plans Survey items measured satisfaction with care from all providers in the preceding year. Preventive care examined included influenza vaccination and colorectal cancer, Papanicolaou, mammography, and prostate-specific antigen screening. RESULTS:: In cross-sectional analyses adjusted for demographics (N=74,792), highest (vs. lowest) quartile satisfaction was associated with preventive adherence [adjusted odds ratios (95% confidence interval)]: influenza vaccination 1.14 (1.07, 1.22); colorectal cancer screening 1.08 (0.99, 1.18); Papanicolaou screening 1.14 (1.04, 1.24); mammography screening 1.20 (1.11, 1.31); prostate-specific antigen screening 1.38 (1.25, 1.52). With full adjustment, associations of satisfaction with adherence were substantially attenuated, eliminated, or reversed. Prospective analyses yielded findings similar to the cross-sectional analyses. CONCLUSIONS:: Cross-sectional and prospective associations between satisfaction with providers and preventive care adherence were similarly explained by patient characteristics. The findings question previously hypothesized causal relationships between satisfaction and preventive adherence.