Observational studyJournal of general internal medicine2022
Terminations in Primary Care: a Retrospective Observational Study of 16 Primary Care Clinics.
Observational study in Journal of general internal medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Saying goodbye to my doctor: a qualitative study on the experiences of chronically ill patients when facing the termination of a long-term treatment relationship in Hong Kong.BMC primary care · 2026Article
- Characteristics of patients dismissed from a retina practice.Eye (London, England) · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe relationship between clinician and patient is the cornerstone of primary care. Breakdown and termination of this relationship are understudied yet important, undesirable outcomes.
objectiveTo better understand the nature and extent of provider and clinic termination of the primary care relationship.
designRetrospective observational case-control study. SUBJECTS: Adult patients in Eastern Massachusetts who received primary care at hospital- and community-based clinics and health centers participating in a practice-based research network between January 2013 and June 2017. MAIN MEASURES: Formal termination by primary care physician (PCP), reasons for termination, independent predictors of termination based on mixed-effects logistic regression, and documentation of a new PCP after termination. KEY
resultsWe identified 158,192 patients who received primary care from 182 PCPs across 16 clinics. We found 536 cases of formal termination. Clinics ranged from 4 to 119 terminations per 10,000 patients (intraclass correlation coefficient [ICC]=0.21; 95% CI: 0.18-0.24). Patient age, race/ethnicity, educational attainment, relationship status, employment status, and insurance type were independent predictors of termination (e.g., compared to patients employed full-time, patients unemployed due to disability were more likely to be terminated [adjusted OR:9.26; 95% CI: 6.74-12.74]). The most common cause for termination (38%) was appointment "no-shows" with some PCPs/clinics found to enforce a policy of dismissal following three no-shows. At the time of chart review, 201 patients (38%) had no documentation of a new PCP. Among patients who re-established care within the network, 134 (25%) had a primary care visit within 6 months of termination.
conclusionsDetailed chart review found that, unlike previous survey-based studies, dismissal was often for missed appointments based on enforcement of no-show policies. Many sociodemographic factors were associated with termination. Variability among clinics highlights the need for further research to better understand circumstances surrounding terminations, with the principal goals of improving patient-provider relationships and providing equitable care.
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