Godfrey Leanda, St-Amant Antoine, Premji Kamila, Fitzsimon Jonathan
Institut du Savoir Montfort, Ottawa, Ontario, Canada.
University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada.
Fam Med Community Health. 2025 Jan 28;13(1):e003115. doi: 10.1136/fmch-2024-003115.
Primary care attachment represents an inclusive, equitable and cost-effective way of enhancing health outcomes globally. However, the growing shortage of family physicians threatens to disrupt patient-provider relationships. Understanding the consequences of these disruptions is essential for guiding future research and policy. The objectives of this study were to map the existing evidence on the impacts of changes in primary care attachment, identify research gaps and recommend areas for further investigation.
Scoping review following Joanna Briggs Institute (JBI) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Two researchers conducted all stages of screening, and study quality was assessed using JBI critical appraisal tools. Key themes included causes of attachment change, direction of change and outcomes aligned with the quintuple aim framework. Both qualitative and quantitative findings were synthesised narratively.
Peer-reviewed, English-language articles published between 1999 and 2024 on primary care attachment changes.
PubMed, Scopus and Web of Science.
Of 2045 studies screened, 31 met inclusion criteria, with 60% published after 2020. Most studies originated from high-income countries, particularly the USA (35%) and Canada (29%). Attachment losses and transfers were the most frequently studied, while attachment and unattachment durations were less explored. These changes in attachment were consistently shown to impact patients, providers, clinics and the healthcare system, influencing all aims of the quintuple aim framework, including clinical outcomes, healthcare utilisation, costs, equity and patient experience. Commonly assessed outcomes included clinical impact (68%), health equity (48%), patient experience (32%) and costs (23%), with no study assessing provider experience.
This scoping review maps the published literature on changes in primary care attachment and introduces clarifying terminology. Key research gaps include geographical diversity (lack of studies from low- and middle-income countries), attachment gain (limited research on strategies to reconnect unattached patients), attachment duration (insufficient evidence on long-term health outcomes), economic implications (underexplored costs of physician turnover and disruption), provider experiences (lack of studies on how changes in primary care attachment impact provider burnout, job satisfaction and workload) and patient health outcomes (focus on healthcare utilisation rather than direct health outcomes). These findings underscore the need for further research and offer valuable insights for future studies and policy development.
基层医疗医患关系是一种在全球范围内改善健康结果的包容性、公平且具成本效益的方式。然而，家庭医生日益短缺，这可能会破坏患者与医疗服务提供者之间的关系。了解这些破坏行为的后果对于指导未来的研究和政策至关重要。本研究的目的是梳理关于基层医疗医患关系变化影响的现有证据，识别研究空白，并推荐进一步调查的领域。
遵循乔安娜·布里格斯研究所（JBI）指南以及系统评价和元分析扩展的范围综述清单中的首选报告项目进行范围综述。两名研究人员进行了筛选的所有阶段，并使用JBI批判性评估工具评估研究质量。关键主题包括医患关系变化的原因、变化方向以及与“五重目标”框架一致的结果。定性和定量研究结果都进行了叙述性综合。
1999年至2024年间发表的关于基层医疗医患关系变化的同行评审英文文章。
PubMed、Scopus和科学网。
在筛选的2045项研究中，31项符合纳入标准，其中60%是2020年以后发表的。大多数研究来自高收入国家，尤其是美国（35%）和加拿大（29%）。医患关系的丧失和转移是研究最多的，而医患关系建立和解除的持续时间研究较少。这些医患关系的变化一直被证明会影响患者、医疗服务提供者、诊所和医疗系统，影响“五重目标”框架的所有目标，包括临床结果、医疗利用、成本、公平性和患者体验。常见的评估结果包括临床影响（68%）、健康公平性（48%）、患者体验（32%）和成本（23%），没有研究评估医疗服务提供者的体验。
本范围综述梳理了关于基层医疗医患关系变化的已发表文献，并引入了明确的术语。主要研究空白包括地域多样性（缺乏来自低收入和中等收入国家的研究）、医患关系建立（对重新联系未建立医患关系患者的策略研究有限）、医患关系持续时间（关于长期健康结果的证据不足）、经济影响（对医生更替和中断成本的研究不足）、医疗服务提供者体验（缺乏关于基层医疗医患关系变化如何影响医疗服务提供者职业倦怠、工作满意度和工作量的研究）以及患者健康结果（侧重于医疗利用而非直接健康结果）。这些发现强调了进一步研究的必要性，并为未来的研究和政策制定提供了有价值的见解。
