The relationship between continuity of care and the health behaviors of patients: does having a usual physician make a difference?

BACKGROUND Implicit in "any willing provider" and "freedom of choice" legislation is the assumption that ongoing provider relationships lead to better patient outcomes on average. Although previous studies have identified associations of usual source of care with medical utilization, its relationship to patient lifestyle has not been examined. OBJECTIVE To determine the effect of having a usual physician on health behaviors. METHODS Data on 3,140 adults from the 1995 Mid-Life in the US study were used to estimate logistic regressions of the effect of having a usual physician on exercise, obesity, vitamin-taking, smoking quits, substance abuse behaviors, preventive medical visits, and respondent assessments of the ability to affect one's own health and risk of heart attacks and cancer. RESULTS Respondents with a usual physician were 3 times as likely to have had a preventive medical visit during the past year. Among lower-income respondents, those with usual physicians were one-half as likely to report substance abuse behaviors. Instrumenting reduced the magnitude of the former but not latter effect. No other significant differences were found. CONCLUSIONS Strategies designed to foster regular patient-provider relationships may affect certain health behaviors, such as preventive care visits and substance abuse. Yet in the absence of interventions to improve the effectiveness of these relationships, they are unlikely to be a powerful policy instrument for achieving widespread improvements in patient lifestyle choices.