Morbidity and older persons' perceptions of the quality of their primary care.

OBJECTIVES To quantify the association between community-dwelling older persons' level of morbidity and their perceptions of the quality of their primary care. DESIGN Cross-sectional study. SETTING Urban primary care practice. PARTICIPANTS A sample of community-dwelling members of a capitated health plan aged 65 and older who were patients of four general internists in one urban practice (N = 120). MEASUREMENTS The Johns Hopkins Adjusted Clinical Groups case-mix system was used to designate a person's aggregate morbidity level as moderate or high depending on the number and types of chronic conditions they had. Aspects of quality of primary care (physician-patient communication, interpersonal treatment, knowledge of patient, integration of care, and trust in physician) were assessed using the Primary Care Assessment Survey. RESULTS All participants were classified as having moderate (41%) or high morbidity (59%). Older adults with high morbidity assigned a lower rating to all aspects of quality of primary care (physician-patient communication (P = .001), interpersonal treatment (P = .002), knowledge of patient (P = .03), integration of care (P = .004), and trust in physician (P = .01)) than those with moderate morbidity. The differences in quality of primary care remained statistically significant after controlling for age, sex, race, and education level. CONCLUSION Older persons with multiple chronic conditions report inadequate quality of primary care and dissatisfaction with their care. Those with high morbidity levels experience poorer quality of primary care than those with moderate morbidity in all five aspects measured here.