Terminations in Primary Care: A Retrospective Observational Study of a Network of Primary Care Clinics in Eastern Massachusetts

Abstract

Purpose: To better understand the nature and extent of formal terminations of patients by their primary care doctors and/or clinics. Methods: Patients terminated from primary care during a 4.5-year period were identified via three data sources, including logs kept by a centralized department and two different searches using the electronic health record (EHR). All cases were reviewed in the EHR; in situations where the patient was not terminated or there was insufficient documentation, they were excluded from analysis. From detailed chart review, we recorded details of the encounter including reasons for termination, whether opioids played a significant role, and a brief summary. We also extracted demographic data from the EHR and compared terminated patients to the study population using means and proportions. Results: In total, we identified 536 terminations among 16 primary care clinics serving 150,456 patients. During the review period, 82% of PCPs dismissed 3 or fewer patients and the median number of dismissals by PCPs was 1; two PCPs accounted for 18% of terminations. Nearly half (45%) of all terminations occurred as a result of multiple “no-shows” or failures to cancel scheduled appointments with more than 24-hours’ notice. The second most common reason cited for terminating a patient was for disrespectful or otherwise disruptive behavior (22% of dismissals). Retired or disabled patients had a higher likelihood of dismissal (OR: 3.27; 95% CI: 2.58-4.14) compared to those employed full-time, as did unemployed patients (OR: 3.61; 95% CI: 2.84-4.58). Compared to White/Caucasian patients, Black/African American patients were more likely to be terminated (OR: 2.92; 95% CI: 2.38-3.60). Conclusions: While patients were terminated from all clinics during the study period, there was great variability among both clinics and providers. The most common reason for dismissal was missed appointments, followed by inappropriate/disrespectful behavior. Patients in certain demographic groups were terminated at a higher rate compared to the entire study population.