22 January 2001 Family Medicine The concept of having a long-term relationship between a patient and a physician is a hallmark of primary care and has long been thought to have a beneficial effect on health care utilization and outcomes. 1 Patients rank continuity of care with a physician as a high priority. 2 High patient-physician continuity is associated with a decreased likelihood of future hospitalization, as well as decreased emergency department use. 3-5 In fact, re- search indicates that continuity with an individual phy- sician provides health benefits that receiving care at the same site but seeing different providers does not provide. 4 Moreover, discontinuity in the delivery of care has been suggested to play a role in medical errors and patient safety. 6 A common explanation given for the relationship between continuity of care and health outcomes is that continuity with a physician leads to increased knowl- edge and trust between a patient and a physician. This increased knowledge and trust may make it easier for the physician to manage medical problems in the of- fice or over the phone, thereby avoiding hospitaliza- tion or emergency department visits. There is, in fact, some evidence that higher continuity of care is related to greater trust in one’s physician. 7 The trust that patients have in their physician to act in their best interest may also contribute to the effec- tiveness of medical care. In an investigation of the ef- fect of a publicized error in cervical cancer screening in the United Kingdom (UK), the study found that most women who reported that they trusted in the cancer Continuity of Care and Trust in One’s Physician: Evidence From Primary Care in the United States and the United Kingdom Arch G. Mainous III, PhD; Richard Baker, MD, FRCGP; Margaret M. Love, PhD; Denis Pereira Gray, OBE, FRCGP; James M. Gill, MD, MPH Special Article: Distinguished Paper From the 2000 North American Primary Care Research Group Meeting From the Department of Family Medicine, Medical University of South Carolina (Dr Mainous); Department of General Practice and Primary Health Care, University of Leicester, Leicester, UK (Dr Baker); Department of Family Practice, University of Kentucky (Dr Love); Institute of General Practice, University of Exeter, Exeter, UK (Professor Sir Pereira Gray); and Department of Family and Community Medicine, Christiana Care Health System, Wilmington, Del (Dr Gill). B a c k g r o u n d a n d O b j e c t i v e s : Patients’ trust in their physician to act in their best interest contributes to the effectiveness of medical care and may be related to the structure of the health care system. This study explored the relationship between continuity of care and trust in one’s physician, particularly in terms of differences between the United States and the United Kingdom (UK). M e t h o d s : We conducted a cross- sectional survey of adult patients (n=418 in the United States and n=650 in the UK) who presented in outpatient primary care settings in the United States (Charleston, SC, and Lexington, Ky) and in the UK (Leicester and Exeter). R e s u l t s : A high percentage of both groups of patients reported having a usual place of care and doctor. A total of 69.8% of UK patients and 8.0% of US patients have had their regular physician for > 6 years. US patients (92.4%) are more likely than UK patients (70.8%) to value continuity with a doctor. Both groups had high levels of trust in their regular doctor. Trust was related to one conti- nuity measure (length of time for the relationship) but not to another (usual provider continuity index more than 1 year). In a multivariate model, country of residence had no independent relationship with trust, but continuity of care was significantly related. C o n c l u s i o n s : Higher continuity is associated with a higher level of trust between a patient and a physician. Efforts to improve the relationship between pa- tients and physicians may improve the quality and outcomes of care. (Fam Med 2001;33(1):22-7.)