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Primary care in the United States is undergoing many changes. Reliable and valid instruments are needed to assess the effects of these changes. The Primary Care Organizational Questionnaire (PCOQ), a 56-item 5-point Likert scale survey that evaluates interactions among members of the clinic/practice and job-related attributes, was administered to clinicians and staff in 36 primary care practices serving paediatric populations in Connecticut. A priori scales were reliable (Cronbach alpha ≥0.7). Analysis of variance (ANOVA) showed greater heterogeneity across clinics than within clinics for 13 of 15 a priori scales, which were then included in a principal component factor analysis with varimax rotation. Eigenvalue analysis showed nine significant factors, largely similar to the a priori scales, indicating concurrent construct validity. Further research will ascertain the utility of the PCOQ in predicting the effectiveness of primary care practices in implementing disease management programmes.

26:T4d4,

Despite its criticality to the provision of health care, little is known about how the patient-physician relationship influences burnout. This article seeks to understand how patient performance (e.g. being informative about needs) during office visits is associated with perceived reciprocity in the patient-physician relationship, which is in turn associated with physician burnout. To that end, we report the results of a cross-sectional survey of 252 matched pairs of patients and their primary care physicians about a recent office visit. The findings support a social exchange model of burnout that suggests that patient stressors and patient performance predict perceived reciprocity and subsequent burnout. Interestingly, patients' perceptions of their performance differed from physicians' perceptions; physicians' perceptions of performance fit the social exchange model better than patients' perceptions of performance.

The present work suggests that while they are a source of demands, patients also provide resources that are critical to the patient-physician relationship. To the extent that we can encourage these resources, we can improve perceived reciprocity and reduce burnout in physicians.

27:T5ab,