Toward a universal definition of provider-patient attachment in primary care.

Objective: To explore definitions of provider-patient attachment in primary care (PC) and help inform a universal definition of provider-patient attachment.

Data sources: Comprehensive searches were conducted using the electronic databases MEDLINE (Ovid), PubMed, CINAHL (EBSCO), PsycInfo (Ovid), Social Sciences Abstracts (EBSCO), Cochrane Library, Scopus, Embase (Ovid), Google Scholar, and ResearchGate.

Study selection: A scoping review was conducted. Articles focusing on PC setting, provider-patient attachment, and attachment approaches (enrolment, rostering, registration, empanelment) were included. All articles were from English-language publications and were available in full text in or after 2005. Of the 5955 unique titles, 97 peer-reviewed articles and 45 gray literature sources were included.

Synthesis: The term attachment is sometimes used interchangeably with enrolment and empanelment. Provider-patient attachment is a confirmed affiliation between a patient and a regular primary care provider (PCP). This affiliation can be formal or informal. The goals are to deliver longitudinal care and establish a therapeutic relationship (relational continuity). Enrolment and empanelment are mechanisms that enable the affiliation of a patient with a PCP. Enrolment is a formal process of provider-patient affiliation, while empanelment is the assignment of a patient to a PCP.

Conclusion: A universal definition of provider-patient attachment is provided: the confirmed and documented affiliation between a patient and a regular PCP (a clinician, ie, a family physician or nurse practitioner, etc), or a combination of clinician and care team or practice in which the PCP is responsible for providing longitudinal and continuous care to the patient via any delivery channel (ie, in person, remotely, or both), enabled by provider access to patient health information.