Patient-Rated Access to Needed Care: Patient-Centered Medical Home Principles Intertwined

Abstract

Background: Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams.

Procedures: We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures.

Key findings: Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65-6.98) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01-2.74) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Associations with in-person communication were not significant.

Conclusions: Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients.

Trial registration: ClinicalTrials.gov NCT02039856.

Published by Elsevier Inc.

Figures

Figure 1:. Increases in marginal probability of high ratings of access to routine and urgent care associated with high ratings of key care team functions

Absolute difference in probabilities of high access to routine and urgent care associated with high ratings of key care team functions, adjusted for sociodemographics, overall rating of VA, settings and types of care, and health status. Vertical lines indicate the 95% confidence interval for the marginal probability.