Accessible services in primary care practices promote preventive health screenings and care
Research Activities, January 2012, No. 377
The patient-centered medical home (PCMH) is a concept aimed at improving the quality of primary care. In order to qualify as a PCMH, primary care practices embrace several principles that promote the delivery of preventive services. Although still evolving, one of these important principles is continuity with a personal provider. Another is the availability and accessibility of services, such as getting appointments and telephone advice—called first-contact access. A new study suggests that first-contact accessibility in addition to provider continuity promotes the receipt of preventive services, such as cholesterol screening and prostate examinations.
Researchers collected data on 5,507 insured adults in Wisconsin who had a usual physician they relied upon for medical care. All had participated in the 2003 to 2006 round of the Wisconsin Longitudinal Study. To determine first-contact accessibility, participants could rate eight items from excellent to poor. These included things such as office hours, location of the doctor's office, waiting room times, ability to make phone appointments, amount of time spent with the doctor, and how easy it was to receive advice over the telephone.
Among those studied, 18 percent had high ratings for their first-contact accessibility in addition to continuity of care with their physician. In the past year, 83 percent of eligible women received a mammogram, 78 percent of men had a prostate examination, and 63 percent of participants had a flu shot. In addition, the vast majority (90 percent) received a cholesterol test. Adding first-contact access to existing continuity of care with a primary care physician boosted the likelihood of receiving preventive services compared to just having continuity of care alone.
Even though this study population already had rates of preventive services higher than national rates, the addition of first-contact accessibility increased the odds of receiving flu shots, prostate exams, and cholesterol tests. Additional studies are needed to determine how different PCMH principles impact care outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS16181).
See "Preventive service gains from first contact access in the primary care home," by Nancy Pandhi, M.D., M.P.H., Jennifer E. DeVoe, M.D., D.Phil, Jessica R. Schumacher, Ph.D., and others in the July/August 2011 Journal of the American Board of Family Medicine 24(4), pp. 351-359.