Patient and physician perceptions of timely access to care

Barry, Daniel W.; Melhado, Trisha V.; Chacko, Karen M.; Lee, Rita Shi-Ming; Steiner, John F.; Kutner, Jean S.

doi:10.1007/s11606-006-0246-1

Cited by 16 publications

(14 citation statements)

References 7 publications

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“…The disparity between patient-assessed severity and GP-assessed appropriateness reflects the known gap between patients and healthcare professionals concerning their understanding of urgency and severity of symptoms [3, 8, 17–19]. Also, the association between medically assessed inappropriateness and unfulfilled patient expectations could reflect the mismatch between the perception of appropriateness among the patients and the medical assessments provided by the GPs.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the organisation of health care, the help-seeking behaviour among the patients depends on many other determinants, such as sociodemographic and cultural factors, previous experience, attitude to health-service use, and perception of symptoms [8, 13–16]. Patients often perceive their symptoms as more severe and urgent than health-care professionals [3, 8, 17–19]. …”

Section: Introductionmentioning

confidence: 99%

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Medical appropriateness of adult calls to Danish out-of-hours primary care: a questionnaire-based survey

et al. 2017

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BackgroundOptimal utilisation of the out-of-hours primary care (OOH-PC) services remains a concern in public health policy. We need more knowledge on potentially avoidable contacts. This study examines the frequency of medically assessed inappropriate OOH-PC calls from adults, explores factors associated with such assessment, and examines the relation to patient-assessed severity of health problem and fulfilment of expectations.MethodsWe performed secondary analyses of data from a large cross-sectional survey on contacts to Danish OOH-PC. As access to Danish OOH-PC is provided through telephone triage delivered by a general practitioner (GP), we included only telephone contacts. A contact was characterised as medically inappropriate when the triage GP assessed that the request from a medical perspective should have been directed to daytime primary care. Appropriateness was examined in relation to patient characteristics, reason for encounter, time of contact, and whether the contact was triaged to a face-to-face consultation, and in relation to patient-assessed severity of the health problem and fulfilment of expectations. Associations were estimated with odds ratios (ORs) using multivariate analysis.ResultsOf all contacts, 23.7% were assessed as medically inappropriate. Such assessment was associated with: younger age, longer symptom duration, exacerbation of chronic condition, and contact only few hours away from own GP’s office hours. Of medically inappropriate contacts, 31.3% were from patients aged 18–30 years, 41.5% concerned symptoms of > 24 h, 19.4% concerned exacerbation of chronic condition, and 21.3% were calls < 3 h away from own GP’s regular office hours. Medicine request was the most frequent reason for an inappropriate contact (14.3% of medically inappropriate contacts). In 53.4% of contacts assessed as inappropriate, the health problem was considered as severe by patients and medical assessed inappropriateness was significantly associated with unfulfilled patient expectations.ConclusionsOne in four OOH-PC calls was considered medically inappropriate. Future efforts to reduce suboptimal use of OOH-PC should focus on the types of contacts with the highest optimisation potential, e.g., medication requests, long-lasting symptoms, and exacerbations. Such interventions should aim at bridging the gap between the GP’s medical assessment and the patient’s expectations to appropriate OOH-PC use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medical appropriateness of adult calls to Danish out-of-hours primary care: a questionnaire-based survey

et al. 2017

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“…Notably, patient expectation of timely care has been shown to differ from that of physicians. In a recent study involving eleven written clinical scenarios, patients felt clinical evaluation should be performed significantly sooner than did physicians for eight of the eleven scenarios [20]. Acknowledging this discrepancy in perceptions and educating patients may help mitigate this rationale for choosing the urgent care setting.…”

Section: Discussionmentioning

confidence: 99%

Access and care issues in urban urgent care clinic patients

Scott

Batal

Majeres

et al. 2009

BMC Health Serv Res

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BackgroundAlthough primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic. The relevance of understanding the motivation driving this patient population is especially pertinent given recent trends towards universal healthcare and the unclear impact it may have on the demands of urgent care.MethodsWe conducted a cross-sectional survey of patients seeking care at an urgent care clinic (UCC) within a large acute care safety-net urban hospital over a six-week period. Survey data included demographics, social and economic information, reasons that patients chose a UCC, previous primary care exposure, reasons for delaying care, and preventive care needs.ResultsA total of 1, 006 patients were randomly surveyed. Twenty-five percent of patients identified Spanish as their preferred language. Fifty-four percent of patients reported choosing the UCC due to not having to make an appointment, 51.2% because it was convenient, 43.9% because of same day test results, 42.7% because of ability to get same-day medications and 15.1% because co-payment was not mandatory. Lack of a regular physician was reported by 67.9% of patients and 57.2% lacked a regular source of care. Patients reported delaying access to care for a variety of reasons.ConclusionDespite a common belief that patients seek care in the urgent care setting primarily for economic reasons, this study suggests that patients choose the urgent care setting based largely on convenience and more timely care. This information is especially applicable to the potential increase in urgent care volume in a universal healthcare system. Additionally, this study adds to the body of literature supporting the important role of timely primary care in healthcare maintenance.

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“…Measuring timeliness as a quality indicator is a complex, multifactor process that often is correlated with patient satisfaction, efficiency, and outcomes (Barry et al, 2006). Measuring timeliness as a quality indicator is a complex, multifactor process that often is correlated with patient satisfaction, efficiency, and outcomes (Barry et al, 2006).…”

Section: Literature Reviewmentioning

confidence: 99%

Timeliness in Breast Cancer Care as an Indicator of Quality

Kiely

2014

Clinical Journal of Oncology Nursing

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The current study sought to define best practice for timeliness for a breast cancer program at each diagnostic step. The study was a retrospective review of patients newly diagnosed with invasive breast cancer who were enrolled in the breast cancer database from 2009-2011. A convenience sampling methodology was used for patient selection, and descriptive statistics for various time intervals were calculated for identified data points from abnormal imaging to surgery. No evidence-based practice standards exist for access to breast cancer care. Practice guidelines that include benchmarks for quality measures and an established process to measure patient outcomes would promote high-quality care. An understanding of how practice sites function also would help healthcare providers identify and develop resources to improve patient outcomes. In the current study, the advanced practice nurse (APN) in the practice setting was identified as a key point person in facilitating patients' timely access to healthcare services. The physician and APN practice model was instrumental in influencing the process. The results of the current study provided clinical data to identify benchmarks that a breast oncology practice can use to monitor timeliness as a quality indicator.

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Patient and physician perceptions of timely access to care

Abstract: BACKGROUND: Timeliness of care is 1 of 6 dimensions of quality identified in Crossing the Quality Chasm. We compared patient and physician perceptions of appropriate timing of visits for common medical problems.

Cited by 16 publications

References 7 publications

Medical appropriateness of adult calls to Danish out-of-hours primary care: a questionnaire-based survey

Medical appropriateness of adult calls to Danish out-of-hours primary care: a questionnaire-based survey

Access and care issues in urban urgent care clinic patients

Timeliness in Breast Cancer Care as an Indicator of Quality

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