Practice Features Associated With Patient-Reported Accessibility, Continuity, and Coordination of Primary Health Care

Abstract

PURPOSE On the eve of major primary health care reforms, we conducted a multilevel survey of primary health care clinics to identify attributes of clinic organization and physician practice that predict accessibility, continuity, and coordination of care as experienced by patients.METHODS Primary health care clinics were selected by stratifi ed random sampling in urban, suburban, rural, and remote locations in Quebec, Canada. Up to 4 family or general physicians were selected in each clinic, and 20 patients seeing each physician used the Primary Care Assessment Tool to report on fi rst-contact accessibility (being able to obtain care promptly for sudden illness), relational continuity (having an ongoing relationship with a physician who knew their particulars), and coordination continuity (having coordination between their physician and specialists). Physicians reported on aspects of their practice, and secretaries and directors reported on organizational features of the clinic. We used hierarchical regression modeling on the subsample of regular patients at the clinic. RESULTSOne hundred clinics participated (61% response rate), for a total of 221 physicians and 2,725 regular patients (87% response and completion rate). Firstcontact accessibility was most problematic. Such accessibility was better in clinics with 10 or fewer physicians, a nurse, telephone access 24 hours a day and 7 days a week, operational agreements to facilitate care with other health care establishments, and evening walk-in services. Operational agreements and evening care also positively affected relational continuity. Physicians who valued continuity and felt attached to the community fostered better relational continuity, whereas an accessibility-oriented style (as indicated by a high proportion of walk-in care and high patient volume) hindered it. Coordination continuity was also associated with more operational agreements and continuous telephone access, and was better when physicians practiced part time in hospitals and performed a larger range of medical procedures in their offi ce. CONCLUSIONSThe way a clinic is organized allows physicians to achieve both accessibility and continuity rather than one or the other. Features that achieve both are offering care in the evenings and access to telephone advice, and having operational agreements with other health care establishments.

Avaliação da presença e extensão dos atributos da atenção primária em Curitiba

“…No presente estudo, em consonância com vários estudos nacionais que utilizaram o PCATool, o resultado foi divergente, apontando baixo escore médio. Este atributo também apresentou baixo escore em estudo internacional que utilizou a mesma metodologia e foi realizado por Haggerty et al 24 , com usuários e profissionais no Quebec. No seu estudo, Haggerty menciona que, em uma pesquisa nacional sobre acesso aos serviços de cuidados de saúde, 18,8% dos canadenses relataram ter dificuldades para acessar esses serviços para problemas de saúde agudos em 2001, e estes índices aumentaram para 24,2% em 2003.…”

Patient Experiences with Coordination of Care: The Benefit of Continuity and Primary Care Physician as Referral Source

“…7 A survey of PCPs and their patients identified continuous telephone access, the presence of agreements with other health care providers, and the performance of more services within the PC office as being associated with higher levels of coordination between PCPs and specialists. 22 To this prior work, we add the finding that coordination of care between PCP and specialists is much better, from the patient perspective, when the PCP is the referral source.…”

Challenges in Referral Communication Between VHA Primary Care and Specialty Care

“…8 An integrated delivery system is more likely to have an infrastructure of operational agreements already in place between primary and specialty services, an incentive structure that supports communication outside the office visit setting, and a sense of shared mission among providers. [13][14][15][16] The use of a single, shared EMR is cited in a number of studies as an effective means of conveying patients' complete medical histories from primary to specialty care, as well as communicating specialists' assessments back to primary care. 8,15,[17][18][19][20] EMRs can also be applied specifically to facilitate the referral process, one of the most common and important types of primary-specialty care communication.…”

“…21 The EMR alone, therefore, may not be "enough" to solve the problems in primary-specialty communication. 4,9,13,23 Little is known about referral communication between primary and specialty care in the VHA and similar healthcare systems that already benefit from an integrated delivery system and shared EMRs. More specifically, there is a lack of information about the nature of primary-specialty communication challenges, including potential specialty-dependent variability, as well as primary care provider (PCP) responses to these challenges.…”