The Effects of Telephone Visits and Rurality on Veterans Perceptions of Access to Primary Care

Abstract

The objectives of this study were to examine if self-reported access to primary care is associated with actual patient wait times and use of telephone visits, and to assess whether this relationship differs by rural residence. Methods: This study used 2016 administrative data from 994 primary care clinics within the Veterans Health Administration. Multiple-linear regression was used to examine relationships between patient perceptions of access and average actual patient wait time, use of telephone visits, and rural residence. Average panel size, clinic type, and panel severity were included as model covariates with cross-product terms for actual wait time, telephone use, and rurality to test for interactions. Results: This study found patient perceptions of access aggregated at the clinic level to be conditional on the relationship between use of telephone visits, actual patient wait times, and rural residence. As actual wait time for routine appointments increases, Veterans served by clinics with a higher percent of rural Veterans perceive telephone visits more positively. Discussion: These findings contribute to our understanding of factors associated with patient perceptions of access by highlighting complex interrelationships between strategies intended to improve access to care and how they can have differing impacts on perceptions among those living in rural or urban locations.

Patient Aligned Care Team (PACT) Performance in Urban and Rural VHA Primary Care Clinics: A Mixed Methods Study

“…Patient perceptions regarding the use of nontraditional encounters, such as telephone visits, may differ depending on other access‐related factors such as clinic wait time. A previous study found that veterans served by rural clinics with higher wait times perceived the use of telephone visits more positively in terms of creating access to routine care compared to veterans served by urban clinics 33 . Providing care that addresses the unique needs of patients while incorporating their personal preferences is central to the PCMH model.…”

Associations Between Primary Care Providers and Staff-Reported Access Management Challenges and Patient Perceptions of Access

“…1 , 2 Access is foundational to building patient trust with providers, obtaining preventive care; conversely, poorer outcomes are associated with delayed or missed care. 3 Earlier studies have focused on patient-level correlates of access 4 – 9 and clinic-level interventions intended to improve patients’ access to care such as advanced access 10 – 12 or patient-centered medical homes. 13 – 15 Nonetheless, primary care clinic leaders face ongoing challenges to ensuring timely access to needed care given varied resources, challenges, and local contexts.…”