Number of first-contact access components required to improve preventive service receipt in primary care homes

Abstract

Background: A fundamental aim of primary care redesign and the patient-centered medical home is improving access to care. Patients who report having a usual site of care and usual provider are more likely to receive preventive services, but less is known about the influence of specific components of first-contact access (e.g., availability of appointments, advice by telephone) on preventive services receipt.

Objective: To examine the relationship between number of first-contact access components and receipt of recommended preventive services.

Design: Secondary survey data analysis.

Participants: Five thousand five hundred and seven insured adults who had continuity with a usual primary care physician and participated in the 2003-2006 round of the Wisconsin Longitudinal Survey.

Main measures: Using multivariable logistic regression, we calculated adjusted risk ratios, adjusted predicted probabilities and 95% confidence intervals for each preventive service.

Key results: Experiencing more first-contact access components was significantly associated with a higher rate of receiving cholesterol tests, flu shots and prostate exams but not mammography. There was variation in the number of components needed (between two and seven) to achieve a significant difference.

Conclusions: Having an increasing number of first-access components in a primary care office may improve preventive services receipt, and more components may be required for those services requiring greater provider contact (e.g., prostate exam) versus those that require less (e.g., mammography). In primary care redesign, the largest gains in preventive services receipt likely will come with redesign of multiple components simultaneously. While our study is a necessary step towards broadly understanding the relationship between first-contact access and preventive service receipt, other important questions remain. Certain components may drive greater improvements in the receipt of different services, and the effect of some of these components may depend on individual patient characteristics. Further research is critical for understanding redesign strategies that may optimize preventive service delivery.

Figure 1.

Percent of participants receiving 0–8 first-contact access components^{* *} First-contact access components defined as very good or excellent ratings on the following: convenience of doctor’s location, hours of doctor’s availability, phone appointment arrangements, office wait time, time between making appointment and visit, medical advice and information availability by phone, ease of seeing doctor of choice, and amount of visit time spent with doctors and staff