Background: Direct Primary Care (DPC) offers an alternative healthcare delivery model with potential benefits for patient-centered care. However, concerns remain about its equity and accessibility, particularly in urban settings. This study examines the utilization patterns and patient engagement within a DPC clinic in Houston, Texas, and whether subscription duration impacts patient-provider interactions in an urban healthcare environment.
Methods: Deidentified data from a Houston-based DPC clinic (January 2023-January 2024) were analyzed. Patient demographics, subscription details, and interaction data (including in-person appointments and audio-visual calls) were collected. Descriptive statistics summarized utilization patterns, while logistic regression models assessed relationships between demographic factors and DPC utilization.
Results: The sample included 71% Non-Hispanic Black patients, 21% Non-Hispanic White, and 77% females. Most patients resided in urban areas (79%) and paid over $125 monthly (44%). Subscription duration positively correlated with engagement: patients subscribed for ≥21 months had higher yearly averages for chart interactions and appointments compared to those who subscribed for ≤5 months. Regression analysis revealed significant dose-response increases in patient engagement among those with longer subscription durations across all interaction types. No other demographic characteristics were significant predictors of DPC utilization.
Conclusion: Subscription duration strongly influences DPC utilization, suggesting sustained enrollment fosters deeper patient engagement and more frequent provider interactions. While DPC may enhance patient-provider relationships, cost and urban-centric accessibility may pose barriers to equity.
Keywords: access to primary care; concierge medicine; facilities and services utilization; health disparities; health equity; primary health care.