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

Humans United States Primary Health Care Cross-Sectional Studies Patient-Centered Care Health Services Accessibility Veterans United States Department of Veterans Affairs
access to care primary care veterans

Journal

Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834

Informations de publication

Date de publication:
10 2023
Historique:
received: 20 06 2022
accepted: 13 03 2023
medline: 27 10 2023
pubmed: 3 8 2023
entrez: 2 8 2023
Statut: ppublish

Résumé

Optimizing patients' access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes. Study design: Cross sectional. National Primary Care Personnel Survey (NPCPS) (2018) participants included 6210 primary care providers (PCPs) and staff in 813 clinics (19% response rate) and 158,645 of their patients. We linked PCP and staff ratings of access management challenges to veterans' perceived access from 2018-2019 Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (SHEP-PCMH) surveys (35.6% response rate). The NPCPS queried PCPs and staff about access management challenges. The mean overall access challenge score was 28.6, SD 6.0. The SHEP-PCMH access composite asked how often veterans reported always obtaining urgent appointments same/next day; routine appointments when desired and having medical questions answered during office hours. We aggregated PCP and staff responses to clinic level, and use multi-level, multivariate logistic regressions to assess associations between clinic-level access management challenges and patient perceptions of access. We controlled for veteran-, facility-, and area-level characteristics. Veterans at clinics with more access management challenges (> 75 Findings show a strong relationship between higher levels of access management challenges and worse patient perceptions of access. Addressing access management challenges, particularly those associated with call center communication, may be an actionable path for improved patient experience.

Sections du résumé

BACKGROUND/OBJECTIVE
Optimizing patients' access to primary care is critically important but challenging. In a national survey, we asked primary care providers and staff to rate specific care processes as access management challenges and assessed whether clinics with more of these challenges had worse access outcomes.
METHODS
Study design: Cross sectional. National Primary Care Personnel Survey (NPCPS) (2018) participants included 6210 primary care providers (PCPs) and staff in 813 clinics (19% response rate) and 158,645 of their patients. We linked PCP and staff ratings of access management challenges to veterans' perceived access from 2018-2019 Survey of Healthcare Experiences of Patients-Patient Centered Medical Home (SHEP-PCMH) surveys (35.6% response rate).
MAIN MEASURES
The NPCPS queried PCPs and staff about access management challenges. The mean overall access challenge score was 28.6, SD 6.0. The SHEP-PCMH access composite asked how often veterans reported always obtaining urgent appointments same/next day; routine appointments when desired and having medical questions answered during office hours.
ANALYTIC APPROACH
We aggregated PCP and staff responses to clinic level, and use multi-level, multivariate logistic regressions to assess associations between clinic-level access management challenges and patient perceptions of access. We controlled for veteran-, facility-, and area-level characteristics.
KEY RESULTS
Veterans at clinics with more access management challenges (> 75
DISCUSSION/CONCLUSION
Findings show a strong relationship between higher levels of access management challenges and worse patient perceptions of access. Addressing access management challenges, particularly those associated with call center communication, may be an actionable path for improved patient experience.

Identifiants

DOI: 10.1007/s11606-023-08172-w PMID: 37532877 PMC: PMC10593665
pubmed: 37532877
doi: 10.1007/s11606-023-08172-w
pii: 10.1007/s11606-023-08172-w
pmc: PMC10593665
doi:

Types de publication

Journal Article Research Support, U.S. Gov't, Non-P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

2870-2878

Subventions

Organisme : Office of Patient Care Services, Department of Veterans Affairs
ID : XVA 65-018
Organisme : Health Services Research and Development
ID : RCS 05-195
Organisme : U.S. Department of Veterans Affairs
ID : #IK2 HX002867

Informations de copyright

© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

Références

J Fam Pract. 2003 Mar;52(3):222-7
pubmed: 12620177
Med Care. 2018 Jun;56(6):491-496
pubmed: 29683867
J Gen Intern Med. 2017 Nov;32(11):1202-1209
pubmed: 28808852
J Gen Intern Med. 2020 Jun;35(6):1736-1742
pubmed: 31993947
Int J Health Serv. 2005;35(2):313-23
pubmed: 15932009
J Ambul Care Manage. 2022 Jul-Sep 01;45(3):171-181
pubmed: 35612388
J Gen Intern Med. 2011 Nov;26 Suppl 2:639-47
pubmed: 21989616
J Gen Intern Med. 2022 Jun;37(8):1963-1969
pubmed: 35106718
Med Care. 2018 Oct;56(10):815-817
pubmed: 30113424
Med Care. 2019 Oct;57 Suppl 10 Suppl 3:S213-S220
pubmed: 31517790
J Ambul Care Manage. 2022 Oct-Dec 01;45(4):321-331
pubmed: 35943358
Health Serv Res. 2007 Jun;42(3 Pt 1):1130-49
pubmed: 17489907
J Gen Intern Med. 2022 Feb;37(2):390-396
pubmed: 34109542
Womens Health Issues. 2022 Nov-Dec;32(6):623-632
pubmed: 36115812
Fam Pract Manag. 2000 Sep;7(8):45-50
pubmed: 11183460
BMJ Open Qual. 2021 Oct;10(4):
pubmed: 34649853
Womens Health Issues. 2014 Nov-Dec;24(6):605-12
pubmed: 25442706
BMC Health Serv Res. 2021 Aug 13;21(1):809
pubmed: 34384398
J Ambul Care Manage. 2021 Apr-Jun 01;44(2):126-137
pubmed: 33394816
J Healthc Manag. 2020 May-Jun;65(3):171-184
pubmed: 32398527
Ann Fam Med. 2013 May-Jun;11 Suppl 1:S82-9
pubmed: 23690391
Fam Pract. 2012 Oct;29(5):547-52
pubmed: 22327415
J Health Commun. 2016;21 Suppl 1:43-50
pubmed: 27043757
JAMA Intern Med. 2014 Aug;174(8):1350-8
pubmed: 25055197
Med Care. 2015 Dec;53(12):1040-9
pubmed: 26569643
J Gen Intern Med. 2020 Feb;35(2):523-530
pubmed: 31728895
Healthc (Amst). 2020 Sep;8(3):100451
pubmed: 32919589
Int J Equity Health. 2013 Mar 11;12:18
pubmed: 23496984
Eval Health Prof. 2005 Dec;28(4):414-27
pubmed: 16272423
BMC Health Serv Res. 2022 May 16;22(1):658
pubmed: 35578226
BMJ Open Qual. 2020 Apr;9(2):
pubmed: 32241765
J Gen Intern Med. 2014 Jul;29 Suppl 2:S555-62
pubmed: 24715394
Health Econ. 2022 Jul;31(7):1296-1316
pubmed: 35383414
Jt Comm J Qual Saf. 2004 Aug;30(8):415-23
pubmed: 15357131
J Am Board Fam Med. 2019 Sep-Oct;32(5):749-751
pubmed: 31506372
Womens Health Issues. 2011 Jul-Aug;21(4 Suppl):S112-9
pubmed: 21724130
Ann Intern Med. 2008 Jun 17;148(12):915-22
pubmed: 18559842

Auteurs

Danielle E Rose (DE)

VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. Danielle.Rose@va.gov.
ORCID: 0000-0001-6797-2611

Lucinda B Leung (LB)

VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

Michael McClean (M)

VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

Karin M Nelson (KM)

VA Puget Sound Healthcare System, Seattle, WA, USA.
University of Washington School of Medicine, Seattle, WA, USA.

Idamay Curtis (I)

VA Puget Sound Healthcare System, Seattle, WA, USA.

Elizabeth M Yano (EM)

VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Fielding School of Public Health, UCLA, Los Angeles, CA, USA.

Lisa V Rubenstein (LV)

Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Fielding School of Public Health, UCLA, Los Angeles, CA, USA.
RAND Corporation, Santa Monica, CA, USA.

Susan E Stockdale (SE)

VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA.

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questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Soins centrés sur le patient › Associations Between Primary Care Providers...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Accessibilité des services de santé › Associations Between Primary Care Providers...
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questionsmedicales.fr › Organisations et économie des soins de santé › Organismes › Gouvernement › Agences gouvernementale américaines › Department of Veterans Affairs (USA) › Associations Between Primary Care Providers...