Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

Schuttner, Linnaea; Gunnink, Eric; Sylling, Philip; Taylor, Larry E.; Fihn, Stephan D.; Nelson, Karin M.

doi:10.1007/s11606-020-05668-7

Cited by 8 publications

(7 citation statements)

References 30 publications

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“…Other successful interventions we found were similar in that the pillars of the PMH model were addressed while ensuring the intervention was grounded in the specific culture of the community. For example, the Patient Aligned Care Team (PACT) implemented by the Veterans Health Administration in the United States is focused on providing flexible team-based care that meets the unique social and health needs of veterans (Schuttner et al, 2020). In the PACT model, health information technologies are also used to facilitate more virtual encounters and increase communication between providers, patients, and families.…”

Section: Resultsmentioning

confidence: 99%

“…While Canada has experimented with various solutions to alleviate issues associated with the PCP shortage and unattached patients, reforms are needed to address the organization of a primary care system within a community context (Schuttner et al, 2020). For a health care delivery model to be successful in delivering equitable access to all community members it serves, meaningful, multilevel interventions that are aligned with and mutually supportive of each other are needed.…”

Section: Discussionmentioning

confidence: 99%

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Connecting unattached patients to comprehensive primary care: a rapid review

Nabieva

McCutcheon

Liddy

2023

Prim Health Care Res Dev

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Introduction: Lack of access to primary care providers (PCPs) is a significant hurdle to receiving high-quality comprehensive health care and creates greater reliance on emergency departments and walk-in clinics. Methods: We conducted a rapid review and analysis of the literature that discusses approaches to increasing access to continuous care for patients with no PCP (‘unattached patients’). Results: Five distinct themes across 38 resources were identified: financial incentives for patients and providers, health care organization, policy intervention, virtual care and health information technology (HIT), and medical education. Approaches that increased attachment were primary care models that combined two or more of these and reflected the Patient’s Medical Home (PMH) model. Conclusions: Although there are individual initiatives that could allow for temporary relief, long-term and community-wide success lies in designing models of primary care that use multiple tools, meet the needs of the community, and are supported by regional, provincial, and national policies.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Connecting unattached patients to comprehensive primary care: a rapid review

Nabieva

McCutcheon

Liddy

2023

Prim Health Care Res Dev

View full text Add to dashboard Cite

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“…Turnover in primary care is costly, 21 and among MSAs, it has previously been linked to negative patient perceptions of access. 22 Given that PC MSAs are often the first employees that Veterans encounter during PC visits, their attrition could adversely impact patient experience by impeding the development of stable, lasting relationships with frontline healthcare staff.…”

Section: Discussionmentioning

confidence: 99%

The Unrecognized Role of VA Call Center and Primary Care Clerical Staff in Assisting Patients with Obtaining Needed Care

et al. 2021

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Background VA clerks, or medical support assistants (MSAs), are a critical part of patients’ primary care (PC) experiences and are often the first points of contact between Veterans and the healthcare system. Despite the important role they might play in assisting Veterans with accessing care, research is lacking on the specific tasks they perform and what training and preparation they receive to perform their roles. Objective Our primary aim in this study was to document MSA perceptions of their roles, the tasks they undertake helping Veterans with accessing healthcare, and additional training they may need to optimally perform their role. Design Thematic analysis of semi-structured qualitative interviews with VA call center and PC MSAs (n=29) collected as part of in-person site visits from August to October 2019. Participants MSAs at administrative call centers and primary care clinics in one large VA regional network representing 8 healthcare systems serving nearly 1.5 million Veterans. Key Results We identified three key findings from the interviews: (1) MSAs perform tasks in addition to scheduling that help Veterans obtain needed care; (2) MSAs may not be fully prepared for their roles as first points of contact; and (3) low status and lack of recognition of the important and complex tasks performed by MSAs contribute to high turnover. Conclusions As healthcare systems continue expanding virtual access, the roles of administrative call center and PC MSAs as first points of contact will be increasingly important for shaping patient experiences. Our research suggests that MSAs may need better training and preparation for the roles they perform assisting Veterans with accessing care, coupled with an intentional approach by healthcare systems to address MSAs’ concerns about recognition/compensation. Future research should explore the potential for enhanced MSA customer service training to improve the Veteran patient experience.

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“…Patient-rated access was based on the percentage of patients that responded “Always” to the following question from the Consumer Assessment of Health Plans (CAHPS)– Patient Centered Medical Home items included in 2016 VA Survey of Healthcare Experiences of Patients (SHEP): “In the last 6 months, when you contacted this provider’s office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?” SHEP CAHPS is administered monthly to a stratified random sample of patients with an outpatient visit at a VA clinic; sampling weights adjust for proportionate population representation and survey non-response by age, gender, and site size. 17 In 2016, the overall response rate was 41%. Sites were considered as having high patient-reported access if they were ≥90 th percentile on this measure ( n =18) and low patient-rated access if ≤25 th percentile ( n =8).…”

Section: Methodsmentioning

confidence: 99%

Telephone Access Management in Primary Care: Cross-Case Analysis of High-Performing Primary Care Access Sites

et al. 2022

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Background Primary care telephone access has been associated with patient satisfaction and emergency department utilization even after accounting for objective appointment wait times. However, relatively little is known about how to best structure and manage telephone access in primary care. Objective Assess how primary care telephone access is structured and managed and explore how variation in telephone management may affect primary care teams and patients. Design We used 2016 administrative and patient survey data to select six Veterans Administration medical centers (VAMCs) with above-average primary care access (time to third next available appointment) but variable patient-reported access, geographic region, and urbanicity. Semi-structured interviews were conducted August –October 2017. Participants Forty-three key stakeholders knowledgeable about primary care, telephone management, and operational priorities nationally and/or within each VAMC. Key Results Telephone access was organized and managed differently across sites. Regional call centers were perceived as more efficient but less flexible in tailoring processes to meet local needs. Patient preferences for speaking with their own care teams were cited as a reason to manage telephone access locally rather than regionally, particularly in rural sites. Sites with high patient-rated access described call center functions as well-integrated with primary care team workflow, while those with low patient-rated access perceived telephone management practices as negatively affecting primary care team workload. Call center understaffing was a major barrier to optimal telephone access in all six sites, though rural sites reported greater challenges with provider recruitment and retention. Conclusions In VA, efforts to improve telephone access have focused on centralizing call center operations but current call center performance metrics do not account for the extent to which call center functions are integrated with primary care workflows or may impact patient experience. Efforts to improve primary care access should carefully consider impact of telephone management practices on providers and patients.

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Components of the Patient-Centered Medical Home Associated with Perceived Access to Primary Care

Cited by 8 publications

References 30 publications

Connecting unattached patients to comprehensive primary care: a rapid review

Connecting unattached patients to comprehensive primary care: a rapid review

The Unrecognized Role of VA Call Center and Primary Care Clerical Staff in Assisting Patients with Obtaining Needed Care

Telephone Access Management in Primary Care: Cross-Case Analysis of High-Performing Primary Care Access Sites

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