How Preferences for Continuity and Access Differ Between Multimorbidity and Healthy Patients in a Team Care Setting

Abstract

Introduction: Team-based care has become an essential part of modern medical practice. Patient-centered medical homes often struggle to balance the dual competing goals of acute access and continuity of care. Multimorbidity patients may value continuity more than healthy patients, and thus may prefer to wait to see their primary care physician (PCP). Methods: A total of 1700 randomly selected healthy adults and multimorbidity patients were asked to rate satisfaction with care and presented with 4 acute and 4 chronic scenarios to choose an access and continuity preference in an anonymous mailed survey. Results: In all, 770 responses were obtained. All respondents preferred to be seen 2.5 days sooner for acute appointments. Multimorbidity patients preferred to wait 0.28 days longer for acute issues to see their PCP. Patients who were not satisfied with their care team preferred to wait 0.75 days to see their PCP. Those not satisfied with their PCP choose to be seen 0.38 days sooner by their care team or any physician. Conclusions: All patients prefer continuity of care with their PCP for chronic disease management and value quick access to care for acute problems. For acute visits, multimorbidity patients prefer to wait longer to see their PCP than healthy adults. Satisfaction also plays an important role in patients’ willingness to wait for an appointment with their PCP.

Health-related preferences of older patients with multimorbidity: an evidence map

“…Twelve studies (8%) focused on preferences for certain healthcare services, and specifically (1) preferred care processes (10/12),45 135–143 such as continuity of care, accessibility and acceptance of the substitution of a physician by nurses and (2) service models (2/12),31 144 perhaps asking patients about their preferences regarding Chronic Care Model recommendations 31…”

Association between continuity and access in primary care: a retrospective cohort study

“…Other investigators have explored the relations between access and continuity of care, 16,25,38,39,45,[50][51][52][53][54][55][56][57][58][59][60] access and emergency department use, 16,[61][62][63][64][65][66][67][68][69][70][71][72] and continuity of care and emergency department use. 4,[12][13][14][15]63,73,74 Various algorithms have been used to develop virtual panels to associate patient to activity to specific physicians.…”

“…4,[12][13][14][15]63,73,74 Various algorithms have been used to develop virtual panels to associate patient to activity to specific physicians. 12,14,33,36,75 In the majority of these studies, access 25,38,[50][51][52][53]56,59,60,62,64,[67][68][69][70][71][72]75 and continuity of care and emergency department use 25,38,[50][51][52][53]56,59,60,62,64,[66][67][68][69][70][71][72]75 were inferred through self-report in patient surveys. Although these studies provide valuable insight into the topic area, using a standa...…”

Quantifying organization of care in a complex healthcare environment

“…Medical care has become more fragmented and specialized with an emphasis on convenience and care teams 2‐4 . Despite these amazing medical advances, patients with chronic diseases still desire a relationship with their physician 5‐7 …”