Number of First-Contact Access Components Required to Improve Preventive Service Receipt in Primary Care Homes
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
To examine the relationship between number of first-contact access components and receipt of recommended preventive services.
Secondary survey data analysis.
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.
Using multivariable logistic regression, we calculated adjusted risk ratios, adjusted predicted probabilities and 95% confidence intervals for each preventive service.
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.
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.
- Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: Institute of Medicine; 1993.
- Blewett LA, Johnson PJ, Lee B, Scal PB. When a usual source of care and usual provider matter: adult prevention and screening services. J Gen Intern Med. 2008;23:1354–1360. CrossRef
- Xu KT. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res. 2002;37:1509–1529. CrossRef
- Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med. 2005;3:159–166. CrossRef
- U.S. Preventive Services Task Force. Summaries for patients. Screening for depression in adults: U.S. preventive services task force recommendations. Ann Intern Med. 2009;151–I56.
- Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis JAMA. 1995;273:149–154.
- Simonsen L, Reichert TA, Viboud C, Blackwelder WC, Taylor RJ, Miller MA. Impact of influenza vaccination on seasonal mortality in the US elderly population. Arch Intern Med. 2005;165:265–272. CrossRef
- Fireman B, Lee J, Lewis N, Bembom O, van der Laan M, Baxter R. Influenza vaccination and mortality: differentiating vaccine effects from bias. Am J Epidemiol. 2009;170:650–656. CrossRef
- Lewington S, Whitlock G, Clarke R, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. 2007;370:1829–1839. CrossRef
- Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the U.S. by improvements in use of clinical preventive services. Am J Prev Med. 2010;38:600–609. CrossRef
- Forrest CB, Starfield B. The effect of first-contact care with primary care clinicians on ambulatory health care expenditures. J Fam Pract. 1996;43:40–48.
- Stange KC, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25:601–612. CrossRef
- Bindman AB, Grumbach K, Osmond D, Vranizan K, Stewart AL. Primary care and receipt of preventive services. J Gen Intern Med. 1996;11:269–276. CrossRef
- DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: Insurance status and usual source of care. Am J Public Health. 2003;93:786–791. CrossRef
- Hauser RM, Sewell WH, Logan JA, et al. The Wisconsin Longitudinal Study: Adults as Parents and Children at Age 50. IASSIST Q. 1992;16:23–38.
- American Cancer Society. American Cancer Society guidelines for the early detection of cancer. 5 March 2008. Available at: http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp. Accessed 12 March 2008.
- National Cholesterol Education Program. Detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Bethesda: National Institutes of Health, National Heart, Lung, and Blood Institute; 2002.
- Bridges CB, Harper SA, Fukuda K, Uyeki TM, Cox NJ, Singleton JA. Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2003;52(RR-8):1–36.
- Agency for Healthcare Research and Quality. The pocket guide to clinical preventive services 2005. Rockville, MD: Agency for Healthcare Research and Quality; 2005.
- Davies AR, Ware JE. GHAA’s consumer satisfaction survey and user’s manual. 2nd ed. Washington, D.C.: Group Health Association of America; 1991.
- StataCorp. Stata Statistical Software. 11.1 ed. College Station, TX: StataCorp LP; 2009.
- Kleinman LC, Norton EC. What’s the Risk? A simple approach for estimating adjusted risk measures from nonlinear models including logistic regression. Health Serv Res. 2009;44:288–302. CrossRef
- Suter LG, Elmore JG. Self-referral for screening mammography. J Gen Intern Med. 1998;13:710–713. CrossRef
- O’Malley AS, Mandelblatt J, Gold K, Cagney KA, Kerner J. Continuity of care and the use of breast and cervical cancer screening services in a multiethnic community. Arch Intern Med. 1997;157:1462–1470. CrossRef
- Corbie-Smith G, Flagg EW, Doyle JP, O’Brien MA. Influence of usual source of care on differences by race/ethnicity in receipt of preventive services. J Gen Intern Med. 2002;17:458–464. CrossRef
- Beal AC, Doty MM, Hernandez MM, Shea KK, Davis K. Closing the divide: How medical homes promote equity in health care: Results from The Commonwealth Fund 2006 Health Care Quality Survey. Washington, D.C.: The Commonwealth Fund; 2007.
- NCQA. Standards and Guidelines for Physician Practice Connections®—Patient-Centered Medical Home (PPC-PCMH™). Washington, D.C.: National Committee for Quality Assurance; 2008.
- Fiscella K, Shin P. The inverse care law: implications for healthcare of vulnerable populations. J Ambul Care Manage. 2005;28:304–312.
- Thorpe JM, Thorpe CT, Kennelty KA, Pandhi N. Patterns of perceived barriers to medical care in older adults: a latent class analysis. BMC Health Serv Res. 2011;11:181. CrossRef
- Ajzen I. Nature and operation of attitudes. Annu Rev Psychol. 2001;52:27–58. CrossRef
- Cooke R, French D. How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? A meta-analysis. Psychol Heal. 2008;23:745–765. CrossRef
- Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9:208–220.
- Fontana SA, Baumann LC, Helberg C, Love RR. The delivery of preventive services in primary care practices according to chronic disease status. Am J Public Health. 1997;87:1190–1196. CrossRef
- U.S. Bureau of the Census. Educational Attainment in the United States: March 2000. Series P-20, No. 536. Washington, D.C.: Government Printing Office; 2000.
- Fiscella K, Holt K, Meldrum S, Franks P. Disparities in preventive procedures: comparisons of self-report and Medicare claims data. BMC Health Serv Res. 2006;6:122. CrossRef
- Singleton JA, Poel AJ, Lu PJ, Nichol KL, Iwane MK. Where adults reported receiving influenza vaccination in the United States. Am J Infect Control. 2005;33:563–570. CrossRef
- Westrick SC, Watcharadamrongkun S, Mount JK, Breland ML. Community pharmacy involvement in vaccine distribution and administration. Vaccine. 2009;27:2858–2863. CrossRef
- Number of First-Contact Access Components Required to Improve Preventive Service Receipt in Primary Care Homes
Journal of General Internal Medicine
Volume 27, Issue 6 , pp 677-684
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- patient-centered medical home
- preventive medicine
- access to care
- continuity of care
- primary care
- health care utilization
- Industry Sectors
- Author Affiliations
- 1. Department of Family Medicine, University of Wisconsin, Madison, Wisconsin, 53715, USA
- 2. Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, 53726, USA
- 8. Health Innovation Program, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53792, USA
- 3. Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, 97239, USA
- 4. Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, 32610, USA
- 5. Department of Medicine, Rheumatology Section, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705, USA
- 6. Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, 15206, USA
- 7. Department of Pharmacy & Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261, USA
- 9. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53792, USA