Journal of General Internal Medicine

, Volume 27, Issue 6, pp 677–684 | Cite as

Number of First-Contact Access Components Required to Improve Preventive Service Receipt in Primary Care Homes

  • Nancy Pandhi
  • Jennifer E. DeVoe
  • Jessica R. Schumacher
  • Christie Bartels
  • Carolyn T. Thorpe
  • Joshua M. Thorpe
  • Maureen A. Smith
Original Research



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.


patient-centered medical home preventive medicine access to care continuity of care primary care health care utilization aging 





This project was supported by the Health Innovation Program and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR) funded through an NIH Clinical and Translational Science Award (CTSA), grant number 1 UL1 RR025011. In addition, Nancy Pandhi is supported by a National Institute on Aging Mentored Clinical Scientist Research Career Development Award, grant number l K08 AG029527. Dr. DeVoe’s time on this project was supported by grant number K08 HS16181 from the Agency for Healthcare Research and Quality (AHRQ). This project was also supported by the University of Wisconsin Carbone Cancer Center (UWCCC) Support Grant from the National Cancer Institute, grant number P30 CA014520. Additional support was provided by the UW School of Medicine and Public Health from the Wisconsin Partnership Program. This research uses data from the Wisconsin Longitudinal Study of the University of Wisconsin-Madison. Since 1991, the WLS has been supported principally by the National Institute on Aging (R01 AG09775, R01 AG033285), with additional support from the Vilas Estate Trust, the National Science Foundation, the Spencer Foundation, and the Graduate School of the University of Wisconsin-Madison. A public use file of data from the Wisconsin Longitudinal Study is available from the Wisconsin Longitudinal Study, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, Wisconsin, 53706 and at The view expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Prior presentations


Conflicts of interest

None disclosed.


  1. 1.
    Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: Institute of Medicine; 1993.Google Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    Xu KT. Usual source of care in preventive service use: a regular doctor versus a regular site. Health Serv Res. 2002;37:1509–1529.PubMedCrossRefGoogle Scholar
  4. 4.
    Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med. 2005;3:159–166.PubMedCrossRefGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis JAMA. 1995;273:149–154.Google Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedGoogle Scholar
  12. 12.
    Stange KC, Nutting PA, Miller WL, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25:601–612.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    American Cancer Society. American Cancer Society guidelines for the early detection of cancer. 5 March 2008. Available at: Accessed 12 March 2008.
  17. 17.
    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.Google Scholar
  18. 18.
    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.Google Scholar
  19. 19.
    Agency for Healthcare Research and Quality. The pocket guide to clinical preventive services 2005. Rockville, MD: Agency for Healthcare Research and Quality; 2005.Google Scholar
  20. 20.
    Davies AR, Ware JE. GHAA’s consumer satisfaction survey and user’s manual. 2nd ed. Washington, D.C.: Group Health Association of America; 1991.Google Scholar
  21. 21.
    StataCorp. Stata Statistical Software. 11.1 ed. College Station, TX: StataCorp LP; 2009.Google Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Suter LG, Elmore JG. Self-referral for screening mammography. J Gen Intern Med. 1998;13:710–713.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    NCQA. Standards and Guidelines for Physician Practice Connections®—Patient-Centered Medical Home (PPC-PCMH™). Washington, D.C.: National Committee for Quality Assurance; 2008.Google Scholar
  28. 28.
    Fiscella K, Shin P. The inverse care law: implications for healthcare of vulnerable populations. J Ambul Care Manage. 2005;28:304–312.PubMedGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    Ajzen I. Nature and operation of attitudes. Annu Rev Psychol. 2001;52:27–58.PubMedCrossRefGoogle Scholar
  31. 31.
    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.CrossRefGoogle Scholar
  32. 32.
    Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9:208–220.PubMedGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.Google Scholar
  35. 35.
    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.PubMedCrossRefGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    Westrick SC, Watcharadamrongkun S, Mount JK, Breland ML. Community pharmacy involvement in vaccine distribution and administration. Vaccine. 2009;27:2858–2863.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Nancy Pandhi
    • 1
    • 2
    • 8
  • Jennifer E. DeVoe
    • 3
  • Jessica R. Schumacher
    • 4
    • 8
  • Christie Bartels
    • 5
    • 8
  • Carolyn T. Thorpe
    • 6
    • 7
    • 8
  • Joshua M. Thorpe
    • 6
    • 7
    • 8
  • Maureen A. Smith
    • 1
    • 2
    • 8
    • 9
  1. 1.Department of Family MedicineUniversity of WisconsinMadisonUSA
  2. 2.Department of Population Health SciencesUniversity of WisconsinMadisonUSA
  3. 3.Department of Family MedicineOregon Health & Science UniversityPortlandUSA
  4. 4.Department of Health Services Research, Management and PolicyUniversity of FloridaGainesvilleUSA
  5. 5.Department of Medicine, Rheumatology SectionUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  6. 6.Health Services Research and DevelopmentVeterans Affairs Pittsburgh Healthcare SystemPittsburghUSA
  7. 7.Department of Pharmacy & Therapeutics, School of PharmacyUniversity of PittsburghPittsburghUSA
  8. 8.Health Innovation Program, Department of Population Health SciencesUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  9. 9.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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