Phone Communication and Care Coordination Associated with Access to Needed Care as Reported by Women Veterans
BACKGROUND:
Improving access to care is one of the central goals of the patient-centered medical home (PCMH) model. In 2010, VA implemented a version of the PCMH called Patient Aligned Care Teams (PACTs), and recent implementation efforts have focused on tailoring PACT to better meet the needs of special patient populations, including women. Primary care teams can facilitate access to care by helping patients determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams. This study used a 2015 survey of 1,395 women Veterans to examine associations between key care team functions and patient-rated access to needed care (routine and urgent). The care team functions were: in-person communication (between patient and care team), phone communication (timely answers to health questions), and care coordination. Analyses controlled for sociodemographics, health status, care settings, and other experience of care measures.
FINDINGS:
- Overall, 74% of participants reported usually or always being able to see a provider for routine care, and 68% for urgent care. In addition, 62% of patients gave high ratings of care coordination, and 76% gave high ratings of in-person communication. Among women Veterans who called their provider with a healthcare question, 63% usually or always got an answer as soon as needed.
- In adjusted analyses, phone communication was strongly associated with better ratings of access to routine and urgent care (absolute increases of 25% and 33%, respectively). Care coordination was also associated with better ratings of access to routine and urgent care (absolute increases of 8% and 13%). Associations with in-person communication were not statistically significant.
IMPLICATIONS:
- Access, communication, and care coordination are interrelated. Approaches to improving access that increase reliance on non-VA providers may prove counter-productive if they compromise the team's ability to coordinate care, or diminish their role as a primary point of contact for patients.
LIMITATIONS:
- There are other important care team functions that this study's measures could not capture.
- This cross-sectional study cannot identify causal relationships between care team functions and access to needed care.
- The study did not examine community care directly.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (CRE 12-026), and Dr. Yano was supported by an HSR&D Senior Research Career Scientist Award. Mr. Brunner, Drs. Washington, Rose, Chanfreau-Coffinier, and Yano (Director), and Ms. Canelo are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA.
Brunner J, Chuang E, Washington D, Rose D, Chanfreau-Coffinier C, Darling J, Canelo I, and Yano E. Patient-Related Access to Needed Care: Patient-Centered Medical Home Principles Intertwined. Women’s Health Issues. Mar-Apr 2018;28(2):165-71.
