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Research ArticleOriginal Research

Preventive Service Gains from First Contact Access in the Primary Care Home

Nancy Pandhi, Jennifer E. DeVoe, Jessica R. Schumacher, Christie Bartels, Carolyn T. Thorpe, Joshua M. Thorpe and Maureen A. Smith
The Journal of the American Board of Family Medicine July 2011, 24 (4) 351-359; DOI: https://doi.org/10.3122/jabfm.2011.04.100254
Nancy Pandhi
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Jennifer E. DeVoe
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Jessica R. Schumacher
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Christie Bartels
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Carolyn T. Thorpe
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Joshua M. Thorpe
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Maureen A. Smith
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Article Figures & Data

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    Table 1.

    Items from the 2004 to 2006 Wisconsin Longitudinal Study Used to Define Desirable First-Contact Accessibility

    Thinking about your own health care, how would you rate*:
        The convenience of location of the doctor's office?
        The hours when the doctor's office is open?
        Arrangements for making appointments for medical care by phone?
        The length of time spent waiting at the office to see the doctor?
        The length of time you wait between making an appointment for routine care and the day of your visit?
        The availability of medical information or advice by phone?
        The ease of seeing the doctor of your choice?
        The amount of time you have with doctors and staff during a visit?
    • * Responses on a scale of 1 to 5 (poor,fair, good, very good, excellent); a 4 or 5 on all items is needed to qualify.

    • View popup
    Table 2.

    Key Characteristics of 2003 to 2006 Respondents Overall and by First-Contact Accessibility Status (n = 5507)*

    Overall PopulationBy First-Contact Accessibility Status
    With First-Contact AccessibilityWithout First-Contact AccessibilityP
    First-contact accessibility status967 (18)4540 (82)
    Age (years).03
        0–59496 (9)71 (7)425 (9)
        60–642829 (51)479 (50)2350 (52)
        65–691677 (30)314 (32)1363 (30)
        ≥70505 (9)103 (11)402 (9)
    Sex.02
        Male2567 (47)417 (43)2150 (47)
        Female2940 (53)550 (57)2390 (53)
    Marital status.20
        Married4429 (80)790 (82)3639 (80)
        Separated or divorced470 (9)70 (7)400 (9)
        Widowed411 (7)79 (8)332 (7)
        Never married195 (4)28 (3)167 (4)
    Educational attainment.36
        <High school2963 (54)534 (56)2429 (54)
        Some college854 (16)133 (14)721 (16)
        College807 (15)149 (16)658 (15)
        Postgraduate831 (15)145 (15)686 (15)
    Total household income ($).13
        <30,0001015 (18)197 (20)818 (18)
        30,000–44,999935 (17)175 (18)760 (17)
        45,000–59,999823 (15)155 (16)668 (15)
        60,000–74,999715 (13)117 (12)598 (13)
        >75,0001781 (32)287 (30)1494 (33)
        Not provided238 (4)36 (4)202 (4)
    Health insurance.06
        Private3071 (56)503 (52)2568 (57)
        Medicare and other private1886 (34)352 (36)1534 (34)
        Medicare or other public550 (10)112 (12)438 (10)
    Chronic conditions (mean n [SD])†4.0 (2.5)3.8 (2.4)4.0 (2.5)<.01
    Self-rated health (mean [SD])‡3.7 (1.0)3.9 (1.0)3.7 (0.9)<.01
    • Sample consists of patients who have reported a continuity relationship with a Family Medicine or Internal Medicine Physician of at least 2 years.

    • All values are presented as n (%) unless otherwise indicated.

    • * First-contact accessibility status is defined as very good or excellent ratings for all of the following: convenience of doctor's location, hours of doctor's availability, phone appointment arrangements, office wait time, time between when appointment is made and visit, availability by phone of medical advice and information, ease of seeing doctor of choice, and amount of visit time spent with doctors and staff. The sample consists of patients who have reported a continuity relationship of at least 2 years with a family medicine or internal medicine physician. Because of rounding, percents may not add up to 100.

    • † The following 22 chronic conditions were measured in this count: asthma, bronchitis/emphysema, serious back trouble, circulation problems, kidney/bladder problems, ulcers, allergies, multiple sclerosis, high blood pressure, diabetes, cancer, coronary heart disease/myocardial infarction, stroke, arthritis, pain and stiffness in the joints, mental illness, chronic sinusitis, fibromyalgia, high cholesterol, irritable bowel syndrome, osteoporosis, and prostate problems.

    • ‡ Self-rated health was measured by respondents on a scale of 1 to 5 (poor, fair, good, very good, excellent).

    • View popup
    Table 3.

    Preventive Services Receipt for Those With Continuity of Care, Comparing Those With (N = 967) and Without (N = 4540) First-Contact Accessibility

    n/N (%)Unadjusted (OR [95% CI])Adjusted* (OR [95% CI])
    Cholesterol test
        With first-contact accessibility657/714 (92)1.29 (0.96–1.73)1.36 (1.01–1.82)
        Without first-contact accessibility3053/3395 (90)1.001.00
    Flu shot
        With first-contact accessibility646/948 (68)1.35 (1.16–1.57)1.36 (1.16–1.59)
        Without first-contact accessibility2731/4451 (61)1.001.00
    Prostate examination
        With first-contact accessibility327/391 (84)1.58 (1.19–2.11)1.62 (1.2–2.18)
        Without first-contact accessibility1519/1990 (76)1.001.00
    Mammogram
        With first-contact accessibility464/542 (86)1.24 (0.96–1.62)1.23 (0.94–1.61)
        Without first-contact accessibility1943/2349 (83)1.001.00
    • This sample consists of patients who have reported a continuity relationship of at least 2 years with a family medicine or internal medicine physician. Bolded values are significant at P < .05.

    • * Adjusted for age, household income, education, marital status, sex, insurance type, chronic conditions count, and self-rated health.

    • OR, odds ratio.

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The Journal of the American Board of Family Medicine: 24 (4)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 4
July-August 2011
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Preventive Service Gains from First Contact Access in the Primary Care Home
Nancy Pandhi, Jennifer E. DeVoe, Jessica R. Schumacher, Christie Bartels, Carolyn T. Thorpe, Joshua M. Thorpe, Maureen A. Smith
The Journal of the American Board of Family Medicine Jul 2011, 24 (4) 351-359; DOI: 10.3122/jabfm.2011.04.100254

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Preventive Service Gains from First Contact Access in the Primary Care Home
Nancy Pandhi, Jennifer E. DeVoe, Jessica R. Schumacher, Christie Bartels, Carolyn T. Thorpe, Joshua M. Thorpe, Maureen A. Smith
The Journal of the American Board of Family Medicine Jul 2011, 24 (4) 351-359; DOI: 10.3122/jabfm.2011.04.100254
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