HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Sepulveda, California; Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
Womens Health Issues. 2018 Mar-Apr;28(2):165-171. doi: 10.1016/j.whi.2017.12.001. Epub 2018 Jan 12.
Primary care teams can facilitate access to care by helping patients to 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.
We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures.
Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65-6.98) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01-2.74) and urgent care (OR, 2.26; 95% CI, 1.23-4.18). Associations with in-person communication were not significant.
Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients.
初级保健团队可以通过帮助患者确定是否需要以及何时需要护理，并协调多名临床医生和多个环境中的护理，从而促进患者获得护理。预约可用性指标可能会或可能不会捕捉到这些贡献，但患者对自身获得护理的评价提供了一种重要的替代方法，这种方法可能与护理团队的这些关键功能更密切相关。
我们使用了 2015 年对 1395 名女性退伍军人的电话调查，研究了关键护理团队功能与患者对所需护理的获得评价之间的关联。护理团队功能包括护理协调、医患之间的当面沟通和（患者向医疗团队）电话沟通（及时回答健康问题）。我们控制了社会人口统计学、健康状况、护理环境和其他护理体验措施。
总体而言，74%的参与者报告说，他们总是或通常能够获得常规护理的医疗服务，68%的参与者能够获得紧急护理服务。在调整后的分析中，电话沟通与更好的常规护理（优势比 [OR]，4.31；95%CI，2.65-6.98）和紧急护理（OR，2.26；95%CI，1.23-4.18）获得评价相关。护理协调也与更好的常规护理（OR，1.66；95%CI，1.01-2.74）和紧急护理（OR，2.26；95%CI，1.23-4.18）获得评价相关。与当面沟通的关联则不显著。
获得、沟通和护理协调是相互关联的。如果改善获得的方法损害了团队协调护理的能力，或者削弱了团队作为患者主要联系人的作用，那么这种方法可能适得其反。
