Mayo-Smith Michael, Radwin Laurel E, Abdulkerim Hassen, Mohr David C
Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Center for Primary Care, Harvard Medical School, Boston, MA, USA.
J Patient Exp. 2020 Dec;7(6):1203-1210. doi: 10.1177/2374373520968979. Epub 2020 Oct 27.
As access is the lowest rated dimension in surveys of outpatient experience, we sought to identify patient, practice, and provider factors associated with positive ratings of timeliness of primary care appointments. A cross-sectional study with multivariable, multilevel logistic regression was performed using survey responses from 236 695 individuals receiving care in the Veterans Health Administration (VA). Top box ratings (response of "always") for whether the patient reported receiving an appointment as soon as they needed in primary care for routine care and for care needed right away were the main outcomes. Independent variables capturing patient, practice, and provider factors were obtained from survey responses and VA databases. Degree of continuity with primary care provider and duration of relationship were strongly associated with higher ratings. Shorter primary care appointment wait times for both new and returning patients were associated with higher ratings. Independent wait times for mental health and specialty appointments had no effect. Older age, better self-reported physical and mental health, lower disease complexity, and rural residence were patient factors associated with higher ratings while gender, race, ethnicity, and education had little effect. Measures of continuity with primary care provider as well as appointment wait times have strong association with positive patient ratings of appointment timeliness. Patients treated in Veterans Affairs clinics may value continuity with their primary care provider over longer times. Initiatives to improve access could focus on improving continuity and ensuring efforts to improve access do not impact continuity.
由于在门诊患者体验调查中，就诊便利性是评分最低的维度，我们试图确定与初级保健预约及时性的积极评分相关的患者、诊所和医疗服务提供者因素。我们利用退伍军人健康管理局（VA）中236695名接受治疗的患者的调查回复，进行了一项包含多变量、多层次逻辑回归的横断面研究。主要结果是患者对于在初级保健中接受常规护理预约以及立即所需护理预约时是否“总是”能及时获得预约的顶格评分（回答“总是”）。从调查回复和VA数据库中获取了反映患者、诊所和医疗服务提供者因素的自变量。与初级保健提供者的连续性程度和医患关系时长与更高的评分密切相关。新患者和复诊患者的初级保健预约等待时间较短与更高的评分相关。心理健康和专科预约的独立等待时间没有影响。年龄较大、自我报告的身心健康状况较好、疾病复杂性较低以及居住在农村是与更高评分相关的患者因素，而性别、种族、民族和教育程度影响较小。与初级保健提供者的连续性措施以及预约等待时间与患者对预约及时性的积极评分密切相关。在退伍军人事务诊所接受治疗的患者可能更看重与初级保健提供者的长期连续性。改善就诊便利性的举措可以侧重于提高连续性，并确保改善就诊便利性的努力不会影响连续性。
