Entry into primary care and continuity: the effects of access.
OBJECTIVE
This study examined the relationship between access and use of primary care physicians as sources of first contact and continuity with the medical system.


METHODS
Data from the 1987 National Medical expenditure Survey were used to examine the effects of access on use of primary care physicians as sources of first contact for new episodes of care (by logistic regression) and as sources of continuity for all ambulatory visits (by multi-variate linear regression).


RESULTS
No after-hours care, longer office waits, and longer travel times reduced the chances of a first-contact visit with a primary care physician for acute health problems. Longer appointment waits, no insurance, and no after-hours care were associated with lower levels of continuity. Generalists provided more first-contact care than specialists acting as primary care physicians, largely because of their more accessible practices.


CONCLUSIONS
These data provide support for the linkage between access and care seeking with primary care physicians.
Forrest
C B
CB
Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Md 21205, USA. cforrest@hsr.hsph.edu
Starfield
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States