title: Preventive service gains from first contact access in the primary care home.
abstract: BACKGROUND
  The patient-centered medical home (PCMH) concept recently has garnered national attention as a means of improving the quality of primary care. Preventive services are one area in which the use of a PCMH is hoped to achieve gains, though there has been limited exploration of PCMH characteristics that can assist with practice redesign. The purpose of this study was to examine whether first-contact access characteristics of a medical home (eg, availability of appointments or advice by telephone) confer additional benefit in the receipt of preventive services for individuals who already have a longitudinal relationship with a primary care physician at a site of care.
  
  
  METHODS
  This was a secondary analysis examining data from 5507 insured adults with a usual physician who participated in the 2003 to 2006 round of the Wisconsin Longitudinal Study. Using logistic regression, we calculated the odds of receiving each preventive service, comparing individuals who had first-contact access with those without first-contact access.
  
  
  RESULTS
  Eighteen percent of the sample received care with first-contact access. In multivariable analyses, after adjustment, individuals who had first-contact access had higher odds of having received a prostate examination (odds ratio [OR], 1.62; 95% CI, 1.20-2.18), a flu shot (OR, 1.36; 95% CI, 1.01-1.82), and a cholesterol test (OR, 1.36; 95% CI, 1.01-1.82) during the past year. There was no significant difference in receipt of mammograms (OR, 1.23; 95% CI, 0.94-1.61).
  
  
  CONCLUSIONS
  In the primary care home, first-contact accessibility adds benefit, beyond continuity of care with a physician, in improving receipt of preventive services. Amid increasing primary care demands and finite resources available to translate the PCMH into clinic settings, there is a need for further studies of the interplay between specific PCMH principles and how they perform in practice.
authors: Department of Family Medicine, University of Wisconsin, Madison, WI 53705, USA. nancy.pandhi@fammed.wisc.edu
authors: Nancy
authors: N
authors: Pandhi
authors: Jennifer E
authors: JE
authors: DeVoe
authors: Jessica R
authors: JR
authors: Schumacher
authors: Christie
authors: C
authors: Bartels
authors: Carolyn T
authors: CT
authors: Thorpe
authors: Joshua M
authors: JM
authors: Thorpe
authors: Maureen A
authors: MA
authors: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000032:analysis; D015331:Cohort Studies; D003266:Continuity of Patient Care; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007251:Influenza, Human / Q000517:prevention & control; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D014611:Vaccination / Q000706:statistics & numerical data; D014922:Wisconsin
chemical_list: D002784:Cholesterol