title: Increasing access to care and reducing mistrust: important considerations when implementing the patient-centered medical home in army health clinics.
abstract: OBJECTIVE
  To determine which individual characteristics (religious participation, mistrust, racism/discrimination, spirituality, perceived access to care, and continuity of care) were predictors of patient outcomes (patient satisfaction, physical health, and mental health status) for an Army health care clinic transitioning to the Patient-Centered Medical Home (PCMH).
  
  
  METHODS
  A descriptive, correlational design using stepwise multivariate regression analyses to assess the effect of individual characteristics on patient outcomes for 200 Army Soldiers and family members receiving health care services.
  
  
  RESULTS
  Perceived access to care was positively and mistrust was negatively related to patient satisfaction (p < 0.001 for both variables). Participants who reported more support from God and more mistrust also reported poorer physical health status (p < 0.008 and p < 0.003, respectively). Perceived access to care was the only individual characteristic that showed a significant (p < 0.019) positive association with a better mental health status.
  
  
  CONCLUSIONS
  This study suggests that better access to care improves patient satisfaction and mental health status; however, those with higher levels of mistrust tend to have lower patient satisfaction and poorer health. Participants with poorer health also tend to rely on more support from God. These important individual characteristics should be the considered when implementing the PCMH.
authors.affiliation: Center for Nursing Science & Clinical Inquiry, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
authors.forename: Angelo D
authors.initials: AD
authors.lastname: Moore
authors.forename: Jill B
authors.initials: JB
authors.lastname: Hamilton
authors.forename: Bosny J
authors.initials: BJ
authors.lastname: Pierre-Louis
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Jennings
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000639:trends*; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult