title: How do patients respond when confronted with telephone access barriers to care?
abstract: OBJECTIVE
  To gain an in-depth understanding of patient barriers to accessing telephone care, subsequent responses to telephone access issues and recommendations for system improvement within a large integrated health-care system.
  
  
  METHODS
  Cross-sectional qualitative focus group study.
  
  
  METHODS
  One focus group was conducted at each of 17 Veterans Affairs facilities with a total of 123 Veteran users of VA health care. All facilities followed a focus group discussion guide, and purposively sampled patients receiving care at their VA facility in primary and/or specialty care. Focus groups' recordings were sent to the authors' independent evaluation centre, transcribed verbatim and analysed using qualitative content analysis methodology.
  
  
  RESULTS
  Participants described many issues with the phone system that resulted in delays to care needs being addressed, including difficulty getting someone to answer the phone, out-dated phone directories, frequent disconnections and incorrect transfers. Participants most frequently responded to access issues by doing nothing or waiting to contact at a later time, or seeking unscheduled in-person care in the emergency department or primary care clinic. Participants offered recommendations for improving telephone care, including access to direct extensions, and upgrades to the telephone system.
  
  
  CONCLUSIONS
  Telephone access issues could result in increased patient harm and/or increased wait times for in-person primary care or emergency services. Periodic evaluation of telephone systems is necessary to ensure telephone systems adequately meet patient needs while using resources efficiently to optimize the delivery of high quality, safe health care.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA.|Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Locatelli
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA.|Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA.|Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.affiliation: Center of Innovation for Complex Chronic Healthcare (CINCCH), Department of Veterans Affairs (DVA), Edward Hines Jr. VA Hospital, Hines, IL, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Talbot
authors.affiliation: Office of Systems Redesign, Veterans Affairs Central Office, Washington, DC, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Davies
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000592:standards*; D006301:Health Services Needs and Demand / Q000592:standards; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D036301:Qualitative Research; D011787:Quality of Health Care; D013689:Telephone / Q000295:instrumentation / Q000706:statistics & numerical data*; D014481:United States
keywords: Veterans; health services accessibility; telephone hotlines