title: Scheduled telephone visits in the veterans health administration patient-centered medical home.
abstract: BACKGROUND
  The Veterans Health Administration (VHA) patient-centered medical home model, Patient Aligned Care Teams (PACT), includes telephone visits to improve care access and efficiency. Scheduled telephone visits can replace in-person care for some focused issues, and more information is needed to understand how this mode can best work for primary care. We conducted a study at the beginning of PACT implementation to elicit stakeholder views on this mode of healthcare delivery, including potential facilitators and barriers.
  
  
  METHODS
  We conducted focus groups with primary care patients (n  = 3 groups), providers (n = 2 groups) and staff (n = 2 groups). Questions were informed by Donabedian's framework to evaluate and improve healthcare quality. Content analysis and theme matrix techniques were used to explore themes. Content was assigned a positive or negative valuation to indicate whether it was a facilitator or barrier. PACT principles were used as an organizing framework to present stakeholder responses within the context of the VHA patient-centered medical home program.
  
  
  RESULTS
  Scheduled telephone visits could potentially improve care quality and efficiency, but stakeholders were cautious. Themes were identified relating to the following PACT principles: comprehensiveness, patient-centeredness, and continuity of care. In sum, scheduled telephone visits were viewed as potentially beneficial for routine care not requiring physical examination, and patients and providers suggested using them to evaluate need for in-person care; however, visits would need to be individualized, with patients able to discontinue if not satisfied. Patients and staff asserted that providers would need to be kept in the loop for continuity of care. Additionally, providers and staff emphasized needing protected time for these calls.
  
  
  CONCLUSIONS
  These findings inform development of scheduled telephone visits as part of patient-centered medical homes by providing evidence about areas that may be leveraged to most effectively implement this mode of care. Presenting this service as enhanced care, with ability to triage need for in-person clinic visits and consequently provide more frequent contact, may most adequately meet different stakeholder expectations. In this way, scheduled telephone visits may serve as both a substitute for in-person care for certain situations and a supplement to in-person interaction.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VAMC, Legacy Tower (NC Mutual Building) Suite 600, 411 West Chapel Hill Street, Durham, NC 27701, USA. nina.sperber@duke.edu.
authors.forename: Nina R
authors.initials: NR
authors.lastname: Sperber
authors.forename: Heather A
authors.initials: HA
authors.lastname: King
authors.forename: Karen
authors.initials: K
authors.lastname: Steinhauser
authors.forename: Natalie
authors.initials: N
authors.lastname: Ammarell
authors.forename: Susanne
authors.initials: S
authors.lastname: Danus
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D004526:Efficiency; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013689:Telephone; D058014:Veterans Health