Relational continuity or rapid accessibility in primary care?: A mixed-methods study of veteran preferences.
OBJECTIVE
To examine preferences for relational continuity and rapid accessibility for telephone care.


METHODS
A mixed-methods sequential explanatory design was utilized. Structured telephone interviews were conducted with 448 Veterans receiving primary care from Veterans Affairs facilities, who rated the importance of relational continuity and rapid accessibility. Seventeen focus groups were conducted with 123 Veterans to examine preferences for continuity versus accessibility and factors affecting these preferences.


RESULTS
Higher proportions of interview patients rated talking with a nurse from their own primary care team (69%) and talking with a nurse with whom they have previous primary care contact (60%) as very important, compared with talking to any nurse as soon as possible (53%) and receiving advice immediately (50%). Focus group participants preferred a familiar provider within 24 hours over immediate contact with an unfamiliar provider, particularly for routine needs. Rapid accessibility was more frequently preferred for urgent questions/concerns. Preference for relational continuity was mitigated by patient age, and access to electronic medical records in larger, but not smaller, facilities.


CONCLUSIONS
Health care systems supplementing in-person care with telephone care need to ensure that this care aligns with patient preferences and provide opportunities for both relational continuity and rapid accessibility where possible.
Department of Veterans Affairs (DVA), Center of Innovation for Complex Chronic Healthcare (Drs Locatelli and LaVela and Mss Hill and Talbot) and Department of Veterans Affairs (DVA), Center for Evaluation of Practices and Experiences of Patient-Centered Care (Drs Locatelli and LaVela and Ms Hill) Edward Hines, Jr. VA Hospital, Hines, Illinois; Primary Care Services, Office of Patient Care Services, Veterans Affairs Central Office, Washington, District of Columbia (Dr Schectman); Department of Medicine, Medical College of Wisconsin, Milwaukee (Dr Schectman); and Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr LaVela).
Sara M
SM
Locatelli
Jennifer N
JN
Hill
Mary E
ME
Talbot
Gordon
G
Schectman
Sherri L
SL
LaVela
D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000592:standards; D014728:Veterans / Q000523:psychology*