title: Exploring the Patient and Staff Experience With the Process of Primary Care.
abstract: OBJECTIVE
  Previous studies suggest that the highest-risk patients value accessible, coordinated primary care that they perceive to be of high technical quality. We have limited understanding, however, of how low-income, chronically ill patients and the staff who care for them experience each individual step in the primary care process.
  
  
  METHODS
  We conducted qualitative interviews with uninsured or Medicaid patients with chronic illnesses, as well as with primary care staff. We interviewed 21 patients and 30 staff members with a variety of job titles from 3 primary care practices (1 federally qualified health center and 2 academically affiliated clinics).]
  
  
  RESULTS
  The interviews revealed 3 major issues that were present at all stages of a primary care episode: (1) information flow throughout an episode of care is a frequent challenge, despite systems that are intended to improve communication; (2) misaligned goals and expectations among patients, clinicians, and staff members are often an impediment to providing and obtaining care; and (3) personal relationships are highly valued by both patients and staff.
  
  
  CONCLUSIONS
  Vulnerable populations and the primary care staff who work with them perceive some of the same challenges throughout the primary care process. Improving information flow, aligning goals and expectations, and developing personal relationships may improve the experience of both patients and staff.
authors.affiliation: The Robert Wood Johnson Foundation Clinical Scholars Program, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania The Department of Family and Community Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania elizbro@upenn.edu.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Brown
authors.affiliation: The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania The Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania Penn Center for Community Health Workers, Philadelphia, Pennsylvania.
authors.forename: Shreya
authors.initials: S
authors.lastname: Kangovi
authors.affiliation: Department of Medicine, University of San Francisco, San Francisco, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sha
authors.affiliation: Department of Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Penn Center for Community Health Workers, Philadelphia, Pennsylvania.
authors.forename: Casey
authors.initials: C
authors.lastname: Chanton
authors.affiliation: Penn Center for Community Health Workers, Philadelphia, Pennsylvania.
authors.forename: Tamala
authors.initials: T
authors.lastname: Carter
authors.affiliation: The Robert Wood Johnson Foundation Clinical Scholars Program, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania The Division of General Internal Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David T
authors.initials: DT
authors.lastname: Grande
mesh_terms: D000328:Adult; D003142:Communication; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D008875:Middle Aged; D009819:Office Visits; D018802:Patient-Centered Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D014481:United States; D035862:Vulnerable Populations
keywords: chronic illness; medical staff; office visits; patient-centered medical home; patients; practice-based research; primary care; process of care; qualitative research; vulnerable populations