title: Cross-sectional study examining whether the extent of first-contact access to primary care differentially benefits those with certain personalities to receive preventive services.
abstract: OBJECTIVE
  The extent of first-contact access to primary care (ie, easy availability when needed) is associated with receiving recommended preventive services. Whether this access benefits patients at risk of preventive services underutilisation, such as those with certain personality characteristics, is unclear.
  
  
  METHODS
  Secondary analysis of the 2003-2006 round of the Wisconsin Longitudinal Study.
  
  
  METHODS
  6975 respondents who reported a usual provider whose specialty was internal medicine or family medicine. Those reporting not visiting a medical provider in the past 12 months, and those who were uninsured were excluded.
  
  
  METHODS
  Receiving mammography, cholesterol testing and influenza vaccination. Adjusted predicted probabilities (aPP) of receiving these services were analysed stratified by personality characteristics overall, and if significant, then interacted with first-contact access.
  
  
  RESULTS
  Lower conscientiousness as compared with higher conscientiousness predicted less of all 3 preventive services; mammography (aPP 80%; 95% CI (77% to 83%) vs aPP 85%; (95% CI 82% to 87%)), cholesterol testing (88%; (85% to 90%) vs 93% (91% to 94%), and influenza vaccination (62%; (59% to 64%) vs 66%; (63% to 68%)). Lower agreeableness as compared with higher agreeableness predicted less mammography (77%; (73% to 81%) vs 84%; (82% to 87%)) and less influenza vaccination (59%; (56% to 62%) vs 65%; (63% to 68%)). Lower extraversion predicted less cholesterol testing (88%; (86% to 91%) vs (92%; (90% to 94%)). Lower openness to experience predicted less influenza vaccination (59%; (56% to 63%) vs (68%; (65% to 70%)). For agreeableness, these differences in receiving preventive services did not persist when first-contact access to primary care was present.
  
  
  CONCLUSIONS
  Certain personality characteristics predicted receiving less preventive care services. For those with less agreeableness, improved first-contact access to primary care mitigated this effect. If these results are replicated in other studies, primary care offices seeking to improve population health through receiving preventive services should prioritise increasing their first-contact accessibility.
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Population Health Sciences, Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Schumacher
authors.affiliation: Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Philadelphia, Pennsylvania, USA Veterans Affairs Pittsburgh Healthcare System, Health Services Research and Development, Pittsburgh, Pennsylvania, USA.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.affiliation: Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Population Health Sciences, Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000368:Aged; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010551:Personality; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D002784:Cholesterol
keywords: PREVENTIVE MEDICINE; PRIMARY CARE