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The number of physicians seeing patients part time is growing, an evolution that challenges the primary care pillars of continuity and access. The growth of part-time practice is a response to burnout and to the pressures facing primary care physicians. Physicians who work fewer clinical hours and thereby reduce burnout are more satisfied with their careers, less likely to leave their jobs, and provide a better patient experience. Primary care practices can make a number of adjustments to optimize continuity and access in this era of part-time practice. Moreover, physicians who work fewer clinical hours are equally capable of fostering trusting relationships with patients as physicians seeing patients full time.

Purpose: We undertook a study to examine national trends in potentially preventable hospitalizations-those for ambulatory care-sensitive conditions that could have been avoided if patients had timely access to primary care-across 3,200 counties and various subpopulations of older adults in the United States.Methods: We used 2010-2014 Medicare claims data to examine trends in potentially preventable hospitalizations among beneficiaries aged 65 years and older and developed heat maps to examine county-level variation. We used a generalized estimating equation and adjusted the model for demographics, comorbidities, dual eligibility (Medicare and Medicaid), ZIP code-level income, and county-level number of primary care physicians and hospitals.Results: Across the 3,200 study counties, potentially preventable hospitalizations decreased in 327 counties, increased in 123 counties, and did not change in the rest. At the population level, the adjusted rate of potentially preventable hospitalizations declined by 3.45 percentage points from 19.42% (95% CI, 18.4%-20.5%) in 2010 to 15.97% (95% CI, 15.3%-16.6%) in 2014; it declined by 2.93, 2.87, and 3.33 percentage points among White, Black, and Hispanic patients to 14.96% (95% CI, 14.67%-15.24%), 17.92% (95% CI, 17.27%-18.58%), and 17.10% (95% CI, 16.25%-18.0%), respectively. Similarly, the rate for dually eligible patients fell by 3.71 percentage points from 21.62% (95% CI, 20.5%-22.8%) in 2010 to 17.91% (95% CI, 17.2%-18.7%) in 2014. (P <.001 for all).Conclusions: During 2010-2014, rates of potentially preventable hospitalization did not change in the majority of counties. At the population level, although the rate declined among all subpopulations, dually eligible patients and Black and Hispanic patients continued to have substantially higher rates compared with non-dually eligible and White patients, respectively. [ABSTRACT FROM AUTHOR]

Purpose: Electronic consultation (eConsult), involving asynchronous primary care clinician-to-specialist consultation, is being adopted at a growing number of health systems. Most evaluations of eConsult programs have assessed clinical and financial impacts and clinician acceptability. Less attention has been focused on patients' opinions. We set out to understand patient perspectives and preferences for hypothetical eConsult use at 5 US academic medical centers in the process of adopting an eConsult model.Methods: We invited adult primary care patients to participate in focus groups. Participants were introduced to the eConsult model, considered its potential benefits and drawbacks, judged the acceptability of a hypothetical copay, and expressed their preferences for future involvement in eConsult decision making and communication. Thematic analysis was used for data interpretation.Results: One focus group was conducted at each of the 5 sites with a total of 52 participants. Focus groups responded positively to the idea of eConsult, with quicker access to specialty care and convenience identified as key benefits. Approval was particularly high among those with a trusted primary care clinician. Preference for involvement in eConsult decision making and communication varied and enthusiasm about eConsult waned when a hypothetical copay was introduced. Concerns included potential misuse of eConsult and exclusion of the patient's illness narrative in the eConsult exchange.Conclusions: Primary care patients expressed strong support for eConsult, particularly when used by a trusted primary care clinician, in addition to voicing several concerns. Patient involvement in eConsult outreach and education efforts could help to enhance the model's effectiveness and acceptability. [ABSTRACT FROM AUTHOR]

Purpose: The Patient Protection and Affordable Care Act (ACA) has improved access to health insurance, yet millions remain uninsured. Many patients who remain uninsured access care at community health centers (CHCs); however, little is known about their health conditions and health care use. We assessed ambulatory care use and diagnosed health conditions among a cohort of CHC patients uninsured before enactment of the ACA (pre-ACA: January 1, 2012 to December 31, 2013) and followed them after enactment (post-ACA: January 1, 2014 to December 31, 2015).Methods: This retrospective cohort analysis used electronic health record data from CHCs in 11 US states that expanded Medicaid eligibility. We assessed ambulatory care visits and documented health conditions among a cohort of 138,246 patients (aged 19 to 64 years) who were uninsured pre-ACA and either remained uninsured, gained Medicaid, gained other health insurance, or did not have a visit post-ACA. We estimated adjusted predicted probabilities of ambulatory care use using an ordinal logistic mixed-effects regression model.Results: Post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The majority of patients had ≥1 diagnosed health condition. The adjusted proportion of patients with high use (≥6 visits over 2 years) increased from pre-ACA to post-ACA among those who gained Medicaid (pre-ACA: 23%, post-ACA: 34%, P <.001) or gained other insurance (pre-ACA: 29%, post-ACA: 48%, P <.001), whereas the percentage fell slightly for those continuously uninsured.Conclusions: A significant percentage of CHC patients remained uninsured; many who remained uninsured had diagnosed health conditions, and one-half continued to have ≥3 visits to CHCs. CHCs continue to be essential providers for uninsured patients. [ABSTRACT FROM AUTHOR]

Primary care access in Medicaid improved after the Patient Protection and Affordable Care Act despite millions of new beneficiaries. One possible explanation is that practices are scheduling more appointments with advanced practitioners. To test this theory, we used data from a secret shopper study in which callers simulated new Medicaid patients and requested appointments with 3,742 randomly selected primary care practices in 10 states. Conditional on scheduling an appointment, simulated patients asked whether the practitioner was a physician or advanced practitioner. From 2012 through 2016, the proportion of appointments scheduled with advanced practitioners increased from 7.7% to 12.9% (P <.001) across the 10 states. [ABSTRACT FROM AUTHOR]

Purpose: Compared with other high-income countries, Canada and the United States have among the highest rates of emergency department use and the lowest rates of primary care physicians reporting arrangements for after-hours care. We assessed whether enrollment in a medical home mandated to provide after-hours care in Ontario, Canada, was associated with reduced emergency department use.Methods: We conducted a retrospective cohort study using linked administrative data. We included all adult Ontarians enrolled in a medical home between April 1, 2005, and March 31, 2012, who had a minimum of 3 years of outcome data before and after enrollment (N = 2,945,087). We performed a linear segmented analysis with patient-level data to understand the association between initial enrollment in a medical home and emergency department visits, the proportion of all primary care visits occurring on the weekend, and the primary care visit rate. Age, income quintile, comorbidity, and morbidity were included in the modeling as time-varying covariates and sex as a stable variable.Results: The emergency department visit rate increased by 0.8% (95% CI, 0.7% to 0.9%) per year before medical home enrollment and by 1.5% (95% CI, 1.4% to 1.5%) per year after the transition. Enrollment in a medical home was associated with an increase in the proportion of visits that occurred on weekends, but a decrease in the overall primary care visit rate.Conclusions: Enrollment of adult Ontarians in a primary care medical home offering after-hours care was not associated with a reduction in emergency department use. It will therefore be important to prospectively evaluate policy reforms aimed at improving access to primary care outside of conventional hours. [ABSTRACT FROM AUTHOR]

The article discusses the establishment of processes to facilitate the use of mifepristone for early pregnancy loss (EPL) within a large healthcare system, with the goal of expanding access to medication abortion in a post-Roe environment. The process involved collaboration with various stakeholders, including pharmacy purchasing teams, clinic management, education teams, and information technology.

Purpose: Despite evidence suggesting that high-quality primary care can prevent unnecessary hospitalizations, many primary care practices face challenges in achieving this goal, and there is little guidance identifying effective strategies for reducing hospitalization rates. We aimed to understand how practices in the Comprehensive Primary Care Plus (CPC+) program substantially reduced their acute hospitalization rate (AHR) over 2 years., Methods: We used Bayesian analyses to identify the CPC+ practice sites having the highest probability of achieving a substantial reduction in the adjusted Medicare AHR between 2016 and 2018 (referred to here as AHR high performers). We then conducted telephone interviews with 64 respondents at 14 AHR high-performer sites and undertook within- and cross-case comparative analysis., Results: The 14 AHR high performers experienced a 6% average decrease (range, 4% to 11%) in their Medicare AHR over the 2-year period. They credited various care delivery activities aligned with 3 strategies for reducing AHR: (1) improving and promoting prompt access to primary care, (2) identifying patients at high risk for hospitalization and addressing their needs with enhanced care management, and (3) expanding the breadth and depth of services offered at the practice site. They also identified facilitators of these strategies: enhanced payments through CPC+, prior primary care practice transformation experience, use of data to identify high-value activities for patient subgroups, teamwork, and organizational support for innovation., Conclusions: The AHR high performers observed that strengthening the local primary care infrastructure through practice-driven, targeted changes in access, care management, and comprehensiveness of care can meaningfully reduce acute hospitalizations. Other primary care practices taking on the challenging work of reducing hospitalizations can learn from CPC+ practices and may consider similar strategies, selecting activities that fit their context, personnel, patient population, and available resources., (© 2023 Annals of Family Medicine, Inc.)

Purpose: Health systems are transitioning patients to medical homes to improve health outcomes and reduce cost. We sought to understand the characteristics and quality of care for patients who did and did not participate in the voluntary transition to medical homes.Methods: We used administrative data for diabetes monitoring and cancer screening to compare services received by patients attached to a medical home (n = 10,785,687) with services received by those seeing a fee-for-service physician (n = 1,321,800) in Ontario, Canada, on March 31, 2011. We used Poisson regression to examine associations in 2011 after adjustment for patient factors and also assessed changes in outcomes between 2001 and 2011.Results: Patients attached to a fee-for-service physician were more likely to be immigrants and live in a low-income neighborhood and urban area. They were less likely to receive recommended testing for diabetes (25% vs 34%; adjusted relative risk [RR] = 0.74; 95% CI, 0.73-0.75) and less likely to receive screening for cervical (52% vs 66%; adjusted RR = 0.79; 95% CI, 0.79-0.79), breast (58% vs 73%; adjusted RR = 0.80; 95% CI, 0.80-0.81), and colorectal cancer (44% vs 62%; adjusted RR = 0.72; 95% CI, 0.71-0.72) compared with patients attached to a medical home physician in 2011. These differences in quality of care preceded medical home reforms.Conclusion: Patients left behind from medical home reforms are more likely to be poor, urban, and new immigrants and receive lower quality care. Strategies are needed to reach out to these patients and their physicians to reduce gaps in care. [ABSTRACT FROM AUTHOR]

The Patient Protection and Affordable Care Act (ACA) mandates that health insurance plans include sufficient access to behavioral health providers, but lacks specific guidelines to define sufficient access Using a secret shopper methodology, we called behavioral health providers in the Denver metropolitan area networked with 3 large insurance companies. We found that, depending on insurance company and level of training, 9.8% to 59% of providers could offer a new patient appointment, with psychiatry appointments being particularly difficult to schedule. These findings are consistent with similar studies conducted in other regions, suggesting that access to outpatient behavioral health care is limited despite existing ACA regulations. [ABSTRACT FROM AUTHOR]

The article reflects on whether medical homes can help patients obtain and retain insurance coverage in the U.S. It informs that not having insurance has a negative impact on the health of an uninsured person and is associated with early death, which could be preventable. It informs that primary care medical homes by partnering with patients and assisting them in obtaining and maintaining health insurance coverage can reduce preventable mortality.

The article presents a study which examines whether patient-reported access to selected primary care attributes is associated with lower individual mortality risk. The study analyzed data from 2000-2005 Medical Expenditure Panel Survey respondents aged 18 to 90 years. It concludes that greater reported patient access to selected primary care attributes was associated with lower mortality.

The article presents a research study which examines the association between child and parent usual source of care (USC) patterns and children's access to health care services in the U.S. The authors state that children whose parents lack a USC receives fewer health care services and experience more unmet needs. They stress that ensuring better access to necessary health care services require comprehensive policy reforms that make it easier for all individuals to maintain a USC status.

The article focuses on a study related to electronic health records (EHRs) and medical claims in community health centers (CHCs) in Oregon. It informs that the study focused on the creation of individual-level association between EHR data from a network of CHCs and Medicaid claims from 2005 to 2007. The study found that EHRs provide more extensive data regarding health services received. Several charts related to the study are also presented

The article presents a study that investigates on the health care services and family health insurance patter given to American children. The study was administered by analyzing the 2002-2006 cross-sectional pooled data regarding the health care needs of children. The study reveals that uninsured children exemplify high rates of unmet health care needs and insured children with different parental insurance coverage is also at risk.

The article presents a study that investigates on the universal health insurance and equity observed in Canadian primary and specialist care. The study was conducted using the 2000-2001 Canadian Community Health Survey which assess the health status, educational attainment and income of physicians. The study reveals that inequities by education is visible in dermatology and ophthalmology practice and the use of universal health insurance is favorable to all physicians.

The article presents a study that explores the relationship between having a personal health care provider and receiving colorectal cancer testing in the U.S. The results revealed that having at least 1 personal health care provider significantly predicted up-to-date colorectal cancer testing in both the univariate and multiple regression. Moreover, several factors including age, sex and ethnicity were significantly associated with up-to-date colorectal cancer testing.

The article discusses the conditions of the current delivery system and financing structures of the U.S. health care system. It presents brief stories to elucidate how multiple system components are breaking down. Moreover, it provides a blueprint for reconstructing the system. It suggests that family physicians must take a proactive approach and lead a meaningful change to uplift the nation's health care system.

The article focuses on the barriers of public health insurance and health care access to low-income families in the U.S. Public health insurance programs expanded coverage for the poor. Family physicians provide significant services to the poor. Study shows that lack of insurance coverage, poor access to services and unaffordable costs are among the major barriers in accessing health care for children. Results indicate that these barriers can be insurmountable for low-income families.

The article focuses on the pursuance of equity in primary care and specialist clinicians in the U.S. Study reveals that long-term shifts in specialty choice and health workforce policy raised concern on the future of primary care. It was found out that most common clinician type accessed and were second to pediatricians for children. These indicates that primary clinicians render a disproportionate share of ambulatory care to disadvantage populations.

The article cites a study which examines whether physicians' self-reported religious characteristics and sense of calling in their work are associated with practice among the underserved in the U.S. The study entailed a cross-sectional survey by mail of a stratified random sample of 2,000 practicing physicians from all specialties. It was found that physicians who were more religious in general do not appear to disproportionately care for the underserved.

The article presents the author's views on the challenges and opportunities for general practitioners presented by the implementation of the Patient Protection and Affordable Care Act in the U.S. in 2013. It reflects that special accountability and efforts are required to enroll the minority populations and the eligible uninsured population for coverage in rural areas. It states that Medicaid expansion will allow funding of new models of community-based health professions education.

An introduction is presented in which the editor discusses various reports within the issue on topics including barriers to the medical care for children, length of hospital stay for insured and unisured patients, and perspective of primary care physicians on the closure of a community hospital.

The author reflects on the study which examines the impact of racial and ethnic disparities in health and hypertension control in the U.S. He argues on the elimination of disparities in health services among ethnic groups to improve their quality of life. He asserts that the medical society is making progress in closing some of the gaps relating to the quality of medical care.

The author reflects on the significance of primary care physician recruitment to low-income countries. She considers the study of balancing the individual rights to move about the globe for happiness. She predicts that the U.S. primary care workforce reductions will differentially affect disadvantaged populations. She notices that physician migration patterns speculate thousands of individual and family-level choices from judgments of economic, social, professional and other interests.

The article reflects on the author's view on several studies focusing on the significance of health insurance in obtaining health care. These studies have provided evidences on the lasting effects of uninsurance on health care access and on health outcomes, particularly in poor populations. According to the author, it has been argued that there have been critics, which state that the findings are natural and expected.