The influence of first-contact access on preventive service receipt in the primary care home.

摘要

Preventive services such as cancer screening, immunizations, and cholesterol screening are well known to reduce premature mortality, yet are extremely difficult to provide for all patients in the context of modern primary care demands and limited resources. The Patient-Centered Medical Home (PCMH) has emerged recently as a national strategy to redesign primary care. Among its many provisions, the PCMH promotes the provision of first-contact access, defined as the availability of and easy access to primary care when it is needed. Given the time and cost burdens of redesigning primary care, it is unclear if practices that are interested in improving preventive services should invest in improving first-contact access as a priority.;This thesis begins to address this critical issue. Data from the 2003-2006 round of the Wisconsin Longitudinal Study are used to (1) investigate the receipt of recommended preventive services in patients with different personality characteristics overall and by report of first-contact access to primary care, (2) examine whether first-contact access confers additional benefit in the receipt of recommended preventive services for individuals already in a longitudinal relationship with a primary care physician and site, and (3) assess the relationship between the number of first-contact access components received and the receipt of recommended preventive services. This work will inform the development of practical interventions that aim to redesign primary care in order to improve receipt of recommended preventive services.