Family medicine patients who use retail clinics have lower continuity of care

Translating 'See-and-Treat' to primary care: opening the gates does not cause a flood

OBJECTIVE

To explore how the See-and-Treat concept can be applied in primary care and its effect on volume and productivity.

DESIGN

An explanatory single-case study design with a mixed methods approach and presented according to the SQUIRE 2.0 guidelines.

SETTING

A publicly-funded, private primary care provider within the Stockholm County, which caters to a diverse patient population in terms of ethnicity, religion, socioeconomic status and care needs.

PARTICIPANTS

CEO, center manager, four physicians, two licensed practical nurses, one medical secretary and one lab assistant.

INTERVENTION

A See-and-Treat unit was established to offer same-day service for acute unplanned visits. Standardized patient symptom forms were created that allowed patients to self-triage and then enter into a streamlined care process consisting of a quick diagnostic lab and a physician visit.

MAIN OUTCOME MEASURES

Volume, productivity, staff perceptions and patient satisfaction were measured through data on number and type of contacts per 1000 listed patients, visits per physician, observations, interviews and a questionnaire.

RESULTS

A significant decrease in the acute and total number of visits, a continued trend of diminishing telephone contacts, and a non-significant increase in physician productivity. Patients were very satisfied, and staff perceived an improved quality of care.

CONCLUSIONS

See-and-Treat appears to be a viable approach for a specific primary care patient segment interested in acute same-day-service. Opening up access and standardizing care made it possible to efficiently address these needs and engage patients.

How Preferences for Continuity and Access Differ Between Multimorbidity and Healthy Patients in a Team Care Setting

Introduction: Team-based care has become an essential part of modern medical practice. Patient-centered medical homes often struggle to balance the dual competing goals of acute access and continuity of care. Multimorbidity patients may value continuity more than healthy patients, and thus may prefer to wait to see their primary care physician (PCP). Methods: A total of 1700 randomly selected healthy adults and multimorbidity patients were asked to rate satisfaction with care and presented with 4 acute and 4 chronic scenarios to choose an access and continuity preference in an anonymous mailed survey. Results: In all, 770 responses were obtained. All respondents preferred to be seen 2.5 days sooner for acute appointments. Multimorbidity patients preferred to wait 0.28 days longer for acute issues to see their PCP. Patients who were not satisfied with their care team preferred to wait 0.75 days to see their PCP. Those not satisfied with their PCP choose to be seen 0.38 days sooner by their care team or any physician. Conclusions: All patients prefer continuity of care with their PCP for chronic disease management and value quick access to care for acute problems. For acute visits, multimorbidity patients prefer to wait longer to see their PCP than healthy adults. Satisfaction also plays an important role in patients’ willingness to wait for an appointment with their PCP.