Article Figures & Data
Tables
Characteristic Value Practice staff (n=30) Female, No. (%) 29 (97) Race, No. (%) Black 14 (47) White 11 (37) Asian 2 (7) Other 3 (10) Age, mean (SD), y 46 (11.1) Practice site, No. (%) Federally qualified health center 11 (37) Academic practice 19 (63) Job title, No. (%) Administrator/Practice manager 4 (13) Call Center/Front desk/Scheduler 7 (23) Medical assistant 2 (7) Physician 3 (10) Nurse 7 (23) Other (psychologist, nutritionist, case manager, social worker, pharmacist) 6 (20) Patients (n=21) Female, No. (%) 12 (57) Black race, No. (%) 20 (95) Age, mean (SD), y 50 (10.0) Emergency department visits in 6 months prior, mean (range), No. 5.4 (0–20) Insurance type, No. (%) Medicaid 9 (43) Uninsured 8 (38) Dually eligible (Medicare/Medicaid) 3 (14) Diagnoses, No. (%) Hypertension 13 (65) Hyperlipidemia 10 (50) Diabetes 9 (40) Mental illness/Addiction 8 (40) Obesity 8 (40) Congestive heart failure 6 (29) Asthma/chronic obstructive pulmonary disease 5 (20) Previsit Visit Postvisit Key Finding Scheduling Appointments Check-in Rooming Clinician Visit Laboratory and Imaging Information flow Reason for visit not always clearly communicated or understood, leading to patients getting visit scheduled for something that could have been dealt with over the telephone Changes to addresses or insurance information need to be updated in multiple places Problems identified by MAs during screening not always seen by physician Medication lists frequently not reconciled appropriately because patients assume the computer is correct Laboratory orders not entered correctly or did not print, which causes confusion or errors when patient goes to laboratory Alignment of goals and expectations Open-access scheduling can conflict with patient’s need to be able to plan ahead Patients frustrated with not being seen when late, even when public transportation issues were the cause MAs caught between need to keep flow moving and increasing number of screening questions they are expected to ask Patients have multiple concerns, and clinicians may be willing to address only 1 or 2 or prioritize chronic disease management Prior authorization requirements of insurance companies conflict with patient and clinician desire for rapid access to needed tests Personal relationships Knowing which patients will have trouble scheduling follow-up can help care coordinators decide whom to schedule in advance Patients feel comfortable with front desk staff whom they have known for many years Patients more likely to discuss true reason for visit with staff they know well Trust between patients and clinicians develops with time Walking patients to laboratory prevents them from leaving before having tests completed MA=medical assistant.
Additional Files
Supplemental Appendix
Supplemental Appendix. Interview guides
Files in this Data Supplement:
- Supplemental data: Appendix - PDF file
The Article in Brief
Exploring the Patient and Staff Experience With the Process of Primary Care
Elizabeth J. Brown , and colleagues
Background Surveys of patient experiences usually target Medicare and privately insured populations, leaving the lowest socioeconomic status patients' voices under-represented. This is the first qualitative study to assess the experience of both low income, chronically ill patients and the clinic staff who care for them during each step of the primary care process.
What This Study Found There are areas of agreement and tension between the needs and preferences of high-risk patients and staff in the primary care setting. Two major challenges frequently get in the way of an effective visit: 1) information flow, despite systems that are intended to improve communication and 2) misaligned goals and expectations among patients, clinicians and staff members. Personal relationships are highly valued by patients and staff.
Implications
- The authors conclude that when considering how to improve the care of vulnerable patients, it is important to focus on improving information flow, aligning goals and expectations, and developing personal relationships.
