Practice Features Associated With Patient-Reported Accessibility, Continuity, and Coordination of Primary Health Care

The article by Haggerty et al is interesting if a bit dated (2002). The outcomes under study were perceived accessibility, relational continuity and coordination continuity (coordination of care) by patients in Quebec in 2002. U.S. readers might be inclined to dismiss the findings because of the differences between their/our care system and that of Canada. I would bet that many of these findings are common to family practice settings in both countries nowadays as the supply of family physicians has declined in the face of rising demand.

Not surprisingly, the way in which practices were organized influenced all three outcomes. The startlingly low perceived accessibility of family physicians by patients may well be influenced by low prevalence then and now of true team based care. Patient perception of provider continuity may well be partly mitigated when the patient related to the office team rather than a single physician. Few practices to date in the non-closed system of care widely prevalent in both countries have incorporated this care successfully.

Care coordination, both perceived and real, can also be affected by team based care. Since 2002, the slow but steady adoption of electronic health systems with electronic messaging to and from the physician have improved the potential for this coordination.

The term "medical home" is thrown around today a great deal. It alludes not to the family practices of the past, where coordination was physician-dependant but to the family practices of the future where real systems and processes work in concert with teams of care providers to address access, continuity and accountability in different ways.

The authors note correctly that this was an exploratory study. At the same time, their findings remind us that the characteristics of the clinic setting in addition to that of the physician, play critical roles in the perception of accessibility and continuity of care by patients.

Competing interests:   None declared