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J Am Board Fam Med. 2019 Sep-Oct;32(5):749-751. doi: 10.3122/jabfm.2019.05.190047.

The Effects of Telephone Visits and Rurality on Veterans Perceptions of Access to Primary Care.

Author information

1
From VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Healthcare System, Iowa City, IA (ML, GS); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (ML); Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System Sepulveda, CA (SS); Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (SS); Center for Access Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA (PJK, GS); Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA (PJK); VA Puget Sound Healthcare System, Seattle, WA (EJ, GBW, WLC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (WLC); University of Iowa-Tippie College of Business, Iowa City, IA (GS). Lampman.Michelle@mayo.edu.
2
From VISN 23 Patient Aligned Care Team Demonstration Lab, Iowa City VA Healthcare System, Iowa City, IA (ML, GS); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (ML); Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System Sepulveda, CA (SS); Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (SS); Center for Access Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA (PJK, GS); Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA (PJK); VA Puget Sound Healthcare System, Seattle, WA (EJ, GBW, WLC); Kaiser Permanente Washington Health Research Institute, Seattle, WA (WLC); University of Iowa-Tippie College of Business, Iowa City, IA (GS).

Abstract

INTRODUCTION:

The objectives of this study were to examine if self-reported access to primary care is associated with actual patient wait times and use of telephone visits, and to assess whether this relationship differs by rural residence.

METHODS:

This study used 2016 administrative data from 994 primary care clinics within the Veterans Health Administration. Multiple-linear regression was used to examine relationships between patient perceptions of access and average actual patient wait time, use of telephone visits, and rural residence. Average panel size, clinic type, and panel severity were included as model covariates with cross-product terms for actual wait time, telephone use, and rurality to test for interactions.

RESULTS:

This study found patient perceptions of access aggregated at the clinic level to be conditional on the relationship between use of telephone visits, actual patient wait times, and rural residence. As actual wait time for routine appointments increases, Veterans served by clinics with a higher percent of rural Veterans perceive telephone visits more positively.

DISCUSSION:

These findings contribute to our understanding of factors associated with patient perceptions of access by highlighting complex interrelationships between strategies intended to improve access to care and how they can have differing impacts on perceptions among those living in rural or urban locations.

KEYWORDS:

Appointments and Schedules; Rural Health; Self Report; United States Department of Veterans Affairs; Veterans Health

PMID:
31506372
DOI:
10.3122/jabfm.2019.05.190047
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Conflict of interest statement

Conflict of interest: none declared.

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