ABSTRACT
BACKGROUND
Despite expectations that medical homes provide “24 × 7 coverage” there is little to guide primary care practices in developing sustainable models for accessible and coordinated after–hours care.
OBJECTIVE
To identify and describe models of after-hours care in the U.S. that are delivered in primary care sites or coordinated with a patient’s usual primary care provider.
DESIGN
Qualitative analysis of data from in-depth telephone interviews.
SETTING
Primary care practices in 16 states and the organizations they partner with to provide after-hours coverage.
PARTICIPANTS
Forty-four primary care physicians, practice managers, nurses and health plan representatives from 28 organizations.
APPROACH
Analyses examined after-hours care models, facilitators, barriers and lessons learned.
RESULTS
Based on 28 organizations interviewed, five broad models of after-hours care were identified, ranging in the extent to which they provide continuity and patient access. Key themes included: 1) The feasibility of a model varies for many reasons, including patient preferences and needs, the local health care market supply, and financial compensation; 2) A shared electronic health record and systematic notification procedures were extremely helpful in maintaining information continuity between providers; and 3) after-hours care is best implemented as part of a larger practice approach to access and continuity.
CONCLUSION
After-hours care coordinated with a patient’s usual primary care provider is facilitated by consideration of patient demand, provider capacity, a shared electronic health record, systematic notification procedures and a broader practice approach to improving primary care access and continuity. Payer support is important to increasing patients’ access to after-hours care.
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Acknowledgment
This study was funded by The Commonwealth Fund (Grant #20100295).
The authors would also like to thank Dr. Robert Berenson, Dr. Ed Wagner and Dr. Stephen Schoenbaum for serving as external advisors to this project.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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O’Malley, A.S., Samuel, D., Bond, A.M. et al. After-Hours Care and its Coordination with Primary Care in the U.S.. J GEN INTERN MED 27, 1406–1415 (2012). https://doi.org/10.1007/s11606-012-2087-4
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DOI: https://doi.org/10.1007/s11606-012-2087-4