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After-Hours Care and its Coordination with Primary Care in the U.S.

June 4, 2012
Journal of General Internal Medicine, Online First
Ann S. O'Malley, Divya R. Samuel, Amelia M. Bond, Emily Carrier



Background: Despite expectations that medical homes provide "24 x 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 afterhours 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.

Access to this article is available at the Journal of General Internal Medicine Web site. (Subscription required.)

 

 

 


 

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