Preventive service gains from first contact access in the primary care home

Nancy Pandhi, Jennifer E. DeVoe, Jessica R. Schumacher, Christie Bartels, Carolyn T. Thorpe, Joshua M. Thorpe, Maureen A. Smith

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background: The patient-centered medical home (PCMH) concept recently has garnered national attention as a means of improving the quality of primary care. Preventive services are one area in which the use of a PCMH is hoped to achieve gains, though there has been limited exploration of PCMH characteristics that can assist with practice redesign. The purpose of this study was to examine whether firstcontact access characteristics of a medical home (eg, availability of appointments or advice by telephone) confer additional benefit in the receipt of preventive services for individuals who already have a longitudinal relationship with a primary care physician at a site of care. Methods: This was a secondary analysis examining data from 5507 insured adults with a usual physician who participated in the 2003 to 2006 round of the Wisconsin Longitudinal Study. Using logistic regression, we calculated the odds of receiving each preventive service, comparing individuals who had first-contact access with those without first-contact access. Results: Eighteen percent of the sample received care with first-contact access. In multivariable analyses, after adjustment, individuals who had first-contact access had higher odds of having received a prostate examination (odds ratio [OR], 1.62; 95% CI, 1.20-2.18), a flu shot (OR, 1.36; 95% CI, 1.01-1.82), and a cholesterol test (OR, 1.36; 95% CI, 1.01-1.82) during the past year. There was no significant difference in receipt of mammograms (OR, 1.23; 95% CI, 0.94-1.61). Conclusions: In the primary care home, first-contact accessibility adds benefit, beyond continuity of care with a physician, in improving receipt of preventive services. Amid increasing primary care demands and finite resources available to translate the PCMH into clinic settings, there is a need for further studies of the interplay between specific PCMH principles and how they perform in practice.

Original languageEnglish (US)
Pages (from-to)351-359
Number of pages9
JournalJournal of the American Board of Family Medicine
Issue number4
StatePublished - Jul 2011


  • Access to care
  • Continuity of care
  • Patient-Centered medical home
  • Preventive medicine
  • Quality improvement

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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