What Patients Want: Flexible Access to Providers

December 9, 2014

Many practices struggle with providing same-day care. But in many cases, offering flexibility may mean the difference between keeping and losing a patient.

One thing my organization is struggling with right now is urgent/acute/same-day care. Basically, the care provided to a patient for an urgent or acute need. Historically, this care can be found at the emergency department, a walk-in clinic, or your regular doctor's office. Nowadays, patients also have the option of getting virtual care over the Internet or visiting a retail clinic. Trying to figure out what patients need and what they most desire is challenging.

A couple of years ago, I was at a family dinner with relatives who were not in the medical profession. They were discussing their recent forays into obtaining acute care. What they said they wanted was care in a convenient location, at a convenient time, with someone who was clinically competent, and who knew all about them through access to their EHR. Seems like both a reasonable request and a tall order.

We, like many organizations, grapple with these same issues:

• When do patients most want to be seen, and is it different for pediatric and geriatric populations?

• Who is best able to provide urgent care?

• Where do patients prefer to be seen?

• Are patients comfortable with and willing to pay for virtual care?

• How important is it that the person providing acute care is the primary care clinician? Unfortunately, I suspect the answers to these questions are not "one size fits all" but rather reflect the diversity of our patients.

I believe that a patient's desire to be seen by their own primary-care clinician rises exponentially with the severity of the presenting concern. Of course, in our current practice environment, at a certain level, the primary-care clinician is no longer the right person to be caring for a surgical emergency, heart attack, or stroke. Similarly, most patients don't feel strongly about having minor issues - strep throat, urinary tract infection, or a sprained ankle - treated by whoever is available, as long as they are clinically competent. Yet, you will still have patients who eschew both more convenient care and more appropriate care, so that they can see their own physician for the strep throat and the heart attack. How do we build a schedule and a clinic that provides varied access?

As retail clinics advance from acute care to chronic disease management and preventive care, more traditional practices are left trying to decide how this will impact their own provision of medical care. While, it may be convenient for patients to get their diabetes managed at the local pharmacy, I suspect that many patients would opt for the relative inconvenience of going to a separate office for medical care if they feel aligned with their medical team and are confident that they get something extra from that interaction; whether it be the comfort of a familiar face, the kindness of the care team, or the confidence that their entire medical history is available to the treating clinician.

Finally, is predicting demand, which is done in a variety of fashions, essentially unreliable? In my neck of the woods, demand may be highly influenced by the weather, the football schedule, and whether influenza season coincides with the holidays. Two of those three are unpredictable.

I am curious what pearls of wisdom readers have learned as they and their practices try to best manage acute care.

Tell us what you think in the comments section below.