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Keywords: Patient centered medical homes, barriers to care, health care access, doctor-patient communication, shared decision making.
Citation: Smith CW, Graedon T. Knocking down barriers to care with patient centered medical homes. J Participat Med. 2012 Dec 5; 4:e30.
Published: December 5, 2012.
Competing Interests: The authors have declared that no competing interests exist.

Have you ever called your doctor’s office to get a prescription renewed, then waited for days for your call to be returned? Or have you struggled during the night with a sick child, not knowing whether you should take her to the hospital, and been unable to get the doctor to return your call to discuss the problem?

Unfortunately, difficulty in accessing the health care team goes way beyond the obvious problems of patients who have neither doctor nor health insurance. These everyday glitches stymie the best of patients’ intentions, and can effectively block participation in shared decision making. These obstacles can be extremely frustrating. They undermine health care and potentially damage health.

Consider this short list of some of the most common problems with our health care system access:

  1. Inability to get an appointment with your doctor within a reasonable time frame.
  2. Failure to be notified about results of a lab or imaging test.
  3. Difficulty getting a needed prescription renewed.
  4. Failure by your health team to return your phone call in a timely manner.
  5. Inability to connect with your doctor or his partners after hours to address an urgent problem.
  6. Insufficient explanation in response to a question to your doctor.

Everyone encounters these barriers at one time or another, but they must be removed if we hope to create a cost-effective health care system that can engage patients and help them take responsibility for their own health. It is easy to understand why they exist: under our current system, minor procedures are reimbursed at several times the rate of simple in-office care and, in most circumstances, phone calls, emails and e-visits are not reimbursed at all by third-party payers. Providers clearly have an incentive to provide the maximum amount of in-office, in-lab, or imaging procedures just to make financial ends meet. This dependence on in-office procedures eliminates the doctor’s motivation to provide alternative means of access to care.

Increasingly, though, primary care practices are organizing around a model called the Patient Centered Medical Home (PCMH) that holds promise for making care more accessible. To be certified as a PCMH, a practice must (among other requirements) provide same day appointments and after hours care, communication by e-mail, and provide oversight to the practice as a whole by monitoring preventive and chronic care parameters. Payers are moving towards reimbursement of these practices according to outcomes of care, rather than a fee-for-service basis. This change will go a long way toward knocking down the barriers to care.

Such practices, over time, will allow patients to provide much more effective self-management of their acute and chronic conditions, only coming to the office on occasions when a face-to-face visit is truly necessary.

If you are frustrated by efforts to overcome barriers to your health care team, look around in your area and inquire as to whether there is a practice that is either certified or working towards certification as a Patient Centered Medical Home. If so, you might consider switching your care to that practice, as you’ll find the barriers to care are starting to fall at last!

Copyright: © 2012 Charles W. Smith and Terry Graedon. Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the author, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.