Feature Story

Lack of same-day access to a primary care provider prompts many HMO patients to seek more costly urgent care

Health maintenance organizations (HMOs) that employ their own staff typically are open from 9 am to 5 pm on weekdays, with an urgent care center open from 7 am to 9 pm 7 days a week. A recent study, which was supported in part by the Agency for Health Care Policy and Research (National Research Service Award T32 HS00020), found that unscheduled patient visits to the urgent care center of one such HMO were common. Although some urgent care visits occurred after regular office hours, others occurred at the same time HMO primary care physicians (PCPs) were seeing patients. Almost half of the patients (47 percent) said they were unable to get a primary care appointment and would have preferred to see their PCP within a day or two rather than going to the urgent care department.

Improvement in HMO organization and scheduling systems to facilitate same-day access to PCPs could reduce use of HMO urgent care services and increase patient satisfaction, according to the study. Anna E. Plauth, M.D., M.P.H., and Steven D. Pearson, M.D., M.Sc., of Harvard Medical School and Harvard Pilgrim Health Care, surveyed patients 18 years of age and older for their reasons for seeking care at the urgent care department of a large, urban health center of a staff-model HMO instead of with their HMO primary care physician.

When asked why they came to the urgent care department instead of the primary care offices, 64 percent said they needed to be seen immediately, 47 percent came because the primary care offices were closed, 27 percent cited the constraints of work or childcare, and 25 percent said they were unable to get an appointment with their PCP. Only 59 percent of patients said it was easy to get an appointment with their PCP when they were sick or needed medical advice.

See "Discontinuity of care: Urgent care utilization within a health maintenance organization," by Drs. Plauth and Pearson, in the November 1998 American Journal of Managed Care 4, pp. 1531-2537.

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