Entry into primary care and continuity: The effects of access

Objectives. This study examined the relationship between access and use of primary care physicians as sources of first contact and continuity with the medical system. Methods. Data from 1987 National Medical Expenditure Survey were used to examine the effects of access on use of primary care physicians as sources of first contact for new episodes of care (by logistic regression) and as sources of continuity for all ambulatory visits (by multivariate linear regression). Results. No after-hours care, longer office waits, and longer travel times reduced the chances of a first-contact visit with a primary care physician for acute health problems. Longer appointment waits, no insurance, and no after-hours care were associated with lower levels of continuity. Generalists provided more first-contact care than specialists acting as primary care physicians, largely because of their more accessible practices. Conclusions. These data provide support for the linkage between access and care seeking with primary care physicians.