Relational Continuity or Rapid Accessibility in Primary Care?: A Mixed-Methods Study of Veteran Preferences

Objective: To examine preferences for relational continuity and rapid accessibility for telephone care. Methods: A mixed-methods sequential explanatory design was utilized. Structured telephone interviews were conducted with 448 Veterans receiving primary care from Veterans Affairs facilities, who rated the importance of relational continuity and rapid accessibility. Seventeen focus groups were conducted with 123 Veterans to examine preferences for continuity versus accessibility and factors affecting these preferences. Results: Higher proportions of interview patients rated talking with a nurse from their own primary care team (69%) and talking with a nurse with whom they have previous primary care contact (60%) as very important, compared with talking to any nurse as soon as possible (53%) and receiving advice immediately (50%). Focus group participants preferred a familiar provider within 24 hours over immediate contact with an unfamiliar provider, particularly for routine needs. Rapid accessibility was more frequently preferred for urgent questions/concerns. Preference for relational continuity was mitigated by patient age, and access to electronic medical records in larger, but not smaller, facilities. Conclusions: Health care systems supplementing in-person care with telephone care need to ensure that this care aligns with patient preferences and provide opportunities for both relational continuity and rapid accessibility where possible.