Evaluating Open Access: Problems with the Program or the Studies?

Arthur L. Kellermann

doi:10.7326/0003-4819-149-12-200812160-00016

Letters |16 December 2008

Evaluating Open Access: Problems with the Program or the Studies?

Arthur L. Kellermann, MD, MPH

Article, Author, and Disclosure Information

Potential Financial Conflicts of Interest: None disclosed.

TO THE EDITOR:

Kudos to Mehrotra and colleagues (1) for their effort to implement and evaluate open-access scheduling of visits to 6 Boston-area primary care practices. Unfortunately, because the authors didn't come close to achieving their goal of same-day access, it is difficult to draw meaningful conclusions from their findings. Few patients with an acute problem are likely to consider an 8-day wait for a 15-minute appointment to be a meaningful improvement. But evidently, that was the best these practices could do.

When a patient with a physically uncomfortable or worrisome problem cannot secure an appointment within a reasonable amount of time, one should not be surprised if he or she heads to the nearest emergency department. In fact, emergency department visits by persons whose family income is greater than 400% above the poverty level, and those whose usual source of care is a physician's office, are growing at a much faster rate than emergency department visits by the uninsured (2). Nevertheless, lack of timely access to primary care has not deterred policymakers and third-party payers from labeling many of these visits “inappropriate” or “preventable.”

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Letters |16 December 2008

Evaluating Open Access: Problems with the Program or the Studies?

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Letters |16 December 2008

Evaluating Open Access: Problems with the Program or the Studies?

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