Top Challenges Impacting Patient Access to Healthcare

Healthcare organizations must look into convenient care options and other patient services to drive more patient access to healthcare.   

By Sara Heath

July 03, 2018 - Patient access to healthcare sets the baseline for all patient encounters with the healthcare industry. When a patient cannot access her clinician, it is impossible to receive medical care, build relationships with her providers, and achieve overall patient wellness.

Despite this importance, patient care access is not a reality for many patients across the country. Between appointment availability issues and troubles getting a ride to the clinician office, patient care access has many associated challenges.

Below, PatientEngagementHIT.com outlines some of the top obstacles to patient care access, as well as the ways some medical professionals are addressing them.

LIMITED APPOINTMENT AVAILABILITY, OFFICE HOURS

Many healthcare organizations offer a typical set of office hours for patient visits. But for the working adult or parent, a clinic that is open between 8 a.m. and 6 p.m. is not always useful. Patients need convenient office hours that allow them to visit the doctor outside of their work or school schedules.

Aside from care quality, access to convenient care is one of the top drivers for patient care site decisions. Patients want to be able to access their healthcare when they want and need it.

Healthcare organizations are overcoming these barriers by expanding their office hours. Extending office hours is one of the fundamental pillars of the patient-centered medical home (PCMH).

Additionally, some organizations are utilizing health IT and connected health to allow patients to seek medical advice without needing to come into the office. Telehealth allows a patient to receive medical treatment without being beholden to an office schedule that does not fit the patient’s needs.

Urgent care centers and retail clinics are also emerging players allowing patients to connect to care outside of a doctor’s office hours.

However, these are simply fixes. Organizations that can manipulate their office hours or stagger appointments in such a way that patients can access their clinicians at convenient times will likely see more patient access.

GEOGRAPHIC, CLINICIAN SHORTAGE ISSUES

Patients living in rural areas are disproportionately more likely to struggle to access their clinician than a patient living in an urban or suburban area.

As many as 57 million Americans currently live in a rural area, according to the American Hospital Association. These individuals face a litany of challenges, ranging from where they live to having enough doctors to provide care.

“Remote geographic location, small size, limited workforce, physician shortages and often constrained financial resources pose a unique set of challenges for rural hospitals,” AHA asserted in a recent rural healthcare resource.

Healthcare organizations have been tapping telemedicine to close care gaps caused by geographic barriers. Direct-to-consumer telemedicine allows patients to use their own computers or smartphones to video call with a provider. Many smaller facilities in rural areas will also use telemedicine to connect with experts in more urban areas, keeping patients from having to travel great distances to receive intensive or specialized care.

Patients living in rural areas must also contend with clinician shortages. As the nation sees an impending clinician shortage even in urban areas, patients in rural regions feel the pinch even harder.

The patient-to-primary care physician ratio in rural areas is 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas, according to statistics from the National Rural Health Association.

A separate report from the University of Nebraska Medical Center showed that clinician shortage issues are plaguing rural areas across the country. Although primary care clinician access is up 11 percent from 2008, doctors are still bracing to get hit hard by the growing national clinician shortage issue.

Healthcare professionals are calling for policy changes that help funnel more providers to rural areas. Some visa waivers could incentivize foreign-born but American-educated providers to practice in rural areas.

Additionally, legislative fixes to expand scope of practice laws for advanced practice registered nurses and physician assistants could help close some care gaps.

TRANSPORTATION BARRIERS

Even when a patient has access to a provider and can schedule an appointment, transportation barriers can keep patients from seeing their clinicians. Patients who are physically unable to drive, who face financial barriers, or who otherwise cannot obtain transportation to the clinician office often go without care.

Per AHA statistics, approximately 3.5 million patients go without care because they cannot access transportation to their providers. Transportation is a critical social determinant of health that has recently gained nationwide attention.

At this year’s HIMSS conference, rideshare giants Uber and Lyft announced plans to close care gaps arising from medical transportation woes. Uber announced its own healthcare offshoot, while Lyft said it will partner with EHR vendor Allscripts to help providers and patients connect with rides to medical appointments.

Healthcare organizations have also been forging their own relationships with Uber, Lyft, and other specialized medical transportation services. These are key examples of community health partnerships that help hospitals keep their patients healthier in the long run.

LIMITED EDUCATION ABOUT CARE SITES

Oftentimes, patient care access issues are not about getting a foot in the door. Instead, it’s about getting a foot in the right door. While it is essential for healthcare organizations to remove obstacles barring patients from getting to the office, it is equally important for organizations to make sure patients are getting to the right type of facility.

This is especially critical as health systems begin to integrate alternative treatment sites into their repertoires. Patients can choose to access care at an urgent care center, a retail clinic, a microhospital, a freestanding emergency department, and numerous other emerging treatment facilities.

While these growing care options are a positive step forward for patient care access, it is essential that medical providers deliver the proper patient education that helps patients identify the appropriate facility for their needs.

A February 2017 survey from CityMD showed that patients largely don’t know where they should receive care for various different symptoms. When presented with different scenarios, patients struggled to regularly identify the proper care site for certain health needs.

For example, only 46 percent of respondents correctly selected urgent care as the appropriate choice for a scenario in which a child is presenting with 104-degree fever, shivering, and coughing.

Respondents were also split on scenarios in which a child has a deep chin laceration or an adult has a seemingly endless nosebleed. For both situations, about half of respondents correctly selected urgent care.

Medical professionals need to educate their patients on the specific uses for different care sites. For example, dire healthcare situations will require a visit to the ED, while pain from a potential sprained ankle may be better off treated in an urgent care clinic.

Clinician offices and hospitals can display this information in their own facilities and offer patient education materials. However, access education should also be a part of different care facilities’ marketing plans. An urgent care center should make it widely-known which types of ailments they are best suited for treating.

Connecting patients with the right care at the right time is an important value-based care principle. When a patient can easily access a primary care or wellness visit, she may see a diminished likelihood of developing a more concerning illness down the line.

Healthcare organizations need to have the right patient-centered mechanisms in place that ensure patients can easily access those care services.

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