Development and implementation of a panel managed preventative health sevices protocol in a rural primary care clinical to improve patient access to care

Abstract

Due to a lack of primary care providers (PCP) in a rural family practice clinic, patient access to health care is being compromised with patients experiencing difficulties scheduling appointments within a timely manner. Periodic health exams (PHE) can be time consuming and lack strong evidence that they improve patient outcomes, however, the actual preventative health services (PHS) reduce morbidity and mortality rates. Suggestions have been made to incorporate preventative health services counseling into other office visits to eliminate lengthy PHE or by use of a panel managed approach. A panel managed preventative health service protocol was developed and implementation was piloted by two PCP at the clinical project site. The goal of this project was to improve patient access by decreasing the number of days to schedule an appointment with a PCP in a rural family practice clinic over a 3-months. A secondary aim was to decrease the daily patient census of the urgent care walk-in clinic partially related to inappropriate use. Thirty days prior to the implementation of the panel managed preventative health service protocol, the mean number of days to schedule an appointment with a PCP was 42.57 days and 50.87 days of month one and 52.19 days of month three of project implementation. The mean daily patient census count in the urgent care walk-in clinic for 30 days prior to project implementation, was 73.57 days and month three of the project implementation was 57.07 days, reflecting the expected change. Despite somewhat conflicting results and several limitations experienced in the implementation portion of this project, a panel managed preventative health service protocol has the potential to benefit the healthcare system by displacing some of the workload from PCP to nonclinican staff and improve compliance of recommended PHS. Recommendations of implementation over a longer timeframe, appropriate allocated staff, and data collection of the recommended PHS patients obtained, may strengthen future, similar projects.