Asking women to see nurses or unfamiliar physicians as part of primary care redesign

To gauge women's flexibility about seeing a nurse or an unfamiliar physician, to assess their interest in telephone visits, and to identify the characteristics of women who are least flexible.

Telephone surveys, focus groups, and in-person interviews with women.

A random, demographically stratified sample of 1500 English-speaking female members of a health maintenance organization (ages 18-80 years) completed a 20-minute telephone survey (with a 72% response rate). A random subgroup of 500 women were asked about care preferences during acute illness and routine visit scenarios. Women (n = 242) from the full sample with a chronic illness were asked about their openness to telephone visits and care managers. Qualitative information was gathered from 10 focus groups and 75 in-person interviews.

Most women (72%) were open to seeing a different physician for a minor acute illness, but they were less so (35%) for a routine checkup. If their physician was not available, the majority said they would be willing to see a registered nurse for the flu (72%) or a nurse-practitioner for a checkup (64%). Half (59%) of the chronically ill women were comfortable with telephone visits, and one third (37%) were "very interested" in care managers. Across scenarios, approximately one third of the women were strongly committed to seeing only their regular physician. They were more likely to be middle-aged or older, to have lower health plan satisfaction and perceived coordination of care, and to recall rude encounters with clinicians.

The flexibility of most women regarding redesigned models of healthcare is encouraging. More attention needs to be paid, however, to education of women about multidisciplinary roles, enhancement of coordination of care, and customization of care to match patients' preferences.