Appointments aren't Access: The Hidden Work of Getting Care

Area of Science:

• Health Services Research
• Primary Care Medicine
• Health Equity

Background:

• Traditional primary care access metrics (appointment supply, wait times) don't capture patient-experienced obstacles.
• Existing literature highlights administrative burden, digital exclusion, and telemedicine inequity as barriers.
• These obstacles accumulate, causing delays, patient drop-off, and health deterioration.

Purpose of the Study:

• To propose the Access Friction Index (AFI) as a practical framework for measuring the real-world effort patients expend to access primary care.
• To link access friction to specific negative health outcomes and inequities.
• To outline methods for identifying and reducing access friction in primary care.

Main Methods:

• Literature review on administrative burden, treatment burden, digital exclusion, and telemedicine inequity.
• Analysis of evidence from the UK, US, and other settings linking access friction to outcomes.
• Proposal of using routine service data and electronic records to identify friction hotspots.

Main Results:

• Access friction is linked to inequities for vulnerable populations, missed screenings, medication non-adherence, and avoidable hospital use.
• Identified friction hotspots include repeated contacts, mode switching, handoffs, and delayed pathway closure.
• Primary care-community approaches like navigation and outreach show potential for friction reduction.

Conclusions:

• The Access Friction Index (AFI) offers a novel framework to measure and understand patient-experienced barriers in primary care.
• Addressing access friction is crucial for reducing health inequities and improving patient outcomes.
• Targeted interventions, including navigation and outreach, can mitigate friction and enhance primary care effectiveness.