Adoption of the medical home in Connecticut.

OBJECTIVE: To examine the implementation of key features of the medical home concept, with its emphasis on chronic care and disease management, care coordination, case management and timely access to care in Connecticut primary-care practices, and to examine predictors of its implementation in Connecticut. METHODS: Primary care physicians affiliated with the Connecticut Chapter of the American College of Physicians (n = 1088), the Connecticut Chapter of the American Academy of Pediatrics (n = 699), and the Connecticut Academy of Family Physicians (n = 376) were invited to participate in a brief online survey. Participation was limited to physicians who were actively engaged in primary-care medicine as determined by the respondent based on information provided as part of the survey. RESULTS: Four hundred ninty-eight primary-care physicians practicing in Connecticut completed the survey resulting in an overall response rate of 23%. In general, many of the core components of the medical home concept were not widely implemented yet in Connecticut. Most common were registries of patients with chronic diseases (33% of sample) and open or advanced access scheduling (57% of sample). Electronic medical records (EMR) systems were currently used by 39% of primary care physicians. Substantial differences by specialty were observed, with chronic disease registries and advanced/open access scheduling significantly less common among internists, and EMR systems significantly less common among pediatricians. The only factor consistently associated with increased likelihood of implementing the medical home concept was larger practice size (number of practicing physicians within the medical practice). Open or advanced access scheduling resulted in significantly shorter appointment wait times for patients. CONCLUSION: These results reveal that the adoption of the medical home model among Connecticut primary-care physicians remains in its infancy and suggests possible approaches to removing barriers to the implementation of the medical home model in Connecticut.

Connecticut 2009 Primary Care Survey: physician satisfaction, physician supply and patient access to medical care.

OBJECTIVE: To provide a more detailed evaluation of the attitudes and opinions of Connecticut's primary-care physicians, the practice environment in which care is provided, and how the evolving practice environment might affect the availability and quality of medical care in the state. METHODS: Primary-care physicians affiliated with the Connecticut Chapter of the American College of Physicians (n = 1088), the Connecticut Chapter of the American Academy of Pediatrics (n = 699), and the Connecticut Academy of Family Physicians (n = 376) were invited to participate in a brief online survey. Participation was limited to physicians who were actively engaged in primary-care medicine. RESULTS: Four hundred ninety-eight primary-care physicians practicing in Connecticut completed the survey resulting in an overall response rate of 23%. Primary-care physicians in Connecticut were generally satisfied with their careers in medicine, although 20% of respondents reported contemplating a career change because of the practice environment in the state. Statistically significant differences in satisfaction among primary-care specialists were observed, with pediatricians expressing greater satisfaction relative to family physicians and internists with hours worked, the Connecticut malpractice environment, level of administrative burden, income, and overall satisfaction. Analyses seeking to account for the greater levels of satisfaction among pediatricians relative to family physicians and internists identified income as a key explanatory factor. Problems related to access to care were also identified, with 23% of primary-care physicians reporting that they were not accepting new patients, and wait time for routine office visits for existing patients averaged 13.4 days. CONCLUSION: These data, combined with information from the US Census Bureau and the state licensure database, indicate that the potential new patient load tied to expanded insurance coverage under health reform may place a significant burden on primary-care physicians in Connecticut's urban areas and could overwhelm physicians in rural communities.