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Relational Continuity or Rapid Accessibility in Primary Care?: A Mixed-Methods Study of Veteran Preferences

Locatelli, Sara M. PhD; Hill, Jennifer N. MA; Talbot, Mary E. MA; Schectman, Gordon MD; LaVela, Sherri L. PhD, MPH, MBA

Quality Management in Healthcare: April/June 2014 - Volume 23 - Issue 2 - p 76–85
doi: 10.1097/QMH.0000000000000028
Original Articles

Objective: To examine preferences for relational continuity and rapid accessibility for telephone care.

Methods: A mixed-methods sequential explanatory design was utilized. Structured telephone interviews were conducted with 448 Veterans receiving primary care from Veterans Affairs facilities, who rated the importance of relational continuity and rapid accessibility. Seventeen focus groups were conducted with 123 Veterans to examine preferences for continuity versus accessibility and factors affecting these preferences.

Results: Higher proportions of interview patients rated talking with a nurse from their own primary care team (69%) and talking with a nurse with whom they have previous primary care contact (60%) as very important, compared with talking to any nurse as soon as possible (53%) and receiving advice immediately (50%). Focus group participants preferred a familiar provider within 24 hours over immediate contact with an unfamiliar provider, particularly for routine needs. Rapid accessibility was more frequently preferred for urgent questions/concerns. Preference for relational continuity was mitigated by patient age, and access to electronic medical records in larger, but not smaller, facilities.

Conclusions: Health care systems supplementing in-person care with telephone care need to ensure that this care aligns with patient preferences and provide opportunities for both relational continuity and rapid accessibility where possible.

Department of Veterans Affairs (DVA), Center of Innovation for Complex Chronic Healthcare (Drs Locatelli and LaVela and Mss Hill and Talbot) and Department of Veterans Affairs (DVA), Center for Evaluation of Practices and Experiences of Patient-Centered Care (Drs Locatelli and LaVela and Ms Hill) Edward Hines, Jr. VA Hospital, Hines, Illinois; Primary Care Services, Office of Patient Care Services, Veterans Affairs Central Office, Washington, District of Columbia (Dr Schectman); Department of Medicine, Medical College of Wisconsin, Milwaukee (Dr Schectman); and Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr LaVela).

Correspondence: Sara M. Locatelli, PhD, Department of Veterans Affairs (DVA), Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave (Mailcode 151H), Hines, IL 60141 (

This article is based upon work supported by the Office of Systems Redesign of the Department of Veterans Affairs.

This article reflects only the authors' opinions and does not necessarily reflect the official position of the Department of Veterans Affairs or United States government.

The authors thank the facility staff involved in data collection, and the primary care patients and caregivers who participated in this project.

The authors declare no potential conflicts of interests with respect to the research, authorship, and/or publication of this article.

© 2014Wolters Kluwer Health | Lippincott Williams & Wilkins