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Urgent care centers are often a last resort, a place for patients who want to see their primary care doctor but can’t get a same-day appointment.
But these centers don’t have to serve as a dumping ground for patient overload. Instead, the centers can become an extension of primary care, offering a different solution to access and coordination of care problems, says Steven D. Pearson, MD, MSc. Pearson is an internist and assistant professor in the Department of Ambulatory Care and Prevention at the Harvard Medical School and Harvard Pilgrim Health Care in Boston.
"When urgent care is handled right, as an extension of a primary care practice, I think it actually provides the highest satisfaction and service to patients," says Pearson. "There’s nothing happier than patients who find they can get such rapid access — not have to go to the emergency room — and have [their condition] immediately communicated with the primary care physician. To them, it’s magical."
At Harvard Vanguard Medical Associates, where Pearson sees urgent care patients, the smooth flow of care relies on both technology and process improvements. The medical group has an integrated computerized medical record system.
Pearson can access a patient’s full medical record, including progress notes from the primary care physician. Then he can add his own notes. "When I dictate an encounter, a copy is sent automatically to the primary care provider."
Ensuring patient follow-up
Pearson also can view the primary care physician’s schedule and arrange a follow-up appointment for the patient. "If I think the person needs to be seen within a week, I make the appointment for them," he says. "I’m sure it’s done. I can tell the patient what time it is."
In cases in which follow-up is especially important, or if there is any question about the possible compliance of a patient with follow-up instructions, the physician can fill out a fluorescent yellow form with the patient information.
An urgent care nurse then taps into the primary care schedule to see if the patient showed up for the appointment. If not, the nurse calls the patient to find out what happened and to make another appointment. "You can’t underestimate the importance of having a system to ensure correct follow-up," says Pearson.
Yet no matter how efficient and cohesive an urgent care center is, it is not the first choice of many patients.
In 1996, Pearson and colleague Anna E. Plauth, MD, MPH, conducted a study of the Harvard Vanguard urgent care; 47% of patients said they were there because they had been unable to get an appointment with their primary care physician. "Among the patients who do come to urgent care, a lot of them said they would have much rather seen their own doctor even if they had to wait a day or two," Pearson says.
The medical group revamped its scheduling system and implemented an open access system, enabling patients to receive same-day appointments. (For more on open access, see Patient Satisfaction & Outcomes Management, February 1999, p. 13.) A portion of the compensation for primary care physicians is now tied to a measure of how many of their patients they see themselves.
Urgent care is now viewed as a resource, both by patients and physicians, says Pearson. For example, the center can provide intense observation of patients the day after discharge from the hospital. The center also coordinates the administration of an injectable form of medication to treat deep vein thrombosis, providing daily communication to the primary care physician and then transferring ongoing care back to that physician.
"The system is set up to respect and foster primary care," says Pearson. "We, as urgent care physicians, respect the primary care relationship of our patients with their doctors. We try to encourage the patients to get back into the primary care physician’s office. All of our systems and our communications flow are structured to assist the primary care practice."