Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Dr Siegel highlights an area of some
confusion and controversy in the primary care redesign movement. One view
holds that improving access to primary care visits will allow people with
chronic illness to see their primary care clinician more promptly and thereby
improve care for those who are chronically ill. I disagree with this view.
I strongly believe that chronic illness care, especially higher-risk people,
requires planned chronic care visits and close follow-up. If advanced access
is implemented poorly, it could serve as a barrier to planned visits and frequent
follow-up as Siegel fears. If advanced access is seen as only a first step
in redesigning primary care (another step being the development of individual
or group chronic-care-only visits, ideally with trained nursing personnel),
and if clinicians are not discouraged from making appointments in advance
for people with chronic illness, then better chronic care and better access
could both be achieved. Primary care redesign ideas are relatively easy to
formulate; implementing these ideas in a clinically thoughtful manner is far
Bodenheimer T. Advanced-Access Scheduling in Primary Care—Reply. JAMA. 2003;290(3):333–334. doi:10.1001/jama.290.3.333
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