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6 factors comprising patient access to care, engagement
Patient access to care relies on ample appointment availability, digital health access and facility accessibility.
Good patient engagement and healthcare experience hinge on patient access to care, but that very concept is broad and therefore can be challenging to define.
Indeed, in an increasingly digitalized healthcare landscape, patient access to care can mean a lot of different things. It can range from an individual's ability to set foot inside the clinic all the way to accessing telehealth appointments.
But that access isn't always happening.
Right now, the U.S. is facing an uphill battle in terms of usual sources of care, with a 2024 Commonwealth Fund report showing that the nation has the lowest rate of usual sources of care in the developed world.
While lacking a usual source of care doesn't necessarily mean someone is foregoing care altogether -- and, conversely, having a usual source of care doesn't guarantee access -- the figures can illustrate some of the country's biggest care access issues.
Add to that problems affording medical care, booking appointments, getting to the clinic or feeling comfortable with one's clinician and patient care access can seem unattainable.
Getting better outcomes at a lower cost relies on strong patient engagement and positive healthcare experiences. But to get there, patients need to get appointments on the books and make their way into the clinic or sign onto a virtual visit. Below, we'll discuss key domains of patient care access and the challenges and solutions associated with them.
Appointment availability
At a base level, patient care access relies on actually being able to book an appointment, and that means having timely appointments available.
Right now, the data shows that those timely appointments are few and far between.
A 2023 report from the American Association of Nurse Practitioners (AANP) revealed that a quarter of patients face two-month appointment wait times. During such wait times, an individual's health status could deteriorate. Folks facing long wait times might also get discouraged and choose to forego needed medical care.
Long appointment wait times are usually fueled by provider shortages. There simply aren't enough clinicians to meet patient demand. According to AANP, advanced practice providers (APPs) like nurse practitioners or physician assistants could help fill in those gaps. However, variable scope of practice laws can limit APPs.
Clinician offices can chip away at the appointment availability problem by reconsidering how they design their daily schedules. Open access scheduling is a process by which clinics leave a portion of the day available for same-day or next-day appointments. In the case of day-of delays, like an appointment running late and affecting the next patient, clear communication with patients in the waiting room might mitigate satisfaction issues.
In addition to making appointments available, healthcare organizations need to make it easy for patients to book those appointments.
Following digital innovation in other service sectors, many organizations have adopted digital tools to allow for provider search and self-service appointment scheduling, but the results of these tools are mixed.
While some researchers have found that offering online self-scheduling is key to a good digital health experience, others say that the systems can be convoluted and frustrating for patients. According to a 2022 report, 61% of patients were dissuaded from booking an appointment because the self-scheduling system simply just forwarded them to a telephone number.
Healthcare organizations should consider how self-scheduling tools integrate with their provider search systems, patient portals and other digital tools. Ensuring these systems are navigable and usable for patients will be key. Additionally, maintaining scheduling options in the clinic's call center will help serve patients who simply prefer human interaction.
Digital health access
In-person appointments are not the only way patients can access care nowadays. Per 2023 data from the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP), 87% of office-based clinicians used telehealth in 2021, the most recent year for which there is complete data.
A separate 2022 report from CVS Health showed that around half of providers think offering telehealth increased patient visits.
Additionally, digital tools like the secure messaging function in the patient portal allow patients to access their clinicians without going into the office. Using secure direct messaging, patients can ask their provider a question or perform tasks like requesting a prescription refill.
These digital tools have helped close the gap for patients who otherwise would not have accessed care and helped keep folks with simpler questions out of the clinic or office. However, they aren't always accessible.
For example, studies have shown that telehealth use is more limited among individuals with limited English proficiency (LEP). Those with limited broadband access are also less likely to use the tool, especially video-based telehealth.
As healthcare organizations continue to leverage digital health to bridge patient care access gaps, they will need to assess whether patients have access to the infrastructure required to support them.
Cultural competence
Even when appointments are available, patients may not access care because that care will not be culturally competent. Culturally competent or responsive care means healthcare providers consider, respond to and integrate a patient's culture into the healthcare experience.
For example, culturally competent care would mean a provider adjusts and responds appropriately to various cultural norms or provides medical guidance, such as dietary recommendations, that would align with a person's cultural identity.
Language concordance is also a key aspect of culturally responsive care. When clinicians do not speak the same language as a patient and do not have access to medical interpreters, the overall patient experience suffers.
Lack of culturally responsive care, and even the creeping specter of implicit bias or healthcare discrimination, can be a blight on healthcare. A third of Americans think racism is a problem in healthcare, and providers agree. In a 2024 Commonwealth Fund report, half of clinicians said they've witnessed discrimination against patients.
When discrimination is at play, patients will be less likely to access healthcare.
In a 2023 survey from KFF, many racial and ethnic minorities said they prepare for racist encounters even before heading into the clinic or hospital. Six in 10 Black adults, 52 percent of American Indian/Alaska Native (AI/AN) adults, 51 percent of Hispanic adults, and 42 percent of Asian adults said they do this.
Additionally, patients who reported negative experiences with healthcare providers said they faced worse health, were less likely to see care, or switched providers. This was more common among AI/AN and Black adults than white adults who had bad healthcare experiences.
Healthcare can begin healing patient trust by requiring cultural competence and implicit bias training for all staff members. Community-based care and efforts to engage the populations most affected by discrimination and bias are also key steps to building trust and improving patient care access for all.
Facility accessibility
While some patients might face challenges obtaining an appointment or connecting with their provider, others might be hampered by the physical accessibility of the healthcare facility.
This is often the case for individuals with disabilities.
All healthcare facilities are subject to the Americans with Disabilities Act, meaning they "must provide full and equal access to those with disabilities." Per the ADA, this can include the following:
- Adjusting policies, practices, and procedures, if needed, to provide goods, services, facilities, privileges, advantages, or accommodations.
- Making communication, in all forms, easily understood.
- Ensuring physical accessibility.
Healthcare organizations might consider how an individual with both physical and intellectual/developmental disabilities might engage with the healthcare system and make design choices based on that.
In addition to the ADA, healthcare organizations are required to provide reasonable accommodations under Section 1557 of the Affordable Care Act. This section of the ACA prohibits discrimination on the basis of race, color, national origin, sex, age or disability in healthcare programs receiving federal funding.
This means healthcare organizations receiving federal funding, including Medicare and Medicaid reimbursement, must offer written materials in accessible formats, such as Braille, and access to interpreters. They must also ensure physical access to buildings and facilities.
The risks of not providing reasonable accommodations are serious. Data has shown that individuals with disabilities report discrimination in the healthcare setting, and other surveys have shown that individuals with disabilities have more trouble accessing healthcare than their typically abled counterparts.
Social determinants of health
Sometimes, an individual's ability to access healthcare lies outside the healthcare organization itself. Rather, a litany of social determinants of health (SDOH) can create barriers to care.
While the SDOH barring patient care access are numerous, three stand out as the most prominent: transportation barriers, poor healthcare affordability or income and employment.
According to the CDC, 5.7% of Americans have transportation access issues, with younger people, people of color and women being the most likely to report transportation access issues.
And, notably, poor access to transportation keeps patients from getting to their medical appointments. In 2023, the Robert Wood Johnson Foundation reported that about a fifth of adult patients did not access care because of limited access to transportation.
Affordability and income, too, can affect patient access to care, with numerous reports indicating that high healthcare costs keep patients out of the exam room. This is true regardless of insurance status, suggesting that healthcare affordability is a broad issue that will continue to hamper patient care access.
Even when patients can get to an appointment and pay for it, care access can still be an uphill battle, especially for those with certain types of jobs. Jobs that operate during typical office hours and jobs that do not provide flexible time off can make it hard for patients to get into a clinic. Low-wage workers might also struggle to attend appointments if doing so means losing out on hours.
Healthcare organizations can circumvent some of those challenges by keeping flexible office hours outside of the traditional 9-to-5. Keeping the clinic open on weekends can also be effective.
Health literacy
Health literacy affects an individual's ability to engage with the healthcare system, including knowing when and how to access care.
For example, having high health literacy will impact whether a patient experiencing flu symptoms visits the urgent care or the emergency department (ED). This is important, as EDs are known for overcrowding, and accessing the appropriate level of care can help ease those problems.
Digital health literacy, which refers to a patient's ability to make use of the health IT available to them, can also affect patient care access. Patients with higher digital health literacy might be more comfortable booking online appointments, messaging their provider via the patient portal or accessing care via telehealth.
Currently, both regular and digital health literacies are somewhat poor, keeping patients from fully engaging with and accessing their healthcare system. Better patient education can help improve patient health literacy, but organizations need to design systems and processes to account for continued low health literacy.
Creating accessible resources outlining when patients should access certain types of care, setting up navigable care access systems and ensuring closed-loop referral systems for patients being transferred to different parts of the healthcare system will be essential.
Sara Heath has covered news related to patient engagement and health equity since 2015.
