After-hours care and its coordination with primary care in the U.S.

Background: Despite expectations that medical homes provide "24 × 7 coverage" there is little to guide primary care practices in developing sustainable models for accessible and coordinated after-hours care.

Objective: To identify and describe models of after-hours care in the U.S. that are delivered in primary care sites or coordinated with a patient's usual primary care provider.

Design: Qualitative analysis of data from in-depth telephone interviews.

Setting: Primary care practices in 16 states and the organizations they partner with to provide after-hours coverage.

Participants: Forty-four primary care physicians, practice managers, nurses and health plan representatives from 28 organizations.

Approach: Analyses examined after-hours care models, facilitators, barriers and lessons learned.

Results: Based on 28 organizations interviewed, five broad models of after-hours care were identified, ranging in the extent to which they provide continuity and patient access. Key themes included: 1) The feasibility of a model varies for many reasons, including patient preferences and needs, the local health care market supply, and financial compensation; 2) A shared electronic health record and systematic notification procedures were extremely helpful in maintaining information continuity between providers; and 3) after-hours care is best implemented as part of a larger practice approach to access and continuity.

Conclusion: After-hours care coordinated with a patient's usual primary care provider is facilitated by consideration of patient demand, provider capacity, a shared electronic health record, systematic notification procedures and a broader practice approach to improving primary care access and continuity. Payer support is important to increasing patients' access to after-hours care.