¶ … Primary Care Beard, C., Weisberg, R.B., & Primack, J. (2012). Socially anxious primary care patients' attitudes toward cognitive bias modification (CBM): a qualitative study. Behavioural and cognitive psychotherapy, 40(05), 618-633.

This study shows how traditional methods of approaching patients with information can cause confusion and thus create barriers to accessing patient knowledge in primary care settings. The study focused on working with primary care patients suffering from anxiety and how they reacted to cognitive bias modification (CBM) for that anxiety. Upon initial discussion of the treatment, most participants showed that they understood. However, it was clear by the end of the treatment that the program was not clarified enough to patients prior to treatment and that created a knowledge barrier that caused the treatment not to work as successfully as previously tested. Better methods for communicating the treatment within the primary care setting must be developed to bring down these barriers.

Beckman, H.B., Wendland, M., Mooney, C., Krasner, M.S., Quill, T.E., Suchman, A.L., & Epstein, R.M. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 815-819.

Here, the authors explore how individual physicians can work to help facilitate greater care practices in their unique environments, despite the flaws in the current system. The researchers claim that when physicians are more satisfied with their job experience, they can serve as greater voices of change, thus helping the system evolve to better practices. The authors interviewed primary care physicians who had just attended a 52-hour communication program to reduce burn out on the job and increase empathy for patients. What the research discovered was that greater access to discussing their job with colleagues can increase satisfaction and ultimately help increase engagement in the field. Such increased devotion then helps generate physicians who are not just reactive, but proactive in helping tear down barriers to primary care in their own fields.

Cheung, P.T., Wiler, J.L., Lowe, R.A., & Ginde, A.A. (2012). National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Annals of emergency medicine, 60(1), 4-10.

Unfortunately, access to quality does come at a high premium. Many patients who cannot afford private insurance have to depend on state run programs, like Medicare. Yet, this study clearly shows the barriers created by Medicare in accessing quality primary and emergency care. Often times, emergency wait times were much higher for Medicare patients when compared to private insurance options. Thus, Medicare patients are more negatively affected by the barriers put into place for primary and emergency care.

Crabtree, B.F., Nutting, P.A., Miller, W.L., McDaniel, R.R., Stange, K.C., Jaen, C.R., & Stewart, E. (2011). Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Medical care, 49(Suppl), S28.

This research used a survey method to review 15 years of data regarding improvement strategies for enhancing clinical performance in the primary care setting. According to the study, interventions that intervention strategies that use complexity science methods can help strengthen the success of intervention methods. This views different elements of the primary care health facility as individual agents. Thus, a complexity systems perspective helps create synergy within each of the agents, including patient knowledge. Thus, treating this unique agent with evidence-based practices can help increase the ability for the transfer of knowledge to patients.

HERT, M., Cohen, D., Bobes, J., CETKOVICH-BAKMAS, M.A.R.C.E.L.O., Leucht, S., Ndetei, D.M., ... & Correll, C.U. (2011). Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry, 10(2), 138-151.

Individuals with mental health challenges often face barriers to care like no other field in medicine. Yet, there are more sensitive needs regarding both physical and mental disorders within such populations, making these individuals have a greater need for effective primary care. Barriers unfortunately leave many without the care they need, especially in regards to medical costs. Often times, such patients fail to receive the same type of preventative screenings and monitoring of physical conditions because of control and monetary factors. This current research explores the unique barriers to primary care experienced by patients with severe mental illness (SMI). The paper concludes with a proposition of encouraging psychiatrists and other mental health professionals to extend their services to include such physical screenings as well as other psychiatric services. This would ultimately...

This may ultimately help provide more access to care for the population.
Kiessling, A., Lewitt, M., & Henriksson, P. (2011). Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease. The Annals of Family Medicine, 9(3), 211-218.

Working specifically within the field of coronary health, the researchers wanted to test interventions implementing at reducing the cost of primary care to facilitate greater access for all patients. The study took place over a ten-year period, where the records of patients were tracked for an experimental group that had greater access to primary care to help with their heart conditions. Meanwhile, a control group was also tracked, where no such interventions had taken place. An astounding 44% of patients without interventions had passed within the ten-year period, while only 22% of the experimental group had. Thus, using evidence-based practice to open up greater access to patient learning can help prevent mortality from cardiac issues. Physicians that use patient learning interventions based on evidence-based practice thus provide greater survival rates for their patients.

Luxford, K., Safran, D.G., & Delbanco, T. (2011). Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience. International Journal for Quality in Health Care, 23(5), 510-515.

This study examined potential barriers to primary care through interviewing senior staff and patient representatives at eight health care facilities around the United States. Thus, the study included a total of 40 participants that participated in semi-structured interviews. They were asked regarding their opinions on hospital leadership, wok environments, evaluation methods, patient engagement, and IT technologies in regards to how these factors may be facilitating or hindering primary care for certain demographics. Overall, the study concluded that most of the participants believed stronger leadership was a key correlation between opening up greater access to care. This was only augmented by patient engagement with staff and accurate feedback of patient experiences. With participants who were more patient-centered in their approach to care, they believed they could help break down some of the barriers to primary healthcare through innovative leadership of hospital and medical facility objectives. Such leadership can help augment undergoing financial and operating restructuring to produce greater access to primary care for more Americans.

Schoen, C., Osborn, R., Squires, D., Doty, M., Rasmussen, P., Pierson, R., & Applebaum, S. (2012). A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Affairs, 31(12), 2805-2816.

In this study, researchers explore the various reforms that have been implemented to reduce healthcare costs in various countries. What they discovered was that when there are more integrated care systems that facilitate greater levels of communication, the quality of care increases without additional costs. This ultimately impacts the patient knowledge transfer and increases the ability for the patient to trust caregivers because of an increased engagement and cooperation between departments. It is clear that to help increase patient engagement and reduce such barriers, primary care physicians need to be more connected with specialists.

Schoen, C., Osborn, R., Squires, D., Doty, M., Pierson, R., & Applebaum, S. (2011). New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated. Health Affairs, 30(12), 2437-2448.

Adults with chronic illnesses have to deal with health care facilities much more often than other types of patients. This study discovered that with their increased experience with healthcare facilities has come a fall of quality in the care they receive. The primary issue in the quality of care is the lack of coordination between interagency facilities and departments. The lack of coordination only decreases the quality of care and creates a sense of patient distrust with physicians and the system as a whole. This can ultimately create a new barrier to patient knowledge in primary health care.

Smith, S.R. (2011). A recipe for medical schools to produce primary care physicians. N Engl J. Med, 364(6), 496-7.

This report explored how medical schools can better train physicians in order to provide more accurate information to patients in a primary care setting. Unfortunately, there are few programs which work on helping physicians increases their communication and interpretation skills at a medical school level. This often leads to physicians working in the field who do not handle working with patients properly enough to facilitate the dissemination of information. Working with school facilities will ultimately help break down communication barriers.