Having a primary care provider (PCP) is important for maintaining health and preventing and managing serious diseases. PCPs can develop long-term relationships with patients and coordinate care across health care providers. Strategies like team-based care and innovative payment methods are promising approaches for improving access to primary care.  2022 NC SHIP, pg. 98.

Access to health services means “the timely use of personal health services to achieve the best health outcomes.” A lack of access to care can impact overall physical, social, and mental health. It can also affect someone’s quality of life and livelihood. Barriers to access typically include the high cost of care, inadequate or no insurance coverage, and a lack of available services (geographically or remotely), especially culturally competent care. These barriers can lead to unmet health needs, delays in receiving appropriate care, an inability to get preventive services, preventable hospitalizations, and financial burdens. Access to care often varies by race/ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location.

Participants in the 2021 NC SHIP Community Council Meeting and Stakeholder Symposia elaborated on the story of primary care in North Carolina with these comments:

• “Surprising that certified nurse midwives (CNMs) are weighted at 0.75 in primary care when an obstetrician (OB) is weighted at 0.25 and most CNMs work in OB.”

• “To the point regarding CNM vs OBs time splitting: CNMs do mostly deliveries, OB visits, and prescribing birth control, and annual exams are all primary care activities. OBs are mostly surgical, so actually, we under-valued CNMs in this regard.”

• “The correlation of good health outcomes in quality primary care is the level of continuity and comprehensiveness – it’s the longitudinal relationship and the understanding of all of the indicators and factors putting the puzzle together.”

• “We have a data problem in counting population per primary care practitioner – example in Chatham Co.  Most of the physicians that work in Northern Chatham Co., have a primary practice in Orange County, but their ambulatory office may be in Chatham County.”  

• “There are primary care physicians that have practices in one county, but they may go out to surrounding counties three days per week but are not counted in those counties.”

• “I am willing to accept that the data is not perfect and that this is all that we have, but it is bothersome that there is no sense of “parttime-redness”.  Most physicians in academic health settings are going to be less than one-half clinical.  In addition, you have people in various stages of retirement or family life cycle.  This is a big impact on access that we have no way to estimate.”

• “This is also an AWESOME measure because it now includes advanced practice providers, whereas previously, it only captured primary care physicians.  This is a huge advance and is really appreciated.  No doubt it can still be refined, but it is still a great advance from what we had been using.”

2022 NC SHIP, pg. 102

• Ensure high speed internet access because it impacts telehealth, electronic health records and access to the controlled substance reporting system
• Identify rural provider champions
• Increase access and payment for specialist consults
• Increase residency positions in rural areas
• Increase rural health clinical rotations for physician assistants (PAs) and Advanced Practice Nurses (DNPs)
• Increase support for all primary care providers
• Increase telehealth primary care initiatives in rural areas
• Invest in rural economies
• Support increased funding for provider loan repayment programs that incentivize primary care providers to practice in medically underserved areas
• Support pipeline programs in rural areas to encourage high school and college students to pursue careers in medicine/primary care

Cecil G. Sheps Center for Health Services - Research analysis of licensure data from North Carolina Medical Board and North Carolina Board of Nursing

• Stories from consumers/residents and their experiences around access to primary care in their community
• Secondary and post- secondary opportunities to pursue careers in health care
• Telehealth availability
• Contact information for all health care providers serving residents