Patient and Visit Characteristics Associated With Use of Direct Scheduling in Primary Care Practices

Importance: Medical practices increasingly allow patients to schedule their own visits through online patient portals, yet little is known about who adopts direct scheduling or how this service is used. Objective: To determine patient and visit characteristics associated with direct scheduling, visit patterns, and potential implications for access and continuity in the primary care setting. Design, Setting, and Participants: This cross-sectional study used electronic health record (EHR) data from 17 adult primary care practices in a large academic medical center in the Boston, Massachusetts, area. Participants included patients 18 years or older who were attributed in the EHR to an active primary care physician at 1 of the included primary care practices, were enrolled in the patient portal, and had at least 1 visit to 1 of these practices between March 1, 2018, and March 1, 2019, the period of analysis. Data were analyzed from October 25, 2019, to April 14, 2020. Main Outcomes and Measures: Adoption of direct scheduling, defined as at least 1 use during the study period. Usual scheduling was defined as scheduling with clinic staff by telephone or in person. Results: We examined 134 225 completed visits by 62 080 patients (mean SD age, 51.1 16.4 years, 37 793 60.9% women) attributed to 140 primary care physicians at 17 primary care practices. A total of 5020 patients (8.1% 95% CI, 7.9%-8.3%) adopted direct scheduling, with an age range of 18 to 95 years. Compared with nonadopters in the same practices, adopters were younger (adjusted odds ratio AOR per additional year, 0.98 95% CI, 0.98-0.99) and were more likely to be White (AOR, 1.09 95% CI, 1.01-1.17) and commercially insured (AOR vs uninsured, 1.40 95% CI, 1.11-1.76) and to have more comorbidities (AOR per additional comorbidity, 1.07 95% CI, 1.04-1.11). Compared with usually scheduled visits, directly scheduled visits were more likely to be for general medical examinations (1979 visits 36.7% vs 26 519 visits 21.9%; P < .001) and with one's own primary care physician (5267 visits 95.2% vs 94 634 visits 73.5%; P < .001). Conclusions and Relevance: These findings suggest that direct scheduling was associated with greater primary care continuity. Early adopters were more likely to be young, White, and commercially insured, and to the extent these differences persist as direct scheduling is used more widely, this service may widen socioeconomic disparities in primary care access.