Primary care services are associated with increased satisfaction and improved clinical outcomes. Yet, many individuals do not use primary care. This study seeks to elucidate the factors which contribute to a patient's decision whether or not to use available primary care services. It is hypothesized that the barriers to primary care within an integrated health care delivery system will be several, including features of the system as well as individuals' beliefs and attitudes. In the first stage of the planned work, 150 members of the HMO who do not use primary care will be invited to participate in focus groups. These will address individuals' attitudes towards their own health as well as any barriers to receiving primary care which they may perceive. This information will be used to develop a grounded theory based model of patient decision making regarding primary care. This preliminary model will be validated using a questionnaire exploring the issues raised by the focus groups. This will be mailed to 1000 members of the HMO and used to determine whether the concerns of the focus group participants reflect the experience of the larger group. It is hoped that this model of patient decision making can then be used to design targeted intervention trails aimed at increasing utilization of primary care.
