where they would need to go to be seen on a weekend or holiday, for example. Determining the level of accessibility that has been achieved is a judgment that is based on a community's needs and expectations as defined by members of the community and based on their experiences in obtaining the care they desire.

Clearly, no clinician can be accessible at all times to all patients. Integrated delivery systems seek ways to ensure timely care, to meet patient expectations, and to use resources efficiently. For example, integrated delivery systems may establish policies regarding maximum waiting times for an urgent appointment, periodic health examinations, coverage when a clinician is out of the office, and getting patients into substance abuse treatment programs on a weekend.

Primary care is a key to accessibility because it can provide an entry point to appropriate care. It is the place to which all health problems can be taken to be addressed. People do not have to know what organ systems are affected, what disease they have, or what kind of skills are needed for their care.

Accessibility also involves “user friendliness.” It also refers to the information people have about a health system that will allow them to navigate the system appropriately. It means directions for health plan members about where to call for certain information or how to get help in an emergency; the ability to get health information and information about self-care or community resources; use of computer technologies to obtain information; and obtaining one's own medical record. Access to guidance and data enhances patients ' ability to care for themselves and act responsibly in relation to their health care system.

Administrative barriers to accessing health services deserve special attention. Even when individuals have a benefit package that provides coverage for a given service, administrative hurdles may sometimes be so burdensome, whether by intention or not, that the service is effectively denied. For example, the approval process for obtaining mental health care is, in some organizations, so intimidating or personally intrusive that individuals may be unable to get timely assistance or even any adequate care at all.

Accessibility can also be increased by the use of telecommunication and information management technologies. For example, clinicians in rural practices can use telecommunication to obtain subspecialist consultations in the reading of diagnostic tests for heart function and for reading slides of pathology specimens.

Accountable

The term accountability in a general sense means the quality or state of being responsible or answerable. It also means “subject to the obligation to report, explain, or justify” (Random House, 1983). Like all clinicians, primary care clinicians are responsible for the care they provide, both legally and ethically.



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