Utilization Patterns in an Urban Direct Primary Care Model: A Case Study.

Abstract

Direct Primary Care (DPC) offers an alternative healthcare delivery model with potential benefits for patient-centered care. However, concerns remain about its equity and accessibility, particularly in urban settings. This study examines the utilization patterns and patient engagement within a DPC clinic in Houston, Texas, and whether subscription duration impacts patient-provider interactions in an urban healthcare environment. Deidentified data from a Houston-based DPC clinic (January 2023-January 2024) were analyzed. Patient demographics, subscription details, and interaction data (including in-person appointments and audio-visual calls) were collected. Descriptive statistics summarized utilization patterns, while logistic regression models assessed relationships between demographic factors and DPC utilization. The sample included 71% Non-Hispanic Black patients, 21% Non-Hispanic White, and 77% females. Most patients resided in urban areas (79%) and paid over $125 monthly (44%). Subscription duration positively correlated with engagement: patients subscribed for ≥21 months had higher yearly averages for chart interactions and appointments compared to those who subscribed for ≤5 months. Regression analysis revealed significant dose-response increases in patient engagement among those with longer subscription durations across all interaction types. No other demographic characteristics were significant predictors of DPC utilization. Subscription duration strongly influences DPC utilization, suggesting sustained enrollment fosters deeper patient engagement and more frequent provider interactions. While DPC may enhance patient-provider relationships, cost and urban-centric accessibility may pose barriers to equity.