To the Editor


To the Editor:—I read with interest the article by Jain and Chou1 regarding “orientation clinics.” Their success serves as an exciting opportunity for future development and collaboration. We conducted a similar clinic for patients and their spouses in the mid-1990s. Patients were scheduled for the orientation session the same day as the primary care visit. Our focus was on prevention and screening measures. We discontinued the clinic, as the no-show rate was unacceptably high. Feedback indicated that patients were willing to come to visit their new primary care provider, but not willing to spend additional time at another presumed unrelated visit. The requirement in Jain and Chou's model to attend the orientation clinic prior to visiting with their new primary care provider makes sense. In my view attendance at the orientation session is an important predictor for identifying patients who are truly serious about transferring their care to the Veteran's Health Administration. We know from experience, and this is validated in the literature,2 that many patients choose to come solely for the VHA prescription benefit. Over the last 18 months we have telephoned our patients prior to their first primary care appointment. This intervention decreased our no-show rate for first visits to primary care. However, we have not performed health maintenance screening for obvious reasons. Group visits, such as orientation clinics, do present unique systems issues, however, such as coding, documentation, and patients needing same-day urgent care. No doubt Jain and Chou and others in the VHA system have solutions to these challenges as well. —David A. Nardone, MD,Clinical Director Primary Care, VHA Medical Center, Portland, Ore.