Abstract
BackgroundTimely access in primary health care is one of the key issues facing health systems. Among many interventions developed around the world, advanced access is the most highly recommended intervention designed specifically to improve timely access in primary care settings. Based on greater accessibility linked with patients’ relational continuity and informational continuity with a primary care professional or team, this organizational model aims to ensure that patients obtain access to healthcare services at a time and date convenient for them when needed regardless of urgency of demand. Its implementation requires a major organizational change based on reorganizing the practices of all the administrative staff and health professionals. In recent years, advanced access has largely been implemented in primary care organizations. However, despite its wide dissemination, we observe considerable variation in the implementation of the five guiding principles of this model across organizations, as well as among professionals working within the same organization.The main objective of this study is to assess the variation in the implementation of the five guiding principles of advanced access in teaching primary healthcare clinics across Quebec and to better understand the influence of the contextual factors on this variation and on outcomes.MethodsThis study will be based on an explanatory sequential design that includes 1) a quantitative survey conducted in 47 teaching primary healthcare clinics, and 2) a multiple case study using mixed data, contrasted cases (n = 4), representing various implementation profiles and geographical contexts. For each case, semi-structured interviews and focus group will be conducted with professionals and patients. Impact analyses will also be conducted in the four selected clinics using data retrieved from the electronic medical records.DiscussionThis study is important in social and political context marked by accessibility issues to primary care services. This research is highly relevant in a context of massive media coverage on timely access to primary healthcare and a large-scale implementation of advanced access across Quebec. This study will likely generate useful lessons and support evidence-based practices to refine and adapt the advanced access model to ensure successful implementation in various clinical contexts facing different challenges.
Highlights
Access in primary health care is one of the key issues facing health systems
Among many interventions developed around the world to improve timely access, advanced access figures as one of the most highly recommended model to reduce wait times in primary care settings [4,5,6]
The results revealed a variety of implementation challenges faced by the organization itself, and many others faced by residents that warrant further investigation in larger-scale studies
Summary
Access in primary health care is one of the key issues facing health systems. Among many interventions developed around the world, advanced access is the most highly recommended intervention designed to improve timely access in primary care settings. Based on greater accessibility linked with patients’ relational continuity and informational continuity with a primary care professional or team, this organizational model aims to ensure that patients obtain access to healthcare services at a time and date convenient for them when needed regardless of urgency of demand. Based on greater accessibility linked with patients’ relational and informational continuity with a primary care professional or team [7], this organizational model is based on five guiding principles (see Fig. 1) [8]: 1) Balancing supply (appointments available) and demand (requests for appointments) consists of assessing the need for services by weighting the patients’ needs according to their medical conditions and their age and adjusting the supply of services . Implementing advanced access requires a major organizational change implying more broadly reorganizing the practice of the whole team members (administrative staff and health professionals) to be more patient-focused and efficient [9, 10]
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