Advanced Access Scheduling Research Articles

Unveiling Patients’ Perspectives: Impact of Varying Durations of Advanced Access Scheduling System Implementation on Access to Care in Academic Family Medicine Clinics

Unveiling Patients’ Perspectives: Impact of Varying Durations of Advanced Access Scheduling System Implementation on Access to Care in Academic Family Medicine Clinics

After COVID-19: Improving the Patient's Outpatient Appointment Experience.

As the COVID-19 pandemic diminishes, it is expected that patients will seek more outpatient appointments resulting in adverse patient and clinic experiences if there is a corresponding increase in missed appointments. This study's purpose was to determine if there was an association between advanced access scheduling, also known as open access or same day scheduling, and missed appointment rates for patients scheduled with preferred primary care physicians vis-a-vis nonpreferred primary care physicians. Patients prescheduled with primary care providers and over the age of 18 years were included in the study, which totaled 4815 visits. Study results demonstrated a statistically significant mean proportion difference between the national no-show rate and the study's no-show rate as well as a significant association between physician type and visit status. The results suggested the potential for improving the patient experience with advanced access scheduling if patients are scheduled with their preferred primary care physician. This study may promote positive patient experiences by providing patients and clinicians with an understanding of the significance surrounding advanced access scheduling thus decreasing missed appointments.

Advanced Access scheduling in general practice and use of primary care: a Danish population-based matched cohort study.

BackgroundAdvanced access scheduling (AAS) allows patients to receive care from their GP at the time chosen by the patient. AAS has shown to increase the accessibility to general practice, but little is known about how AAS implementation affects the use of in-hours and out-of-hours (OOH) services.AimTo describe the impact of AAS on the use of in-hours and OOH services in primary care.Design & settingA population-based matched cohort study using Danish register data.MethodA total of 161 901 patients listed in 33 general practices with AAS were matched with 287 837 reference patients listed in 66 reference practices without AAS. Outcomes of interest were use of daytime face-to-face consultations, and use of OOH face-to-face and phone consultations in a 2-year period preceding and following AAS implementation.ResultsNo significant differences were seen between AAS practices and reference practices. During the year following AAS implementation, the number of daytime face-to-face consultations was 3% (adjusted incidence rate ratio [aIRR] = 1.03; 95% confidence interval [CI] = 0.99 to 1.07) higher in the AAS practices compared with the number in the reference practices. Patients listed with an AAS practice had 2% (aIRR = 0.98; 95% CI = 0.92 to 1.04) fewer OOH phone consultations and 6% (aIRR = 0.94; 95% CI = 0.86 to 1.02) fewer OOH face-to-face consultations compared with patients listed with a reference practice.ConclusionThis study showed no significant differences following AAS implementation. However, a trend was seen towards slightly higher use of daytime primary care and lower use of OOH primary care.

Advanced Access Scheduling in Primary Care: A Synthesis of Evidence.

Advanced access (AA) scheduling aims to improve primary care throughput by decreasing appointment scheduling wait time for patients. The primary objective of this article is to provide a review and analysis of the evidence comparing AA scheduling in primary care with traditional scheduling. A comprehensive search of electronic databases (PubMed, Cochrane, CINAHL, Web of Science, PsychINFO) from 1999 through 2018 was completed to identify all studies that compared practice and patient outcomes before implementation of AA scheduling and after implementation in primary care. PRISMA-P 2015 protocol guidelines for systematic review were used. Of the 177 studies eligible for inclusion, 18 satisfied all inclusion criteria. Findings suggest that AA scheduling may reduce appointment scheduling wait time (83%) and no-show rates (67%), increase patient volume (50%) and productivity of providers (83%), and decrease emergency and urgent care visits (75%). Patient and staff satisfaction, continuity of care, revenue, and quality of care outcomes were mixed in terms of improvement. This author investigated definition controversies, implication to stakeholders, differences in scheduling implementation, and measures and outcomes of AA in primary care. The analysis found that AA scheduling promises to improve access in primary care. Further research must be conducted to better inform healthcare stakeholders on how, where, and with whom AA scheduling systems can be best implemented.

Continuity of Care in Resident Outpatient Clinics: A Scoping Review of the Literature.

Continuity between patients and physicians is a core principle of primary care and an accreditation requirement. Resident continuity clinics face challenges in nurturing continuity for their patients and trainees. We undertook a scoping review of the literature to better understand published benchmarks for resident continuity; the effectiveness of interventions to improve continuity; and the impact of continuity on resident and patient satisfaction, patient outcomes, and resident career choice. We developed a MEDLINE search strategy to identify articles that defined continuity in residency programs in internal medicine, family medicine, and pediatrics published prior to December 31, 2015, and used a quality evaluation tool to assess included studies. The review includes 34 articles describing 12 different measures of continuity. The usual provider of care and continuity for physician formulas were most commonly utilized, and mean baseline continuity was 56 and 55, respectively (out of a total possible score of 100). Clinic and residency program redesign innovations (eg, advanced access scheduling, team-based care, and block scheduling) were studied and had mixed impact on continuity. Continuity in resident clinics is lower than published continuity rates for independently practicing physicians. Interventions to enhance continuity in resident clinics have mixed effects. More research is needed to understand how changes in continuity affect resident and patient satisfaction, patient outcomes, and resident career choice. A major challenge to research in this area is the lack of empanelment of residents' patients, creating difficulties in scheduling and measuring continuity visits.

The Walk-in Clinic

ABSTRACT Access to adequate and timely dermatology care, especially for an acute chief complaint (changing lesion, painful rash, etc.), is an ongoing problem for patients. A same-day service model (same-day appointments, walk-in clinic, “advanced access scheduling,” or “open access scheduling”) can be implemented to increase the supply of dermatology care with demand. Limited evidence exists on how to successfully establish a same-day service, such as a walk-in clinic, in a traditional dermatology practice. This article will discuss the establishment of a walk-in clinic in a dermatology practice in Northern California and will also review the associated advantages and challenges of providing a walk-in clinic. It will also identify the important role of nurses and nurse practitioners in the dermatology walk-in clinic. It is our hope that the information in this article will support the future establishment of dermatology walk-in clinics to better serve dermatology patients with acute skin problems.

Impact of Advanced Access Scheduling on Patient Care Choices and Health Behaviours in a Nurse Practitioner-Led Clinic

The Nurse Practitioner-Led Clinic (NPLC) is a new model of primary healthcare. The wholistic approach of nurse practitioner (NP) led care in an NPLC that implements Advanced Access scheduling has the potential to enhance timely access to care and improve health outcomes. The purpose of this study was to determine the experience of patients in one NPLC as well as their healthcare behaviours related to Advanced Access scheduling. A previously developed survey with items related to appointment access, health behaviours and satisfaction was mailed once to patients at a NPLC in northern Ontario. 535 patients replied for a response rate of 29%. A majority (85.4%) were able to access same-day appointments. Access to same-day appointments was associated with less likelihood of attending a walk-in-clinic or emergency department in addition to self-reports of improvements in lifestyle and better control of medical condition(s). Advanced access scheduling contributes to optimal patient care in an NPLC setting. The NP role in lifestyle counselling and wholistic care in the NPLC model contributes to improved self-reported health. Access to an appointment at a point of ‘readiness’ may positively contribute to lifestyle changes and overall health of patients.

Implementation of an Advanced Access Scheduling System in Primary Healthcare: One Clinic's Experience.

Advanced access scheduling is a system designed to allow patients to be seen same day or next day or in the future according to their preference. The scheduling system has been associated with patients being seen earlier in the course of illness and patients being hospitalized less often. The advanced access system focuses on timely access to primary healthcare, ideally within 48 hours. A group of Ontario primary healthcare nurse practitioners recently implemented the system at a newly established nurse practitioner-led clinic. The team's experiences with the implementation of the advanced access scheduling system are reviewed. The team's experiences are then compared and contrasted with what has been published on the scheduling system to date. The article approaches the subject matter from the perspectives of primary healthcare providers, clerical staff and administrators. Advanced access has become a timely subject in primary care, given the chronic shortages of service and funding constraints and the need for enhanced effectiveness.

Advanced Access Scheduling Outcomes

Advanced ("open") access scheduling, which promotes patient-driven scheduling in lieu of prearranged appointments, has been proposed as a more patient-centered appointment method and has been widely adopted throughout the United Kingdom, within the US Veterans Health Administration, and among US private practices. To describe patient and physician and/or practice outcomes resulting from implementation of advanced access scheduling in the primary care setting. Comprehensive search of electronic databases (MEDLINE, Scopus, Web of Science) through August, 2010, supplemented by reference lists and gray literature. Studies were assessed in duplicate, and reviewers were blinded to author, journal, and date of publication. Controlled and uncontrolled English-language studies of advanced access implementation in primary care were eligible if they specified methods and reported outcomes data. Two reviewers collaboratively assessed risk for bias by using the Cochrane Effective Practice and Organisation of Care Group Risk of Bias criteria. Data were independently extracted in duplicate. Twenty-eight articles describing 24 studies met eligibility criteria. All studies had at least 1 source of potential bias. All 8 studies evaluating time to third-next-available appointment showed reductions (range of decrease, 1.1-32 days), but only 2 achieved a third-next-available appointment in less than 48 hours (25%). No-show rates improved only in practices with baseline no-show rates higher than 15%. Effects on patient satisfaction were variable. Limited data addressed clinical outcomes and loss to follow-up. Studies of advanced access support benefits to wait time and no-show rate. However, effects on patient satisfaction were mixed, and data about clinical outcomes and loss to follow-up were lacking.

Improving quality and patient satisfaction in a pediatric resident continuity clinic through advanced access scheduling.

To evaluate the impact of advanced access scheduling in a pediatric residency clinic on resident and patient satisfaction, medical education, practice quality, and efficiency. Residents were assigned to either the advanced access template (10 appointments available to patients and 2 physician overbooks) or the prior template (5 available and 8 overbooks). Outcomes included resident and patient satisfaction, appointment availability, and continuity of care and clinic costs. Patient satisfaction improved in 7 areas (P < .001). Residents in either template did not report an impact on medical education experiences. Significant increases were realized with appointment availability and the number of patients seen. Continuity also increased as the overflow/acute visits decreased (P < .001). Overall costs per visit decreased 22%. Because of the significant improvements in access, continuity, and efficiency, all residents were switched to the advanced access template after completion of the study. Improvement in access to the primary physician has a significant impact on patient satisfaction with health care delivery. This model optimizes the limited time that residents have in continuity clinic, and it has implications for health care delivery quality improvement.

Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization

The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied. To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits). We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes. Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to non-African Americans [OR 0.27 (CI: 0.21-0.36)]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 - 7.5). There were no differences by clinic type in any of the three health-care utilization outcomes. OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial.

Matching daily healthcare provider capacity to demand in advanced access scheduling systems

Advanced access scheduling, introduced in the early 1990s, is reported to significantly improve the performance of outpatient clinics. The successful implementation of advanced access scheduling requires the match of daily healthcare provider capacity with patient demand. In this paper, for the first time a closed-form approach is presented to determine the optimal percentage of open-access appointments to match daily provider capacity to demand. This paper introduces the conditions for the optimal percentage of open-access appointments and the procedure to find the optimal percentage. Furthermore, the sensitivity of the optimal percentage of open-access appointments to provider capacity, no-show rates, and demand distribution is investigated. Our results demonstrate that the optimal percentage of open-access appointments mainly depends on the ratio of the average demand for open-access appointments to provider capacity and the ratio of the show-up rates for prescheduled and open-access appointments.

Impact of open-access scheduling on realized access

Open-access or advanced-access scheduling, which opens the clinic calendar to patients without requiring them to schedule far in advance of the visit, is being introduced in primary care for the purpose of improving access. None of the evaluations reported to date have measured differences in actual visits that might be associated with different scheduling systems. The purpose of this study was to compare utilization of visits to primary care providers for patients served by an open-access clinic with utilization patterns of patients served at clinics not using open-access scheduling. We hypothesized that the odds that a continuing patient received more than one primary care visit would be greater in the clinic where open-access scheduling was in use than in comparison clinics. Our study provides mixed support for the hypotheses. After adjustment for case mix, stable chronic patients treated in open-access clinics may sometimes have greater odds of receiving two or more preventive care visits. However, these effects do not occur in all clinics, suggesting that other clinic characteristics may overcome the effects of open-access scheduling.

Challenges of change: a qualitative study of chronic care model implementation.

The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues. We conducted a qualitative, comparative case study of 5 of 18 group clinics 18 to 23 months after the implementation began. Built on knowledge of the clinics from a previous study of advanced access implementation, data included in-depth interviews with organizational leaders and varied clinic personnel, observation of clinic care processes, and review of written materials. Relatively small and highly variable care process changes were made during the study period. The change process underwent several marked shifts in strategy when initial efforts failed to achieve much and bore little resemblance to the change process used in the previously successful large-scale implementation of advanced access scheduling. Many barriers were identified, including too many competing priorities, a lack of specificity and agreement about the care process changes desired, and little engagement of physicians. These findings highlight specific organizational challenges with health care transformation in the absence of a blueprint more specific than the CCM. Effective models of organizational change and detailed examples of proven, feasible care changes still need to be demonstrated if we are to transform care as called for by the Institute of Medicine.

Advanced-Access Scheduling in Primary Care--Reply

Advanced-Access Scheduling in Primary Care--Reply

Advanced-Access Scheduling in Primary Care—Reply

In Reply: Dr Shuster's skepticism about advanced access is easy to understand and is a familiar first reaction to the apparently implausible aim of offering patients the care they want exactly when they want it. His critique, however, misrepresents of the basic approach.

Advanced-Access Scheduling in Primary Care--Reply

Advanced-Access Scheduling in Primary Care--Reply

Improving timely access to primary care: case studies of the advanced access model.

The advanced access model of patient scheduling is based on the core principle that if the capacity to provide patient appointments balances the demand for appointments, patients calling to see their physician are offered an appointment the same day. The accompanying article in the series "Innovations in Primary Care" presents the theory behind advanced access scheduling. In this article we describe 4 case studies of primary care practices that successfully implemented advanced access and 3 examples of practices that were unable to achieve advanced access despite considerable efforts. The lessons of these case studies should be useful for primary care practices desiring to improve timely access to care and wishing to avoid the pitfalls that can derail this innovation.