‘Advanced access’ scheduling pleases patients, strengthens PCPs

Primary care providers can significantly improve practice performance as well as patient satisfaction by making one workaday adjustment: leaving some appointment slots open to accommodate walk-ins throughout the day. 

Researchers in Canada made the finding after analyzing a block of diverse but relevant studies. They discovered the scheduling model—called “advanced access” in the literature—correlated with better continuity of care, higher patient satisfaction and, to a lesser but nontrivial extend, reduced use of emergency services.

The benefits held across varying health-system categories. 

Senior study author Simon Berthelot, MD, MSc, of Laval University in Quebec City and colleagues had their work published May 26 in The Annals of Family Medicine. 

Noting that the advanced-access concept was developed in the U.S. in the early 2000s, the team explains the model “aims to restructure appointment scheduling and clinical practice to ensure patients can see their healthcare clinician in a timely manner.”

Further, the researchers write, the unmistakably patient-centered model is based on the simple principle of “doing today’s work today.” 

By welcoming a number of unscheduled patients every day, they add, advanced- access practices enjoy proactive management of supply and demand.

Wait times, care continuity, patient satisfaction, more 

For the study, Berthelot and colleagues concentrated on 29 peer-reviewed studies dealing with advanced access vis-à-vis various outcomes. 

Their key findings: 

• Appointment wait time decreased in all 23 studies assessing this outcome, with 13 reporting statistically significant reductions. 
   
• Continuity of care improved in 11 of 13 studies, of which seven reported statistically significant improvements. 
   
• All three studies evaluating ED use reported reductions in ED visits, although none demonstrated statistical significance. 
   
• Patient satisfaction improved in eight studies, with three reporting statistically significant improvements. 
   
• Overall, findings were consistent across universal (publicly funded) and non-universal healthcare systems.

Results encouraging albeit unsurely generalizable 

Among the limitations the researchers acknowledge is a serious risk of bias in many of the studies they reviewed. Some of these, for example, relied on uncontrolled before-and-after designs and descriptive analyses. 

Another weakness is the study sample’s geographic concentration of evidence in three high-income countries—the U.S., U.K. and Canada. 

This narrowness of focus reflects the lack of relevant studies on advanced access from elsewhere around the world, Berthelot and co-authors suggest. As such, it “highlights a gap in the international literature and may limit the generalizability of our findings to health systems with different economic and organizational contexts.”

Nevertheless, Berthelot et al. point out their findings add evidence to prior research showing advanced access is “likely to improve key dimensions of primary care delivery and may represent a promising approach to enhancing efficiency and patient-centeredness in primary care access across both universal and non-universal, multi-payer health care systems.”

Studies from a broader range of countries, they add, will be needed to confirm the generalizability of their results.

The full study is posted in PDF format here.