Advanced access appointments: Effects on family physician satisfaction, physicians' office income, and emergency department use

Abstract

Objective: To examine the effects of advanced access (same-day physician appointments) on patient and provider satisfaction and to determine its association with other variables such as physician income and patient emergency department use.

Design: Patient satisfaction survey and semistructured interviews with physicians and support staff; analysis of physician medical insurance billings and patient emergency department visits.

Setting: Cape Breton, NS.

Participants: Patients, physicians, and support staff of 3 comparable family physician practices that had not implemented advanced access and an established advanced access practice.

Main outcome measures: Self-reported provider and patient satisfaction, physician office income, and patients' emergency department use.

Results: The key benefits of implementation of advanced access were an increase in provider and patient satisfaction levels, same or greater physician office income, and fewer less urgent (triage level 4) and nonurgent (triage level 5) emergency department visits by patients.

Conclusion: Currently within the Central Cape Breton Region, 33% of patients wait 4 or more days for urgent appointments. Findings from this study can be used to enhance primary care physician practice redesign. This research supports many benefits of transitioning to an advanced access model of patient booking.

Figure 1

Comparison of patient booking models Adapted from Murray and Tantau.

Figure 2

Research schematic

Figure 3

Reported benefits of advanced access