Revising the advanced access model pillars: a multimethod study

Abstract

Background: The advanced access model was developed 20 years ago and has been implemented in several countries. We aimed to revise and operationalize the pillars and subpillars of the advanced access model based on its contemporary practice by professionals in primary health care.

Methods: This multimethod sequential study was informed by a literature review and an expert panel of provincial and local decision-makers, primary health care clinic members (family physicians, nurses and administrative staff), patients and researchers from the province of Quebec. Throughout the consultation process, participants were asked to develop a common vision of the pillars and subpillars that make up the advanced access model and to react to suggested definitions or content.

Results: The revised advanced access model is defined by 5 pillars, of which 2 were updated from the original model ("Appointment system" and "Interprofessional practice"), 1 was merged with a revised pillar ("Develop contingency plans" with "Planning of needs and supply") and 1 underwent major transformations ("Backlog reduction" to "Continuous adjustment"). A new pillar concerning communication emerged from the consultation process. Subsequent steps for operationalizing definitions of subpillars confirmed the nature of the revised advanced access pillars and stabilized their content.

Interpretation: The overall consultation process resulted in a revised contemporary advanced access model, with strong consensus among participating experts. The revised model will be used to develop a reflective tool for primary health care professionals to evaluate their advanced access practice.

Figure 1:

Flow diagram of resources selection. Note: AA = advanced access.

Figure 2:

Phases of the sequential multimethod consultation. Note: AA = advanced access.

Figure 3:

Evolution of the advanced access (AA) model through expert consultation — pillars and subpillars. Each arrow represents the modification performed between phases or subphases. Converging arrows indicate that a concept was combined with a pre-existing pillar, and “new” indicates the introduction of a new element at one of the consultation phases.

Figure 4:

Indicators of consensus on the relevance of subpillars in the e-survey (n = 25). Note: All median values being 9, median values are not presented in the table. Only response choices that were used by at least 1 respondent are presented.

Figure 5:

Final 5 pillars of advanced access (AA) and their operational definitions.