Implementing open-access scheduling of visits in primary care practices: a cautionary tale

Abstract

Background: Open-access scheduling (also known as advanced access or same-day access) is a popular tool for improving patient access to primary care appointments.

Objective: To assess the effect of open-access scheduling and describe the barriers to implementing the open-access scheduling model in primary care.

Design: Case series.

Setting: Boston, Massachusetts, metropolitan area.

Participants: 6 primary care practices studied from October 2003 through June 2006.

Intervention: Implementation of open-access scheduling.

Measurements: Time to third available appointments, no-show rates, and patient and staff satisfaction with appointment availability.

Results: 5 of 6 practices were able to implement open-access scheduling. Within 4 months of implementation, these 5 practices substantially reduced their mean wait for third available appointments from 21 to 8 days for 15-minute visits and from 39 to 14 days for 30-minute visits. However, none of the 5 practices attained the goal of same-day access, and waits for third available appointments increased during 2 years of follow-up. No consistent changes in patient or staff satisfaction or patient no-show rates were found. Barriers to implementation included decreases in appointment supply from provider leaves of absence and departures and increases in appointment demand when practices reopened to new patients after initial implementation of open-access scheduling.

Limitations: The study lacked control practices. The small number of practices and providers precluded formal statistical comparisons.

Conclusion: In 5 of 6 primary care practices, implementation of open-access scheduling improved appointment access in some practices. However, none was able to achieve same-day access and patient and staff satisfaction and patient no-show rates were unchanged. Broader evaluation of open-access scheduling in primary care is needed.

Figure 1

Change in 3^rd Available Time (measured in days) for Long and Short visits from 180 days Pre-implementation to 720 days Post-implementation at each of the Six Practices Note: Practice numbering does not reflect order of practices in Table 2