Advanced access scheduling outcomes: a systematic review

Arch Intern Med. 2011 Jul 11;171(13):1150-9. doi: 10.1001/archinternmed.2011.168. Epub 2011 Apr 25.


Background: 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.

Objective: To describe patient and physician and/or practice outcomes resulting from implementation of advanced access scheduling in the primary care setting.

Data sources: Comprehensive search of electronic databases (MEDLINE, Scopus, Web of Science) through August, 2010, supplemented by reference lists and gray literature.

Study selection: 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.

Data extraction: 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.

Data synthesis: 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.

Conclusions: 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Appointments and Schedules*
  • Continuity of Patient Care* / organization & administration
  • Health Services Accessibility / organization & administration*
  • Humans
  • Patient Satisfaction / statistics & numerical data*
  • Patient-Centered Care / organization & administration
  • Primary Health Care / organization & administration*
  • Primary Health Care / statistics & numerical data
  • Quality Assurance, Health Care / trends*
  • Research Design
  • Time Factors
  • United Kingdom
  • United States
  • United States Department of Veterans Affairs / organization & administration