by Martha Kerr

Last Updated: 2008-06-18 15:42:13 -0400 (Reuters Health)

NEW YORK (Reuters Health) – A new approach to scheduling office visits, called "open-access," "advanced-access" or "same-day access" scheduling, improves patients’ appointment access to their primary care physicians, increases patient satisfaction and is more cost-effective than scheduling patients in advance and squeezing in patients requiring urgent care, researchers report.

"With open-access scheduling, physicians should start their day with the calendar filled only 10% to 20%," lead investigator Dr. Ateev Mehrotra of the University of Pittsburgh School of Medicine explained in an interview with Reuters Health. As patients call in, they are given an appointment that same day, whether it is urgent or not. "We let the patient decide that."

Appointments are classified as either short (15-minute) or long (30-minute) visits. Patients do not schedule a return visit when they leave. Rather, they are told to call back in a specified amount of time and they will be given an appointment that day.

A study describing the effects of open-access scheduling on six primary care practices in the metropolitan Boston area is published in the June 16th online issue of the Annals of Internal Medicine.

Dr. Mehrotra and colleagues assessed the time to an available appointment, no-show rates, and patient and staff satisfaction with appointment availability. They found that five of the six practices were able to implement open-access scheduling.

"Within 4 months of implementation, these five practices substantially reduced their mean wait for…available appointments from 21 to 8 days for 15-minute visits and from 39 to 14 days for 30-minute visits," Dr. Mehrotra said.

"However, none of the five practices attained the goal of same-day access, and waits for…available appointments increased during 2 years of follow-up."

"The model is good. It is cost-effective. However, there were obstacles to implementing open-access scheduling," Dr. Mehrotra said, including physician leaves of absence and other interruptions in physician availability, leading to problems with supply and demand. There was also an initial extra workload on the physician.

"No consistent changes in patient or staff satisfaction or patient no-show rates were found," Dr. Mehrotra’s team reported. "However, improving access to appointments reduces stress on everyone. Nurses said they were happy because they were spending less time on the phone on triage and more time on actual patient care."

"It is an innovative model. It has a lot of potential and it needs a lot of work…and it needs rigorous study on a larger scale," Dr. Mehrotra said.

"Despite the limited benefits we saw in our outcome measures, most practice leaders felt the open-access initiative was beneficial. In their view, the process of implementing open access forced a re-evaluation of the practice systems and a change of the mindset of the physicians and staff regarding access to care."

"The implementation exposed long-standing issues, such as problems in handling patients’ phone calls, scheduling, job descriptions, and patient flow. Addressing these issues led to improvements in practice processes that may not have been captured in the outcome variables we measured," the investigators added.

Ann Intern Med 2008;148:915-922.

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