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Effect of advanced access scheduling on chronic health care in a Canadian practice
Julie Gladstone1, Michelle Howard
1julie.gladstone@medportal.ca
Insights
Advanced access scheduling (AAS) in Canadian family practices did not change overall chronic disease care. However, AAS increased visits for non-chronic conditions without negatively impacting key health markers.
Area of Science:
- Family Medicine
- Health Services Research
- Chronic Disease Management
Background:
- Advanced access scheduling (AAS) is a strategy to improve patient access to primary care.
- Its impact on chronic disease management in Canadian family practices requires investigation.
Purpose of the Study:
- To evaluate the effect of AAS on the care of patients with chronic diseases.
- To assess changes in visit types and clinical outcomes after AAS implementation.
Main Methods:
- Chart abstraction was used to review patient records.
- Data were collected for patients with hypertension, type 2 diabetes mellitus, or coronary artery disease before and after AAS implementation.
- Key metrics included appointment types, blood pressure, HbA1c, and LDL levels.
Main Results:
- The mean number of chronic disease management appointments decreased significantly (2.6 to 2.2, P=.024).
- The mean number of non-chronic disease visits increased significantly (1.7 to 2.1, P=.001).
- While measurement frequency of clinical parameters decreased, actual blood pressure and HbA1c levels remained stable.
Conclusions:
- AAS did not alter overall patient use of family health practices for chronic disease care.
- AAS facilitated increased visits for non-chronic conditions.
- Clinical parameters relevant to chronic disease management were not significantly affected by AAS.
Objective:
To determine the effect of advanced access scheduling (AAS) on the care of patients with chronic disease within a Canadian family practice.
Design:
Chart abstraction.
Setting:
A single family physician's practice in Brantford, Ont.
Participants:
Patient charts were reviewed for all patients with a history of hypertension, type 2 diabetes mellitus, or coronary artery disease during the years before and after implementation of AAS.
Main Outcome Measures:
The following information was extracted for each study patient: total number of appointments, number of appointments specific to chronic disease management, number of appointments for non-chronic disease, blood pressure (BP), and laboratory markers, including hemoglobin A(1c) (HbA(1c)) and low-density lipoprotein levels.
Results:
For the year before and the year after implementation of AAS, the mean number of visits per patient was 4.3. The mean number of appointments for chronic disease management decreased significantly from 2.6 to 2.2 (P = .024), and the mean number of visits for non-chronic disease increased significantly from 1.7 to 2.1 (P = .001). The number of times clinical parameters of BP, HbA(1c), and low-density lipoprotein were measured decreased; however, there were no significant changes in actual BP or HbA(1c) levels.
Conclusion:
Following a 1-year period using AAS, use of the family health practice by patients with chronic disease was unchanged overall; however, AAS allowed for an increase in visits for non-chronic health conditions without significantly affecting the clinical parameters of BP or HbA(1c).
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