Acuity-based Scheduling in Primary Care.

Area of Science:

• Health Services Research
• Primary Care Medicine
• Patient Prioritization

Background:

• Triage algorithms are standard in emergency care but their application in primary care is not well understood.
• Growing demand for primary care services necessitates efficient patient prioritization.

Purpose of the Study:

• To investigate whether primary care practices prioritize patients based on the acuity of their service needs.
• To determine if simulated patients with acute conditions receive preferential appointment scheduling or shorter wait times compared to those seeking routine care.

Main Methods:

• An audit study design was employed, utilizing simulated patients.
• Simulated patients were randomized into two scenarios: routine check-up versus newly diagnosed hypertension.
• Appointments were sought with thousands of primary care physicians across ten states, comparing availability and wait times.

Main Results:

• No significant difference was found in appointment availability between the two clinical scenarios.
• Simulated patients seeking routine check-ups experienced mean wait times nearly 5 days longer than those with hypertension.
• This suggests a difference in how quickly patients with varying needs are seen.

Conclusions:

• Primary care physicians appear to be implicitly prioritizing patients with more acute needs.
• This implicit prioritization may be a response to increasing demand and stable supply in primary care.
• The findings highlight an existing de facto triage system within primary care settings.