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Related Concept Videos

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Using positive deviance to improve timely access in primary care.

MaryBeth DeRocher1,2, Sam Davie3, Tara Kiran3,2,4,5

  • 1Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada marybeth.derocher@unityhealth.to.

BMJ Open Quality
|October 15, 2021
PubMed
Summary
This summary is machine-generated.

Identifying best practices for timely primary care access proved challenging. Strategies used by a few physicians were not widely associated with improved appointment availability in a larger group.

Keywords:
general practiceprimary carequality improvement

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Area of Science:

  • Primary Care Research
  • Health Services Research
  • Medical Practice Management

Background:

  • Timely access to primary care remains a significant challenge globally.
  • This study investigated strategies for improving appointment availability in a Canadian primary care organization.
  • The positive deviance approach was employed to identify successful practices.

Purpose of the Study:

  • To identify best practices for achieving timely access in primary care.
  • To determine the prevalence of these practices among a larger physician group.
  • To assess the association between practice strategies and appointment wait times.

Main Methods:

  • Semistructured interviews with physicians (n=6) who maintained low third next available appointment (TNA) times.
  • Cross-sectional survey of all physicians (n=70) to assess the uptake of identified practices.
  • Statistical analysis (chi-squared testing) to compare practice adoption based on TNA.

Main Results:

  • Seven promising practices were identified, including template adjustment, advance schedule review, and team involvement.
  • Uptake of these practices varied among physicians.
  • No general association was found between practice uptake and TNA, except for advance schedule review being linked to shorter wait times.

Conclusions:

  • Practices of 'positive deviant' physicians did not consistently correlate with improved timely access in the broader group.
  • The study underscores the complexity of linking physician practice style to primary care accessibility.
  • Further research is needed to understand factors influencing timely access.