Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.
BACKGROUND
Case studies from the US suggest that Advanced Access appointment systems lead to shorter delays for appointments, reduced workload, and increased continuity of care.


OBJECTIVE
To determine whether implementation of Advanced Access in general practice is associated with the above benefits in the UK.


METHODS
Controlled before-and-after and simulated-patient study.


METHODS
Twenty-four practices that had implemented Advanced Access and 24 that had not.


METHODS
Anonymous telephone calls were made monthly to request an appointment. Numbers of appointments and patients consulting were calculated from practice records. Continuity was determined from anonymised patient records.


RESULTS
The wait for an appointment with any doctor was slightly shorter at Advanced Access practices than control practices (mean 1.00 day and 1.87 days respectively, adjusted difference -0.75; 95% confidence interval [CI] = -1.51 to 0.004 days). Advanced Access practices met the NHS Plan 48-hour access target on 71% of occasions and control practices on 60% of occasions (adjusted odds ratio 1.61; 95% CI = 0.78 to 3.31; P = 0.200). The number of appointments offered, and patients seen, increased at both Advanced Access and control practices over the period studied, with no evidence of differences between them. There was no difference between Advanced Access and control practices in continuity of care (adjusted difference 0.003; 95% CI = -0.07 to 0.07).


CONCLUSIONS
Advanced Access practices provided slightly shorter waits for an appointment compared with control practices, but performance against NHS access targets was considerably poorer than officially reported for both types of practice. Advanced Access practices did not have reduced workload or increased continuity of care.
Salisbury
Chris
C
Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol. c.salisbury@bristol.ac.uk
Montgomery
Alan A
AA
Simons
Lucy
L
Sampson
Fiona
F
Edwards
Sarah
S
Baxter
Helen
H
Goodall
Stephen
S
Smith
Helen
H
Lattimer
Val
V
Pickin
D Mark
DM
D001071:Appointments and Schedules; D016022:Case-Control Studies; D003266:Continuity of Patient Care / Q000592:standards*; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017060:Patient Satisfaction; D016544:Patient Simulation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists; D016526:Workload
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