Implementing open-access scheduling of visits in primary care practices: a cautionary tale.
BACKGROUND
Open-access scheduling (also known as advanced access or same-day access) is a popular tool for improving patient access to primary care appointments.


OBJECTIVE
To assess the effect of open-access scheduling and describe the barriers to implementing the open-access scheduling model in primary care.


METHODS
Case series.


METHODS
Boston, Massachusetts, metropolitan area.


METHODS
6 primary care practices studied from October 2003 through June 2006.


METHODS
Implementation of open-access scheduling.


METHODS
Time to third available appointments, no-show rates, and patient and staff satisfaction with appointment availability.


RESULTS
5 of 6 practices were able to implement open-access scheduling. Within 4 months of implementation, these 5 practices substantially reduced their mean wait for third available appointments from 21 to 8 days for 15-minute visits and from 39 to 14 days for 30-minute visits. However, none of the 5 practices attained the goal of same-day access, and waits for third available appointments increased during 2 years of follow-up. No consistent changes in patient or staff satisfaction or patient no-show rates were found. Barriers to implementation included decreases in appointment supply from provider leaves of absence and departures and increases in appointment demand when practices reopened to new patients after initial implementation of open-access scheduling.


CONCLUSIONS
The study lacked control practices. The small number of practices and providers precluded formal statistical comparisons.


CONCLUSIONS
In 5 of 6 primary care practices, implementation of open-access scheduling improved appointment access in some practices. However, none was able to achieve same-day access and patient and staff satisfaction and patient no-show rates were unchanged. Broader evaluation of open-access scheduling in primary care is needed.
Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA. mehrotra@rand.org
Ateev
A
Mehrotra
Lori
L
Keehl-Markowitz
John Z
JZ
Ayanian
D001071:Appointments and Schedules; D001900:Boston; D006297:Health Services Accessibility; D006801:Humans; D007588:Job Satisfaction; D009817:Office Management / Q000458:organization & administration* / Q000592:standards; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors