Decreased continuity in a residency clinic: a consequence of open access scheduling.
OBJECTIVE
Open access scheduling decreases waiting time to see physicians by using same-day appointment scheduling. In primary care residency training, continuity of care may be difficult to preserve with this method of scheduling because requirements for rotations often results in residents being unavailable in their primary clinic practice. Our objective was to examine continuity of care in a family medicine residency clinic during a 1-year period prior to implementation of open-access scheduling and during a 1-year period after open access scheduling started.


METHODS
Two indices to measure continuity were used: the Usual Provider Continuity Index (UPC) and the Modified Modified Continuity Index (MMCI). The Mann-Whitney test was used to determine differences in the UPC and MMCI between groups.


RESULTS
The mean UPC and MMCI scores decreased with open access scheduling. Mean UPC was 0.59 with traditional scheduling versus 0.55 with open access scheduling. Mean MMCI was 0.51 for traditional scheduling and 0.44 with open access.


CONCLUSIONS
Continuity of care decreased in our clinic after implementation of open access scheduling. Our results have implications for all primary care residency training programs since one of the hallmarks of primary care is maintaining continuity in the physician-patient relationship.
Phan
Kathy
K
Banner Good Samaritan, Family Medicine Department, Phoenix, AR, USA. kathyphan@hotmail.com
Brown
Steven R
SR
D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013022:South Carolina; D013997:Time Factors; D055815:Young Adult