Dataset Information

Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.

ABSTRACT:

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.

Aim

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

Design of study

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

Setting

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

Method

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).

Conclusion

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.

SUBMITTER: Salisbury C

PROVIDER: S-EPMC2099665 | biostudies-literature | 2007 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.

Salisbury Chris C 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

The British journal of general practice : the journal of the Royal College of General Practitioners 20070801 541

<h4>Background</h4>Case studies from the US suggest that Advanced Access appointment systems lead to shorter delays for appointments, reduced workload, and increased continuity of care.<h4>Aim</h4>To determine whether implementation of Advanced Access in general practice is associated with the above benefits in the UK.<h4>Design of study</h4>Controlled before-and-after and simulated-patient study.<h4>Setting</h4>Twenty-four practices that had implemented Advanced Access and 24 that had not.<h4>M ...[more]

PMID: 17688754

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Project description:OBJECTIVE:In the context of acute conditions seen in an emergency department, where communication may be difficult, patient information leaflets (PILs) could improve doctor-patient communication (DPC) and may have an impact on other outcomes of the consultation. Our objective was to assess the impact of PILs on DPC, patient satisfaction and adherence, and on patient and doctor behaviours. DESIGN:Prospective, controlled, before-after trial between November 2013 and June 2015. SETTING:Two French emergency departments. PARTICIPANTS:Adults and adolescents >15 years diagnosed with ankle sprain or an infection (diverticulitis, infectious colitis, pyelonephritis, pneumonia or prostatitis). INTERVENTION:Physicians in the intervention group gave patients a PIL about their condition along with an oral explanation. MAIN OUTCOME MEASURES:7-10 days later, patients were contacted by phone to answer questionnaires. Results were derived from questions scored using a 4-point Likert scale. MAIN FINDINGS:Analysis of the 324 patients showed that PILs improved the mean DPC score (range: 13-52), with 46 (42-49) for 168 patients with PILs vs 44 (38-48) for 156 patients without PILs (p<0.01). The adjusted OR for good communication (having a score >35/52) was 2.54 (1.27 to 5.06). The overall satisfaction and adherence scores did not show significant differences. In contrast, satisfaction with healthcare professionals and timing of medication intake were improved with PILs. The overall satisfaction score improved significantly on per-protocol analysis. When using PILs, doctors prescribed fewer drugs and more examinations (radiology, biology, appointment with a specialist); the need for a new medical consultation for the same pathology was reduced from 32.1% to 17.9% (OR 0.46 [0.27 to 0.77]), particularly revisiting the emergency department. CONCLUSION:In emergency departments, PILs given by doctors improve DPC, increase patients' satisfaction with healthcare professionals, reduce the number of emergency reconsultations for the same pathology and modify the doctor's behaviour. TRIAL REGISTRATION NUMBER:NCT02246361.

Dataset Information

Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.

Background

Aim

Design of study

Setting

Method

Results

Conclusion

Publications

Impact of Advanced Access on access, workload, and continuity: controlled before-and-after and simulated-patient study.

Similar Datasets

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