Excellent Care for All

Advanced Access is Timely Care

Health Care Challenge

Timely access to primary care is key to keeping Ontarians healthy. If people can quickly access their family health care provider when they need to it can prevent them from becoming sicker and requiring more acute and costly levels of care. It can avoid emergency room visits for conditions that can be more appropriately addressed by a primary care provider.

Timely access also allows patients and providers to better manage chronic diseases like diabetes and to remain up-to-date with preventive care like cancer screening.

Long waits for appointments, crowded waiting rooms and stressful workplaces are not conducive to the delivery of quality care. “Access to care is foundational in primary care quality improvement work,” said Trish O’Brien, Director of Primary Care, Quality Improvement, Health Quality Ontario, (HQO).

Real Change in Action

“Do today’s work, today,” is a core principle behind the Advanced Access and Efficiency for Primary Care Initiative supported by Health Quality Ontario (HQO), aims to guide primary care providers in organizing their practices to improve access for their patients.

HQO supports primary care providers and their teams to identify and overcome obstacles to timely access.  Using best practices, coaching support, team-based learning and a range of other Quality Improvement (QI) tools, the Advanced Access initiative has already helped enlisted providers achieve substantial change in their practices.

“If you called my office in the morning you can get an appointment in the afternoon,” said Dr. Ben Stobo, whose patients typically waited 28 days for a routine appointment prior to his office adopting the Advanced Access approach in April 2009. “I didn’t think it could be done and I’m not that special and I’m doing it. It works better for patients. It works better for the front desk staff. It works better for the nurse. It works better for me,” said Stobo, who is part of the Athens and District Family Health Team (FHT) in southeast, Ontario with a roster of 3,500 patients.

“The wait has gone from 20 days down to zero for my patients,” said Dr. Michelle Greiver, a family doctor, who is part of the busy North York FHT. Greiver reorganized her practice to offer her patients Advanced Access in January 2010. She made the dramatic shift with the support of a QI coach, attending collaborative learning sessions with her team and being given tools to measure the efficiency of her practice and the experience of patients in her office.

But Greiver said the key thing was for her and her team to make the decision and commit to change. “We wanted to do better regarding diabetes and cancer screening. But if patients can’t get in to see me, they’re not going to get better care.”

A key lesson Greiver learned from her experience in the Advanced Access initiative is that: “You can’t improve what you don’t measure. It was shocking to me when we measured and I realized how long patients were waiting for an appointment.”

The initiative gets primary health care providers to focus on several key measurements :

Support is provided to assist providers in overcoming physical, structural and administrative obstacles in their practice that limit access.

Stobo said he had a backlog of patient appointments he had to clear up before he was in a position to offer Advanced Access. He committed to working longer hours for about a six-week period to clear up the backlog.

Both Stobo and Greiver said an important step was also looking to their team and ensuring that they were making the most use of everyone’s skill set. Stobo works with a team consisting of two nurse practitioners, a registered nurse and a registered practical nurse. Greiver works with a diverse team of health professionals, including a dietitian, pharmacist and nurse practitioner. Front office staff, who answer the phones and book appointments, play a key role in supporting Advanced Access and they must be well versed in the philosophy and its benefits. “My front desk staff love it. They’re less stressed out. When someone calls in for an appointment, there is one available,” Greiver said.

To offer Advanced Access primary care providers have pre-booked appointments only in the first few hours of the day and the afternoon is left open for patients who call to come in that day. Educating patients is a big part of the process. “Once patients understand that they really can get into see you when they want, they don’t make just in case appointments, there are less cancellations and no shows and no need for reminder calls,” Stobo said. When patients can get an appointment quickly, they tend not to come in with as many health concerns. “So, I have time to look and see when their prescription needs refilling or check their blood pressure. I can be more proactive.”

Susan Ouellet is the Administrator of Greenstone FHT in Northwestern Ontario that has operated based on Advanced Access since it opened in February 2009. “Participating in the Advanced Access initiative far exceeded my expectations. It’s a simple but revolutionary sort of process,” Ouellet said. “In the morning, ten per cent of our day is booked. The rest of the day we keep for people calling in for appointments,” said Ouellet of the FHT, which had about 5,600 client visits in 2010-2011.

The Greenstone FHT has also evolved a collaboration with their local hospital where patients who arrive at the emergency room seeking care for non-emergency conditions can be directed to the Family Health Team. “Advanced Access allows us to do this.”

Maintaining Advanced Access requires ongoing commitment, but Ouellet said it is more than worth the effort. “It’s better for everyone. It allows for flexibility in scheduling and patients deserve that kind of care. We owe it to them to see them as soon as possible.”

Better Quality, Sustainable Care

More than 250 primary care providers have participated in HQO’s Advanced Access and Efficiency for Primary Care Initiative; and the number is growing O’Brien said. “The concept is starting to spread. It makes sense,” Greiver added. Reorganizing her practice in this way has allowed her to spend more time devoted to better support patients in managing chronic diseases, which will keep them healthier. Advanced Access is timely access. It’s good for patients. It’s good for providers. It’s good for the health system.

Learn more about Advanced Access.

For more information contact :

Susan Taylor, BScN, MBA
Program Manager, Access and Chronic Disease Health Quality Ontario
130 Bloor Street West, 10th Floor
Toronto, ON  M5S 1N5
Cell:  647 448-9355
Fax: 416 323-9261

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
TTY 1-800-387-5559
In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm