https://orcid.org/0000-0001-5713-9618
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ABSTRACT
The advanced access (AA) model is among the most recommended innovations for improving timely access in primary health care (PHC). Originally developed for physicians, it is now relevant to evaluate the model’s implementation in more interprofessional practices. We compared AA implementation among family physicians, nurse practitioners, and nurses. A cross-sectional online open survey was completed by 514 PHC providers working in 35 university-affiliated clinics. Family physicians delegated tasks to other professionals in the team more often than nurse practitioners (p = .001) and nurses (p < .001). They also left a smaller proportion of their schedules open for urgent patient needs than did nurse practitioners (p = .015) and nurses (p < .001). Nurses created more alternatives to in-person visits than family physicians (p < .001) and coordinated health and social services more than family physicians (p = .003). During periods of absence, physicians referred patients to walk-in services for urgent needs significantly more often than nurses (p = .003), whereas nurses planned replacements between colleagues more often than physicians (p <.001). The variations among provider categories indicate that a one-size-fits-all implementation of AA principles is not recommended.
Acknowledgments
This project is funded by a Project Grant from the Canadian Institutes of Health Research (#399757) for four years (2018–2022). MB holds a Canada Research Chair in Clinical Governance on Primary Health Care.
Disclosure statement
No potential conflict of interest was reported by the authors.
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Notes on contributors
Mylaine Breton
Mylaine Breton is Associate Professor, Department of Community Health Services, Université de Sherbrooke. She holds a Canada Research Chair in Clinical Governance on Primary Health Care. Her research expertise is in analyzing innovations to improve primary health care.
Nadia Deville-Stoetzel
Nadia Deville-Stoetzel is a postdoctoral fellow at Université de Sherbrooke. Her research expertise is in vulnerable populations and the implementation of health programs.
Isabelle Gaboury
Isabelle Gaboury is Full Professor, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke. Her expertise is in interprofessional collaboration and supporting quality improvement in primary care.
Arnaud Duhoux
Arnaud Duhoux is Associate Professor, Faculty of Nursing, Université de Montreal. His expertise is in integrated multidisciplinary primary care models.
Lara Maillet
Lara Maillet is Associate Professor, National School of Public Administration. Her research expertise is in health care systems adaptation and governance.
Sabina Abou Malham
Sabina Abou Malham is Assistant Professor, School of Nursing, Université de Sherbrooke. Her research expertise is on health care professionals’ role changes within organizational innovations.
France Légaré
France Légaré is Professor, Department of Family Medicine and Emergency Medicine, Université Laval. She holds a Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation.
Isabelle Vedel
Isabelle Vedel is Associate Professor, Department of Family Medicine, McGill University. Her expertise is in models of primary care for older persons, in particular persons with dementia.
Catherine Hudon
Catherine Hudon is Professor, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke. Her expertise is in integration of care for people with complex needs.
Nassera Touati
Nassera Touati is Professor, National School of Public Administration. Her research expertise is in the governance, structure, and mobilization of solidarity networks.
Jalila Jbilou
Jalila Jbilou is Associate Professor, Centre de formation médicale du Nouveau-Brunswick and School of Psychology, Université de Moncton. Her research expertise is in sex/gender-based analysis and collaborative care for persons living with comorbid physical and mental health conditions.
Christine Loignon
Christine Loignon is Full Professor, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke. Her expertise is in qualitative methods and participatory research.
Marie-Thérèse Lussier
Marie-Thérèse Lussier is Full Professor, Department of Family Medicine and Emergency Medicine, Université de Montréal. Her expertise is in primary care practice-based research and the quantitative analysis of communication in health care.