Table of Contents
International Journal of Family Medicine
Volume 2017, Article ID 1595406, 15 pages
Research Article

What Are the Factors Influencing Implementation of Advanced Access in Family Medicine Units? A Cross-Case Comparison of Four Early Adopters in Quebec

1Charles LeMoyne Hospital Research Center, Longueuil, QC, Canada
2Université de Sherbrooke, Sherbrooke, QC, Canada
3École Nationale d’Administration Publique, Montréal, QC, Canada
4Institut Universitaire de Première Ligne en Santé et Services Sociaux, Sherbrooke, QC, Canada

Correspondence should be addressed to Sabina Abou Malham; ac.ekoorbrehsu@mahlam.uoba.anibas and Mylaine Breton; ac.ekoorbrehsu@noterb.enialym

Received 23 January 2017; Revised 30 April 2017; Accepted 31 May 2017; Published 10 July 2017

Academic Editor: Samuel Y. S. Wong

Copyright © 2017 Sabina Abou Malham et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Advanced access is an organizational model that has shown promise in improving timely access to primary care. In Quebec, it has recently been introduced in several family medicine units (FMUs) with a teaching mission. The objectives of this paper are to analyze the principles of advanced access implemented in FMUs and to identify which factors influenced their implementation. Methods. A multiple case study of four purposefully selected FMUs was conducted. Data included document analysis and 40 semistructured interviews with health professionals and staff. Cross-case comparison and thematic analysis were performed. Results. Three out of four FMUs implemented the key principles of advanced access at various levels. One scheduling pattern was observed: 90% of open appointment slots over three- to four-week periods and 10% of prebooked appointments. Structural and organizational factors facilitated the implementation: training of staff to support change, collective leadership, and openness to change. Conversely, family physicians practicing in multiple clinical settings, lack of team resources, turnover of clerical staff, rotation of medical residents, and management capacity were reported as major barriers to implementing the model. Conclusion. Our results call for multilevel implementation strategies to improve the design of the advanced access model in academic teaching settings.