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

Table 3

An overview of the key principles of advanced access implemented across the four family medicine units.

	FMU 1	FMU 2	FMU 3	FMU 4
(1) Balance supply and demand
Measure provider’s supply	√	√		√
Measure demand	√	√		√
Standardize appointment length	√			√
Restore balance with various strategies	√			√
Eliminate annual exam	√		√	√
Max-pack visits	√		√	√
(2) Eliminate backlog	√			√
Cancel unnecessary appointments	√			√
Provide extra appointments temporarily; add office hours for a period of time	√
Patient education strategy
Provide verbal explanation	√	√	√	√
Send letters to patients	√			√
Put up posters				√
Publish a notice in a local journal				√
(3) Review the appointment system
Appointment model: 90-10%; 90% open slots over three- to four-week periods and 10% prebooked slots	√		√	√
Some form of the carve-out model: 50% open for semiurgent and urgent care needs, 50%; prebooked slots		√
Maintain recall list (patients with chronic disease, pregnant women, infants, elderly and; vulnerable patients, etc.)	√		√	√
(4) Integrating interprofessional practices
Reinforce the collaboration between physicians, nurses, advanced practice nurses, and clerical staff	√			√
Implement a joint nurse/physician practice model	√
Implement a small team configuration				√
Expand nurses’ role	√			√
Redesign clerical staff role	√			√
(5) Create contingency plan
Formal contingency plan	√		√	√
Cross-coverage within a team-based approach	√			√
Coverage for the absent provider by peers			√
Informal arrangements system between professionals to cover for absent colleagues		√
Informal arrangement between residents to cover for each other	√	√	√	√
Pre- and postvacation scheduling: increase and extend working hours before leaving on vacation; and when returning to the unit	√

FMU = family medicine unit; √ = strategy used; = attempt to use the strategy (early stage of reflection and use).