An option for improving access to outpatient general neurology

Ross, Stephen C.

doi:10.1212/cpj.0000000000000075

Cited by 12 publications

(9 citation statements)

References 13 publications

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“…16 For neurology specifically, one successful model of a physician-nonphysician clinician (nurse practitioners and physician assistants) team model allowed the health system to extend available physician resources in an effort to improve timeliness of outpatient care. 10 Although we did not introduce open scheduling in this iteration of our access improvement, the convenience of the extended office hours was rated higher by patients. Although the concepts of scheduling technology and office hour extension may be more readily generalizable between medical specialties and practice systems, our model carries several additional characteristics that are more applicable to academic medical departments.…”

Section: Discussionmentioning

confidence: 95%

Neurology Access Clinic

et al. 2022

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Background:Delays in access to neurologic care is a major problem. In this pilot program, we aimed to evaluate the effectiveness of a novel staffing model for neurology outpatient clinic within an academic neurology center to increase access to neurological care, while incorporating such a model into a growing academic neurology department.Methods:We created a new model for provision of access to neurological care that could be introduced in an academic neurological department, the “access clinic”. One attending was assigned to staff the access clinic for one week at a time. This was introduced as rotation equal to conventional on-service inpatient rotations. Descriptive analyses were performed to characterize the access clinic’s performance characteristics. Comparisons were made to the previously established traditional faculty clinic model.Results:5,917 access clinic visits were compared to 6,000 traditional clinic visits. Lead time dropped from 142 to 18 days for new patients, and from 64 to 0 days for return visits. While total readmission rates were similar during both clinic periods, readmission through the emergency room was less for access clinic patients. Access clinic resulted in significant improvement in patient satisfaction ratings. The access clinic model was financially profitable.Conclusions:Our findings suggest that introducing an access clinic as service rotation for neurology faculty is both effective in offering enhanced access for patients to neurological care and for patient satisfaction. Future studies may test this model in other centers, and should address effect on provider satisfaction.

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Section: Discussionmentioning

confidence: 95%

Neurology Access Clinic

et al. 2022

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“…We had expanded our outpatient APC employment over the last two years with a large focus on improving access to Neurology. This expansion along with the development of an access clinic was successful in reducing lead time for new patient visits from about one year down to several weeks [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

Advanced Practice Clinician Training for Neurology

Ermak

Cox

Ahmed

2017

Cureus

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BackgroundThe specialty of Neurology is faced with a fundamental problem of economics: supply and demand. The projected increase in provider supply is unlikely to keep up with projected increases in patient-care demand. Many large academic centers have used residents to meet this patient-care demand. However, the conflict between education of residents and patient-care needs has created a hindrance to both of those missions. Many specialties have been using advanced practice clinicians (APCs) to help address the need for patient care. In the setting of a residency program, this availability of APCs can help to alleviate patient-care demands for the resident and allow for better allocated educational time. Neurology has not historically been a popular choice for APCs and a standardized educational curriculum for a Neurology APC has not been established.MethodsThe authors share an example curriculum recently implemented for training new inpatient Neurology APCs. This curriculum includes a 12-week program complete with rotations through various subspecialties and proposes fundamental lecture topics for use in education. The authors share their expectations for clinical duties that evolve over the course of the 12-week program in conjunction with expectations for increasing clinical knowledge as well as efficiency in system utilization.ConclusionThe addition of APCs to support a busy inpatient Neurology practice has obvious beneficial implications but the integration and education of this new staff must be structured and well-designed to support the confidence of the APC in both their knowledge and their role as an indispensable member of the care team.

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“…9 Precise current data in adult neurology are not available but reports agree that wait times are excessive, 8 reported in 2012 as already at 35 days and rising, 10 and with even longer delays in some markets. 11 Supply Medical students are clear that early clinical exposure to a specialty is critical in their selection, with the majority choosing a specialty midway to late in their third year. 12 However, of the programs requiring neurology rotations, 33% allow the rotations to be completed in the fourth year, after students have made their specialty choices.…”

Section: Scope Of the Mismatch Problemmentioning

confidence: 99%

Section: Scope Of the Mismatch Problemmentioning

confidence: 99%

A Shortage of Neurologists – We Must Act Now

et al. 2021

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In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurologic care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value. The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. The time to act is now to allow concerted effort and targeted interventions to avert this looming public health crisis.

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An option for improving access to outpatient general neurology

Cited by 12 publications

References 13 publications

Neurology Access Clinic

Neurology Access Clinic

Advanced Practice Clinician Training for Neurology

A Shortage of Neurologists – We Must Act Now

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