Perceptions of the first family physicians to adopt advanced access in the province of Quebec, Canada

Abstract

In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi-structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early-adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd.

The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?

“…Optimizing the role of other professionals through joint monitoring with nurses has also been raised [1,16] as a way to improve access to family physicians. However, with respect to residents, little has been written on developing contingency plans to alleviate the difficulty of providing rapid access to patients during residents’ absence from the clinic [6], or on evaluating their effects.…”

“…In Quebec, AA implementation is a growing priority for the Federation of General Practitioners of Quebec (FMOQ) and the Ministry of Health and Social Services (MSSS), to address the long-standing problem of accessing services [16]. Many Family Medicine Units (FMUs), primary healthcare organizations with a teaching mission, have already switched to the AA model, and many more will soon follow.…”

Evaluation of the implementation and associated effects of advanced access in university family medicine groups: a study protocol

“…Over the past 4 years, the majority of family physicians, in close partnership with other professionals working in primary care settings, have implemented advanced access in their organization. We conducted the first two studies (2014, 2016) to understand the early experiences of implementing advanced access with the first adopters family physicians [7], as well as with the first university family medicine groups (UFMGs) who implemented it in Quebec [22]. Results showed not only a wide variation in its implementation levels, but also different combinations of its key guiding principles, among medical practices, as well as among professionals working within the same settings.…”

“…Lastly, the professionals themselves could provide verbal information on the research project to patients during their visits. These techniques have already been used in our previous project [7,22] on advanced access and were successful in recruiting and conducting three focus groups in a single UFMG. The patient partners on our advisory team will be involved in the data collection and results interpretation.…”

“…Originally developed in the United States, advanced access has been adopted in many countries and is considered a cornerstone of primary care services of high quality and performance. Based on greater accessibility linked with patients' relational and informational continuity with a primary care professional or team [7], this organizational model is based on five guiding principles (see Fig. 1) [8]: 1) Balancing supply (appointments available) and demand (requests for appointments) consists of assessing the need for services by weighting the patients' needs according to their medical conditions and their age and adjusting the supply of services accordingly.…”