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

Abstract

Background: The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. Objective: To identify these challenges within these clinics, as well as potential strategies to address them. Design: The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (N = 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residents’ patient; 2) managing and balancing residents’ appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residents’ patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. Conclusions: To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models.

Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic

“…Particular aspects of this study may limit the generalizability of findings. Firstly, it was conducted in teaching PHC clinics in Quebec that have certain characteristics – notably their teaching mission and the broad range of PHC providers working alongside physicians – that distinguish them from other clinical settings ( Abou Malham et al 2018 ). Secondly, the participating U-FMGs were located in both rural and urban areas, but information was not collected to enable analysis of the differences between these settings.…”

Changing nursing practice within primary health care innovations: the case of advanced access model

“…This study is nested within a larger multiple case study conducted in four UFMGs in the province of Quebec [ 16 ] that are considered early adopters of AA. University Family medicine groups (UFMGs) are public primary healthcare organizations with a teaching mission, devoted to training family medicine residents [ 22 ], and enabling them to learn how to work as part of an inter-professional team including FPs, nurses, pharmacists and social workers. Selection of the four FMUs is based on two criteria: 1) having at least 1 year of experience in implementing AA; and 2) representing diverse socio-demographic environments (rural and urban UFMGs).…”

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

“…UFMGs are an exemplary setting that provides early exposure of future health professionals' to best practices during their training program and are potentially conducive to implementing advanced access in their future practice [23]. Aside from the exploratory study [24] that we conducted, few studies has been identified on the impact of variations in advanced access implementation in various teaching settings [25]. We observed different models of implementation of advanced access by residents, ranging from a simple pairing/ twinning (i.e., sharing a panel of patients between two residents) to the implementation of a joint care model with nurses or a subteam (teamlet) of professionals, in which the resident is included.…”