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

Abstract

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.

Barriers and facilitators for implementation of family medicine–oriented model of primary care in Bosnia and Herzegovina: A qualitative study

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

“…The perceived challenges are numerous and concern choosing and organizing the residents’ patient population, balancing accessibility and relational continuity of care, managing and balancing residents’ appointment schedules, understanding and appropriating the model, and establishing collaborative practice. They are also influenced by organizational challenges (e.g., lack of financial or professional resources, or leadership), as reported in a separate article [21] and in other research studies conducted abroad [1,22] that should not be overlooked.…”

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

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“…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.…”