Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 82-87 (doi:10.1542/peds.2004-2573)
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Open Access in Primary Care: Results of a North Carolina Pilot Project

David G. Bundy, MD, MPH*,{ddagger}, Greg D. Randolph, MD, MPH*,§, Mark Murray, MD, MPA||, John Anderson, MD and Peter A. Margolis, MD, PhD*,§

* Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics
{ddagger} Robert Wood Johnson Clinical Scholars Program
§ Center for Children's Healthcare Improvement, University of North Carolina, Chapel Hill, North Carolina
|| Mark Murray and Associates, Sacramento, California
Duke University Affiliated Physicians, Durham, North Carolina

OBJECTIVE.: Appointment delays impede access to primary health care. By reducing appointment delays, open access (OA) scheduling may improve access to and the quality of primary health care. The objective of this pilot study was to assess the potential impact of OA on practice and patient outcomes by using pilot-study data from 4 North Carolina primary care practices.

METHODS.: We conducted an interrupted time-series pilot study of 4 North Carolina primary care practices (2 family medicine and 2 pediatric practices) participating in a quality-improvement (QI) collaborative from May 2001 to May 2002. The year-long collaborative comprised 25 practices and consisted of three 2-day meetings led by expert faculty, monthly data feedback, and monthly conference calls. Our main outcome measures were appointment delays, appointment no-shows, patient satisfaction, continuity of care, and staff satisfaction during the 12-month study period.

RESULTS.: Providers in all 4 practices successfully implemented OA. On average, providers reduced their delay to the third available preventive care appointment from 36 to 4 days. No-show rates declined (first quarter [Q1] rate: 16%; fourth quarter [Q4] rate: 11%; no-show reduction: 5% [95% confidence interval: 1%, 10%]), and overall patient satisfaction improved (Q1: 45% rated overall visit quality as excellent; Q4: 61% rated overall visit quality as excellent; change in satisfaction: 16% [95% confidence interval: 0.2%, 30%]). Continuity of care followed a similar pattern of improvement, but the change was not statistically significant. Staff satisfaction neither improved nor declined.

CONCLUSIONS.: This pilot study suggests that primary care practices can implement OA successfully by using QI-collaborative methods. These results provide preliminary evidence that OA may improve practice and patient outcomes in primary care. These analyses should be repeated in larger groups of practices with longer follow-up.

Key Words: health services accessibility • appointments and schedules • quality of care

Abbreviations: OA, open access • PCP, primary care physician • QI, quality improvement • Qn, quarter n • CI, confidence interval

Accepted Feb 28, 2005.




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