Despite anecdotal praise of the 'advanced' or 'open access' model of scheduling patients, a new review of the limited research on the subject indicates that reality may not live up to the hype.
Published in the April 25 Archives of Internal Medicine, the review of 28 papers analyzing 24 open-access projects revealed the following:
- Patients waited less time for appointments at open-access practices, though few were able to be seen within the 48 hours the model is purported to achieve.
- No-shows decreased with open access only for practices that began with a no-show rate of at least 15 percent.
- Patient satisfaction data were inconsistent, with some practices reporting an increase in satisfaction and others indicating a decline.
- Practices have not measured relationships between open access and patient outcomes, nor how many patients may become lost to follow up.
Because of the emphasis on open access as a component of newly designed models of care, including the patient-centered medical home, authors of the paper recommend randomized controlled trials to determine the impact of open-access scheduling. However, advocates of the model argue that making urgent and nonurgent care available to patients when they need it just makes good business sense.
Organizations that have implemented open access also note that it generally takes physicians months of extra work to achieve the long-term benefits of the model. Even once the backlog of patients is diminished enough for physicians to begin seeing some patients on the same day or next day, the system requires constant evaluation and adaptation to staffing changes and seasonal fluctuations in patient demand.