Ever wish you could see the doctor the same day you call for an appointment?
Physicians at two Duke-affiliated clinics are using a program called open access to see patients the same day they call. With this program, doctors hope to reduce not only the waiting time required to schedule an appointment, but also the time spent in the waiting room.
"This is a solution to do away with waits and delays in the health care system," said Dr. John Anderson, medical director of Duke University Affiliated Physicians, the group involved in developing pilot programs at Triangle Family Practice and Butner-Creedmoor Family Medicine. "Any time there's a wait or delay in the care process, it causes all sorts of problems about continuity of care."
On any given day at the two clinics, 10 to 20 percent of a physician's schedule will be filled, leaving the rest of the day open to make appointments with patients who call. Open access applies to all appointments, including emergencies, routine checkups and physicals that could otherwise take months to schedule.
"The goal is to have a schedule that is open. When you start with a full schedule [as physicians do in other clinics], you have no room to see patients when they call. Your choices are either to work them in, book them in the future if they can wait that long or send them to urgent care," said Sonya Morin, a family nurse practitioner at Triangle Family Practice. "Now you don't have to prove how sick you are in order to be seen."
However, the transition has not been an easy one. Implementing the project requires significant resources, as well as making it necessary to assess the level of demand of patient appointments on any given day.
"This program is an excellent investment but not easy to do since it takes a lot of time and energy. Many clinics work on a pretty tight budget, so even if there are financial gains down the road, it's hard for some practices to handle," said Dr. Greg Randolph, assistant professor of pediatrics at the University of North Carolina at Chapel Hill. "Also, scheduling future [appointments] is a basic function of a practice and it makes you a little nervous if you have to change that--you have to be convinced that it will be worthwhile before making such a dramatic change."
Randolph played a major role in the development of open access programs in North Carolina clinics by soliciting a grant from the Duke Endowment.
Preparation is also key because doctors need to anticipate the future to accommodate patients immediately. But program directors believe this mindset is the direction health care needs to take.
"The difficulty that care providers often have is that they are already overwhelmed with work and don't want even more. Once you get rid of backlog, though, it becomes much clearer that you're doing today's work today so you can get a better handle on the demand in same-day setup," Anderson said.
In the nine months since the two clinics implemented the program, organizers have seen success. Wait times for appointments dropped from an average of three months to two to three days, and doctors have found that demand is very predictable. In addition, canceled appointments have decreased from 9 percent to 3 percent of patients.
The concept of open access was first developed several years ago, and program directors believe there is a national trend moving toward implementing it in other clinics. The Butner-Creedmoor and Triangle Family practices are both involved in a national collaborative initiative with the Institute for Health Care Improvement. There are currently 15 open access clinics in the country, five of which are in North Carolina.
Given the success of the two pilot programs, DUAP hopes to spread the plan to other Duke clinics within 18 to 24 months.
"Initially the process is stressful because change is stressful, but we've seen increased patient and staff satisfaction, better continuity of care, improved clinical outcomes and overall better health care," Morin said.
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