Enhancing Access to Primary Health Care

Guest Blog By:  Jennifer Fournier RN(EC), BA, MHS

Director, Capreol Nurse Practitioner-Led Clinic in Capreol, Ontario, Canada

I work as a Nurse Practitioner in Ontario, Canada. In recent years our provincial government has funded Nurse Practitioner-Led Clinics. These clinics were the product of a local innovation designed to address the ongoing shortage of primary health care services in our community. While past strategies have focused on physician recruitment exclusively, this strategy embraced the capacity of another group of providers (NPs) who had been under utilized in our health care system. I was fortunate enough to secure funding for our community and to embark on the journey that would become the Capreol Nurse Practitioner-Led Clinic.

In the planning stages I sought strategies to enhance the patient care experience, to increase access to care and to improve outcomes. I discovered a fair amount of evidence in support of the Advanced Access scheduling system. Therefore, I decided to use the system exclusively at our practice.

Advanced Access is a system designed to simplify scheduling while ensuring an adequate supply of appointments are available – an ongoing balance of appointment supply and demand. It can be used in primary health care practices as well as specialty clinics. Within this system patients should be able to secure a booking same day or next day if they choose, regardless of what they need. Unlike other structured scheduling approaches, Advanced Access does not leave administrative staff to decide who will be granted an appointment today.  The “today” and “tomorrow” appointments are available to any patient, even if they are seeking service for something non urgent like filling a prescription that has not yet run out, having an annual pap smear etc.

The clinic and the scheduling system have been well received. As the Director of the clinic I am pleased that my team has embraced a change in thinking about scheduling. We have been able to see patients earlier in the course of their illness. Patients have avoided walk in clinic visits, emergency department visits and more serious illnesses due to a delay in getting care.

While government funding provided the infrastructure and human resources required to set up the clinic the Advanced Access system has extended our capacity and impact as an organization. As a system we need to move beyond a narrow focus on infrastructure and human resources to consider other programs, approaches and innovations that can maximize patient outcomes while ensuring good use of government resources.

Fournier, J., Heale, R. and Rietze, L. (2012). “I can’t wait”: Improving wait times in primary care. Healthcare Quarterly 15(1), 64-68.

Murray, M., Bodenheimer, T., Rittenhouse, D., and Grumback, K (2003). Improving timely access to primary care: case studies of the advanced access model. JAMA: 289(8), 1042-6.



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