Comprehensive planning of needs and supply
Measure and manage for better advanced access practice
An advanced access schedule bears little resemblance to that of "traditional" primary healthcare. This is because, rather than filling appointments well in advance, time slots are kept open in professionals’ schedules for appointments to be made on short notice so that patients' needs can be met in a timely manner. As a general rule, it is recommended that appointments be made over a period of no more than two to four weeks, with certain exceptions such as obstetrical follow-ups, CNESST cases or similar situations, or in cases where patient accountability for making an appointment is an issue.
Rule of Thumb
Overall patient demand for the coming year can be estimated using the rule of thumb.
Based on utilization data, the rule of thumb specifies that the required availability for 200 registered patients is one half day per week (3 hours) for a professional with an advanced access practice. For 800 patients, the rule of thumb is four half days of practice in the clinic per week. These four half days should be spread out to ensure accessibility throughout the week and to avoid pushing emergency appointments on the weekend. This could be done, for example, by reserving half days on Monday morning, Wednesday afternoon and all day Thursday. The rule varies between 150 and 250 patients depending on the number of vulnerable patients and their characteristics.
Plan supply and demand for the coming year
Advanced access practice is based on achieving and maintaining a balance between a professional's service supply and patient demand. To ensure that this balance is achieved, the supply and demand can be estimated using formulas that incorporate parameters of the physician’s or professional's practice (e.g., hospital or management responsibilities) and characteristics of their patients (e.g., home follow-up, pregnancy follow-up).
Formula to estimate overall demand
To obtain an estimate of overall patient demand for the coming year, professionals should take into account certain characteristics of their registered patients, including, for example, pregnant women, vulnerable patients and the elderly, who require more frequent consultations.
The formula uses the following weighting (these characteristics can be found in your electronic medical record (EMR):
To estimate overall demand for your registered patients for the coming year, enter the number of patients corresponding to each characteristic directly in the calculator below.
Formula to estimate overall service supply
To obtain an estimate of your clinic’s overall service supply for the coming year, the following elements should be considered:
To obtain the total number of consultations offered for the coming year, enter the numbers corresponding to your practice at the clinic directly into the calculator below.
Estimate the balance between your service supply and patient demand
The following formula can be used to estimate the balance between supply and demand:
To estimate the gap between your service supply and patient demand, enter the results of the above calculations into the calculator below :
Identifying the gap between your service supply and patient demand provides an opportunity to consider strategies to achieve or maintain balance by adjusting one or more of the following elements:
Positive gap: If your service supply exceeds demand...
But your patients still experience access problems: you may need to work on other issues, such as updating your availability in a timely manner, your appointment scheduling system or interprofessional collaboration.
And your patients do not experience access problems: you could probably enroll more patients or increase availability for unattached patients.
Negative gap: If patient demand exceeds your service supply, you should review the advanced access strategies that help decrease demand or increase supply.
Consequently, you will need to make choices, such as:
Improve collaboration with clinic members so that patients see the appropriate professional according to their need.
Relinquish some medical or management tasks so that you can spend more time in the clinic.
Increase your number of consultations per day.
You will need to decide which adjustments to make in order to have a more rewarding, effective and enjoyable practice.
Take recurring variations into account
Offer a consultation schedule that is spread out over the week Once you know your patient demand and offer a balanced service supply, you should select your clinic days according to the supply and demand, ideally throughout the week. For example, if you work four half days per week, you should spread them out over several days as much as possible. The important thing is to avoid lumping them all together. This way, a patient who calls on Monday, for example, can be seen the same day, during the week or before the weekend. In addition, if the patient's condition requires urgent attention, they will only have to wait one or two days to receive the required care.
Reduce demand during peak periods As much as possible, avoid scheduling follow-up appointments during peak periods by postponing them to late spring or during a period that you know will be less busy. You can do this, for example, by changing prescription renewal dates so that periodic follow-ups are scheduled during quieter times of the year.
Avoid taking on new patients during peak periods (longer consultations required). Plan to see new patients in late spring, during the summer or during periods that you know will be less busy.