Article Text
Abstract
Continuity and timely access are hallmarks of high-quality primary care and are important considerations for urgent concerns that present both during the day and after-hours. It can be especially difficult to ensure continuity of primary care after-hours in urban settings where walk-in clinics offer patients easy and convenient access. Patients of our large, multisite primary care practice in inner-city Toronto, Canada were reporting that they were not easily able to access after-hours care from their team without having to use outside services. In partnership with patients, we combined the Model for Improvement with Experience-Based Design methodology to address the issue of poor access to after-hours care. We did a root cause analysis to isolate the causes of the local problem, using a variety of capture tools designed to incorporate the patient voice. Then, patients and providers codesigned two Plan-Do-Study-Act (PDSA) cycles aimed to increase the ease of accessing after-hours care. Key actions included a redesign of our after-hours advertisement and communication of the material in multiple formats. Following these PDSA cycles, the team saw a 26%, 23% and 17% increase in awareness of weekday evening clinics, weekend clinics and after-hours phone services, respectively, and a 16% increase in the proportion of patients reporting that it was very or somewhat easy to get care during the evening, on the weekend or on a holiday from their care team. Measures continued to improve and improvements have been sustained 3 years later. Our success highlights the effectiveness of partnering with patients to improve access to primary care.
- continuity of patient care
- continuous quality improvement
- PDSA
- quality improvement methodologies
- quality measurement
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors SD and TK conceived and designed the initiative together with members of their team. SD conducted the analysis. SD and TK interpreted the results. SD drafted the manuscript. Both authors critically reviewed the manuscript and gave final approval.
Funding TK is the Fidani Chair of Improvement and Innovation at the University of Toronto. She is supported as a Clinician Scientist by the Department of Family and Community Medicine at St. Michael’s Hospital and at the University of Toronto. She is also supported as an Embedded Clinician Researcher by the Canadian Institutes of Health Research and Ontario Health (Quality Business Unit).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.