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Faisal Hammad Alatawi et al, 2020;4(2):477–480.

International Journal of Medicine in Developing Countries

Interventions to minimize waiting times for primary care units’ appointments: a review

Faisal Hammad Alatawi1*, Mohammed Saeed Bafail2, Abdulaziz Sulaiman Alosaily3, Abdulaziz Faraj Alqahtani4, Omar Khalid Alsaawi5, Abrar Fahad Alotaibi6

Correspondence to: Faisal Hammad Alatawi

*Medical Intern, College of Medicine, Tabuk University, Saudi Arabia.

Email: dr.faisal1ksa1 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 03 December 2019 | Accepted: 22 December 2019

ABSTRACT

Increased waiting time, especially in an outpatient setting, is considered a significant cause for patients’ dissatisfaction in most of the countries. Reducing waiting time could improve the patients’ experience with healthcare services and reduce the workload over healthcare providers. This study aimed to evaluate the current literature to explore the causes of delays in primary care appointments and methods to reduce this delay to improve patients’ satisfaction. A wide range of databases were searched using pre-designed keywords, to explore the reasons for the delay in primary care appointments. The next step was evaluating those articles against the eligibility criteria. The search included 26 articles, while only 5 articles were included in this review; the reports were published in 2019. Telephone arrangements and managing overbooking of patients were found to be among the most effective interventions that can shorten the time of waiting in primary care units.


Keywords:

Waiting time; primary care; outpatient; interventions.


Introduction

Primary care units are mainly designed to provide non-urgent care for patients, presenting with either an acute or chronic condition [1]. However, prolonged waiting time in primary care units is one of the most common problems of the healthcare systems all over the world and is mainly due to increasing demand over the available supply [2].

This prolonged waiting time is more prevalent in healthcare systems that work with both full public health insurance and private patients as well [3]. This is commonly a structural component of the healthcare system [2,4].

The presence of overwhelming waiting lists and overlapped booking could easily be avoided through some simple interventions that would not require exhaustion of resources [5]. An additional reason for increased waiting time in primary care appointments is the misuse of the full capacity of the primary care unit, which in turn, increases patients suffering while receiving their right in a convenient healthcare service [2,6].

Furthermore, long waiting duration is demonstrated to be a leading cause of patients’ distress that can lead to adverse health outcomes [7]. Patients usually perceive this problem as un-planning from public organizations and decision-makers [3,8].


Materials and Methods

An online searching process was carried out to obtain articles included in this review. The research team searched for potential articles in scientific websites, including PubMed and Google Scholar, using several keywords, such as “primary care units,” “waiting times,” and “interventions” to obtain all possible articles.

Twenty-six articles appeared in search results containing any of the keywords used; however, 18 articles were excluded as their titles were different and didn’t refer to the subject under review, other 3 articles were poster presentations, and only 5 articles were included in this review which were published between in 2019.


Discussion

Timely access to primary healthcare is linked to improved health outcomes and contributes to cost control [9]. Accessibility and availability are essential characteristics of efficient and effective primary healthcare systems [1,10].

In developed countries, ambulatory primary healthcare services are used for many different reasons. These include minor but urgent health problems, routine care, mental health, child and maternity care, health promotion, and end-of-life care [11].

Having timely access to primary care is shown to increase patient satisfaction as well as the quality of care delivered [5,12]. However, recent reports showed that access to family physicians is becoming more difficult because of physician shortages, as well as an increasing number of cases with disabilities and chronic diseases [8,13].

In 2012, reports from the Canadian Foundation for Healthcare Improvement demonstrated that developed countries had a higher incidence of ill adults (23%) who reportedly wait six or more days for a primary care appointment [14]. In addition, International surveys have also shown that patients usually suffer to schedule an appointment with their physician on the same day and subsequently often rely on urgent care for non-urgent health problems [11,15].

Waiting for a primary care appointment can usually lead to an emotional, as well as a physical burden on an individual who is in pain or worried about a severe health condition [16].

Some trials have shown that adverse consequences may arise from prolonged waiting for primary care appointments [17]. For example, extended waiting times for heart disease and cancer are correlated to an elevated risk of morbidity and mortality, because of the delay of medical care [9,18]. Also, patients suffering from mental health conditions, who do not receive timely access to care, usually suffer from a rapid decline in their medical condition and a lost opportunity for effective treatment [19].

Consequently, poor health outcomes are frequently correlated to elevated healthcare costs to patients, because waiting for care can be burdened by a loss of income due to the inability to work [4,20]. Even developed countries usually fail to offer timely access to primary care providers [8,13]. This is because of numerous reasons, including a healthcare system that is governed at varying degrees, the absence of cooperation between healthcare providers to develop and implement policy, and the need to implement measurement systems for quality improvement [2,6,15].

Currently, strategies outlined to improve access to primary care have concentrated on rising the number of family physicians, incentives for family physicians to accept additional or more complex patients, enhancing patients’ flow and practice management efficiency by utilizing advanced access scheduling, and offering incentives for family physicians to elevate the number of evening and weekend clinics that they provide [14,16,19].

Also, one of the most economical techniques to enhance access to primary care appointments proved to be the use of open-access scheduling [3,11]. This technique focuses on lessening and eliminating delays without adding staffing resources [11,15].

Open-access scheduling approaches this through keeping a majority of short appointments unscheduled, and only fill them on the same day if any patient calls in for appointments [17,19,20]. On the other hand, longer or foreseeable routine appointments are scheduled ahead of time. In turn, open-access scheduling may help mitigate the continuous rise for chronic care appointments in primary care settings [12,18].

To enhance primary care scheduling efficiency, several practices have implemented the use of the open-access concept, also known as same-day scheduling or advanced access [9,11,19]. This scheduling model spares about half of the day for booking. This allows the prevention of booking a physician’s schedule weeks and months in advance, in addition to keeping the remaining hours of the day for necessary follow-up appointments [8,10].

In comparison to the traditional scheduling where the schedule is already full before the start of the workday, the open-access model allows for more flexibility in scheduling, eliminate delays, and improve patient satisfaction and health outcomes [11,18].

Extended primary care unit hours have been shown to be efficient at reducing wait times. A significant number of family physicians in the US and Canada currently practice in group-based settings. This permits overtime coverage to be shared among physicians. In turn, this will enable physicians to provide patients with more opportunities to be seen promptly [13,15,18].

It is also revealed that patients who have access to evening and weekend care are less likely to visit the Emergency Department [4,9]. Moreover, electronic communication and telephone follow-ups are considered as other ways for primary care physicians to use. This may reduce the number of unnecessary and time-consuming face-to-face appointments while maintaining continuity of care [5].

In addition, using the medical expertise of the family physician, nurse, pharmacist, social worker, psychologist, physiotherapist, and dietician, patients are allowed to be seen for various medical problems by the appropriate healthcare provider in a single physical framework [6,9,13].

This permits physicians to care more effectively for patients and consequently lead to decrease wait times for primary care appointments [5,12].


Conclusion

Open-access scheduling can significantly decrease waiting times and is the most widely used intervention to decrease waiting times in primary care contexts. Future studies should focus on measuring the cumulative effect of interventions, to reduce wait times for primary care appointments, to discover the relation between open access and other interventions to lessen waiting times. Future research should also focus on practice cost and revenue and include a cost–benefit assessment of the application of interventions. Finally, future trials should also focus on measuring the impact of interventions on the quality of care, the continuity of care, and the effect on other healthcare services utilization.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Faisal Hammad Alatawi1, Mohammed Saeed Bafail2, Abdulaziz Sulaiman Alosaily3, Abdulaziz Faraj Alqahtani4, Omar Khalid Alsaawi5, Abrar Fahad Alotaibi6

  1. Medical Intern, College of Medicine, Tabuk University, Tabuk, Saudi Arabia
  2. Medical Intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
  3. GP, Al Saddah PHC, Buraydah Central Hospital, Saudi Arabia
  4. Medical Intern, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  5. Medical Intern, College of Medicine, Qassim University, Qassim, Saudi Arabia
  6. GP, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alatawi FH, Bafail MS, Alosaily AS, Alqahtani AF, Alsaawi OK, Alotaibi AF. Interventions to minimize waiting times for primary care units' appointments: a review. IJMDC. 2020; 4(2): 477-480. doi:10.24911/IJMDC.51-1575412092


Web Style

Alatawi FH, Bafail MS, Alosaily AS, Alqahtani AF, Alsaawi OK, Alotaibi AF. Interventions to minimize waiting times for primary care units' appointments: a review. https://www.ijmdc.com/?mno=76482 [Access: January 28, 2022]. doi:10.24911/IJMDC.51-1575412092


AMA (American Medical Association) Style

Alatawi FH, Bafail MS, Alosaily AS, Alqahtani AF, Alsaawi OK, Alotaibi AF. Interventions to minimize waiting times for primary care units' appointments: a review. IJMDC. 2020; 4(2): 477-480. doi:10.24911/IJMDC.51-1575412092



Vancouver/ICMJE Style

Alatawi FH, Bafail MS, Alosaily AS, Alqahtani AF, Alsaawi OK, Alotaibi AF. Interventions to minimize waiting times for primary care units' appointments: a review. IJMDC. (2020), [cited January 28, 2022]; 4(2): 477-480. doi:10.24911/IJMDC.51-1575412092



Harvard Style

Alatawi, F. H., Bafail, . M. S., Alosaily, . A. S., Alqahtani, . A. F., Alsaawi, . O. K. & Alotaibi, . A. F. (2020) Interventions to minimize waiting times for primary care units' appointments: a review. IJMDC, 4 (2), 477-480. doi:10.24911/IJMDC.51-1575412092



Turabian Style

Alatawi, Faisal Hammad, Mohammed Saeed Bafail, Abdulaziz Sulaiman Alosaily, Abdulaziz Faraj Alqahtani, Omar Khalid Alsaawi, and Abrar Fahad Alotaibi. 2020. Interventions to minimize waiting times for primary care units' appointments: a review. International Journal of Medicine in Developing Countries, 4 (2), 477-480. doi:10.24911/IJMDC.51-1575412092



Chicago Style

Alatawi, Faisal Hammad, Mohammed Saeed Bafail, Abdulaziz Sulaiman Alosaily, Abdulaziz Faraj Alqahtani, Omar Khalid Alsaawi, and Abrar Fahad Alotaibi. "Interventions to minimize waiting times for primary care units' appointments: a review." International Journal of Medicine in Developing Countries 4 (2020), 477-480. doi:10.24911/IJMDC.51-1575412092



MLA (The Modern Language Association) Style

Alatawi, Faisal Hammad, Mohammed Saeed Bafail, Abdulaziz Sulaiman Alosaily, Abdulaziz Faraj Alqahtani, Omar Khalid Alsaawi, and Abrar Fahad Alotaibi. "Interventions to minimize waiting times for primary care units' appointments: a review." International Journal of Medicine in Developing Countries 4.2 (2020), 477-480. Print. doi:10.24911/IJMDC.51-1575412092



APA (American Psychological Association) Style

Alatawi, F. H., Bafail, . M. S., Alosaily, . A. S., Alqahtani, . A. F., Alsaawi, . O. K. & Alotaibi, . A. F. (2020) Interventions to minimize waiting times for primary care units' appointments: a review. International Journal of Medicine in Developing Countries, 4 (2), 477-480. doi:10.24911/IJMDC.51-1575412092