Session Summary
Session Hosts: Dr. Janet Craig & Dr. Jerrett Stephenson
Session Objectives:
At the end of this webinar, you will be able to:
- Describe 3 strategies that physicians and teams can employ to proactively manage demand for appointments.
- Describe 2 strategies for increasing supply of appointments through utilizing team and protecting physician time.
Recommended Resources:
- Session Recording
- Podcast episode on primary care nurse's (RN, LPN) scopes of practice
- ‘Primary Care Nursing in Alberta: A guide to the role’
- Ideal Panel Size Calculator and other resources
- Access-related tools & resources
Session Highlights & Themes:
- Access for appointments is dependent on the demand from the patient panel and the supply of appointment slots from the provider.
- When demand and supply are balanced, there is no backlog of patients needing appointments who can’t get in.
- When demand goes up and/or supply decreases, a backlog is created – as well as stress for all involved!
- Simple strategies aimed at reducing demand and increasing supply can make a big difference in improving access.
3 Strategies to Reduce Demand
1. Consider appointment types
- For example, emailing the patient with lab results and/or medication refills.
- Support self-management of conditions to reduce follow up visits (e.g., self-monitoring HTN with guidelines to follow up only when out of range)
- Provide next steps for acute conditions (e.g., use neti pot for postnasal drip x 2 weeks; if that doesn't work then nasal steroids x 2-4 weeks, then trial OTC antihistamine, so patient can self-manage in a stepwise fashion)
- Common Concern: In fee for service, I make more money seeing patients in person
- Response: True, and a new fee model is part of the solution. But sending a quick message via the patient portal allows you to bill, and will open up a future appointment. So you will actually be ahead financially.
2. Extend return visit rates
- For patients with stable conditions, consider extending re-check and prescription intervals
- Over the course of one year, extending recalls from every 2 months to every 4 months for 100 of your stable patients would result in 300 open appointments to work down backlog
- As an example for prescriptions, extending scripts for chronic conditions to 100 days with 3 refills (versus 90 days x 3 refills) extends the patient contact by 40 days. Also, advise patient to follow up only if their condition hasn't improved or is worsening (I.e., NO follow up for stable patients)
- Common Concern: If I don’t see a patient regularly after I start a new blood pressure medication, how will I know whether they are improving?
- Response: We can teach patients to do self-monitoring, and that they only need to follow-up when out of range.
3. ‘Max pack’ visits
- Address more than 1 concern at each appointment as time allows
- For example, do a punch biopsy same day instead of at a follow-up visit, or complete a pap when due
- Also, max pack prescription refill requests from the pharmacy – fill them all, not just one
- Consider PrescribeIT
- Common Concern: Trying to pack more into each visit is going to get me further behind.
- Response: Sometimes you can max pack, and sometimes you can’t. But again, doing more at a visit might open up a future appointment slot for you.
2 Strategies to Increase Supply
1. Decrease the admin load on the primary provider
- What can the team do to allow the primary provider to focus on delivering clinical care
- Examples:
- Reception/MOA to arrange lipids/FIT/A1C/mammo ASAP screening using EMR supports
- Have reception create a req for any Creatinine required for CT scans
- Have clinic nurse or PCN pharmacist update Rx and do medication reconciliation when patient discharged from hospital
- Common Concern: Aren’t I responsible for arranging screening for my patients?
- Response: Yes, but you can get help from team members. In a recent study published by the American Academy of Family Practice, it takes 26.7 hours per day for a physician to provide preventative care, chronic care, acute care and documentation and inbox management for a panel of 2500 patients. Physicians can’t do it alone anymore!
2. Ensure team members are working to full scope of practice
- Determine which clinical team members you have access to (clinic, PCN, community pharmacist, etc.) and have a conversation about what they could potentially be managing for you clinically – where does their scope overlap with yours?
- RNs and LPNs have a vast scope as outlined in the document ‘Primary Care Nursing in Alberta: A guide to the role'
- For example: nurses and pharmacists can be especially helpful in managing patients with diabetes