Improving Access at the Saskatoon Community Clinic

Saskatoon Community Clinic

 Citizen sponsored health care co-operative founded 1962  Multi-disciplinary primary care team with 140 staff working from 3 sites  13 full time equivalent physician positions/1 nurse practitioner position  40,000 patient visits; 28,000 patient charts

Change Process

     There was a lot of “noise” in our patient group about timely access to one’s family physician Committee struck to review the concern “Improved Access” model discussed, reviewed and evaluated over 6 month period Pre-program patient survey administered with support of Health Quality Council In fall 2004 after careful study introduced “Improved Access” at Main Clinic

Patient Care Goals

 To meet patient appointment needs within two working days for most types of appointments.

 To try as much as possible to have patients see their own family physician rather than another doctor at the Community Clinic.

Anticipated Outcomes

 More timely access for our patients to their family physician  Reduction of stress for our health care team  Improved patient and staff satisfaction

Program Implementation Phases      Exploring the problem and solutions:  Literature review   Mutual learning about the model Meetings with relevant team players  Participation in Re-designing the Clinical Office Practice conference with support of Health Quality Council Understanding supply and demand Shaping the handling of demand Creating contingency plans Evaluation and adjustment

Evaluation Questions

1.

2.

Is there a change over time in the access of patients to their primary health care provider?

Is there an improvement in patient satisfaction?

Evaluation Tools

 3 rd available appointment measure   continuous, before intervention and during intervention Gold standard for measuring wait times  Patient satisfaction questionnaires    British NHS General Practice Assessment Questionnaire (GPAQ) East Hampshire Primary Care Trust short patient questionnaire pre-program, mid-program, and post program  Patient self-reports on continuity of care

40 35 30 25 20 15 10 5 0

Saskatoon Community Clinic Weighted Group Average for Regular Appointments March 2004 compared to March 2005

2004 2005

Year

40 35 30 25 20 15 10 5 0

Saskatoon Community Clinic Weighted Group Average for Complete Appointments March 2004 compared to March 2005

2004 2005

Year

Mid-Cycle Patient Questionnaire

91 % said their appt. was within their timescale 78% saw their own family doctor

   Administered for 5 days over 5 week period 6 months after implementation of Improved Access Completed by 372 patients Patients asked who the appointment was with, when they asked to be seen, and whether or not this was within their timescale

General Practice Assessment Questionnaire (GPAQ)    General Practice Assessment Questionnaires (GPAQ) administered to 350 patients before implementation of Improved Access and one year following implementation The GPAQ is a tested, reliable measurement instrument, that was developed and is used by the National Health Services (UK) designed to measure patient satisfaction with various aspects of physician practice including access to care

Pre and Post Program GPAQ Scores

Relevant Question

4b. Satisfaction with availability of particular doctor 5b. Satisfaction with availability of any doctor 9b. Satisfaction with continuity of care

Mean Score 2004 %

58.28

Mean Score 2005 %

68.69

Margin of Difference

+10.33 69.01

68.99

69.81

70.86

+.80

+1.87

Next Steps…

 Participating in province-wide Health Quality Council Chronic Disease Management Collaborative  Sharing expertise re: Improved Access with 34 other physician practices from across the province  Using our Improved Access capacity to start improving Chronic Disease Management

Contacts

Saskatoon Community Clinic

Ingrid Larson  664-4243  [email protected]

Dr. Carla Eisenhauer   652-0300 [email protected]

Health Quality Council

Katherine Stevenson   668-8810, ext. 107 [email protected]