Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
BMJ Open Qual. 2020 Apr;9(2). doi: 10.1136/bmjoq-2019-000777.
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.
连续性和及时获得医疗服务是高质量初级保健的标志，对于白天和下班后出现的紧急问题也是重要的考虑因素。在城市环境中，尤其是在提供患者便捷服务的步行诊所，确保下班后的初级保健连续性可能特别困难。我们在加拿大多伦多市中心的一个大型多地点初级保健实践中，患者报告说，他们无法轻松地从自己的医疗团队获得下班后的医疗服务，而不得不使用外部服务。我们与患者合作，将改进模型与基于经验的设计方法相结合，以解决下班后医疗服务获取困难的问题。我们进行了根本原因分析，以隔离当地问题的原因，使用了各种旨在纳入患者意见的捕获工具。然后，患者和提供者共同设计了两个计划-执行-研究-行动（PDSA）循环，旨在增加下班后医疗服务的便利性。主要措施包括重新设计我们的下班后广告，并以多种格式传达材料。在这些 PDSA 循环之后，团队分别注意到工作日晚上诊所、周末诊所和下班后电话服务的知晓率分别提高了 26%、23%和 17%，并且报告说从他们的医疗团队在晚上、周末或节假日获得医疗服务非常或有些容易的患者比例增加了 16%。措施继续得到改善，并且 3 年后仍在持续改进。我们的成功突显了与患者合作改善初级保健服务获取的有效性。
