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On-Demand Scheduling May Hinder Chronic Illness Care


 

The outcomes of some patients with type 2 diabetes appeared to be poorer when they were enrolled in clinics with open access scheduling, in which patients are seen for appointments within 24 hours.

The finding is surprising because open access scheduling has been hailed as a strategy for increasing practice efficiency and improving access to care. The premise is to eliminate appointment backlogs, and patient no-shows.

In a retrospective, cohort study, researchers at the Indiana University School of Medicine compared the impact of open access and traditional scheduling on the care processes and outcomes of 4,060 adult patients with type 2 diabetes. All study participants came from a large health plan and received care between July 1, 2004, and June 30, 2006, at one of six open access clinics or at one of six traditional access clinics.

In adjusted multivariate analyses comparing open access to traditional scheduling, open access scheduling “significantly affected diabetes-related clinical outcomes in the short term,” Dr. Usha Subramanian and colleagues reported. In particular, the quality of care was worse for African American patients, they noted (J. Gen. Intern. Med. 2009 Mar[24]:327-33).

In the open access group, the odds ratio for hemoglobin A1c testing among African American patients was 0.47 and the odds ratio for microalbumin testing was 0.37, the authors wrote. Additionally, patients in the open access clinics had significantly higher systolic blood pressure at 1 year as did patients in the conventional scheduling clinics. There were no between-group differences in health care utilization outcomes.

The study was conducted among patients in a single health plan located in one city and most patients were of low socioeconomic status, so “results may not generalize to all other settings or patients groups,” they stressed.

Rigorously designed studies are needed to examine open access scheduling more critically, the authors wrote. Such studies should be conducted in multiple health care settings and should incorporate measures for patient satisfaction, continuity of care, and access to care.

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