1. Improving Access at the Saskatoon Community Clinic

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

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

5. Patient Care Goals To meet patient appointment needs within two working days for most types of appointments. 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. To try as much as possible to have patients see their own family physician rather than another doctor at the Community Clinic.

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

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

8. Evaluation Questions 1. Is there a change over time in the access of patients to their primary health care provider? 2. Is there an improvement in patient satisfaction?

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

10. Saskatoon Community Clinic Weighted Group Average for Regular Appointments March 2004 compared to March 2005 0 5 10 15 20 25 30 35 40 20042005 Year # of days

11. Saskatoon Community Clinic Weighted Group Average for Complete Appointments March 2004 compared to March 2005 0 5 10 15 20 25 30 35 40 20042005 Year # of days

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

13. General Practice Assessment Questionnaire (GPAQ) General Practice Assessment Questionnaires (GPAQ) administered to 350 patients before implementation of Improved Access and one year following implementation 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) 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 designed to measure patient satisfaction with various aspects of physician practice including access to care

14. Pre and Post Program GPAQ Scores Relevant Question Mean Score 2004 % Mean Score 2005 % Margin of Difference 4b. Satisfaction with availability of particular doctor 58.2868.69+10.33 5b. Satisfaction with availability of any doctor 69.0169.81 +.80 +.80 9b. Satisfaction with continuity of care 68.9970.86+1.87

15. Next Steps… Participating in province-wide Health Quality Council Chronic Disease Management Collaborative 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 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 Using our Improved Access capacity to start improving Chronic Disease Management

16. Contacts Saskatoon Community Clinic Ingrid Larson 664-4243 664-4243 ilarson@communityclinic.sk.ca ilarson@communityclinic.sk.ca Dr. Carla Eisenhauer 652-0300 652-0300 ceisenhauer@communityclinic.sk.ca ceisenhauer@communityclinic.sk.ca Health Quality Council Katherine Stevenson 668-8810, ext. 107 668-8810, ext. 107 kstevenson@hqc.sk.ca kstevenson@hqc.sk.ca