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Am Fam Physician. 2007;75(5):716-718

Background: Difficulties in scheduling appointments results in an immunization rate lower than the goal established by Healthy People 2010 (i.e., 90 percent vaccination rate among children 19 to 35 months of age). Parents report that failure to get timely appointments has a negative impact on their ability to get care for their infants. Open access scheduling was developed in an attempt to provide care at the time of need, allowing for acute and well-child care in a timely fashion. Its use has been shown to decrease missed appointments and improve continuity of care and patient satisfaction. However, there are no studies that look at the effect of open access scheduling on infant well-child care visits. O'Conner and colleagues evaluated the effect of open access scheduling on missed appointments and on-time immunization rates.

The Study: The study was performed in the children's clinic of a large community health center where most patients were uninsured or had Medicaid. Ten clinicians and 878 infants were included in the study. For two months before changing the scheduling to open access (baseline period), researchers recorded missed appointments and immunizations for all infants scheduled for two-, four-, or six-month well-child care visits. At the start of open access scheduling, clinicians were divided into four groups based on various factors (e.g., sessions worked per week, education, Spanish-language fluency). In each of these groups, one half of the clinician's patients were randomized to an open access future-visit group, and the other half were put into an open access same-day group.

In the same-day group, parents were given a card notifying them which week they should call for a well-child visit and instructing them to call for an appointment the week it was needed. In the future-visit group, parents scheduled appointments before leaving the clinic. The open access scheduling system kept 50 to 75 percent of the appointments open until the beginning of the day. Parents in both groups who missed appointments were called or sent a postcard to remind them of the need for a well-child care visit. The main outcome measures included missed appointment rates, on-time immunization rates, and continuity of care.

Results: The open access scheduling groups had a significant reduction in missed appointments compared with baseline: decreases were 50 percent in the same-day group and 30 percent in the future-visit group. At the end of the study, the on-time immunization rate for patients older than five months in the open access groups was 74 percent; this represented a significant increase from the baseline rate. The percentage of patients being coded as having perfect continuity of care (i.e., having two or more well-child visits with the same clinician) was lower in the same-day group (60 percent) compared with the future-visit group (75 percent), but this was because of differences in clinicians between the two groups, not scheduling technique.

Conclusion: The authors conclude that open access scheduling can increase on-time immunization rates and decrease the number of missed appointments for well-child care visits. They add that open access scheduling improves overall health care access for infants in this population.

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Copyright © 2007 by the American Academy of Family Physicians.

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