JMIR Publications

ABSTRACT

Background:

Access to – and availability of – primary health care remains a major concern for many industrialized countries. In turn, the adoption of efficient digital health solutions is an issue that has become of the utmost importance to these countries. Medical appointment scheduling (MAS) systems figure amongst the most needed solutions, as they have proven to be effective in lightening the administrative burden of medical appointments scheduling, thereby allowing clinics to better care for patients. While multiple MAS solutions are available in Canada, a managerial solution to healthcare accessibility, i.e., advanced access, has also been widely promoted.

Objective:

This study’s primary objective is to advance knowledge and gain insight on: (1) the extent to which family medicine clinics that have already assimilateded MAS systems differ from those that have not, (2) the benefits associated with such assimilation, in conjunction with the application of advanced access principles, and (3) the organizational and managerial factors associated with greater MAS assimilation.

Methods:

Data from 70 family medicine clinics in Quebec, Canada were collected from November 11 to December 20, 2020. For each clinic, the person in charge of medical scheduling was asked to complete a web-based questionnaire. The questions addressed the clinic's organizational and managerial context, integration and use of MAS systems, and the accessibility and availability of care. To add richness to the data, interviews were conducted with five experts on MAS system adoption in Quebec in the period from February 12 to March 16, 2021.

Results:

A large majority of clinics (83%) reported having implemented at least one MAS system, however leaving most MAS system functionalities unused. The main findings of a causal analysis were that the clinics' organizational context was positively associated with MAS systems integration (β = 0.30, P = .009) and extensiveness of use (β = 0.30, P = .009), while their managerial context was only significantly associated with the integration of MAS systems (β = -0.26, P = .006).The main findings of a cluster analysis were that smaller clinics and those that are not FMGs are less likely to integrate their MAS solution into their EMR (F = 7.4, P = .001), are less likely to have adopted an iMAS solution (F = 5.2, P = .008), and show less availability of care (scheduling performance: F = 4.9, P = .010; patient attendance: F = 23.8, P < .001).

Conclusions:

The main contribution of this study lies in its empirical demonstration that greater integration and assimilation of MAS systems in medical clinics lead to greater accessibility and availability of care for their patients and the general population. Moreover, valuable information is provided as to which clinics stand to benefit most from primary care accessibility interventions by governments and health authorities.