Keywords
Health services accessibility
Appointments and schedule
How to Cite
Abstract
Introduction: Primary care access is related to the quality of care provided and must meet demands. There are three proposed models to organize scheduling that are described (traditional, carve-out and advanced access). This study aims to present effective
strategies for scheduling appointments in primary care with positive access outcomes. Methodology: A Synthesis of Evidence for
Policies was developed, followed by a Deliberative Dialogue, to discuss aspects related to the implementation of the strategies.
Results: Several effective strategies were identified, grouped by similarity of themes into six options: 1) Expansion of appointments
offer in the same day; 2) Multidisciplinary teams monitoring patients; 3) Capacity increase; 4) Patient Care Bundles; 5) Interventions
prior to scheduling the appointments; 6) Regulation between service levels. Discussion: These options can be implemented partially
or completely, associated between each other or not. It is necessary to observe barriers and facilitators for the implementation
of each of them in relation to four levels: service users, professionals, organization of services and health systems. Conclusion: The
synthesis offers the theoretical basis for improving scheduling in primary health care, but it has limitations and the results must be
interpreted with caution for the Brazilian reality.
References
Starfield B. Atenção primária: equilíbrio entre necessidades de saúde, servicos e tecnologia [internet]. Brasília (DF): Ministério da Saúde; 2002.
Canuto LE, Silva AFL, Pinheiro LSP, Canuto Jr JCA, Santos NLP. Estudo da demanda de uma equipe da Estratégia Saúde da Família que utiliza o acesso avançado como modelo de organização da agenda. Revista Brasileira de Medicina de Família e Comunidade. 2021;16(43):2378.
Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med. 2000;51(11):1611-25.
Murray M, Tantau C. Redefining open access to primary care. Manag Care Q. 1999;7(3):45-55.
Knight A, Lembke T. Appointments 101: how to shape a more effective appointment system. Aust Fam Physician. 2013;42(3):152-6.
Vidal TB. O acesso avançado e sua relação com o número de atendimentos médicos em atenção primária à saúde [dissertação]. Porto Alegre: Faculdade de Medicina da UFRGS; 2013.
Vidal TB, Rocha SA, Harzheim E, Hauser L, Tesser CD. Modelos de agendamento e qualidade da atenção primária: estudo transversal multinível. Rev. Saude Publica. 2019;53.8. Rose KD, Ross JS, Horwitz LI. Advanced access scheduling outcomes: a systematic review. Arch Intern Med. 2011;171(13):1150-9.
Bastos GAN, Fasolo LR, Bastos GAN, Fasolo LR. Fatores que influenciam a satisfação de usuários de serviços ambulatoriais em população de baixa renda: um estudo de base populacional. Rev Bras Epidemiol 2013;16(1).
Vieira-da-Silva LM, Chaves SCL, Esperidião MA, Lopes-Martinho RM. Accessibility to primary healthcare in the capital city of a northeastern state of Brazil: an evaluation of the results of a programme. J Epidemiol Community Health. 2010;64(12):1100-5.
Stein AT. A avaliação dos serviços de saúde deve ser realizada com instrumentos validados. Epidemiol Serv Saude. 2013;22(1):179-181.
Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Ciência e Tecnologia. Diretriz Metodológica: síntese de evidências para políticas. Brasília (DF); 2020.
Parente SS, Bortoli MC, Oliveira CF, Araujo BC. Agendamentos de consultas na atenção primária: síntese de evidências para políticas – Protocolo [internet]. 2023 [acesso em 10 jan 2023]. Disponível em: https://zenodo.org/
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan a web and mobile app for systematic reviews. Systematic Reviews. 2016;5;210.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
Ansell D, Crispo JAG, Simard B, Bjerre LM. Interventions to reduce wait times for primary care appointments: a systematic review. BMC Health Services Research. 2017;295.
Nuti L, Turkcan, A., Lawley, M. A., Zhang, L., Sands, L., & McComb, S. The impact of interventions on appointment and clinical outcomes for individuals with diabetes: a systematic review. BMC Health Services Research. 2015;15:355.
Stubbs ND, Sanders S, Jones DB, Geraci SA, Stephenson PL. Methods to Reduce Outpatient Non-attendance. The American Journal of the Medical Sciences. 2012;344(3):211-9.
Tan S, Mays N. Impact of initiatives to improve access to, and choice of, primary and urgent care in England: A systematic review. Health Policy. 2014;118(3):304-15.
Jimenez G, Matchar D, Koh GCH, Car J. Multicomponent interventions for enhancing primary care: a systematic review. British Journal of General Practice. 2021;71(702):e10-e21.
Jimenez G, Matchar D, Koh CHG, van der Kleij R, Chavannes NH, Car J. The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review. J Med Internet Res. 2021;23(1):e20195.
Thomas KA, Schroder AM, Rickwood DJ. A systematic review of current approaches to managing demand and waitlists for mental health services, Mental Health Review Journal. 2021;26(1).
Low LL, Ab Rahim FI, Johari MZ. et al. Assessing receptiveness to change among primary healthcare providers by adopting the consolidated framework for implementation research. 2019;497.
Soares LS, Junqueira MAB. A percepção sobre o acesso avançado em uma unidade unidade-escola de atenção básica à saúde. Revista Brasileira de Educação Médica. 2022;46(01).
Seckler E, Regauer V, Rotter T. et al. Barreiras e facilitadores para a implementação de vias de atenção multidisciplinar na atenção básica: uma revisão sistemática. BMC. 2020
Moreira DA,Tibães HBB, Batista RCR, Cardoso CML, Brito MJM. Manchester Triage System in Primary Health Care: Ambiguities And Challenges Related To Access. Texto & contexto enferm. 2017;26(02).
Pessoa C, Sousa L, Ribeiro A, Oliveira T, Silva JL, Alkmim MB, Marcolino M. Description of Factors Related to the Use of the Teleconsultation System of a Large Telehealth Service in Brazil – the Telehealth Network of Minas Gerais. JISfTeH. 2016;4:e4:1-4.
Theis LC, Marinho Mikosz D, Rosa SV, Tetu Moysés S, Proença de Moraes T. Percepção dos profissionais de saúde em relação à implantação do Modelo de Atenção às Condições Crônicas. Revista de Atenção à Saúde. 2021;19(68).
Rogers HL, Pablo Hernando S, Núñez-Fernández S, Sanchez A, Martos C, Moreno M, Grandes G. Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study. J Health Organ Manag. 2021;35(9):349-367.
Almeida PF, Gérvas J, Freire J-M, Giovanella L. Estratégias de integração entre atenção primária à saúde e atenção especializada: paralelos entre Brasil e Espanha. Saúde debate. 2013:98.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Sanni Silvino Parente, Maritsa Carla de Bortoli, Cintia de Freitas Oliveira, Bruna Carolina Araújo