L’accès adapté au sein du réseau de cliniques universitaires de l’Université de Montréal : une étude observationnelle
Objective: To describe and compare the accessibility of the Family Medicine Units (FMU) of the University of Montreal network regarding the implementation of the advanced access model, using the dimensions of the concept of patient-centred access.  Methods: A descriptive cross-sectional study was conducted using a quantitative approach. A survey aimed at identifying organizational characteristics through the dimensions of access to primary care was completed by the lead physician of each of the 18 FMUs of the University of Montreal. Descriptive comparisons then revealed differences between the FMUs that were labelled as using Advanced access and those that did not implement the model. Results: Of the 18 FMUs studied, 12 mentioned having implemented Adapted Access and differ in several points from the other six. First, they are more concentrated in secondary care settings, are younger, and seem to spread their services offer more widely. Despite being heterogeneous in terms of size, this group includes larger FMUs, suggesting proportional funding by ministerial authorities. Nurses are more numerous and use more diverse standing over prescriptions, but do not appear to have a larger scope of practice. Physicians are also more numerous, more present and offer more visits to the FMUs using advanced access. However, these clinics are less inclined to fully base their response to the client's needs on an open appointments formulation, often choosing a combination with walk-in services. Finally, the FMUs using the Advanced access method offer more and larger availability during out-of-hour periods. Conclusion: Although this study does not establish any form of causality, it raises questions regarding the potential role of these characteristics regarding the implementation of Advanced access by these FMUs. In keeping with the constant evolution of primary care services, our results call for a timely evaluation of the FMUs and a more concrete analysis of the factors influencing the implementation of the model in these environments.
Advanced access Appointments Models, organizational Family Practice Academic medical center Health services accessibility Waiting time