Association of Advanced Access With Primary Care Performance: A Systematic Review

Clinical Snapshot

Key Findings

• P Value: Statistical significance reported for 13/23 wait time studies, 7/13 continuity studies, 0/3 ED use studies, 3/8 satisfaction studies

• Effect Size: Not reported - narrative synthesis only

• Primary Outcome: Appointment wait time decreased in all 23 studies, with 13 showing statistical significance

• Nnt Or Sensitivity: Not calculated - insufficient data for meta-analysis

• Confidence Interval: Not provided

Clinical Application

Implementation requires organizational change management and staff training, but appears feasible across different healthcare system structures Highly relevant to Australian primary care given Medicare-funded GP services and emphasis on continuity through patient-centered medical homes. Aligns with RACGP Standards for General Practice regarding timely access and care coordination Primary care patients across diverse healthcare settings seeking timely access to care

Abstract

PURPOSE: Timely access to primary care remains a major challenge. Advanced access, an organizational model for appointment management, aims to improve accessibility by allowing patients to consult their health care professional in a timely manner. This systematic review evaluated its association with several key dimensions of primary care performance. METHODS: We conducted a comprehensive search in MEDLINE, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to May 10, 2025. Randomized intervention studies, nonrandomized intervention studies, and observational studies comparing advanced access with traditional scheduling systems among patients in primary care were eligible. Outcomes were the wait time to an appointment, continuity of care, emergency department (ED) use, and patient satisfaction. Two independent reviewers selected studies, extracted data, and assessed risk of bias. We performed a narrative synthesis, separately analyzing universal and non-universal health care systems. RESULTS: Among 7,595 unique records identified, 29 studies were included. Of these, 23 evaluated appointment wait time, 13 examined continuity of care, 3 assessed ED use, and 13 evaluated patient satisfaction. Appointment wait time decreased in all 23 studies assessing this outcome, with 13 reporting statistically significant reductions. Continuity of care improved in 11 of 13 studies, of which 7 reported statistically significant improvements. All 3 studies evaluating ED use reported reductions in ED visits, although none demonstrated statistical significance. Patient satisfaction improved in 8 studies, with 3 reporting statistically significant improvements. Overall, findings were consistent across universal and non-universal health care systems. CONCLUSIONS: Advanced access appears to improve appointment timeliness, continuity of care, and patient satisfaction, and may help reduce avoidable ED use across diverse health care systems.

References

1. 1.Adadja, J., Lafrance, S., Gnanvi, J., Bergeron, F., Boutin, A., Breton, M., Guertin, J. R., & Berthelot, S. (2026). Association of Advanced Access With Primary Care Performance: A Systematic Review. Annals of Family Medicine, 24(3). https://doi.org/10.1370/afm.250593