In Reply: Dr Shuster's skepticism about advanced
access is easy to understand and is a familiar first reaction to the apparently
implausible aim of offering patients the care they want exactly when they
want it. His critique, however, misrepresents of the basic approach.
Advanced access has the fundamental goal of trying to balance supply
and demand. As Shuster notes, demand and supply are quite variable, but much
of that variation is predictable. We usually find that there is far more supply
than demand in most health care settings; it is only the faulty scheduling
systems that create an illusion that supply is inadequate. Practices that
fail to use prediction feel continually surprised and stressed. Proper scheduling
systems, balancing supply and demand, bring delays to a minimum, allowing
patients many more options for scheduling exactly the appointment that meets
their needs, an option they do not have when schedules are filled far out
into the future. We believe, perhaps disagreeing with Shuster, that the right
time for a patient, in the final analysis, should be the patient's choice.
Murray M, Berwick DM. Advanced-Access Scheduling in Primary Care—Reply. JAMA. 2003;290(3):333. doi:10.1001/jama.290.3.333
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