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July 16, 2003

Advanced-Access Scheduling in Primary Care—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(3):333-334. doi:10.1001/jama.290.3.333

In Reply: Dr Siegel highlights an area of some confusion and controversy in the primary care redesign movement. One view holds that improving access to primary care visits will allow people with chronic illness to see their primary care clinician more promptly and thereby improve care for those who are chronically ill. I disagree with this view. I strongly believe that chronic illness care, especially higher-risk people, requires planned chronic care visits and close follow-up. If advanced access is implemented poorly, it could serve as a barrier to planned visits and frequent follow-up as Siegel fears. If advanced access is seen as only a first step in redesigning primary care (another step being the development of individual or group chronic-care-only visits, ideally with trained nursing personnel), and if clinicians are not discouraged from making appointments in advance for people with chronic illness, then better chronic care and better access could both be achieved. Primary care redesign ideas are relatively easy to formulate; implementing these ideas in a clinically thoughtful manner is far more difficult.