Association of Advanced Access With Primary Care Performance: A Systematic Review
Advanced access scheduling generally shortened appointment waits and improved continuity in primary care.
*Systematic review of nonrandomized studies; Level 2a (OCEBM).
Citation
Adadja J, Lafrance S, Gnanvi J, et al. Association of Advanced Access With Primary Care Performance: A Systematic Review. Ann Fam Med. 2026;24:239-251. doi:10.1370/afm.250593
Background
Timely primary care access is worsening in many high-income countries and may increase avoidable emergency department use. Advanced access keeps more appointments open for same-day or near-term needs.
Patients
Patients receiving primary care in 29 studies from the United States, United Kingdom, and Canada. Reviews, editorials, conference abstracts, conceptual papers, and non-primary-care studies were excluded.
Intervention
Advanced access appointment scheduling.
Control
Traditional appointment scheduling.
Outcome
Appointment wait time, continuity of care, emergency department use, and patient satisfaction.
Follow-up Period
3 to 48 months; 10 studies followed patients for less than 12 months.
Results
| Outcome | Studies reporting improvement | Studies with statistically significant improvement |
|---|---|---|
| Appointment wait time | 23 of 23 | 13 of 23 |
| Continuity of care | 11 of 13 | 7 of 13 |
| Patient satisfaction | 8 of 13 | 3 of 13 |
| Emergency department use | 3 of 3 | NS |
The authors used narrative synthesis because study designs, outcome definitions, and reporting differed too much for pooled analysis. Results were broadly similar in universal and non-universal health care systems. Traditional scheduling was the usual existing alternative.
Limitations
Most studies were uncontrolled before-and-after designs with serious risk of bias, limiting causal conclusions. Outcomes were measured inconsistently, many studies were short, and evidence came only from high-income countries. No pooled effect size was calculated.
Funding
Not reported; authors declared no conflicts.
Clinical Application
Consider advanced access to reduce waits and improve continuity, but implement with monitoring because evidence is suggestive, not definitive.
Discussion
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In this systematic review of mostly uncontrolled before-and-after studies, advanced access reduced appointment wait time in all 23 studies (13 statistically significant), but cannot prove causality. Given serious risk of bias, should health systems adopt it, and how applicable are the findings to your clinic? This systematic review included mostly uncontrolled before-and-after studies comparing advanced access with traditional scheduling. Which limitation most affects the interpretation that advanced access caused the observed reductions in appointment wait time?