What do you see?
- Which type of visit other than an office visit is most commonly used?
- Are there any differences between use of alternate appointment types between Primary Care Networks (PCNs)? What might account for these differences?
Whether you’re a patient, provider, or health system administrator, thinking about why these differences might exist can start conversations and lead to solutions for improved quality of healthcare.
*Data courtesy of Alberta Health Services and Alberta Health
Understanding this chart
In Alberta, as well as healthcare systems around the world, we are looking at different ways to meet patients’ needs for interacting with their doctor, other than through an office visit.
Alternate appointment types can improve access to care by patients in some situations. They can also remove barriers of time and distance that can make it difficult for patients to visit their family doctor on short notice for some issues. For example, in rural areas, patients may have to travel a long distance to see a family doctor. Using alternate ways of communicating with patients may give a family doctor more flexibility in how they meet their patients’ care needs.
Family doctors in Alberta can bill to a limited extent for four different types of appointments other than an office visit:
- Phone – can be useful for follow-up or short discussions that do not require an in-person examination.
- Email – can be useful for follow-up or short discussions that do not require an in-person examination. Can also be helpful to communicate with patients for things a patient wouldn’t usually make an appointment for.
- Home visits – usually reserved for patients who have specific needs.
Use of alternate appointment types is expected to increase over the next few years as technology becomes more accessible, confidence in privacy and security improves, and comfort of both patients and doctors in interacting this way increases.
Some things that might limit uptake of alternate appointment types are time and how doctors get paid. An alternate appointment type takes the same amount of time as an in-person appointment and the amount of time allowed for them must be balanced with all the other demands on a family doctor’s time. In the current fee-for-service system used to pay doctors in Alberta, they are paid less for phone and e-mail consultations than for in-person visits. This limits the number of these types of visits that doctors will book.
Considerations when reviewing the results
- This chart only includes the alternate appointment types that are billed by the family doctor. It does not include alternate visit types by the doctor that are not billed (for example, phone call or e-mail). It does not include alternate appointment types with another team member such as a nurse.
- Currently a family doctor may bill only for a total of seven phone, e-mail or videoconference visits each week, and only once for any given patient in a week.
- Billing for phone appointments became available in April 2015. Billing for e-mail communication became available in April 2016.
- E-mail appointments are currently limited by the types of office computer systems available that support secure e-mail communication between doctors and patients.
- Videoconference is very rarely used because the infrastructure to provide this service is not routinely available in the community. There are limitations to how an examination can be done at a distance.
The Health Quality Council of Alberta uses the Alberta Quality Matrix for Health as a way of organizing information and thinking around the complexity of the healthcare system. The information in this chart can be used as input to think and have conversations about primary healthcare in Alberta using the lens of the dimensions of quality shown on the right:
Dimensions of Quality