• Mylaine Breton, Lara Maillet, Arnaud Duhoux, Sabina Abou Malham, Isabelle Gaboury, Luiza Maria Manceau, Catherine Hudon, Isabel Rodrigues, Jeannie Haggerty, Nassera Touati, Marie-Claude Beaulieu, Christine Loignon, Marie-Thérèse Lussier, Isabelle Vedel, Jalila Jbilou, and France Légaré.
• Faculty of Medicine and Health Sciences, Canada Research Chair - Clinical Governance in Primary Health Care, Université de Sherbrooke - Campus Longueuil, 150 Place Charles-Le Moyne, Office 200, Longueuil, QC, J4K 0A8, Canada. mylaine.breton@usherbrooke.ca.
• Bmc Fam Pract. 2020 Feb 21; 21 (1): 41.

BackgroundTimely access in primary health care is one of the key issues facing health systems. Among many interventions developed around the world, advanced access is the most highly recommended intervention designed specifically to improve timely access in primary care settings. Based on greater accessibility linked with patients' relational continuity and informational continuity with a primary care professional or team, this organizational model aims to ensure that patients obtain access to healthcare services at a time and date convenient for them when needed regardless of urgency of demand. Its implementation requires a major organizational change based on reorganizing the practices of all the administrative staff and health professionals. In recent years, advanced access has largely been implemented in primary care organizations. However, despite its wide dissemination, we observe considerable variation in the implementation of the five guiding principles of this model across organizations, as well as among professionals working within the same organization. The main objective of this study is to assess the variation in the implementation of the five guiding principles of advanced access in teaching primary healthcare clinics across Quebec and to better understand the influence of the contextual factors on this variation and on outcomes.MethodsThis study will be based on an explanatory sequential design that includes 1) a quantitative survey conducted in 47 teaching primary healthcare clinics, and 2) a multiple case study using mixed data, contrasted cases (n = 4), representing various implementation profiles and geographical contexts. For each case, semi-structured interviews and focus group will be conducted with professionals and patients. Impact analyses will also be conducted in the four selected clinics using data retrieved from the electronic medical records.DiscussionThis study is important in social and political context marked by accessibility issues to primary care services. This research is highly relevant in a context of massive media coverage on timely access to primary healthcare and a large-scale implementation of advanced access across Quebec. This study will likely generate useful lessons and support evidence-based practices to refine and adapt the advanced access model to ensure successful implementation in various clinical contexts facing different challenges.

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