Extended Office Hours and Treatment Compliance
Extended office hours can improve treatment compliance by increasing access to care, particularly for working patients and those with inflexible schedules, though the benefit depends heavily on implementation strategy and patient population characteristics. 1
Primary Mechanisms of Benefit
Improved access translates to better compliance through several pathways that directly address barriers to care:
Reduced appointment barriers: Extended hours eliminate the need for patients to miss work, arrange childcare, or navigate rigid scheduling constraints that often lead to missed appointments and treatment discontinuation 2, 1
Capture of at-risk populations: Evening and weekend appointments specifically benefit working-class patients, single parents, and those in inflexible employment—populations with historically lower compliance rates 3
Prevention of care abandonment: When patients cannot access timely appointments during standard hours, they either delay necessary care or default to emergency departments, both of which disrupt treatment continuity 3, 1
Evidence-Based Implementation Strategies
The effectiveness of extended hours depends on combining access expansion with active compliance interventions:
Scheduling Optimization
Reserve same-day slots within extended hours for urgent follow-ups and patients at high risk of non-compliance, preventing treatment gaps 1
Implement automated reminders (mail or telephone) for extended-hour appointments, which reduce broken appointments with odds ratios of 2.2 and 2.9 respectively 4
Use telehealth for appropriate follow-ups during extended hours to maximize accessibility while reducing the burden on in-person capacity 1, 2
Patient Engagement Tactics
Provide orientation statements explaining the purpose and availability of extended hours (OR 2.9 for improved compliance) 4
Contract with patients by scheduling follow-up appointments before they leave, particularly during extended-hour visits, to ensure continuity (OR 1.9 for compliance improvement) 4, 1
Offer closely-spaced follow-up appointments during extended hours for patients with poor compliance history, as frequent contact improves adherence 2
Population-Specific Considerations
Extended hours disproportionately benefit specific patient groups who face the greatest compliance barriers:
Working poor and socioeconomically disadvantaged: Nearly 40% of extended-hour appointments are used by patients from the poorest quintile, who typically have the least flexible work schedules 3
Parents of young children: Women and families with children under 5 dominate extended-hour utilization, as standard hours conflict with childcare and work obligations 3
Patients with chronic conditions requiring frequent monitoring: Extended hours allow these patients to maintain treatment schedules without employment disruption 2
Critical Implementation Pitfalls
Avoid these common mistakes that undermine the compliance benefits of extended hours:
Failing to staff extended hours adequately: Overloading clinicians during extended shifts increases burnout and reduces care quality, ultimately harming compliance 2, 1
Not integrating extended hours with reminder systems: Access alone is insufficient—patients still need prompts and orientation to utilize extended appointments effectively 4
Assuming all patients benefit equally: Extended hours primarily help those with inflexible daytime schedules; patients who can attend standard hours may not show improved compliance 3
Neglecting to track utilization patterns: Regular monitoring of who uses extended hours and their compliance outcomes is essential to justify the resource investment 1
Complementary Strategies
Extended hours work best when combined with other compliance-enhancing interventions:
Telephone consultations for administrative needs (prescription renewals, minor follow-ups) during extended hours free up in-person slots for patients requiring physical examination 1
Patient portals for secure messaging reduce unnecessary appointments while maintaining treatment continuity 1
Physician-initiated prompts during extended-hour visits about upcoming appointments improve compliance (OR 1.6) 4
Cost-Benefit Reality
The financial viability of extended hours depends on capturing revenue that would otherwise be lost:
Extended hours can capture visits that would otherwise go to emergency departments or urgent care centers, improving both continuity and practice revenue 2, 3
However, 93% of patients using extended hours rate them as "extremely likely" or "likely" to recommend, suggesting high satisfaction that may improve long-term patient retention 3
Practices must balance the costs of staffing extended hours against reduced no-show rates and improved chronic disease management outcomes 1