Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review

International Journal for Equity in Health

Systematic Review

Jean-Frederic Levesque¹  Vladimir Khanassov²  Pierre Pluye²  Jeannie L. Haggerty³  Grant Russell⁴  Sarah Descoteaux⁵  Jane Gunn⁶ 

[1] Centre for Primary Health Care and Equity, University of New South Wales, Bureau of Health Information, 67 Albert Avenue, Chatswood, 2067, Sydney, NSW, Australia;Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, H3S 1Z1, Montreal, QC, Canada;Department of Family Medicine, McGill University, St. Mary’s Hospital Research Centre, 3830 Lacombe Ave, H3T1M5, Montréal, QC, Canada;Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Rd, 3168, Notting Hill, VIC, Australia;St. Mary’s Hospital Research Centre, 3830 Lacombe Ave, H3T1M5, Montréal, QC, Canada;University of Melbourne, 200 Berkeley Street, 3053, Melbourne, VIC, Australia;

关键词: Delivery of Health Care;    Accessibility to Health Services;    Vulnerable populations;    Underserved populations;    Organizational Interventions;    Improve Access;    Canada;    Australia;   

DOI  :  10.1186/s12939-016-0459-9

 received in 2016-04-05, accepted in 2016-10-03,  发布年份 2016

来源: Springer

【 摘 要 】

Access to community-based primary health care (hereafter, ‘primary care’) is a priority in many countries. Health care systems have emphasized policies that help the community ‘get the right service in the right place at the right time’. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). Sources: Main bibliographic databases (Medline, Embase, CINAHL) and team members’ personal files. Study selection: One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the ‘Patient Centered Access to Healthcare’ conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of ‘dimension-outcome’ patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as ‘Formal integration of services’ suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and reduction of hospitalizations (four/four studies), emergency department admissions (six/six studies), and unmet healthcare needs (five/six studies). These 10 studies included seven non-randomized studies, one randomized controlled trial, one quantitative descriptive study, and one mixed methods study. Our results suggest the limited breadth of research in this area, and that it will be feasible to conduct a full systematic review of studies on the effectiveness of the formal integration of services to improve access to primary care services for vulnerable populations.

【 授权许可】

CC BY   
© The Author(s). 2016