Abstract
BackgroundImproving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field.MethodsWe distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation.ResultsSeven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations were developed to enhance patients’ or populations’ abilities to access services (demand-side), and rarely did initiatives target both supply- and demand-side determinants of access.ConclusionsA wide range of innovations improving access to PHC were identified. The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention to close the equity gap for vulnerable populations in accessing PHC services that correspond to their needs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0351-7) contains supplementary material, which is available to authorized users.
Highlights
Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging
Over 2000 emails were sent to key PHC informants and 248 tweets were posted on Twitter, creating a social media presence aimed at building interest in the survey topic
We identified that interventions reported as being delivered outside the traditional clinical health service setting were limited, despite recognition that action must take place outside the health sector to address the wide range of social determinants of health which have an impact on health and access to PHC [5]
Summary
Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Striking differences in health still exist within and between populations, and inequities in access to PHC persist and tend to affect the most vulnerable1a people in our communities, those with the most complex healthcare needs [3,4,5]. [11, 12]) and translated into substantial health service reforms internationally Notwithstanding these efforts, there remains little evidence of equity of access to PHC at a population level. Inequitable access to healthcare translates into unmet healthcare needs, worse and inequitable health outcomes and increased healthcare costs [20,21,22]
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