How general practitioners perceive access needs of vulnerable patients and act to address these needs: a mixed-methods study in south-east Melbourne, Australia.

Abstract

Objective The aim of this study was to understand primary health care (PHC) access barriers for vulnerable people living in south-east Melbourne from the perspective of general practitioners (GPs) who work in the area and to outline strategies that GPs have used to address these barriers. Methods A convergent mixed-methods design was used. Quantitative surveys were conducted with practice managers and GPs, and semistructured qualitative interviews were undertaken with GPs. Data were analysed using a thematic framework approach. Results Each of the vulnerable groups frequently seen by GPs in south-east Melbourne is thought to encounter access barriers in one or more access domains. GPs reported: (1) improving transparency, outreach and information on available treatments to address limited health literacy; (2) using culturally sensitive and language-speaking staff to overcome cultural stereotypes; (3) making practice-level arrangements to overcome limited mobility and social isolation; (4) bulk billing and helping find affordable services to overcome financial hardship; and (5) building trusting relationships with vulnerable patients to improve their engagement with treatment. Conclusion GPs understand the nature of access barriers for local vulnerable groups and have the potential to improve equitable access to primary health care. GPs need support in the on-going application and further development of strategies to accommodate access needs of vulnerable patients. What is known about the topic? Access to primary health care (PHC) is integral to reducing gaps in health outcomes for vulnerable groups. Vulnerable groups often encounter challenges in accessing PHC, and GPs have the potential to improve PHC access. What does this paper add? GPs thought that the vulnerable patients they frequently treat encounter barriers pertaining to both patient access abilities and service accessibility. They reported addressing these barriers by improving transparency, outreach and information on available treatments; using culturally sensitive and multilingual staff; making practice-level arrangements to overcome limited mobility and social isolation; bulk billing and helping find affordable services; and building trusting relationships with vulnerable patients. What are the implications for practitioners? Understanding the nature of access barriers for local vulnerable groups and information on strategies used by GPs allows for the further development of PHC access strategies.