Access To Primary Health Care Services Research Articles

Primary health care challenges: insights from older people with multimorbidity in Malawi – a qualitative study

BackgroundThe global population is undergoing a significant surge in aging leading to increased susceptibility to various forms of progressive illnesses. This phenomenon significantly impacts both individual health and healthcare systems. Low and Middle Income Countries face particular challenges, as their Primary Health Care (PHC) settings often lack the necessary human and material resources to effectively address the escalating healthcare demands of the older people. This study set out to explore the experiences of older people living with progressive multimorbidity in accessing PHC services in Malawi.MethodsBetween July 2022 and January 2023, a total of sixty in-depth interviews were conducted with dyads of individuals aged ≥ 50 years and their caregivers, and twelve healthcare workers in three public hospitals across Malawi’s three administrative regions. The study employed a stratified selection of sites, ensuring representation from rural, peri-urban, and urban settings, allowing for a comprehensive comparison of diverse perspectives. Guided by the Andersen-Newman theoretical framework, the study assessed the barriers, facilitators, and need factors influencing PHC service access and utilization by the older people.ResultsThree themes, consistent across all sites emerged, encompassing barriers, facilitators, and need factors respectively. The themes include: (1) clinic environment: inconvenient clinic setup, reliable PHC services and research on diabetic foods; (2) geographical factors: available means of transportation, bad road conditions, lack of comprehensive PHC services at local health facility and need for community approaches; and (3) social and personal factors: encompassing use of alternative medicine, perceived health care benefit and support with startup capital for small-scale businesses.ConclusionThis research highlights the impact of various factors on older people’s access to and use of PHC services. A comprehensive understanding of the barriers, facilitators, and specific needs of older people is essential for developing tailored services that effectively address their unique challenges and preferences. The study underscores the necessity of community-based approaches to improve PHC access for this demographic. Engaging multiple stakeholders is important to tackle the diverse challenges, enhance PHC services at all levels, and facilitate access for older people living with progressive multimorbidity.

Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA

BackgroundIndigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements.MethodsWe systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10–24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety.ResultsA total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors – providers’ competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents.ConclusionThis review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.

Patient-reported primary health care experiences in Canada: The challenges faced by Nepalese immigrant men

BackgroundDespite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care. MethodsWe undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada. Data collection and analysisWe conducted six focus groups in total with 34 participants (each group comprising 5–7 participants) in their preferred language, Nepalese, or English. Demographic information was collected prior to each focus group. Transcriptions of the discussions were prepared, and thematic analysis was employed in the qualitative data set. ResultsParticipants reported experiencing barriers at two stages: before accessing PHC services and after accessing PHC services. The barriers before accessing PHC were long wait time for an appointment with physicians, limited knowledge of own health- and services-related issues, limited service availability hours, cultural differences in health practices, and transportation and work-related challenges. The barriers after accessing PHC were long wait time in the clinic to meet with the physicians at the time of appointment, communication challenges and misunderstandings, high healthcare costs associated with dental and vision care and prescribed medicines, and inappropriate behaviours and practices of doctors and service providers. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC. ConclusionsThis study identifies barriers to accessing PHC in Canada from a group of immigrant men's perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.

Factors Associated with Access to the Saudi Primary Healthcare in Light of Vision 2030

Objective: Primary healthcare is a comprehensive approach to ensuring universal access to essential healthcare services. The Ministry of Health in Saudi Arabia has developed health-related objectives to enhance the accessibility of healthcare services and refining its policies. However, certain obstacles may impede the delivery and accessibility of healthcare, particularly to primary healthcare centers. The current study explored the variables associated with the accessibility of primary healthcare services in the context of Saudi Vision 2030. In particular, the research focused on examining the organizational and doctor-patient communication factors that are linked to primary healthcare accessibility. Methodology: In this cross-sectional study, an electronic questionnaire is used to collect data from patients visiting the primary healthcare facilities located within the second health cluster in Riyadh, Saudi Arabia. Results: The findings indicate that the organizational factors that have the greatest influence on primary healthcare accessibility are the proximity of the primary healthcare centers, the rapid and convenient nature of the registration and payment procedures, the cleanliness, design, and clarity of the facility, and the availability of up-to-date technologies and equipment. As for the factors affecting access to primary healthcare in doctor-patient communication, the most notable factors include the provision of respectful treatment by the doctor toward patients, attentive listening to patients’ concerns and questions, and clear explanation of treatment plans and outcomes. Conclusion: The findings of this study demonstrated the effect of several factors on primary healthcare accessibility, which will benefit the policymakers in healthcare planning in Saudi Arabia to improve the quality and accessibility to primary healthcare centers.

34 Using Spatial Analysis to Identify Access to IFHP-registered Paediatric Providers in Ontario

Abstract Introduction/Background Compared to non-refugees, child refugees face a wide array of health disparities, including higher levels of nutritional deficiencies, infectious diseases, and mental illness secondary to experienced poverty, trauma, and migration. After migration, refugee families continue to face health inequities, necessitating access to health care. In Canada, the Interim Federal Health Program (IFHP) provides temporary health care benefits to refugees and refugee claimants who are ineligible for provincial or territorial health insurance. The program requires healthcare providers to register to be reimbursed for care provided. However, physicians are not required to register for IFHP, leading to fewer providers. Objectives This study aimed to map where IFHP-registered primary care physicians (PCPs) and paediatricians live and work in Ontario, relative to where IFHP-insured patients live, to identify geographic accessibility of primary healthcare services for paediatric refugee populations. Design/Methods We performed spatial analysis using ArcMap (version 10.8.2), a geographic information system (GIS). The practice location of PCPs and paediatricians registered for IFHP as of December 2021 were geocoded and the percent of IHFP provider per population for each Census Tract (CT) was calculated. Refugee populations eligible for IFHP in Ontario by CT, as identified by the 2016 Canadian Census, were calculated as percentages and per 10,000 population, and linked to geospatial data for comparison. Ratios of IFHP providers to refugees were calculated for each CT. Results At the time of data collection, there were 481,710 documented refugees living in Ontario, and 11,854 IFHP-registered paediatricians or PCPs. Toronto, Windsor, and Kitchener-Waterloo had the largest percentages of refugees per population (5.4%, 5.1%, and 4.6%, respectively), while Toronto, Hamilton, and London had the highest percentage of IFHP providers per population (0.13%, 0.11%, and 0.09%, respectively). Generally, CTs with the highest proportion of refugees had more IFHP-registered providers, and rural areas had the fewest number of both refugees and IFHP-registered providers. However, there were 941 CTs recognized across Ontario with identified refugee populations but no registered IFHP providers. The CTs with the highest ratio of IFHP providers to refugees were in Toronto and Ottawa (3.9, 2.0 in Toronto, and 2.1 in Ottawa, respectively). Conclusion While some regions with large refugee populations have registered IFHP PCP providers, there are regions that are relative IFHP provider-deserts for resident refugees. Identifying areas where geographic barriers are likely to exist in Ontario is necessary to improve accessibility of existing services and could help reduce healthcare inequities faced by the refugee population.

Prevalence and determinants of community members utilizing preventive services offered by family physicians in Riyadh, Saudi Arabia.

Early detection and prevention of diseases can reduce morbidity, mortality, and economic burden. There is need to assess the utilization of preventive services for common chronic diseases, cancers, and vaccinations. This study aimed to estimate the prevalence and sequence of utilization of preventive services for common chronic diseases, cancers, and vaccinations in addition to exploring community perspectives on these services. This study was a cross-sectional survey, which was conducted at primary healthcare centers in Prince Sultan Military Medical City covering Riyadh region from October 2022 to January 2023. The study used a self-administered questionnaire to collect data from attendees aged 18 years and older, focusing on the utilization of eight preventive services (blood glucose testing, blood pressure measurement, cholesterol testing, screening for breast cancer, screening for cervical cancer, screening for colorectal cancer, screening for prostate cancer, and flu and pneumococcal vaccines). Descriptive statistics of the study were reported in frequencies and percentages. Chi-square test was used to assess association between outcome variables. Participants were mostly married and had a higher educational degree. However, a considerable number is not accessing primary healthcare services regularly. The results showed that the rate of utilizing preventive services was as follows: blood pressure screening (91%), blood glucose testing (72%), cholesterol testing (65.8%), vaccination utilization (39.5%), breast cancer screening (8%), prostate cancer screening (4.6%), colon cancer screening (4.2%), and least utilized was cervical cancer screening with frequency of (3%). The results underscore the importance of increasing awareness and accessibility of primary healthcare services to promote better health outcomes in the region.

Time-varying spatial accessibility of primary healthcare services based on spatiotemporal variations in demand, supply, and traffic conditions: A case study of Seoul, South Korea

IntroductionAlthough demand, supply, and traffic conditions are interdependent, scholars have considered them separately when measuring accessibility of healthcare services. Additionally, the spatiotemporal variations in these three factors are given relatively less attention in healthcare accessibility research, thereby misleading the policy decisions of healthcare planners. This study aims to examine the spatiotemporal variability of accessibility to primary healthcare services and identify areas with a spatial discrepancy between time-varying and static accessibility models in Seoul, South Korea. MethodsUsing the generalized two-step floating catchment area method, we measure time-varying spatial accessibility with de facto population from hourly collected mobile-based data, available primary healthcare facilities, and actual traffic conditions in Seoul. Additionally, the bivariate Local Moran's I allowed for the identification of areas with discrepancies between the two accessibility models. ResultsThe results show that a geographical pattern of time-varying accessibility significantly differs with that of static accessibility. Time-varying accessibility is lower in commercial and business areas and higher in residential areas, compared with static accessibility, which is higher in central Seoul. The result of the bivariate Local Moran's I analysis highlights that ignoring time variations of the three factors will result in overestimation in commercial areas and underestimation in residential areas. Based on the discrepancy between the two models, we identified the overestimated and underestimated areas. ConclusionWe suggest areas to which healthcare policy needs to pay more attention by identifying areas with spatial discrepancies between time-varying accessibility and static accessibility. Considering the time variations will provide a more realistic impression of spatial accessibility to primary healthcare.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China.

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial accessibility and reduce primary healthcare service disparity in Beijing.

Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa

BackgroundThe proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice.MethodsWe conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities).ResultsThe majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice.ConclusionsIt is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

Accessibility of primary healthcare services at primary health centre level in northern and central zones of Odisha

Healthcare services revolve around a major objective for providing equal distribution of quality health. Mostly basic healthcare services comprise primary healthcare services that play a major role in decreasing mortality level and major disabilities among patients. The objectives of this research paper are to study the accessibility of the healthcare services delivered at the primary health centre (PHC) level and to further analyse the disparity in the usage of the primary healthcare services in the identified districts of Odisha. The statistical tools like descriptive and inferential statistics were used to analyse the collected data. Even after major growth in the healthcare infrastructure, there still has been a subsequent discrepancy in the usage of the services which has impacted the vulnerable masses. Sensitivity analysis was also performed on three major services comprising of maternal and child healthcare, laboratory services, and labour room for healthcare services decision making.

Accessibility of primary healthcare services at primary health centre level in northern and central zones of Odisha

Healthcare services revolve around a major objective for providing equal distribution of quality health. Mostly basic healthcare services comprise primary healthcare services that play a major role...

Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada.

ObjectiveThe study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada.DesignA qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied.SettingThe focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy.ParticipantThirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years.ResultThe focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study.ConclusionThe barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.

Factors Contributing to Patients' Preferences for Primary Health Care Institutions in China: A Qualitative Study.

Background: Primary health care (PHC) is a key component of the health care system in many countries. In China, however, PHC institutions are less preferred by patients, leading to the underuse of PHC services. Factors affecting patients' preferences for PHC institutions in China remain unreported in the current literature, which was first explored in this study.Method: A qualitative interview study was conducted in Nanjing, Jiangsu Province of China. A semi-structured interview guide was applied to ask patients' opinions regarding the PHC institutions in China. Qualitative data analysis was conducted using the thematic framework approach.Results: A total of 142 participants were interviewed. Three themes and their sub-themes emerged from the study: (1) attributes of PHC services, including accessibility of primary healthcare services, consultation time, drug cost, continuity of care, referral system, opening hours, waiting time, and drug accessibility; (2) attributes of PHC doctors' workforce, including doctors' attitude, competence, and accessibility; (3) attributes of PHC facility infrastructure, including basic facilities, diagnostic facilities and department settings. It was identified that some attributes of PHC services had positive impacts on participants' preferences for PHC institutions, while the same attributes of PHC doctors were the opposite.Conclusion: There are three major factors that contribute to patients' preferences for PHC institutions in China. Policy interventions to improve doctors' workforce and facility infrastructure of PHC institutions are needed to promote patients' preferences for PHC.

Community Health Workers Engagement in Prevention of Mother-to-Child Transmission of HIV (PMTCT): A Cross-Sectional Study from Selected Fishing Communities in Tanzania

The prevalence of HIV infection is reported to be higher in fishing communities of Lake Victoria compared to non fishing neighboring communities. Besides, access to HIV/AIDS related services has been reported to be either inadequate or unavailable to some of these fishing communities particularly for those residing in islands. This study explored the engagement of Community Health Workers (CHWs) in provision of PMTCT services among the fishing communities of Sengerema and Musoma District Councils (DCs) in the Lake Zone of Tanzania. This was a cross sectional study using qualitative approach. Intrinsic and extrinsic motives were found to influence community members to be engaged as CHWs. The majority of CHWs were involved in Antenatal Care (ANC) and Reproductive and Child Health (RCH) as well as in health promotion activities as a strategy to cope with the shortage of trained health staff. CHWs were found to assist in HIV/AIDS Counseling and Treatment Center (CTC), generally, CHWs were not directly engaged in provision of PMTCT services. On the other hand, the National Health Policy does not clearly set roles of the CHWs and their incentives. Nevertheless, there are potentials of people willingness to volunteer in community health works that need to be better leveraged. Deploying CHWs is critical to enabling accessible primary health care services including HIV/AIDS particularly PMTCT services in remote areas such as fishing communities where human resource for health is reported to be inadequate.

Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK.

Anecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population's views and experiences of such services. To explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services. A qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England. Semi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis. A total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH). Participants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.

The feasibility and potential use of case-tracked client journeys in primary healthcare: a pilot study

ObjectivesTo determine the feasibility of case-tracking methods in documenting client journeys at primary healthcare (PHC) services in order to investigate the comprehensiveness of service responses and the experiences of clients.DesignProspective...

‘When I don't have money to buy the drugs, I just manage.’—Exploring the lived experience of persons with physical disabilities in accessing primary health care services in rural Ghana

The United Nations Convention on the Rights of Persons with Disabilities recognizes the rights of persons with disabilities' access to health care, including primary health care (PHC). However, growing evidence indicates that individuals in rural areas generally experience health access issues, and these issues are even worse for those with physical disabilities. Knowledge about such experiences is critical for policy design and clinical practice to promote PHC access for persons with physical disabilities in rural areas. This study seeks to explore the experiences of persons with physical disabilities in accessing PHC services in the predominantly rural Upper West Region of Ghana. We conducted semi-structured interviews with 18 participants living with physical disabilities, and used both deductive and inductive approaches to analyze the data. Participants shared experiences at three broad levels: the health system level, individual level and health-seeking behaviors level. Within the health system level, we identified three main categories: service availability (presence of health facilities, deficient drug supply and lack of providers), acceptability (positive and negative attitudes of providers and perceived high and low quality of care) and accommodation (inaccessible health facilities and equipment). The experiences at the individual level included financial constraints and mobility to health care facilities. Health-seeking behaviors related to how the individual reacted and responded to access barriers, which included searching for traditional healing, resorting to self-medication, making sacrifices in managing their conditions and relying on spiritual means. The information provided in this study is potentially important to policy makers and PHC providers as it presents evidence on the barriers and facilitators to PHC access in a rural setting. In particular, understanding individuals' experiences and how they develop health-seeking behaviors to overcome access barriers will be critical for policy design and client-centered service delivery in rural Ghana and potentially other low- and middle-income countries.

Transition to Retirement and Use of Private Health Care.

Associations between retirement and changes in health care use have not been shown in a longitudinal setting. In the Finnish universal health care system, transition into retirement from employment entails loss of access to occupational health care that provides easily accessible primary health care services, which may cause changes in utilization of other health care sectors. The aim of this study was to find out whether transition into old-age retirement is associated with change in utilization of private health care. The panel data consist of a 30% random sample of the Finnish population aged 62-75 in 2006-2011. Register data on National Health Insurance compensation were linked to socio-demographic covariates. Fixed-effects logistic and Poisson regression models were used. Adjusted for changes in covariates, retirement from employment was associated especially with private general practitioner visits but also with specialist visits among both women and men. Interaction analyses showed that retirement was associated with an increase in private care use only among those with higher-than-median income. The results may indicate preferences for quick access to care, mistrust toward the universal system, and problems of the public system in delivering needed services.

Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations.

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.

The quality of medical services in primary healthcare centres in selected communes of the Lubelskie Voivodeship, as assessed by patients – preliminary reports

Abstract Introduction. Family medicine has a growing responsibility for the health of an individual, and therefore of society as a whole. Establishing an efficient primary healthcare system requires devising an appropriate management strategy. Surveying the quality assessment of medical services is an important element that influences the future shape of the development and management strategy in communes due to the dynamically changing demographic and economic trends, which are leaving their mark on the functioning of local communities. Aim. Evaluation of quality of medical services in primary healthcare centres in communes of Lubelskie Voivodeship. Material and methods. The anonymous survey was conducted among 60 patients benefitting from the medical services provided in healthcare centres in Niemce (Niemce Commune, Lublin District). An original questionnaire in the form of a poll was used to assess the quality of services provided in primary healthcare centres. Results. The results of surveys carried out among the patients of medical centres providing services in the field of primary healthcare (PHC) demonstrated the high level of satisfaction with the received services among the respondents. However, the accessibility of primary healthcare services outside the business hours of PHC centres and the functioning of prevention and health-education programmes need improvement. Conclusions. Based on the survey results we can conclude that the quality assessment of medical services provided by PHC centres, carried out through the ongoing monitoring of patients’ satisfaction, should be the most important indicator of changes in the management of primary healthcare.