Kizito James, Kayendeke Miriam, Nabirye Christine, Staedke Sarah G, Chandler Clare I R
Malar J. 2012 Feb 23;11:55. doi: 10.1186/1475-2875-11-55.
Increasing access to health care services is considered central to improving the health of populations. Existing reviews to understand factors affecting access to health care have focused on attributes of patients and their communities that act as 'barriers' to access, such as education level, financial and cultural factors. This review addresses the need to learn about provider characteristics that encourage patients to attend their health services.
This literature review aims to describe research that has identified characteristics that clients are looking for in the providers they approach for their health care needs, specifically for malaria in Africa. Keywords of 'malaria' and 'treatment seek*' or 'health seek*' and 'Africa' were searched for in the following databases: Web of Science, IBSS and Medline. Reviews of each paper were undertaken by two members of the team. Factors attracting patients according to each paper were listed and the strength of evidence was assessed by evaluating the methods used and the richness of descriptions of findings.
A total of 97 papers fulfilled the inclusion criteria and were included in the review. The review of these papers identified several characteristics that were reported to attract patients to providers of all types, including lower cost of services, close proximity to patients, positive manner of providers, medicines that patients believe will cure them, and timeliness of services. Additional categories of factors were noted to attract patients to either higher or lower-level providers. The strength of evidence reviewed varied, with limitations observed in the use of methods utilizing pre-defined questions and the uncritical use of concepts such as 'quality', 'costs' and 'access'. Although most papers (90%) were published since the year 2000, most categories of attributes had been described in earlier papers.
This paper argues that improving access to services requires attention to factors that will attract patients, and recommends that public services are improved in the specific aspects identified in this review. It also argues that research into access should expand its lens to consider provider characteristics more broadly, especially using methods that enable open responses. Access must be reconceptualized beyond the notion of barriers to consider attributes of attraction if patients are to receive quality care quickly.
增加医疗服务的可及性被认为是改善人群健康的核心。现有的旨在了解影响医疗服务可及性因素的综述主要关注患者及其社区中作为获取服务“障碍”的属性，如教育水平、经济和文化因素。本综述旨在探讨了解鼓励患者就医的医疗服务提供者特征的必要性。
本文献综述旨在描述已确定患者在寻求医疗服务（特别是非洲疟疾治疗服务）时对医疗服务提供者所期望特征的研究。在以下数据库中搜索了“疟疾”和“治疗寻求*”或“健康寻求*”以及“非洲”等关键词：科学网、国际社会科学文摘数据库和医学期刊数据库。团队的两名成员对每篇论文进行了评审。列出每篇论文中吸引患者的因素，并通过评估所使用的方法和研究结果描述的丰富程度来评估证据的强度。
共有97篇论文符合纳入标准并被纳入综述。对这些论文的评审确定了几个据报道能吸引患者前往各类医疗服务提供者的特征，包括服务成本较低、距离患者较近、医疗服务提供者态度积极、患者认为能治愈他们的药物以及服务的及时性。还注意到其他类别的因素会吸引患者前往不同层级的医疗服务提供者。所评审证据的强度各不相同，在使用预定义问题的方法以及对“质量”“成本”和“可及性”等概念的不加批判使用方面存在局限性。尽管大多数论文（90%）自2000年以来发表，但大多数属性类别在早期论文中已有描述。
本文认为，改善服务可及性需要关注吸引患者的因素，并建议在本综述确定的具体方面改善公共服务。本文还认为，关于可及性的研究应拓宽视角，更广泛地考虑医疗服务提供者的特征，特别是采用能促使开放式回答的方法。如果患者要快速获得高质量的医疗服务，就必须超越障碍的概念，重新认识可及性，将吸引因素纳入考量。
