Richard Lauralie, Furler John, Densley Konstancja, Haggerty Jeannie, Russell Grant, Levesque Jean-Frederic, Gunn Jane
Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC, 3004, Australia.
St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, Qc, H3T 1M5, Canada.
Int J Equity Health. 2016 Apr 12;15:64. doi: 10.1186/s12939-016-0351-7.
Improving 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.
We 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.
Seven 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.
A 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.
改善弱势群体获得初级医疗保健（PHC）的机会对于实现健康公平至关重要，但这仍然具有挑战性。有效干预措施的证据相当有限且零散。我们需要确定创新方法来改善弱势群体获得初级医疗保健的机会，并阐明卫生系统、组织或服务的哪些要素（获得医疗服务的供应方维度）以及患者或人群的能力（获得医疗服务的需求方维度）需要加强，以实现变革性变化。此处报告的工作是作为“促进医疗服务可及性转变的创新模式”（IMPACT）的一部分开展的，这是一个为期5年的加拿大 - 澳大利亚研究项目，旨在识别、实施和试验最佳实践干预措施，以改善弱势群体获得初级医疗保健的机会。我们进行了一次环境扫描，作为一种广泛的筛选方法，以确定该领域当前创新的广度。
我们通过电子邮件和社交媒体相结合的方式，向国际范围内的初级医疗保健研究人员、从业者、政策制定者和利益相关者群体分发了一份简短的在线调查问卷。受访者被邀请描述他们认为在帮助弱势群体获得初级医疗保健方面具有创新性的项目、服务、方法或护理模式。我们使用描述性统计来描述这些创新，并进行定性框架分析以进一步审查描述每个创新的文本。
在为期6周的时间里共记录了744份回复。描述了来自14个国家的240个独特的创新实例，其中大多数来自加拿大和澳大利亚。大多数干预措施针对多种人群，由政府资助，并在社区卫生、全科医疗或外展诊所环境中提供。干预措施主要集中在卫生部门，针对获得医疗服务的组织和/或系统层面的决定因素（供应方）。很少有创新是为了提高患者或人群获得服务的能力（需求方）而开发的，而且很少有举措同时针对获得医疗服务的供应方和需求方决定因素。
确定了一系列改善获得初级医疗保健机会的创新措施。该获得医疗服务框架有助于揭示供应方和需求方维度之间的差距，并确定哪些领域可能受益于进一步关注，以缩小弱势群体在获得符合其需求的初级医疗保健服务方面的公平差距。
