Welch Vivian, Pottie Kevin, Gaudet Caroline, Thuku Micere, Mallard Ryan, Spenceley Shannon, Amjed Nida, Wadhwani Arpana, Ghogomu Elizabeth, Scott Cathie, Dahrouge Simone
Bruyère Research Institute, Methods Centre, 85 Primrose, Ottawa, ON, K1R 7G5, Canada.
Bruyère Research Institute, C.T. Lamont Primary Health Care Research Centre (CTLC), 85 Primrose, Ottawa, ON, K1R 7G5, Canada.
Arch Public Health. 2023 Jun 24;81(1):115. doi: 10.1186/s13690-023-01105-3.
There are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.
To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.
A realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening.
We included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the "reach" of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered.
Realist reviews can help guide the development of locally adapted primary health care interventions.
在西方国家广泛改革后，初级卫生保健（PHC）的公平可及性存在显著差距，尤其是对弱势群体而言。促进医疗服务可及性转变的创新模式（IMPACT）研究项目是加拿大和澳大利亚的合作项目，旨在改善弱势群体获得初级卫生保健的机会。该项目与加拿大和澳大利亚六个地区的利益相关者建立了联系，在这些地区可以确定与可及性相关的需求。将实施和测试最有前景的干预措施，以满足所确定的需求。进行这项实证性综述是为了了解社区联盟和外展（如移动或临时搭建）服务如何改善服务不足的弱势居民的可及性。
为开发和提供创新干预措施提供信息，以增加弱势群体获得初级卫生保健的机会。
与当地创新伙伴关系（LIP）研究团队和进行该综述的IMPACT研究成员合作进行了一项实证性综述。我们于2015年10月19日之前使用MEDLINE、EMBASE、PsycINFO和Cochrane图书馆进行了初步的全面系统检索，并于2020年8月8日进行了更新。如果研究侧重于使用社区联盟、外展服务或移动提供方式来改善初级卫生保健可及性的干预措施，则将其纳入。我们纳入了随机对照试验（RCT）和系统综述。由两名独立评审员对研究进行筛选，并使用可及性、有效性、采用率、实施情况和维持情况（RE-AIM）框架进行数据提取和框架分析，以获取主题。LIP研究团队也可以建议在筛选时未纳入的其他论文。
我们纳入了43条记录，包括31项随机对照试验、11项系统综述和LIP研究团队补充的1项病例对照研究。我们确定了促进弱势居民获得初级卫生保健的干预措施的三个主要主题，包括：1）根据具体情况调整材料和服务可减少初级卫生保健的障碍，2）在弱势群体聚集的地方提供服务可增加干预措施的“可及范围”，3）伙伴关系和合作可带来积极的健康结果。此外，应考虑实施设计和报告要素。
实证性综述有助于指导因地制宜的初级卫生保健干预措施的开发。
