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Lau JYC, Hung C, Lee S. A review of HIV pre-exposure prophylaxis (PrEP) programmes by delivery models in the Asia-Pacific through the healthcare accessibility framework. J Int AIDS Soc 2020; 23:e25531. [PMID: 32603517 PMCID: PMC7326464 DOI: 10.1002/jia2.25531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. The best delivery models and strategies for broadening access of the vulnerable communities are not fully known. This review identified PrEP programmes reported in the Asia-Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework. METHODS We performed a literature search on PubMed and Ovid MEDLINE using relevant search terms, manual searched grey literature by visiting relevant websites, examined reference lists and contacted authors for clarification of included PrEP programmes reported through July 2019. A structured table was used for data extraction and summarizing findings in accordance with the five constructs of approachability, acceptability, availability, affordability and appropriateness grounded in the conceptual framework of Healthcare Accessibility. RESULTS AND DISCUSSION This literature search yielded a total of 1308 publications; 119 full texts and abstracts were screened, and 24 publications were included in the review. We identified 11 programmes implemented in seven cities/countries in the Asia-Pacific. A typology of four PrEP delivery models was delineated: (a) fee-based public service model; (b) fee-based community setting model; (c) free public service model; and (d) free community setting model. Overall, the free community setting model was most commonly adopted in the Asia-Pacific, with the strength to boost the capacity of facility and human resources, which enhanced "approachability", "availability" and "acceptability." The free public service model was characterized by components designed in improving "approachability," "availability" and "appropriateness," with attention on equity in accessing PrEP. Among free-based models, long-term affordability both to the government and PrEP users would need to be maximized to increase accessibility. Alongside the need for raising awareness, supportive environments and ensuring timely access were means for enabling the development of a sustainable PrEP service. CONCLUSION PrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia-Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed.
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Affiliation(s)
- Janice YC Lau
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Chi‐Tim Hung
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Shui‐Shan Lee
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
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Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
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Lazar M, Thomas S, Davenport L. Seeking Care at Free Episodic Health Care Clinics in Appalachia. JOURNAL OF APPALACHIAN HEALTH 2020; 2:67-79. [PMID: 35769864 PMCID: PMC9138721 DOI: 10.13023/jah.0202.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background People who live in rural Appalachia experience a wide variety of problems when seeking access to health care. Health care disparities continue to be one of the most complex and prevalent problems, and many barriers exist for impoverished men and women such as a lack of education, complications with health insurance, and personal distrust of healthcare providers. Purpose A critical gap in the literature is the unheard voice of persons in rural underserved areas. The purpose of this study was to explore the perspectives of persons in rural Appalachia who seek healthcare services at free episodic health care clinics, a common alternative source of care. Methods In Fall 2017, a qualitative approach was used to discover the perceptions of 12 men and women in rural Appalachia who were seeking medical care at a Remote Area Medical Clinic. A transdisciplinary research group provided insight and assistance with thematic analysis in Spring 2018–Spring 2019. Results Five overall themes emerged capturing the essence of how rural Appalachians view the experience of seeking healthcare, which include difficulties with insurance/finances, inconsistency in care, isolation in rural areas, seeking solutions, and need to feel valued. Implications A rich description of participant experiences portrays real-life complexities for Appalachian men and women who seek healthcare. Understanding the perceptions of persons who seek healthcare and the essence of their experiences is the first step in determining future sustainable solutions for social justice.
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Qureshi S, Xiong J(J. Equitable Healthcare Provision: Uncovering the Impact of the Mobility Effect on Human Development. INFORMATION SYSTEMS MANAGEMENT 2020. [DOI: 10.1080/10580530.2020.1732531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sajda Qureshi
- Department of Information Systems and Quantitative Analysis, College of Information Science & Technology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Jason (Jie) Xiong
- Department of Computer Information Systems, Walker College of Business, Appalachian State University, Boone, North Carolina, USA
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Houghton N, Bascolo E, Del Riego A. Socioeconomic inequalities in access barriers to seeking health services in four Latin American countries. Rev Panam Salud Publica 2020; 44:e11. [PMID: 32165889 PMCID: PMC7055457 DOI: 10.26633/rpsp.2020.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/04/2019] [Indexed: 01/23/2023] Open
Abstract
Objective. To present summary measures of socioeconomic inequalities in access barriers to health services in Colombia, El Salvador, Paraguay, and Peru. Methods. This cross-sectional study used data from nationally - representative household surveys in Colombia, El Salvador, Peru, and Paraguay to analyze income-related inequalities in barriers to seeking health services. Households that reported having a health problem (disease/accident) and not seeking professional health care were considered to be facing access barriers. The measures of inequality were the slope index of inequality and relative index of inequality. Results. Inequality trends were mixed across the four countries. All showed improvement, but large inequality gaps persisted between the highest and lowest income quintiles, despite health care reforms. Relative inequality gaps were highest in Colombia (60%), followed by Paraguay (30%), Peru (20%), and El Salvador (20%). Conclusions. The effect of national policy initiatives on equity to accessing health services should be the object of future analysis. There is also a need for research on national and regional monitoring of access barriers and explanatory factors for why people do not seek care, even when having a health problem.
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Affiliation(s)
- Natalia Houghton
- Pan American Health Organization World Health Organization WashingtonDC United States of America Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | - Ernesto Bascolo
- Pan American Health Organization World Health Organization WashingtonDC United States of America Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | - Amalia Del Riego
- Pan American Health Organization World Health Organization WashingtonDC United States of America Pan American Health Organization/World Health Organization, Washington, DC, United States of America
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Ruas BM, Castilho LS, Carneiro NCR, Cardoso NMDM, Reis AB, Silva MESE, Borges-Oliveira AC. Integrality of care for hemodialysis patient in Brazil: an analysis of access to dental care. CIENCIA & SAUDE COLETIVA 2020; 25:533-540. [PMID: 32022193 DOI: 10.1590/1413-81232020252.06362018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 06/18/2018] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to analyze factors associated with access of dental care services by Brazilian hemodialysis patients. A cross-sectional study was carried out with 467 hemodialysis patients aging from 19 to 90 years in two renal therapy centers located in the cities of Contagem and Belo Horizonte, Southeastern Brazil. Data were collected through an oral clinical examination of the patients and the application of a structured questionnaire. The dependent variable was the access to dental care, measured by the question "Have you consulted with a dentist in last six months?". The mean age of participants was 49.9 years. The average number of teeth present in the mouth was 19.3. An average of 1.5 teeth with dental caries cavities lesion was diagnosed among hemodialysis patients. One-third of the sample had gone to the dentist in the last six months (27.8%). The access to dental care was associated with formal education (OR = 1.5 [1.1-2.4]), professional advising to consult with a dentist (OR = 2.1 [1.2-3.8]) and prevalence of dental caries (OR = 2.1 [1.3-3.2]). Hemodialysis patients with eight or more years of formal education, who received professional advising to consult with a dentist and without dental caries cavities had higher chances obtaining access to dental care.
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Affiliation(s)
- Bruna Mara Ruas
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901, Belo Horizonte, MG, Brasil.
| | - Lia Silva Castilho
- DepartamenAto de Odontologia Restauradora, Faculdade de Odontologia, UFMG. Belo Horizonte, MG, Brasil
| | | | | | - Augusto Barbosa Reis
- Departamento de Nefrologia e Urologia, Faculdade de Odontologia, UFMG. Belo Horizonte, MG, Brasil
| | - Maria Elisa Sousa E Silva
- DepartamenAto de Odontologia Restauradora, Faculdade de Odontologia, UFMG. Belo Horizonte, MG, Brasil
| | - Ana Cristina Borges-Oliveira
- Departamento de Odontologia Social e Preventiva, Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG). Av. Presidente Antônio Carlos 6627, Pampulha. 31270-901, Belo Horizonte, MG, Brasil.
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Chávez GM, Almeida NAD, Nitschke RG, Viegas SMDF. THEORIZING DEMAND BY FAMILY HEALTH STRATEGY PROFESSIONALS AND USERS: SPONTANEOUS, SCHEDULED, SUPPRESSED. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2018-0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to understand spontaneous, scheduled and suppressed demands in the face of health needs and accessibility, from the perspective of Family Health Strategy professionals and users. Method: a qualitative study using Grounded Theory and Symbolic Interactionism, with 34 participants, 16 of whom are health professionals and 18 are users. The sources of evidence were open, intensive and individual interviews and memos. Data collection occurred between October/2016 to May/2017. Data analysis took place in interdependent steps: open, axial, selective coding, for the process. Results: thirty-two in vivo codes were indicated that represent the statement and meanings of the research participants regarding demand at Family Health Strategy, compiled in three theoretical codes that originated the central category “The Theory of Demand at Family Health Strategy: spontaneous, scheduled or suppressed?”. Spontaneous demand turns to complaints and illness, in daily appointments without previous scheduling, with restricted hours and as a means of accessing the health service. Scheduled demand is established in scheduling medical appointments for specific groups. Suppressed demand, more and more frequent in the daily routine of health services, is associated with the lack of access and resolution. Conclusion: health demands are configured in a space of lack of access and accessibility, denoting the main problem experienced by FHS users and professionals.
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Bálint C. The Capacities of Primary Health Care in Hungary: A Problem Statement. Eur J Investig Health Psychol Educ 2019; 10:327-345. [PMID: 34542488 PMCID: PMC8314245 DOI: 10.3390/ejihpe10010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
In the establishment, development, and provision of equal access to the health care system, the operation of adequate primary health care is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary health care, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary health care system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary health care—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary Health Care Department of the National Health Care Services Centre. In Hungary, the fundamentals of primary health care are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to health care, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.
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Affiliation(s)
- Csaba Bálint
- Institute of Regional Economics and Rural Development, Szent István University, H-2100 Gödöllő, Hungary
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Stokes T, Tumilty E, Latu ATF, Doolan-Noble F, Baxter J, McAuley K, Hannah D, Donlevy S, Dummer J. Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients. BMJ Open 2019; 9:e033524. [PMID: 31767598 PMCID: PMC6886961 DOI: 10.1136/bmjopen-2019-033524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Māori, which places a large burden on the New Zealand (NZ) health system. We undertook a qualitative study as part of a mixed-methods implementation research project which aimed to determine the barriers and enablers to the provision of accessible high-quality COPD care. SETTING Southern Health Region of NZ (Otago and Southland). PARTICIPANTS Thirteen health professional stakeholders and 23 patients with severe COPD (including one Māori and one Pasifika participant). METHODS Semistructured interviews were undertaken. A thematic analysis using the Levesque conceptual framework for access to healthcare was conducted. RESULTS Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD and the copayment charge for seeing a general practitioner) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning (ACP). Māori stakeholders highlighted the importance of communication and relationships and the role of whānau (extended family) for support. Patients' accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to comorbidities) and direct (medication and copayment charges) and indirect (transport) costs. CONCLUSIONS People with severe COPD experience multilevel barriers to accessing healthcare in the NZ health system along the pathway of care from diagnosis to ACP. These need to be addressed by local health services if this group of patients are to receive high-quality care.
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Affiliation(s)
- Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Tumilty
- Institute for Translational Sciences, University of Texas Medical Branch School of Health Professions, Galveston, Texas, USA
| | | | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jo Baxter
- Kōhatu, Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Kathryn McAuley
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Debbie Hannah
- Southern District Health Board, Otago and Southland, Dunedin, New Zealand
| | - Simon Donlevy
- Southern District Health Board, Otago and Southland, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Abstract
Summary
Saliva as a microfluidic system offers numerous advantages for both general and oral health diagnostic and therapeutic procedures since its assembly is quick, stress-free, inexpensive and non-invasive. Moreover, saliva is frequently referred to as a mirror of the body due to the fact that it can reflect the physiological and pathological state of the body. More than a decade ago the term “Salivaomics” has been introduced with the aim of emphasizing the development of research, knowledge and applications of five salivary constituents: proteome, transcriptome, micro-RNA, metabolome, and microbiome. Contemporary oral health care delivery in pediatric and special care dentistry is focused toward the development of new diagnostic and therapeutical procedures that are essentially noninvasive due to common issue of intolerability to invasive procedures among these patients, with the possibility of increasing participation rates. Besides the criteria of being easily and non-invasive collected, there are additional standards that should be met before routine application in everyday clinical practice; the existence of specific biomarkers for a disease, and ability of having its biomarkers detected using present-day equipment. For example, there are recent suggestions that a salivary RNA panel could objectively differentiate children with autism spectrum disorder from their neurotypical peers. In addition, due to the ease of the administration, the oral cavity is an attractive site for the drug delivery systems development because through this route it is possible to realize mucosal and transmucosal, systemic effect. All these contemporary advances extended the salivary diagnostic approach from the oral to general health pointing towards a promising future of salivary diagnostics for personalized medicine devices.
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Latif A, Waring J, Pollock K, Solomon J, Gulzar N, Choudhary S, Anderson C. Towards equity: a qualitative exploration of the implementation and impact of a digital educational intervention for pharmacy professionals in England. Int J Equity Health 2019; 18:151. [PMID: 31604434 PMCID: PMC6790050 DOI: 10.1186/s12939-019-1069-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients belonging to marginalised (medically under-served) groups experience problems with medicines (i.e. non-adherence, side effects) and poorer health outcomes largely due to inequitable access to healthcare (arising from poor governance, cultural exclusion etc.). In order to promote service equity and outcomes for patients, the focus of this paper is to explore the implementation and impact of a new co-produced digital educational intervention on one National Health Service (NHS) funded community pharmacy medicines management service. METHODS Semi-structured interviews with a total of 32 participants. This included a purposive sample of 22 community pharmacy professionals, (16 pharmacists and 6 pharmacy support staff) all who offered the medicine management service. In order to obtain a fuller picture of the barriers to learning, five professionals who were unable to complete the learning were also included. Ten patients (from a marginalised group) who had received the service (as a result of the digital educational intervention) were also interviewed. Drawing on an interpretative analysis, Normalisation Process Theory (NPT) was used as a theoretical framework. RESULTS Three themes are explored. The first is how the digital learning intervention was implemented and applied. Despite being well received, pharmacists found it challenging completing and cascading the learning due to organisational constraints (e.g. lack of time, workload). Using the four NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) the second theme exposes the impact of the learning and the organisational process of 'normalisation'. Professional reflective accounts revealed instances where inequitable access to health services were evident. Those completing the intervention felt more aware, capable and better equipped to engage with the needs of patients who were from a marginalised group. Operationally there was minimal structural change in service delivery constraining translation of learning to practice. The impact on patients, explored in our final theme, revealed that they experience significant disadvantage and problems with their medicines. The medication review was welcomed and the discussion with the pharmacist was helpful in addressing their medicine-related concerns. CONCLUSIONS The co-produced digital educational intervention increases pharmacy professionals' awareness and motivation to engage with marginalised groups. However structural barriers often hindered translation into practice. Patients reported significant health and medicine challenges that were going unnoticed. They welcomed the additional support the medication review offered. Policy makers and employers should better enable and facilitate ways for pharmacy professionals to better engage with marginalised groups. The impact of the educational intervention on patients' health and medicines management could be substantial if supported and promoted effectively.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kristian Pollock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Nargis Gulzar
- Leicester School of Pharmacy, Faculty of Health and Life Sciences, De Montfort University, Hawthorn Building, Leicester, LE1 9BH UK
| | - Shahida Choudhary
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- Claire Anderson, Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, UK
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Fernandes NFS, Galvão JR, Assis MMA, Almeida PFD, Santos AMD. [Access to uterine cervical cytology in a health region: invisible women and vulnerable bodies]. CAD SAUDE PUBLICA 2019; 35:e00234618. [PMID: 31596403 DOI: 10.1590/0102-311x00234618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/15/2019] [Indexed: 11/22/2022] Open
Abstract
This article evaluates access to the Papanicolaou test in the Family Health Strategy (FHS) in municipalities in a health region. Cervical cancer control depends on a well-organized Family Health Strategy, so assessment of access to the Papanicolaou test reflects the quality of care at this level. This is a qualitative study with data produced in 10 focus groups, totaling 70 participants in four municipalities. We analyzed the organizational, symbolic, and technical dimensions of access to the Pap test, with cervical cancer control as the marker. The results indicate that living in rural areas was a barrier to access to the Papanicolaou test and exacerbated the inequalities. Nurses were the principal reference for access to the Pap test. The absence of necessary items for collecting cervical cytopathology specimens was a barrier to access in all the municipalities. There were obstacles to access for women with disabilities and lesbian women, with care that was fragmented and out of sync with individual characteristics. The numerous obstacles to access to the Papanicolaou test exposed the selectiveness of the Family Health Strategy in the health region, since it reproduced the invisibility of women with greater social vulnerability and exacerbated the existing inequalities.
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Russell G, Kunin M, Harris M, Levesque JF, Descôteaux S, Scott C, Lewis V, Dionne É, Advocat J, Dahrouge S, Stocks N, Spooner C, Haggerty J. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open 2019; 9:e027869. [PMID: 31352414 PMCID: PMC6661687 DOI: 10.1136/bmjopen-2018-027869] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/03/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Access to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations. METHODS AND ANALYSIS The evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3-6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on individuals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices. ETHICS AND DISSEMINATION The IMPACT research programme received initial ethics approval from St Mary's Hospital (Montreal) SMHC #13-30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.
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Affiliation(s)
- Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Marina Kunin
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, Sydney, New South Wales, Australia
| | - Sarah Descôteaux
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Émilie Dionne
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Jenny Advocat
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Health care insecurity in the underserved: Effect of a charitable pharmacy model. J Am Pharm Assoc (2003) 2019; 59:S19-S24. [PMID: 31080150 DOI: 10.1016/j.japh.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/11/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objectives of this study were to assess how a charitable pharmacy model affects patient perception of health care insecurity, physical and emotional functioning, and medication access in an underserved population. METHODS New patients presenting for medication at their initial pharmacy visit at Charitable Pharmacy of Central Ohio were screened for eligibility during a 12-week enrollment period. Participants completed a baseline survey containing the Health Care Insecurity Measure (HCIM), Veterans RAND 12-Item Health Survey (VR-12), and medication access questions. The follow-up survey, which contained the HCIM and VR-12 only, was administered during a pharmacy visit at least 14 days after the patient's initial visit. Survey data were analyzed with the use of descriptive statistics. RESULTS A total of 105 patients met eligibility criteria, and 17 patients declined to participate. Of the 88 remaining participants, 33 (38%) completed the study (both baseline and follow-up survey). Of the 33 participants who completed the study, there was a statistically significant decrease from the baseline health care insecurity score (23.2 ± 11.1) to the follow-up score (17.9 ± 8.5; P = 0.0031). CONCLUSION This study demonstrated that pharmacists working in a charitable pharmacy can have a positive impact on the sense of security patients feel about their health care and can better understand their medication-related needs.
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Shukor AR, Edelman S, Brown D, Rivard C. Developing Community-Based Primary Health Care for Complex and Vulnerable Populations in the Vancouver Coastal Health Region: HealthConnection Clinic. Perm J 2019; 22:18-010. [PMID: 30227907 DOI: 10.7812/tpp/18-010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Designing, delivering, and evaluating high-performing primary health care services for complex and vulnerable subpopulations are challenging endeavors. However, there is a relative paucity of research evidence available to support such work. OBJECTIVE To provide a case study using HealthConnection Clinic, a public primary care center located in Metropolitan Vancouver's North Shore. METHODS Developmental evaluation approach operationalizing the 10 Building Blocks of High-Performing Primary Care framework using qualitative and quantitative methods. RESULTS The clinic provided valuable insights to policymakers and researchers related to development of the Building Blocks' foundational elements, particularly engaged leadership, empanelment, and data-driven improvement. The study highlighted the key enablers, achievements, challenges, and barriers related to operationalizing each Building Block. The Building Blocks were a useful heuristic that enabled the development and evaluation of primary care for complex subpopulations. Particularly salient from a Canadian policy perspective was the demonstration that system integration was possible when highly engaged leaders from a Regional Health Authority and a Division of Family Practice shared a common vision and purpose. HealthConnection Clinic's entrepreneurial spirit has enabled the development of innovative, evidence-based tools such as the AMPS complexity assessment tool (attachment, medical conditions, psychological/mental health/addictions challenges, and socioeconomic status), designed to identify and assess biopsychosocial complexity and needs. The study also highlighted the importance of incorporating community orientation and equity into developmental work. CONCLUSION The study demonstrates how the Building Blocks approach can be adapted to operationalize high-performing primary care standards in settings serving complex and vulnerable populations.
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Affiliation(s)
- Ali Rafik Shukor
- Regional Primary Care Evaluator for the Vancouver Coastal Health Authority in Vancouver, British Columbia, Canada
| | - Sandra Edelman
- Manager of Public Health and Chronic Disease Services for the North Shore Division of Community Family Health in Vancouver, British Columbia, Canada
| | - Dean Brown
- Medical Director of the North Shore Division of Community Family Health in Vancouver, British Columbia, Canada
| | - Cheryl Rivard
- Project Manager for the Vancouver Coast Health Authority in Vancouver, British Columbia, Canada
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66
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Murphy AL, Gardner DM, Jacobs LM. The patient experience in a community pharmacy mental illness and addictions program. Can Pharm J (Ott) 2019; 152:186-192. [PMID: 31156732 DOI: 10.1177/1715163519839424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The Bloom Program was designed to enhance pharmacists' care of people with lived experience of mental illness and addictions in Nova Scotia. The Program's demonstration period was from September 2014 to December 2016 and included a qualitative evaluation of the patient experience. Methods Patients were recruited for individual interviews through Bloom Program pharmacies. Interviews were transcribed verbatim and analyzed following Braun and Clarke's 6-step approach for thematic analysis. Results Ten patients were interviewed between May and June 2016. Ten themes were determined through data analysis and included medication management, accessing pharmacists in a new way, providing social support, bridging service gaps, providing interim care, reducing financial barriers, navigation and advocacy, holistic approaches, empowerment through knowledge and awareness and collaboration. Discussion Pharmacists expectedly provided medication management activities to patients for both physical and mental health concerns in the Bloom Program. Many activities conducted with Bloom Program patients fell outside of dispensing roles and medication management. These activities, such as social support, triage, navigation and increasing access, which were highly valued by patients, are poorly measured and assessed in pharmacy practice research. Conclusion Participants in the Bloom Program reported the significant contributions of pharmacists and pharmacy teams in their overall health and wellness. Future evaluations of interventions like the Bloom Program should include measurement of constructs valued by patients and also consider impacts on inequalities and inequities. Pharmacy practice researchers can benefit from other research and evaluation being conducted for primary care interventions.
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Affiliation(s)
- Andrea L Murphy
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax.,Department of Psychiatry (Murphy, Gardner), Dalhousie University, Halifax.,Contact Consulting (Jacobs), Halifax, Nova Scotia
| | - David M Gardner
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax.,Department of Psychiatry (Murphy, Gardner), Dalhousie University, Halifax.,Contact Consulting (Jacobs), Halifax, Nova Scotia
| | - Lisa M Jacobs
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax.,Department of Psychiatry (Murphy, Gardner), Dalhousie University, Halifax.,Contact Consulting (Jacobs), Halifax, Nova Scotia
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Galvão JR, Almeida PFD, Santos AMD, Bousquat A. Percursos e obstáculos na Rede de Atenção à Saúde: trajetórias assistenciais de mulheres em região de saúde do Nordeste brasileiro. CAD SAUDE PUBLICA 2019; 35:e00004119. [DOI: 10.1590/0102-31100004119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: O artigo tem como objetivo avaliar a organização e o acesso à Rede de Atenção à Saúde em uma região de saúde, na perspectiva das usuárias. Foram construídas trajetórias assistenciais de mulheres com lesão intraepitelial escamosa de alto grau do colo do útero, adscritas a diferentes modalidades de atenção primária à saúde (APS) de zonas urbana e rural, em municípios do interior e da sede de região de saúde do Nordeste do Brasil. As mulheres utilizavam a APS como serviço de busca regular para ações preventivas e assistenciais, mas reportaram barreiras de acesso para consultas médicas, sobretudo nas zonas rurais. Avaliações positivas foram vinculadas ao acolhimento e à representação da unidade básica de saúde/unidade de saúde da família (UBS/USF) como lócus disponível para cuidados. Percepção de baixa resolutividade da APS esteve ligada à demora para o agendamento das referências, abastecimento irregular/insuficiente de medicamentos e rotatividade de médicos. As mulheres indicaram dificuldade de acesso à atenção especializada, mais evidente nos municípios do interior da região, com utilização de serviços públicos e privados. Todas as usuárias da sede da região realizaram exames de confirmação diagnóstica e cirurgia pelo Sistema Único de Saúde. Apoio de familiares, amigos e políticos atravessaram as trajetórias assistenciais. Comunicação interprofissional foi quase inexistente e entre profissional/usuária, precária. A rede regionalizada apresentou-se desarticulada e com fluxos desordenados, não garantindo acesso oportuno às usuárias dos municípios do interior e apresentando dificuldades adicionais àquelas da área rural, mesmo no município sede, desvelando a incompletude dos arranjos regionais e a manutenção de desigualdades de acesso inter e intramunicipal.
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Tookey S, Renzi C, Waller J, von Wagner C, Whitaker KL. Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: a qualitative interview study. BMC Health Serv Res 2018; 18:937. [PMID: 30514369 PMCID: PMC6278141 DOI: 10.1186/s12913-018-3730-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND 'Candidacy' is concerned with the way people consider their eligibility for accessing health services. We used the Candidacy Framework to explore how the doctor-patient relationship can influence perceived eligibility to visit their General Practitioner (GP) among people experiencing cancer alarm symptoms. METHODS We carried out a secondary analysis of qualitative interviews with 29 women and 33 men, aged ≥50 years experiencing cancer alarm symptoms, recruited through primary care. Interviews focused on symptom experience, help-seeking and primary care use. Framework analysis was used to analyse transcripts with a focus on GP-patient interactions. RESULTS Perceived (im)permeability of services acted as a barrier to help-seeking, due to limited availability of appointments, time-limited communication and difficulties asserting candidacy. There was also a focal role of communication in building a positive doctor-patient relationship, with some participants describing resisting offers of appointments as a result of previous negative GP adjudication. These factors not only influenced the current consultation but had longer-term consequences for future consultation. CONCLUSIONS Candidacy provides a valuable theoretical framework to understand the interactional factors of the doctor-patient relationship which influence perceived eligibility to seek help for possible cancer alarm symptoms. We have highlighted areas for targeted interventions to improve patient-centred care and improve earlier diagnosis.
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Affiliation(s)
- Sara Tookey
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Cristina Renzi
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, WC1E 6BT, London, UK
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Sterling-Fox C. Access to Five Nonprimary Health Care Services by Homebound Older Adults: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318810384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally, the number of homebound older adults is rising exponentially as the aging population increases. Homebound older adults have complex medical and psychological issues for which many receive home-based primary care services. The purpose of this integrative review was to identify, analyze, and synthesize the existing literature regarding homebound older adults’ need for, use of, and access to five nonprimary health care services. They are dental, nutritional, optical, pharmacy, and psychological services. The integrative review was conducted using a database search of CINAHL, Health Source: Nursing Education, PubMed, Medline, PsycINFO, and Cochrane, that was supplemented by a hand search. Little research was found addressing the five nonprimary health care services. Five themes emerged from the 10 studies. They were (1) complex and interrelated health problems require more health care services; (2) perceived unimportance of nonprimary health care services; (3) barriers to use of and access to nonprimary health care services; (4) the impact of socioeconomic and demographical factors on access to services; and (5) the impact of psychological factors (depression and social isolation) on the use and access to health care services. These findings suggest further inequity and barriers to health care services by homebound older adults. Future research is needed with nonprimary health care providers to examine the clinical outcomes and costs of providing the services to homebound older adults.
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Affiliation(s)
- Cynthia Sterling-Fox
- Cynthia Sterling-Fox, PhD Student, The Graduate Center, City University of New York, New York, NY, USA
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70
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Tompkins JW, Mequanint S, Barre DE, Fournie M, Green ME, Hanley AJ, Hayward MN, Zwarenstein M, Harris SB. National Survey of Indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey. BMC Health Serv Res 2018; 18:828. [PMID: 30382912 PMCID: PMC6211407 DOI: 10.1186/s12913-018-3578-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes. Conclusions The CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada. Trial registration Current ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014. Electronic supplementary material The online version of this article (10.1186/s12913-018-3578-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordan W Tompkins
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada.
| | - Selam Mequanint
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada
| | - Douglas Edward Barre
- Department of Health Sciences and Emergency Management, School of Professional Studies, Cape Breton University, Sydney, NS, Canada
| | - Meghan Fournie
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada
| | - Michael E Green
- Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Anthony J Hanley
- Departments of Nutritional Sciences and Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mariam Naqshbandi Hayward
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1511 Richmond Street, London, ON, N6K 3K7, Canada
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Ford-Gilboe M, Wathen CN, Varcoe C, Herbert C, Jackson BE, Lavoie JG, Pauly BB, Perrin NA, Smye V, Wallace B, Wong ST, Browne For The Equip Research Program AJ. How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy. Milbank Q 2018; 96:635-671. [PMID: 30350420 PMCID: PMC6287068 DOI: 10.1111/1468-0009.12349] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy Points A consensus regarding the need to orient health systems to address inequities is emerging, with much of this discussion targeting population health interventions and indicators. We know less about applying these approaches to primary health care. This study empirically demonstrates that providing more equity‐oriented health care (EOHC) in primary health care, including trauma‐ and violence‐informed, culturally safe, and contextually tailored care, predicts improved health outcomes across time for people living in marginalizing conditions. This is achieved by enhancing patients’ comfort and confidence in their care and their own confidence in preventing and managing health problems. This promising new evidence suggests that equity‐oriented interventions at the point of care can begin to shift inequities in health outcomes for those with the greatest need.
Context Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity‐oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, we tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship. Methods Our analysis uses longitudinal data from 395 patients recruited from 4 primary health care clinics serving people living in marginalizing conditions. The participants completed 4 structured interviews composed of self‐report measures and survey questions over a 2‐year period. Using path analysis techniques, we tested a hypothesized model of the process through which patients’ perceptions of EOHC led to improvements in self‐reported health outcomes (quality of life, chronic pain disability, and posttraumatic stress [PTSD] and depressive symptoms), including particular covariates of health outcomes (age, gender, financial strain, experiences of discrimination). Findings Over a 24‐month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life). In addition, financial strain and experiences of discrimination had significant negative effects on all health outcomes. Conclusions This study is among the first to demonstrate empirically that providing more EOHC predicts better patient health outcomes over time. At a policy level, this research supports investments in equity‐focused organizational and provider‐level processes in primary health care as a means of improving patients’ health, particularly for those living in marginalizing conditions. Whether these results are robust in different patient groups and across a broader range of health care contexts requires further study.
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Affiliation(s)
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, University of Western Ontario.,Centre for Research and Education on Violence Against Women and Children, University of Western Ontario
| | | | - Carol Herbert
- Schulich School of Medicine and Dentistry, University of Western Ontario
| | - Beth E Jackson
- Centre for Chronic Disease and Health Equity, Public Health Agency of Canada.,Carleton University, Canada
| | - Josée G Lavoie
- Ongomiizwin-Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba
| | | | | | - Victoria Smye
- Arthur Labatt Family School of Nursing, University of Western Ontario
| | - Bruce Wallace
- School of Social Work, University of Victoria, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia.,Centre for Health Services and Policy Research, University of British Columbia
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Selby K, Zuchuat JC, Cohidon C, Senn N. Associations between primary care practice type and patient-reported access. BMC Health Serv Res 2018; 18:779. [PMID: 30326886 PMCID: PMC6191897 DOI: 10.1186/s12913-018-3590-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background We recently defined a global typology of primary care (PC) in Switzerland using a mixed inductive/deductive approach to construct latent, composite variables that summarize variance between practices. Now we explore associations between the primary variable that describes the comprehensiveness of services and patient-perceived access to PC in Switzerland. Methods Cross-sectional surveys were administered to physicians from the Swiss PC Active Monitoring (SPAM) network and their patients. The primary outcomes were patient responses to: “Was it easy to get the appointment?”, “The opening hours are too restricted” and “In the past 12 months, did you postpone or abstain from a visit to this doctor or another GP when you needed one?” Multivariate, multilevel analyses with stepwise regression were used to assess associations between practice type (practices with a broader range of services have higher scores) and perceived access, controlling for patient characteristics. Results One hundred and ninety nine of 200 PC physicians in the network completed the questionnaire. Of 2628 patients approached after a physician visit, 1791 accepted (participation = 76%), with 9 patients at each practice. No association was observed between comprehensiveness of services and difficulty getting an appointment. When controlling for patient factors, there was a weak association between higher scores for comprehensiveness of services and patients reporting that the opening hours are too restricted (p = 0.05), though this was no longer significant after controlling for language area. Greater comprehensiveness of services was associated with fewer patients needing to postpone visits (OR 0.93, 95%CI 0.88–0.99, p = 0.03). Conclusions Though fewer patients report needing to postpone visits at practices with more comprehensive offering of services, there is limited evidence of associations between patient-reported access and a global typology of Swiss primary care.
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Affiliation(s)
- K Selby
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - J-C Zuchuat
- Bureau d'étude JC Zuchuat, 1806, St-Légier, Switzerland
| | - C Cohidon
- Institute of Family Medicine, Department of ambulatory care and community medicine, University of Lausanne, Lausanne, Switzerland
| | - N Senn
- Institute of Family Medicine, Department of ambulatory care and community medicine, University of Lausanne, Lausanne, Switzerland
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Javanparast S, Windle A, Freeman T, Baum F. Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries? Int J Health Policy Manag 2018; 7:943-954. [PMID: 30316247 PMCID: PMC6186464 DOI: 10.15171/ijhpm.2018.53] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/02/2018] [Indexed: 11/28/2022] Open
Abstract
Background: Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored.
Methods: Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers, program managers and practitioners, to develop an understanding of policy and practice.
Results: Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter.
Conclusion: CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.
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Affiliation(s)
- Sara Javanparast
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Alice Windle
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Fran Baum
- Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia
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Sándor J, Pálinkás A, Vincze F, Kovács N, Sipos V, Kőrösi L, Falusi Z, Pál L, Fürjes G, Papp M, Ádány R. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091835. [PMID: 30149586 PMCID: PMC6163424 DOI: 10.3390/ijerph15091835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/13/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022]
Abstract
Roma is the largest ethnic minority of Europe with deprived health status, which is poorly explored due to legal constrains of ethnicity assessment. We aimed to elaborate health indicators for adults living in segregated Roma settlements (SRS), representing the most vulnerable Roma subpopulation. SRSs were mapped in a study area populated by 54,682 adults. Records of all adults living in the study area were processed in the National Institute of Health Insurance Fund Management. Aggregated, age-sex standardized SRS-specific and non-SRS-specific indicators on healthcare utilization and all-cause premature death along with the ratio of them (RR) were computed with 95% confidence intervals. The rate of GP appointments was significantly higher among SRS inhabitants (RR = 1.152, 95% CI: 1.136–1.167). The proportion of subjects hospitalized (RR = 1.286, 95% CI: 1.177–1.405) and the reimbursement for inpatient care (RR = 1.060, 95% CI: 1.057–1.064) were elevated for SRS. All-cause premature mortality was significantly higher in SRSs (RR = 1.711, 1.085–2.696). Our study demonstrated that it is possible to compute the SRS-specific version of routine healthcare indicators without violating the protection of personal data by converting a sensitive ethical issue into a non-sensitive small-area geographical analysis; there is an SRS-specific healthcare utilization pattern, which is associated with elevated costs and increased risk of all-cause premature death.
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Affiliation(s)
- János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Anita Pálinkás
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Ferenc Vincze
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Nóra Kovács
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - Valéria Sipos
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Zsófia Falusi
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - László Pál
- Department of Financing, National Health Insurance Fund, Váci Rd 73/A, H-1139 Budapest, Hungary.
| | - Gergely Fürjes
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Magor Papp
- National Institute for Health Development, Diószegi St 64, Budapest H-1113, Hungary.
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- MTA-DE-Public Health Research Group, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
- WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai St 26/B, H-4028 Debrecen, Hungary.
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Ward B, Lane R, McDonald J, Powell-Davies G, Fuller J, Dennis S, Kearns R, Russell G. Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care. Int J Equity Health 2018; 17:78. [PMID: 29903017 PMCID: PMC6003144 DOI: 10.1186/s12939-018-0788-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC. Methods A multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites. Results Overall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives. Conclusions These findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.
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Affiliation(s)
- Bernadette Ward
- School of Rural Health, Monash University, PO Box 666, Bendigo, VIC, Australia.
| | - Riki Lane
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Julie McDonald
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Gawaine Powell-Davies
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Jeff Fuller
- College of Nursing & Health Sciences, Flinders University, South, Bedford Park, South Australia
| | - Sarah Dennis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.,South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Rachael Kearns
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Grant Russell
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
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76
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Smits CCF, Toelsie JR, Eersel MGM, Krishnadath ISK. Equity in health care: An urban and rural, and gender perspective; the Suriname Health Study. AIMS Public Health 2018; 5:1-12. [PMID: 30083566 PMCID: PMC6070465 DOI: 10.3934/publichealth.2018.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The literature reports that the use of healthcare services in urban areas compared to rural areas and by females compared to males is often higher. The aim of this study is to evaluate equity on geographical living area and gender for the use of primary and secondary healthcare in Suriname. METHODS We used 5,671 records (99%) from the Suriname Health study which was designed according to World Health Organization (WHO) Steps guidelines. We evaluated the Prevalence Ratio (PR) for living area and gender in using primary (PHC) and secondary healthcare (SHC) adjusted for the perceived need for healthcare, socio-economic factors and disease factors and the effect of all factors was measured. RESULTS Overall a percentage of 46.7 (95% Confidence Interval (CI) 45.1-48.4) had used primary healthcare and 12.7 (95% CI 11.6-13.8) secondary healthcare in the past 12 months. The PR for males compared to females was 0.75 (95% CI 0.70-0.81) for primary healthcare and 0.82 (95% CI 0.69-0.98) for secondary healthcare. The PR for urban and rural coastal areas compared to the rural interior was 1.52 (95 % CI 1.36-1.70) and 1.53 (95% CI 1.36-1.71), respectively. For the use of SHC, the PR for urban and rural coastal areas compared to the rural interior was 9.3 (95 % CI 5.44-15.89) and 8.58 (95% CI 4.98-14.81). The attributable effect of perceived healthcare-need to the PR of the urban and rural coastal areas was 39.64% and 37.81% compared to the rural interior for secondary healthcare. Further, 31.74% and 13.56% were due to socioeconomic factors. CONCLUSION Although we observed equity between living areas for PHC use, for SHC use we observed a disadvantaged position for the rural interior, mainly influenced by socioeconomic factors. We measured gender equity for both PHC and SHC use.
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Affiliation(s)
- CCF Smits
- Faculty of Medical Sciences, Department of Public Health, Anton de Kom University of Suriname
| | - JR Toelsie
- Faculty of Medical Sciences, Department of Physiology, Anton de Kom University of Suriname
| | - MGM Eersel
- Faculty of Medical Sciences, Department of Public Health, Anton de Kom University of Suriname
| | - ISK Krishnadath
- Faculty of Medical Sciences, Department of Public Health, Anton de Kom University of Suriname
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77
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Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health 2018; 17:28. [PMID: 29458379 PMCID: PMC5819269 DOI: 10.1186/s12939-018-0740-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 02/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Disparities in access to primary care (PC) have been demonstrated within and between health systems. However, few studies have assessed the factors associated with multiple barriers to access occurring along the care-seeking process in different healthcare systems. Methods In this secondary analysis of the 2016 Commonwealth Fund International Health Policy Survey of Adults, access was represented through participant responses to questions relating to access barriers either before or after reaching the PC practice in 11 countries (Australia, Canada, France, Germany, Norway, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and United States). The number of respondents in each country ranged from 1000 to 7000 and the response rates ranged from 11% to 47%. We used multivariable logistic regression models within each of eleven countries to identify disparities in response to the access barriers by age, sex, immigrant status, income and the presence of chronic conditions. Results Overall, one in five adults (21%) experienced multiple barriers before reaching PC practices. After reaching care, an average of 16% of adults had two or more barriers. There was a sixfold difference between nations in the experience of these barriers to access. Vulnerable groups experiencing multiple barriers were relatively consistent across countries. People with lower income were more likely to experience multiple barriers, particularly before reaching primary care practices. Respondents with mental health problems and those born outside the country displayed substantial vulnerability in terms of barriers after reaching care. Conclusion A greater understanding of the multiple barriers to access to PC across the stages of the care-seeking process may help to inform planning and performance monitoring of disparities in access. Variation across countries may reveal organisational and system drivers of access, and inform efforts to improve access to PC for vulnerable groups. The cumulative nature of these barriers remains to be assessed. Electronic supplementary material The online version of this article (10.1186/s12939-018-0740-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Corscadden
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4812, Australia. .,Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW, 2067, Australia.
| | - J F Levesque
- Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW, 2067, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia
| | - V Lewis
- Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, VIC, 3068, Australia
| | - E Strumpf
- Department of Economics and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 855 Sherbrooke St. West, Montreal, QC, H3A 2T7, Canada
| | - M Breton
- Department of community health, University of Sherbrooke, 150 Place Charles LeMoyne, Longueil, Québec, J4K 0A8, Canada
| | - G Russell
- General Practice Research, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gull Rd Notting Hill, Melbourne, VIC, 3168, Australia
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78
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Okpala P. Increasing access to quality healthcare through collaborative leadership. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2017. [DOI: 10.1080/20479700.2017.1401276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paulchris Okpala
- California State University San Bernardino, San Bernardino, CA, USA
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79
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Non-attendance of vulnerable populations within epilepsy outpatient services in Ireland. Ir J Med Sci 2017; 187:525-528. [PMID: 29032416 DOI: 10.1007/s11845-017-1697-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Outpatient non-attendance is a prevalent issue that contributes to significant wasted clinical resources and can be influenced by a number of complex factors. AIMS The aim of this study is to characterize "did not attend" (DNA) rates in three identified subpopulations of epilepsy patients to determine if current care provision models suffice. METHODS In this study, we identified all patients residing in social housing, in residential care, and those incarcerated who have been offered appointments by our service. We calculated the total number of appointments issued to each group over their entire interaction with our service and their subsequent non-attendance rate as a group. Additionally, we calculated the baseline DNA rate for our epilepsy clinic as a whole for comparison. RESULTS We found that the baseline DNA rate for the clinic as a whole was 18.9%. Those in social housing, in residential care, and incarcerated had significantly higher DNA rates of 24, 20.2, and 54.3%, respectively. CONCLUSIONS This study provided evidence that in certain groups of patients, clinicians may need to explore other care delivery models due to high DNA rates.
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O’Donnell P, Tierney E, O’Carroll A, Nurse D, MacFarlane A. Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. Int J Equity Health 2016; 15:197. [PMID: 27912783 PMCID: PMC5135741 DOI: 10.1186/s12939-016-0487-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/25/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. METHODS This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. RESULTS Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. CONCLUSIONS Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.
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Affiliation(s)
- Patrick O’Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Edel Tierney
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Austin O’Carroll
- North Dublin City General Practice Training Scheme, Catherine McAuley Centre, Nelson Street, Dublin 7, Ireland
| | - Diane Nurse
- National Social Inclusion Office, Primary Care Division, Health Service Executive, Mill Lane, Palmerstown, Dublin 20, Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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