Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review

BACKGROUND

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.

OBJECTIVE

To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.

METHODS

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.

RESULTS

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.

CONCLUSION

Realist reviews can help guide the development of locally adapted primary health care interventions.

Evaluation of nuclear reaction cross sections for optimization of production of the important non-standard positron emitting radionuclide 89Zr using proton and deuteron induced reactions on 89Y target

⁸⁹Zr (T_1/2 = 3.27 d) is an important β⁺-emitting radionuclide of zirconium used in immuno PET. The excitation functions of the ⁸⁹Y(d,2n)⁸⁹Zr and ⁸⁹Y(p,n)⁸⁹Zr reactions were analyzed to deduce the optimum conditions for the high purity production of ⁸⁹Zr. The nuclear model codes ALICE-IPPE, EMPIRE 3.2 and TALYS 1.9 were used to check the consistency and reliability of the experimental data. A polynomial fit to the chosen data for each reaction gave the excitation function, which was then used for the integral yield calculation of the product. The amount of the major radioactive impurity ⁸⁸Zr was precisely analyzed for both the proton and the deuteron induced reactions on the ⁸⁹Y target.

Evaluation of nuclear reaction cross sections for optimization of production of the emerging diagnostic radionuclide ⁵⁵Co

The excitation functions of the (54)Fe(d,n)(55)Co, (56)Fe(p,2n)(55)Co and (58)Ni(p,α)(55)Co reactions were analyzed with relevance to the production of the β(+)-emitter (55)Co (T½=17.53 h), a promising cobalt radionuclide for PET imaging. The nuclear model codes ALICE-IPPE, EMPIRE and TALYS were used to check the consistency of the experimental data. The statistically fitted excitation function was employed to calculate the integral yield of the product. The amounts of the radioactive impurities (56)Co and (57)Co were assessed. A comparison of the three investigated production routes is given.