Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review

Abstract

Access to community-based primary health care (hereafter, ‘primary care’) is a priority in many countries. Health care systems have emphasized policies that help the community ‘get the right service in the right place at the right time’. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). Sources: Main bibliographic databases (Medline, Embase, CINAHL) and team members’ personal files. Study selection: One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the ‘Patient Centered Access to Healthcare’ conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of ‘dimension-outcome’ patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as ‘Formal integration of services’ suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and reduction of hospitalizations (four/four studies), emergency department admissions (six/six studies), and unmet healthcare needs (five/six studies). These 10 studies included seven non-randomized studies, one randomized controlled trial, one quantitative descriptive study, and one mixed methods study. Our results suggest the limited breadth of research in this area, and that it will be feasible to conduct a full systematic review of studies on the effectiveness of the formal integration of services to improve access to primary care services for vulnerable populations.

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

“…A scoping literature review concluded that access to community-based primary healthcare can be improved for vulnerable populations by a formal integration of services, while also reducing hospitalizations, emergency department admissions, and unmet healthcare needs [15]. Another recent review concluded that integrated care improved access to care for older people, and quality of care [16].…”

Patient safety in marginalised groups: a narrative scoping review

“…All included studies were published between 2002 and July 2019. We identified 8 reviews [29][30][31][32][33][34][35][36] and 59 empirical studies [8,. The vast majority of these studies were conducted in high income countries (82%), used a mixture of methods (predominantly quantitative (66%)) and were conducted across multiple settings, with the majority (49%) in secondary care settings.…”

“…In 7 studies, no factors were identified [31,34,50,58,65,78,81] and in two, it was unclear [44]. Most studies reporting factors, discussed multiple individual factors (range = 1-7, average = 2.3) across multiple domains (range = 1-4, average = 2.0).…”

Nurse‐led primary health care for homeless men: a multimethods descriptive study

“…Facilitators of access to healthcare services include the availability of the service, the approachability of staff and its affordability (Khanassov et al. ). The location of the service accentuates availability, and health services targeted towards homeless people are often located in residential hostels or other contexts close to the population being served, frequently adopting open‐door policies and treatment drop‐in to enhance access (Keogh et al.…”

“…Nurses have a key role in the organization and provision of available, approachable and affordable care (Khanassov et al. ; Savage et al. ).…”