Study ID | Dimensions of access of primary care services | Dimensions of ability of consumers | Outcomes | ||||||
---|---|---|---|---|---|---|---|---|---|
Approachability | Acceptability | Availability and Accommodation | Affordability | Appropriateness | Ability to (1) Perceive; (2) Seek; (3) Reach; (4) Pay; (5) Engage | Avoidable hospitalization | Avoidable ED admission | Unmet health care needs | |
Revision of professional roles | |||||||||
Gray, 2013 [61] | Students with symptoms of sore throat and skin infection were regularly searched | The social worker providing health care services was the same ethnic group | Health care services delivered directly at primary school, at home (for household members), regular phone contacts. | Free health care program | Ability to perceive: education of parents on the importance of the provided services; Ability to reach: availability of the health care program in the primary school. Ability to pay: free health care program | Health care service received in a timely manner. | |||
Clinical multidisciplinary teams | |||||||||
Doey, 2008 [54] | “One-stop shopping for clients” – co-location of primary health services with mental care. | Intervention in public health care system | Timeliness of primary health services delivery (preventive measures) | 75 % decrease of hospitalization | - 51.6 % decrease in the number of emergency visits; - 38 % never used emergency services. | ||||
Crustolo, 2005 [52] | Referral to the dietitian by the PCP if nutrition-related problems were present | Location of dietitian in primary care. | Intervention in public health care system | Intervention was offered at an early stage of the health condition (e.g., priority to prevent childhood obesity). | Patients were satisfied with: - length of wait for appointment; - getting through by phone; - length of time waiting; - time spent with healthcare professional; - explanation of what was done; - personal manner of healthcare professional; - major health concerns were addressed. | ||||
McCuloch, 2000 [45] | Patients identified through diabetes registers | Available assessment by specialists in primary care practice | Timely assessment of patients to avoid complications (retinal screening, screening for microalbuminuria, hyperglycemia) | Decrease by 17 % | No difference | ||||
Michelen, 2006 [44] | Information about frequent users of ED (3 or more times in the past 6 months) was e-mailed to healthcare professionals who contacted them thereafter. | Healthcare professionals providing the intervention were from the same ethnical background | Patients living in three neighborhoods (Harlem, Washington Heights, Inwood) were enrolled | Ability to reach: primary care services available in the geographic catch area (neighborhood) of the intervention. | Decrease at 3 months (p = 0.002), no difference at 6 month | ||||
Driscoll, 2013 [50] | Payers are Indian Health Services, Medicaid/Medicare, independent insurers | Decrease (p < 0.001) | |||||||
Formal integration of services | |||||||||
Day, 2006 [65] | Location of specialized mental health services in primary care practice. | Satisfied with: - length of wait prior to the first appointment (85.1 %); - location (95.5 %); - quality of venue (89.5 %); - duration of the appointment (92.7 %); - 94 % found the appointment convenient. | |||||||
Garg, 2012 [26] | Community services were provided appropriate to the needs (e.g., employment to unemployed participants). | Reduction of unmet social needs (50 % of families enrolled in at least one community-based resources). | |||||||
Lamothe, 2006 [56] | The monitoring of health condition was from home of participants. | Timely delivery of services based on the alerts received from patients. | Ability to engage: participation of patients and healthcare professionals in decision-making regarding of the treatment options based on the measurements of vital signs. | Decrease in the number of emergency visits | - no need to travel to physician’s office for blood pressure reading; - absence of waiting time to have blood pressure read by a nurse; - better access to services and easier access to nursing and medical expertise. | ||||
24/7 access to the Health Info Line for the assessment of needs. | “The single entry point” mechanism for accessing the services in the area for frail seniors with complex needs. | Intervention in public health care system | The continuous nature of the intervention (close collaborative work of PCP, case manager, and multidisciplinary team). | - increase of hospitalization within 10 days (p = 0.043); - no difference within 30 or 90 days; - higher in year 1 (31 % vs 28 %, p = 0.281); - no difference over 4 years (p = 0.113). | - no difference within 10 days; - higher in year 1 and 2 (p < 0.001); - no difference in year 3 and 4. | ||||
Referral to the mental health services based on the screening by primary care providers | Co-location of primary care services with mental health services | - got the service patients wanted (p = 0.01); - service received met patients needs (p = 0.0001). | |||||||
Brown, 2005 [29] | Referral to the mental health services by the PCP; identification in the database patients with a large number of hospitalizations. | Co-location of primary care services with mental health services | Decrease (p = 0.02) | Decrease (p = 0.05) | |||||
MacKinney, 2013 [33] | Contact of identified people without insurance by the county social worker to offer an access to primary health services | Absence of co-payment for basic medical services | Decrease (13 % vs 6 %; p < 0.03) | Decrease (32 % vs 19 %; p < 0.0001) | |||||
Bradley, 2012 [34] | Contact of identified people without insurance to offer an access to primary health services | Primary care providers located near the residence of patients | Absence of payment for primary care services | Decrease (p < 0.01) | Decrease (p < 0.01) | ||||
Kaufman, 2000 [31] | Uninsured patients according the eligibility criteria were enrolled. | The program was eligible for the residents of New Mexico county only. | Small copayment depending on the poverty level (ranged from no premium to $10 per patient per month) | Ability to pay: ranged from no payment to a small monthly premium. | Decrease (p < 0.0001) | Decrease (p < 0.0001) | Decrease of time for the first appointment with PCP (from 45 to 28 days). | ||
Roby, 2010 [46] | Uninsured patients were enrolled at the time they sought for health services. | Decrease (p < 0.05) | |||||||
Continuity of care via case management | |||||||||
Beland, 2006 [55] | Intervention delivered through the public community organizations responsible for home care | The intervention team physically was located in the public community organizations | Intervention in public health care system | 50 % reduction in the number of “bed-blockers” (p < 0.05) but no overall effect on hospitalization. | Trend for 10 % lower utilization (p = NS) | ||||
Glendenning-Napoli, 2012 [30] | Uninsured patients with frequent hospital and emergency use were contacted by the phone to enroll in the program. | Ability to perceive: assessment of patient health literacy level and ability to manage health condition is a part of the intervention; Ability to engage: participants were involved in the development of the preventive care plan tailored to their needs. | Decrease (p < 0.0001) | Decrease (p < 0.0007) | |||||
Insured older patients at high risk of health service use were contacted (screening based on the insurance claims) | In-home assessment of needs | Eligible patients were those with existing insurance. | Ability to reach: some elements of the intervention were delivered at home (e.g., assessment of needs) Ability to engage: involvement in the development of individual care plan. | Decrease (p = NS) | Decrease (p = NS) | ||||
Shah, 2011 [47] | Uninsured frequent ED users were identified and enrolled | Ability to reach: follow-up at home and during hospitalization; Ability to engage: involvement in the development of the individual care plan. | Decrease (p < 0.0001) | Decrease (p < 0.0001) | |||||
Wang, 2012 [43] | Mandatory attendance of an appointment with a community health worker within 2 weeks of the release date from the prison | Health care services were provided and coordinated by a healthcare professional with a history of incarceration. | No difference (p = 0.34) | Decrease (p < 0.04) | |||||
Wohl, 2011 [37] | Services were offered to HIV patients prior their release from the prison | Services were identified in the neighborhood | Individualized care plans were developed according to the needs | Ability to engage: clients were actively involved in the development of care plan for short and long-term objectives. | No difference | No difference | |||
Sylvia, 2008 [39] | Patients referred by PCPs | Individualized care plans were developed according to the needs | Ability to engage: patients were actively involved in the development of care plan. | Decrease (p = 0.19) | Decrease (p = 0.20) | ||||
Horwitz, 2005 [40] | Patients identified at discharge | Intervention was offered to patients living in the proximity of primary care facilitates | No difference | No difference | |||||
Palfrey, 2002; 2004 [32] | Children already receiving care in pediatric primary care practices were approached | - In-home assessment of needs and regular home follow-up; - Intervention was designed for the residents of the particular neighborhood. | Ability to reach: some elements of the intervention were delivered at home (e.g., assessment of needs); Ability to engage: involvement in the development of the individual care plan; participation of a local parent consultant in the development and amendment of the intervention. | Decrease (p < 0.01) | No difference | Decrease of unmet health care needs: - getting a phone calls returned (61 %); - getting an appointment (60.9 %); - getting early medical care (61.4 %); - getting resources for a child (59.7 %); - getting letters of medical necessity (66.9 %); - communicating with a child’s doctor (60.9 %); - getting referral to doctors (60.5 %). | |||
Farmer, 2005 [27] | Patients referred to the program according to the eligibility criteria | Children residing in the region primary care clinics provide health services for. | Participants were enrolled in Medicaid fee-for-service, Medicaid managed care, and commercial health insurance | Ability to perceive: children were already involved in the services provided by multiple medical specialists due to severe health disorder/s interfering their everyday functioning; Ability to reach: comprehensive assessment of needs was provided at home; a web site to ease access to additional support services online. Ability to engage: involvement in the development of individual short-term family goals. | Decrease (p = 0.55) | Less need for: - social support (p = 0.03); - help with family relationship (p = 0.015). | |||
Druss, 2001 [36] | Referral of patients to primary care by mental health providers | Primary care clinic located contiguous to the mental health clinics | Development of the individualized care plan according to the needs of patients. | Decrease (8.5 % vs 18 %; p = 0.12) | Decrease (11.9 % vs 26.2 %; p = 0.04) | Fewer problems with: - access to care (p < 0.01); - attention to patient preferences (p = 0.03); - courtesy (p = 0.046); - coordination of services (p = 0.01); - continuity of care (p < 0.001). | |||
Counsell, 2007 [38] | Patients referred by PCPs | Individualized care plans were developed according to the needs | Ability to engage: patients were actively involved in the development of care plan | No difference except for high risk patients (decrease, p = 0.03). | Decrease (p = 0.03) | ||||
Callahan, 2006 [51] | Patients referred by PCPs | Individualized care plans were developed according to the needs | Ability to engage: patients were actively involved in the development of care plan | No difference (29.8 % vs 24.6 %, p = 0.59) | |||||
Continuity of care via arrangements for follow-up | |||||||||
Sin, 2004 [57] | Patients approached at discharge to make an appointment with their PCP | Intervention in public health care system | Continuous nature of care: from discharge to asthma control by PCP | Decrease at 3 (p = 0.53) and 6 months (p = 0.27) but no difference at 12 months (p = 0.63). | |||||
DeHaven, 2012 [48] | Patients were contacted to be enrolled in the intervention program after ED admission | To have an access to the health services, patients have to reside in the target area zip code. | Free access to health care services | Decrease (p < 0.01) | |||||
Institution incentives | |||||||||
Feinglass, 2014 [28] | Uninsured residents of suburban DuPage County with a household income below 200 % of Federal Poverty Level were assigned. | Program was implemented in 45 sites across the county. | County hospitals, county government, and other foundations financially supported the program. Moreover, the Access DuPage program pays a small capitated fee to clinics and PCPs. | Ability to pay: only a small copayment was required for the prescribed medications. | Increase by 14 %. | Increase by 9 %. | - decrease of waiting time to see a doctor/nurse (p = NS); - increase of clinic working hours (p < 0.0001); - increase access trough the phone (p < 0.05); - increase of ease to get an appointment (p < 0.05); - increase of ease to get transportation (p < 0.05); - increase of receiving care participants thought they needed (e.g., blood tests, appointment with a doctor) (p < 0.0001); - increase of satisfaction to communicate with a doctor/nurse (due to language barrier) (p < 0.0001); - increase of satisfaction with explanations doctors/nurses give (p < 0.05); - increase of time healthcare professionals spend with patients (p < 0.05); - satisfaction with respect healthcare professionals show (p < 0.05) |