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 | |
Clinical multidisciplinary teams | |||||||||
McDermott, 2004 [62] | Implementation of diabetes registers, recall and reminder systems | Delivery of services by the local indigenous health workers | Delivery of the diabetes health services in the remote indigenous communities. | - 32 % reduction of hospitalization for diabetes-related conditions (p = 0.012); - Decline of hospitalization from 25 % to 20 % over 3 years (2004). | |||||
Continuity of care via case management | |||||||||
Dorr, 2008 [49] | 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 = 0.55) | By 2 years of follow-up: increase (p = 0.02 for all patients, p = 0.37 for patients with diabetes) | ||||
Gravelle, 2007 [60] | Patients identified based on the age and frequency of emergency use | No additional payment | Individualized care plans were developed according to the needs | Ability to engage: patients were actively involved in the development of care plan | No effect (p = 0.14) | ||||
Landi, 2001 [63] | Patients referred by PCPs | Integration of all the community-based services and services provided by the health agency/municipality into one “single enter” center | Individualized care plans were developed according to the needs | Ability to engage: patients were actively involved in the development of care plan | Decrease by 18 % (p < 0.001) | ||||
Institution incentives | |||||||||
Addink, 2011 [58] | No large improvement in - satisfaction with phone access (2.96 % of increase); - ability to get appointment within 48 h (1.12 % of increase); - ability to book an appointment in advance (4.42 % of increase); - ability to see a particular PCP (1.21 % of increase); - satisfaction with opening hours (1.25 % of decrease). | ||||||||
Tan, 2012 [66] | The whole population is eligible | Services were developed with active partnership of ethnic communities (iwi) | Depending on the income level: very low fees (free to $15 for all ages), low fees ($16–$30), medium ($31–$39), high ($40 or above). | Ability to engage: representatives of local ethnic communities were actively involved in the development of care programs | 4 % decrease over five years | Enrolled patients contributed to 0.2 % increase in comparison to 1.7 % increase of not enrolled (overall steady increase of 2 % per year). | |||
Capitation | |||||||||
Davidoff, 2008 [25] | No payment (Medicaid and State Children’s Health insurance Program) | Ability to pay: no charge as these managed care programs are funded by the State. | Slight reduction (3.8 % points) (p = NS). | No effect on unmet medical care needs |