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Table 5 Characteristics of included studies (state/national intervention): Access dimension and outcome

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

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