From: Improving access to primary health care: a cross-case comparison based on an a priori program theory
Box | Impact | Evidence | Source |
---|---|---|---|
10 | Consumer ability to perceive need | Not measured. | |
11 | Consumer ability to seek | Significant improvement on score on ‘Ability to seek’ (Scale; 1 = Not easy at all to 4 = Very easy) increased from 3.2 to 3.4 p = 0.006. | Patient surveys |
12 | Consumer ability to reach social/ community services | There were no significant changes in responses to the question: In the last 6 months, have you used a health or social service in the community for a specific health problem? | Patient surveys |
22 | GP knowledge, skills, confidence | Significant improvement in scores out of 10 for confidence in providing care to patients with poorly managed diabetes from 7.99 to 9.27 (p = 0.03). | Provider surveys |
24 | Clinic policies | 9 of 10 practices reported the intervention changed the way the practice organizes access or care for patients with poorly managed Type 2 diabetes: a little (10%), quite a lot (50%) or a great deal (20%). Some clinics had instituted recall systems as part of the study to help with recall of patients for health checks. | Practice surveys |
31 | Appropriate referrals | GP self-report provided mixed results. Significant increase in the frequency of someone from the clinic helping patients to make the appointment for a referral; p = 0.046 No significant changes in frequency of: • providing information on different referral options • allowing patients to choose which referral option suits them • referring patients to self-mgt education. | Provider surveys |
32 | Appropriate primary care | There was no significant improvement in patient reports that the GP provided everything they needed to help them manage their health. However, there was a ceiling effect with a baseline score of 3.8 out of 4 (4 = yes, definitely). | Patient surveys |
33 | Consumer ability to engage | Significant improvement in patients’ reports of how easy it was to explain their problems to their health professionals. On a scale of 1 to 4 (1 = Not easy at all; 4 = Very easy), patient scores changed from mean = 3.26 to mean = 3.50 p = 0.007. | Patient surveys |
GPs and patients suggested increased engagement of patients, although not universally. | Interviews | ||
41 | Consumer needs addressed at right location | Significantly fewer patients reported spending one or more nights in a hospital after the intervention. | Patient surveys |
43 | Healthcare is perceived /experienced positively | Responses to question: “Did you have confidence and trust in the person you saw or spoke to?” did not change – very high at baseline and follow-up (3.9/4) i.e. ceiling effect. | Patient follow-up survey |