Dataset Information

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

ABSTRACT:

Background

Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care.

Methods

An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions).

Results

The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n?=?45), episodic care (n?=?19), and chronic disease management (n?=?11). They were undertaken in a number of countries including Australia (n?=?25), USA (n?=?25), and UK (n?=?15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n?=?46 studies) or as a combination of two (n?=?20) or more strategies (n?=?9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n?=?43 studies), patient support (n?=?29), provision of new services (n?=?19), workforce development (n?=?11), and financial incentives (n?=?9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results.

Conclusions

This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these.

SUBMITTER: Comino EJ

PROVIDER: S-EPMC3512489 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

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Publications

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

Comino Elizabeth Jean EJ Davies Gawaine Powell GP Krastev Yordanka Y Haas Marion M Christl Bettina B Furler John J Raymont Anthony A Harris Mark F MF

BMC health services research 20121121

<h4>Background</h4>Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care.<h4>Methods</h4>An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers we ...[more]

PMID: 23170843

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Project description:BackgroundPrimary care telephone access has been associated with patient satisfaction and emergency department utilization even after accounting for objective appointment wait times. However, relatively little is known about how to best structure and manage telephone access in primary care.ObjectiveAssess how primary care telephone access is structured and managed and explore how variation in telephone management may affect primary care teams and patients.DesignWe used 2016 administrative and patient survey data to select six Veterans Administration medical centers (VAMCs) with above-average primary care access (time to third next available appointment) but variable patient-reported access, geographic region, and urbanicity. Semi-structured interviews were conducted August -October 2017.ParticipantsForty-three key stakeholders knowledgeable about primary care, telephone management, and operational priorities nationally and/or within each VAMC.Key resultsTelephone access was organized and managed differently across sites. Regional call centers were perceived as more efficient but less flexible in tailoring processes to meet local needs. Patient preferences for speaking with their own care teams were cited as a reason to manage telephone access locally rather than regionally, particularly in rural sites. Sites with high patient-rated access described call center functions as well-integrated with primary care team workflow, while those with low patient-rated access perceived telephone management practices as negatively affecting primary care team workload. Call center understaffing was a major barrier to optimal telephone access in all six sites, though rural sites reported greater challenges with provider recruitment and retention.ConclusionsIn VA, efforts to improve telephone access have focused on centralizing call center operations but current call center performance metrics do not account for the extent to which call center functions are integrated with primary care workflows or may impact patient experience. Efforts to improve primary care access should carefully consider impact of telephone management practices on providers and patients.

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Dataset Information

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

Background

Methods

Results

Conclusions

Publications

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.

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