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Table 6 Summary of key themes and implications for health services and research

From: A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries?

Summarized themes Relation to study objective Health service or research implications
Demographic characteristics create or exacerbate barriers Frequent barrier Improve breadth of patient participation and health literacy to reduce disparities
Assess the degree to which services are culturally competent
Target disadvantaged groups with additional supportive services
Availability barriers exist at first point of contact Common barrier Provide explanations for and estimates of delays
Service structures create accommodation and accessibility barriers Common barrier Improve appointment scheduling systems:
- record individual preferences for date and time
- coordinate all required appointments at the facility on one day
-convenient rescheduling process
Decrease wait-times
Incorporate notification system for estimated wait-times
Continuity and coordination of care poses barriers Common barrier Improve content and access to medical records:
-systematic data collection for accuracy and completeness
ability to record additional patient concerns
-notification or alerts when test results are available
-centralized progress summaries for multiple service providers
Decisional involvement and information provision impacts acceptability of care Common barrier Provide personalized information to patients
Provide ongoing opportunities to review progress and concerns
Provide access to additional information sources
Provide communication training for providers
Consider and discuss individual patient preferences for decisional involvement
Need assessment and referral processes for cancer and/or depression can be improved Unique barrier Conduct systematic, comprehensive and routine screening of patients’ needs
Refer automatically to support services
Inform health professionals of additional services available
Barriers can be described in additional detail Scope of barrier Deconstruct barriers to design more targeted initiatives for improving access
Evidence on barriers to non-oncology services is limited Volume of articles Barriers reported within clusters of conditions mask differences across groups
Conduct more studies in non-oncology patient groups