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Table 6 Vignettes of the types of interventions

From: Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations

Illustrative vignettes of interventions
Types of vignette Description of intervention Access dimension(s) addressed* Components of interventions relating to access dimensions*
Innovations that illustrate the most targeted supply-side dimensions Name of the innovation: PACER Model of Primary Mental Health Care
Country of innovation: Australia
Setting: mobile service
Target population: people living with a mental illness
What does it do? PACER is a mobile emergency mental health program that teams a Police officer with mental health training and an experienced mental health clinician to respond to mental health crises encountered by Police. This program offers improved coordination of activities between emergency services (Ambulance and Police) and the area of mental health services. The PACER team’s complementary skill sets ensure personal and community safety during the crises and skilled in-time assessment, treatment and referral as appropriate.
Approachability
Acceptability
Availability and accommodation
Appropriateness
Mobile clinic Outreach from PHC into community setting
Expanded hours
Multi-sectoral network
Name of the innovation: The Alex Community Health Bus
Country of innovation: Canada
Setting: mobile service
Target population: low income individuals and homeless people
What does it do? The Alex Community Health Bus is a mobile clinic providing healthcare services to low income individuals and homeless people five days a week. The Alex Health Bus stops at a number of locations on its weekly route, including low-income seniors housing complexes and homeless shelters. It provides healthcare and education services, and facilitates referrals to a wide range of PHC and community organisations. It is also a roaming food bank, with hampers and emergency food on-board for those in need.
Approachability
Availability and accommodation
Appropriateness
Mobile clinic
Outreach from PHC into community setting
Facilitated referral for services
Multi-sectoral network
Name of the innovation: Bromley By Bow Health Centre
Country of innovation: UK
Setting: community organisation
Target population: no particular population group
What does it do? Bromley By Bow Health Centre is a community organisation in East London, working in one of the most deprived neighbourhoods of the city. As a healthy living centre, it offers a wide range of health services such as consultations with general practitioners and psychologists, home visits, antenatal and baby clinics, family planning services, blood clinics, new patient health checks and nurse clinics.
Approachability
Availability and accommodation
Appropriateness
Geographic location of PHC services Comprehensive PHC team – One Stop Shop
PHC network with community organisations
Name of the innovation: Cool Aid Community Health Centre
Country of innovation: Canada
Setting: community health centre
Target population: homeless people, people living with a mental illness or disability, low income individuals, people facing addiction problems
What does it do? Cool Aid provides primary healthcare, counseling, dental care and a dispensing pharmacy. These services are provided by a multidisciplinary team and rely on a holistic approach to healthcare that includes a strong patient-centered vision, offering opportunities for patients to take part in their care and making decisions regarding their health. This team includes doctors and nurses, counselors, a nutritionist, a psychiatrist, an acupuncturist, a podiatrist, dentists and dental hygienists, a pharmacist and a pharmacy technician. In particular, Cool Aid offers shelter services, health and dental care, mental health and employment support, food supplies, community engagement programs, outreach clinics, peer-based support groups, harm reduction services, onsite pharmacy with opiate substitution program, and group medical visits for individuals with complex social, psychiatric and medical needs.
Approachability
Acceptability
Availability and accommodation
Appropriateness
Comprehensive PHC team – One Stop Shop
Adaptation to needs of specific subpopulation
Outreach from PHC into community setting
In-reach from specialised services to PHC
Group visits
Patient-centered care
Name of the innovation: PRIME: A Health Centre for Seniors
Country of innovation: Canada
Setting: health centre and residence
Target population: elderly people
What does it do? PRIME: A Health Centre for Seniors offers a program aimed at keeping seniors healthy and living in their own homes. PRIME provides alternatives to entering a personal care home by offering an all-inclusive health service including medical care, personal care, socialisation and exercises, after hours support, rehabilitation, day program and home care coordination, amongst other services for seniors. Services are provided based on a collaborative, multidisciplinary approach. Transportation is provided to help people attend the service.
Approachability
Availability and accommodation
Appropriateness
Comprehensive PHC team – One Stop Shop
Integrated healthcare network
Outreach from PHC into community setting
Transportation
Innovation that illustrates the most targeted demand-side dimensions Name of the innovation: Byron Bay homeless breakfast
Country of innovation: Australia
Setting: community organisation
Target population: homeless people
What does it do? Byron Bay homeless breakfast is run once a week at the community centre by volunteers who provide free meals for the homeless and anyone in need in the neighbourhood. The local community health centre staff attend breakfast and use it as an opportunity to provide primary healthcare services to the people who come to breakfast.
Ability to perceive
Ability to engage
Approachability
Acceptability
Availability and accommodation
Adaptation to needs of specific subpopulation
Outreach from PHC into community setting
PHC network with community organisations
Name of the innovation: MyGRiST
Country of innovation: UK
Setting: online
Target population: people living with a mental illness
What does it do? MyGRiST is an online tool designed to help people self-assess and manage risks and safety associated with their mental health problems, with the aim of promoting wellbeing. It is a companion tool to a suite of clinical tools that have been developed based on a model of clinical risk assessment founded on the most recent evidence in the field. MyGRiST collects identical information to the clinical tools, but using language and a format co-designed with mental health service users. This helps empower patients and enables them to tell their story and communicate risk information to clinicians. It does this by providing them with a script - i.e. an output report which clearly indicates where patients’ main concerns are. Reports can be shared online, for purposes of remote supervision. Patients' personalised output reports also contain self-management advice and planning.
Ability to perceive
Ability to seek
Ability to engage
Approachability
Acceptability
Availability and accommodation
Appropriateness
Virtual monitoring of health condition
Self-management coaching
Common tools
Name of the innovation: Diabetes Coordination and Assessment Service
Country of innovation: Australia
Setting: phone-based, primary healthcare organisation
Target population: people living with diabetes
What does it do? Diabetes Coordination and Assessment Service is a phone-based care coordination service aiming to promote chronic disease self-management (diabetes in particular) through screening, triage, assessment, coaching, referral and follow-up. It assists primary healthcare to connect people with services that correspond to their needs. Services also include public diabetes groups, individual coaching sessions and specialist clinics.
Ability to seek
Ability to engage
Approachability
Availability and accommodation
Appropriateness
Self-management coaching
Facilitated referral for services
Proactive follow-ups
Navigation and information
Virtual consultation of health provider
Name of the innovation: Living Well with COPD
Country of innovation: Canada
Setting: online
Target population: people living with chronic obstructive pulmonary disease (COPD) and their family
What does it do? Living Well with COPD is a self-management education program developed to help people living with COPD and their family to take charge and cope with their disease, in collaboration with their healthcare team. The goal is to facilitate the adoption of healthy lifestyle behaviors and the skills needed to ensure optimal management of COPD on a day-to-day basis. It provides free access to a large number of educational modules to help manage COPD and resources about how to navigate the healthcare system.
Ability to perceive
Ability to seek
Ability to engage
Approachability
Affordability
Appropriateness
Self-management coaching
Navigation and information
Defraying costs to patients
Innovation that combines the most targeted pairs of access determinants Name of the innovation: The HOME study
Country of innovation: Australia
Setting: home-based
Target population: Aboriginal and Torres Strait Islander people with complex chronic disease
What does it do? The Home based Outreach chronic disease Management Exploratory Study (HOMES) explores novel approaches to address chronic disease management in home-based outreach settings for Aboriginal and Torres Strait Islander people. The integrated family-based chronic disease management program involves the engagement and empowerment of families in the management and prevention of chronic disease; comprehensive needs assessment (family health, social situation and needs, physical healthcare needs and social and emotional wellbeing); and integration of health and health related care delivery to patients and their families to improve health outcomes.
Approachability-Ability to perceive
Appropriateness-Ability to engage
Ability to seek
Outreach from PHC into community setting
System case manager
Patient-centered care
Advocacy
Comprehensive PHC team – One Stop Shop
Name of the innovation: IMAGINE
Country of innovation: Canada
Setting: community-based drop-in clinic
Target population: marginalised and underserved communities
What does it do? IMAGINE (Interprofessional Medical and Allied Groups for Improving Neighbourhood Environment) is an interprofessional, student-run community health initiative aimed at promoting and providing holistic healthcare to the core neighbourhoods of downtown Toronto. It offers outreach activities with community partners as well as health promotion educational workshops with clients.
Approachability – Ability to perceive
Appropriateness – Ability to engage
Ability to seek
Student-led services Comprehensive PHC team – One Stop Shop
Outreach from PHC into community setting
Name of the innovation: AMP (Access to Mental health in Primary care)
Country of innovation: UK
Setting: primary healthcare model implemented in different health and community settings
Target population: people from underserved groups
What does it do? The aim of the AMP Program is to increase access to high quality primary care mental health services for people from underserved groups. It provides services that are based on a patient-centered and culturally responsive approach. The AMP model is comprised of three core components: 1) community engagement; 2) primary care quality; 3) psychosocial interventions.
Approachability-Ability to perceive
Appropriateness-Ability to engage
PHC network with community organisations
Navigation and information
Comprehensive PHC team – One Stop Shop
PHC research embedded in continuous quality improvement
Patient-centered care
  Name of the innovation: The Kalwun Development Corporation
Country of innovation: Australia
Setting: community health service
Target population: Aboriginal and Torres Strait Islander people
What does it do? The Kalwun Development Corporation provides services to Aboriginal and Torres Strait Islander people, based on a community controlled designed and led approach to the delivery of accessible, efficient, effective and appropriate comprehensive primary healthcare. The Kalwun Development Corporation offers a combination of primary healthcare and community-based services such as access to general practitioners, comprehensive screening, onsite allied health services, mobile outreach medical clinic on regular basis, immunisation and transport services. It also offers a program of care coordination to support patients with chronic diseases in accessing necessary services.
Appropriateness - Ability to engage
Approachability
Acceptability
Community governance model
Adaptation to needs of specific subpopulation
PHC network with community organisations Mobile clinic
Transportation
Innovations that combine multiple access dimensions and bridge social and health sectors Name of the innovation: Multicultural Health Brokers
Country of innovation: Canada
Setting: community organisation
Target population: Immigrants, refugees/new comers
What does it do? The Multicultural Health Brokers Co-operative supports families that are new to Canada to bridge between their own knowledge from their home country and Canada’s health, social services, education, justice, immigration and employment support systems. The Brokers are a group of 54 people who represent 22 different cultural and linguistic communities in Edmonton, Canada. They started as volunteers and were identified as natural leaders in their communities, and were brought in as a paid capacity with the Co-operative. The organisation offers a wide range of programs that cover social and healthcare needs.
Approachability
Acceptability
Availability and accommodation
Appropriateness-Ability to engage
Community health worker
Health service broker
Adaptation to needs of specific subpopulation
Outreach from PHC into community setting
Navigation & information
Advocacy
Name of the innovation: Youth projects – The Living Room Primary Health Service
Country of innovation: Australia
Setting: primary health service, mobile/outreach
Target population: homeless people
What does it do? The Living Room is a Primary Health Service that provides free healthcare and support to improve the physical, mental and social wellbeing of individuals who are homeless or at risk of homelessness, disadvantaged or marginalised, with complex healthcare needs. It provides a wide range of services such as health and social assessments, professional nursing care, counselling and active support, first aid, medication management, and follow up to clients; housing support and referral; shower and laundry facilities; food and material aid; legal support; and art therapy. It uses an assertive outreach service model to respond to the after-hours healthcare needs of the homeless community, delivering services in public spaces and crisis accommodation.
Approachability
Availability and accommodation
Affordability
Appropriateness
Comprehensive PHC team – One Stop Shop
Adaptation to needs of specific subpopulation
Mobile clinic
Name of the innovation: Grameen PrimaCare
Country of innovation: USA
Setting: primary healthcare service
Target population: immigrant women
What does it do? Grameen PrimaCare is a non-profit organisation that provides underserved women from low-income immigrant communities with a high-quality, affordable primary healthcare and health promotion program, empowering them to lead healthier lives. Grameen PrimaCare is founded on a comprehensive approach to healthcare, providing its members with access to a broad range of primary healthcare services, a wellness centre, healthcare tools and a combination of discounted services. The practice is conveniently located to recruit women from different cultural backgrounds and its team is comprised of a bilingual female doctor, two nurse practitioners and one registered nurse. Also on staff is a team of 10–13 health coaches who work to motivate members to achieve health goals, implement customised care plans, coordinate care amongst providers and connect members to additional services and resources. Grameen PrimaCare offers support groups focusing on wellness education. The curriculum covers a range of topics that engage members in becoming active participants in their health. An online platform is also available and allows members to track their own health and access educational resources that support their journey towards better health and well-being.
Approachability-Ability to perceive
Acceptability - Ability to seek
Appropriateness-Ability to engage
Affordability
Geographic location of PHC services
Adaptation to needs of specific subpopulation
Self-management coaching
Virtual monitoring of health condition
Comprehensive PHC team – One Stop Shop
PHC network with community organisations
Name of the innovation: The Blue Mountains Aboriginal healthy for life program
Country of innovation: Australia
Setting: partnership between community organisations, community health centres and General Practices
Target population: Aboriginal and Torres Strait Islander people
What does it do? The Blue Mountains Aboriginal healthy for life program is an Australian Government program that is aimed at helping Aboriginal and Torres Strait Islander people improve their health. Its specific objectives are to enhance the quality of life and health outcomes of Aboriginal and Torres Strait Islander people living with chronic and complex illnesses, and to reduce the incidence of such illnesses over time. The team is made up of two registered nurses, a male and female Aboriginal outreach worker, a Aboriginal child and family worker, a Healthy for life practice/project support officer and a program manager. The team assists by meeting in the family home or other preferred location to discuss health issues, providing a link to health professionals, doctors or specialists, and arranging regular health checks and transportation to health appointments.
Approachability
Acceptability
Appropriateness-Ability to engage
Facilitated referral for services
Adaptation to needs of specific subpopulation Comprehensive PHC team – One Stop Shop
PHC network with community organisations Transportation
Community governance model
  1. * Dimensions of access and components of interventions identifiable through the description of innovation provided by survey respondents