Author/year/ country | Study design | Population (participants and setting) | Vulnerability context | Main characteristics of the intervention | Other elements |
---|---|---|---|---|---|
Revision of professional roles | |||||
Gray, 2013/ New Zealand [61] | Quantitative descriptive | Sample size: 400 Age: not reported. Patients: Children with rheumatic fever caused by the Group A Streptococcal infections. Setting: primary school | Children of primary school (1-8 years old), ethnic composition (Pacific and Maori). | Nurse-led school-based clinics: - social worker (ethnicity of whanau) was trained in recognition of skin infection and swabbing of sore throats; - identification of students with symptoms of a sore throat by the social worker under the supervision of the public health nurse; - medical treatment by a public health nurse (antibiotics and ointment) guided by the evidence-based guidelines; - referral of students with skin infection by the social worker to the public health nurse for the full assessment; - education of the parents on the importance and adherence to the medical treatment; - regular phone follow-up by the public health nurse; - assessment and treatment of household members at home. | Annual cost: $510 per student ($10 for consumables, $80 for diagnostic services, $420 for staffing costs). |
Clinical multidisciplinary teams | |||||
McDermott, 2001; 2004/ Australia [62] | RCT | Sample size: 21 primary healthcare centers (921 people) Age: 53.3 ± 13.6 vs 52.4 ± 14 Patients: Patients with diabetes (type 2) Setting: primary care | People with diabetes from remote indigenous communities | - implementation by the local indigenous health workers supported by a specialist outreach service in the 21 primary healthcare centers of the Torres Strait District: (i) registers of patients with diabetes; (ii) recall and reminder systems; (iii) basic diabetes care plans; - training of the local indigenous health workers in clinical diabetes care; - two-monthly newsletters. | |
Doey, 2008/ Canada [54] | NRS | Sample size: 380 (survey), 805 (charts) Age: 40.7 ± 15.2 Sex (female): 51 % Patients: Patients with mental diseases Setting: community mental health clinic | Patients with mental diseases such as depression, bipolar disorder, schizophrenia, psychosis, personality disorder | Collaborative care: - nurse practitioner was hired to provide primary care services in collaboration with the existing team of mental healthcare professionals (including nurses, social workers, a psychiatrist, a psychologist) in a community mental health clinic; - nurse practitioner’s responsibilities were assessment and treatment of non-psychiatric acute and chronic diseases, physical examination, counseling on diet, exercise, substance abuse, - the hospitalist (PCP) from the hospital treated patients outside the nurse’s scope of practice (5 afternoons per week); - availability of the physician by phone and e-mail between visits. | External funding was allocated to hire nurse practitioners. |
Crustolo, 2005/ Canada [52] | Quantitative descriptive | Sample size: 4,280 referrals annually Age: 45 % were 45-64 years old Patients: Patients with nutrition-related health conditions. Setting: primary care | Patients with dyslipidemia, type 2 diabetes, obesity. | Shared care model of collaboration of PCP and dietitian: - primary care practice received 10 h of nutrition services per month (half a day each week); - registered dietitian provided assessment of patients and consultation of PCP on nutrition-related problems; - patients were referred by the PCP (within 2 weeks after referral). | The Provincial Ministry of Health funded the intervention program in primary care practices. |
McCuloch, 2000/USA [45] | NRS | Sample size: 15,000 (approximately) Age: not reported. Patients: Patients with diabetes Setting: Managed care (200 PCPs practicing in 25 clinics) | Patients with diabetes | Group Health Cooperative program: - development of electronic registry of patients with diabetes updated daily; - joint examination of patients by PCP, diabetologist, and diabetes nurse specialist (at least one visit); - application of evidence-based diabetes guidelines (retinal screening, microalbuminuria, and glycemic management; - use of patient-friendly notebook for self-management. | Decrease in diabetic per member per month costs of $62. |
Michelen, 2006/USA [44] | NRS | Sample size: 1,250 (539 vs 711) Age (1-5 years): 27.1 % Ethnicity: 92.1 % of Hispanic Patients: Uninsured immigrants Setting: primary care, community health services | Uninsured immigrants with frequent use of the ED for preventable crisis. | The Northern Manhattan Community Voices partners program: - recruitment of a native Spanish speaker Health Priority Specialist experienced and knowledgeable of the target community and medical services; - recruitment of linguistically similar to the target population Community Health Workers; - Community Health Workers centered on direct patient and community outreach and assessment; - Community Health Workers was physically located within their community. - Health Priority Specialist were located in community medical centers; - identification of frequent users of ED and assistance to find appropriate primary care services. | |
Driscoll, 2013/ USA [50] | Mixed methods study (sequential explanatory design) | Sample size: 3,213 (390 vs 2,823) Age: not reported Participants: Alaska Native/Indian population, adults with asthma Setting: primary care | The Alaska Native and American Indian population, patients with asthma | Patient-centered medical home: - matching of the patient to the team of medical home (self-selection or assignment); - open scheduling of the appointment; - expanded office hours; - increased ability of electronic communication between patients and healthcare professionals; - delivery of care by the multidisciplinary team: PCP, physician assistant, nurse, certified medical assistant, behavioral health consultants, nutritionists; - delegation of more authority by the physicians to non-physician members (behavioral health consultants). | |
Formal integration of services | |||||
Day, 2006/UK [65] | NRS | Sample size: 289 (126 vs 163) Age: 0-18 Diseases: Children with mental health conditions. Setting: primary care | Children 0 to 18 years old with mental health conditions | Adolescent mental health outreach clinics: - staffed with three clinical child psychologists, one child and family therapist; - assessment and treatment of broad range of mental health problems; - referral of patients with more complex conditions to the specialist clinics; - referral to the outreach clinics were accepted from any sources (majority from PCPs). | |
Garg, 2012/USA [26] | Quantitative descriptive | Sample size: 1059 families Age: not reported. Participants: Low-income people Setting: Medical home | Low-income people | Health lead model: - completing a brief screening survey for social issues (e.g., food, housing) by parents at well-child care visit; - referral to the intervention team located in the pediatric clinic; - volunteer undergraduate students assist with connecting families to community-based resources through in-person meetings and telephone follow-up; - follow-up by the students; - update of referring physicians (e.g., pediatric primary care provider, nurse practitioner) on health outcomes. | |
Lamothe, 2006/ Canada [56] | Mixed methods study (convergent parallel design) | Sample size: 82 Age: 75 and older Participants: Elderly patients with severe chronic conditions Setting: primary care and community (home of patients) | Elderly patients with severe chronic conditions: cardiac insufficiency, chronic obstructive pulmonary diseases, hypertension, unstable diabetes | Telehomecare to create a network of services between hospital and primary care providers. - equipment installed at patients’ home (a scale, thermometer, sphyngmomanometer, oxymeter, and pulse; if needed glucometer, spirometer, electrocardiograph, and a system for the measure of blood clotting); - sending of measures on a daily basis to the primary care setting; - nurse of primary care responsible for monitoring and responding to alerts from patients; - telephone and home follow-up by the nurse if needed. | |
NRS | Sample size: 920 (501 vs 419) Age: 83 Sex (female): 67 % Participants: Elderly people Setting: primary care | Elderly people at risk of functional decline | Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA): - coordination between decision makers and managers at the regional and local levels; - the “single entry point” (mechanism of accessing the services such as home care, rehabilitation services, hospital services, voluntary agencies, social economy agencies); it can be access by the telephone or written referral; - 24/7 access to the general population through Health Info Line; - use of “the single assessment instrument” for evaluating needs coupled with case-mix management system; - development of the individualized service plan in collaboration of PCPs with multidisciplinary team; - computerized clinical chart to facilitate communication between organizations and healthcare professionals. | ||
RCT | Sample size: 2,022 (999 vs 1,023) Age: 65 and older Patients: Patient with mental health conditions Setting: primary care | Patients with mental health conditions such as depression, anxiety, at risk drinking | Integrated care model: - co-location of mental health and substance abuse services in primary care facility; - mental health and substance abuse services include assessment, care planning, counseling, psychotherapy, pharmacological treatment); - PCPs required to be closely involved in the patient’s care. | ||
Brown, 2005/ USA [29] | NRS | Sample size: 17 Age: 41 Sex (female): 65 % Patients: Patients with mental health problems Setting: primary care | Patients with psychiatric health conditions (e.g., depression, panic disorder) and with high level of medical admission, ED visits, frequent outpatient visits, and frequent telephone calls. | Primary intensive care: Integration of mental health services in primary care facility: - location of an internist, psychiatrist-internist, nurse practitioner, and social worker in primary care; - initial assessment (2–3 sessions) lasted longer than usual time; - multidisciplinary assessment and follow-up; - frequent visits to the clinic (weekly initially); - 24/7 availability of a team member on call via pager. - development of care plan in collaboration with PCP. | Post-intervention total hospital cost was lower (p = NS). |
MacKinney, 2013/USA [33] | NRS | Sample size: 278 (278 vs 278) Age: not reported. Patients: Uninsured population Setting: primary care | Uninsured patients (18 years old and older) with income less than 200 % of the Federal Poverty Level | Project Access Program (Milwaukee): - identification of uninsured individuals via an administrative system by the county social worker; - identification of healthcare providers willing to provide free services via online, radio, newspaper public advertising; - connections of the person in need of primary care services with a provider; - delivery of full-spectrum basic laboratory and non-invasive radiology services; - no pharmacy component. | |
Bradley, 2012/USA [34] | NRS | Sample size: 26,000 Age (mean): 34.2 Sex (female): 63 % Patients: Uninsured population Setting: primary care | Uninsured patients with income less than 200 % of the Federal Poverty Level | Community-based coordinated care program: - identification of uninsured patients in ED, outpatient or inpatient settings; - assistance with financial eligibility forms; - assignment of the primary care provider willing to provide primary care services to this category of patients; - remuneration of primary care providers: monthly management fee and fee-for-services | Over 3 years, inpatient costs per year fell by 50 % (p < 0.01) |
Kaufman, 2000/USA [31] | NRS | Sample size: 23,143 (10,029 vs 13,114) Age (19–49): 69.5 % Sex (female): 68.6 % Patients: Uninsured patients Setting: primary care | Uninsured patients below 235 % of the Federal Poverty Level not eligible for Medicaid | Managed care: - relocation of county funds to primary care sites from hospitals; - assignment of eligible patients to preferred PCPs; - each patient received a care plan identification card listing his/her PCP; - monthly premium ranged from $0 to $10 for primary care visits depending upon income level; - the benefit package also includes reduced out-of-pocket cost of medications, access to 24/7 telephone triage system; behavioral health service is not covered. - increase of staff (12 new PCPs and 5 new family nurse practitioners); - extension of clinic hours; - relocation of case managers and social workers from inpatient to primary care clinics; - relocation of alcohol and substance abuse counselors to primary care clinics. | The primary care clinics received: - capitation of $4 per plan member per month as compensation; - Medicaid professional primary care services capitation rate; - reduced fee-for-service rate for specialists. Savings of $148 per member per year on the cost of outpatient and inpatient care. |
Roby, 2010/USA [46] | NRS | Sample size: 2,708 (20,663 vs 34,079) Age (55 and older): 67 % Sex (female): 69 % Patients: Low-income uninsured population Setting: primary care | Uninsured patients (21–64 years old) with income less than 200 % of the Federal Poverty Level | Medical services initiative program (a safety-net-based system): - eligible patients are identified at the time they seek for health services; - patient is assigned to a medical home within which they choose or are assigned to the primary care provider; - patients were eligible for at least one visit to medical home within 12 months; - patients with diabetes, congestive heart failure, hypertension, asthma are required to see a doctor at least twice within 12 months; - multidisciplinary team consists of PCP, nurses, nurse practitioners, case managers/social workers; - information system connected emergency rooms and community clinics to get a history of disease by the physicians of ED; - this electronic system allowed to refer patients to their PCPs in case of nonemergent conditions; - emergency phone line staffed with registered nurses is available 24/7; - reimbursement: $15 to ED physicians for entering clinical information in the electronic system and $100 to community clinics for acceptance of referral from emergency. | PCPs are reimbursed on a fee-for-service rate based on 70 % of the Medicare fee schedule. Private providers received incentives to join the network and pay-for-performance payments for primary and preventive services. |
Continuity of care via case management | |||||
Beland, 2006/Canada [55] | RCT | Sample size: 1230 (606 vs 624) Age: 82 vs 82 Sex (female): 71 % vs 72 % Participants: Disabled elderly patients Setting: primary care | Elderly patients with chronic diseases and functional disabilities | System of Integrated Care for Older Persons (SIPA): Two public community organizations responsible for home care (Centre Local de Services Communautaires) conducted: - comprehensive geriatric assessment; - assessment of patients’ needs; - development of care plan in collaboration with PCP; - mobilization and delivery of community services; - availability of 24-h on-call services; - patients were followed between hospital and community. | - compensation of PCPs for their time communicating with the research team ($400 per patient annually); - 44 % higher community costs; - 22 % lower total institutional costs; - overall the intervention was neutral; - no difference in out-of-pocket costs. |
Glendenning-Napoli, 2012/ USA [30] | NRS | Sample size: 83 Age (50–65): 76 % Sex (female): 60.2 % Patients: Uninsured patients Setting: primary care | Uninsured patients with one or more chronic diseases (diabetes mellitus, hypertension, congestive heart failure, coronary artery disease) with frequent admissions to the ED and hospital | Intensive case management program: - identification of patients with frequent use of ED and frequent hospitalizations; - in-home assessment of patient’s needs by a registered nurse (identification of barriers to accessing health care, health literacy level); - accompany of patients to PCP to engage patients in their care; - development of preventive care plan; - in collaboration with social worker identification of patient’s need for social programs; - telephone follow-up and home visits to reinforce the intervention; - in-home education sessions on available pharmacy assistance programs. | - reduction in cost for acute outpatient visits (p < 0.009) and inpatient hospitalizations (p < 0.002); - increase in cost for primary care visits (p < 0.02). |
RCT | Sample size: 835 (433 vs 402) Age: not reported. Patients: Older patients Setting: Managed care | Older patients (65 years and older) at high risk of using health services | Practice-based team intervention: - in-home comprehensive assessment of needs by a nurse (caseload 50 to 60 patients); - development of the care plan; - facilitation of the access to community resources; - monthly follow-up; - coordination of all patient care providers; - facilitation of transition between care practices; - education and support of caregivers. | Net savings (2/3 due to reductions in hospital utilization). | |
Shah, 2011/USA [47] | NRS | Sample size: 258 (98 vs 160) Age: 46.4 ± 9.6 vs 46 ± 10.7 Sex (female): 40.8 % vs 53.1 % Patients: Uninsured population Setting: Managed care | Uninsured Medicaid population, frequent users of ED (4 or more ED admissions, 3 or more admissions, 2 or more admissions and one ED visit within 1 year) | Managed Care program: - identification of uninsured frequent users of emergency room; - assignment of a personal care manager who assists with access to social and medical resources; - personal care manager helps schedule an appointment with a PCP; - personal care manager helps bridge barriers between patients and health care system; - monthly meeting of case manager with patients (at home, resource centers, at appointment); - individually developed care plan; - daily work of case manager with a patient in case of hospital admission. | Decrease of ED (p < 0.0001) and inpatient admission costs (p < 0.001) |
Wang, 2012/USA [43] | RCT | Sample size: 200 (98 vs 102) Age: 42.9 ± 9.7 vs 43.6 ± 8.3 Sex (female): 8.2 % vs 3.5 % Patients: Individuals released from prison Setting: primary care | Formerly incarcerated people | Primary care-based, complex care management: - primary care services provided by a provider with experience working with this population and a community health worker with a personal history of incarceration ; Community health worker provides: - case management support, referrals to community-based housing, education, and employment support; - medical and social service navigation (accompanying patients to pharmacies, social services, medical and behavioral health appointments; - chronic disease self-management support (home visit for health education and medication adherence support). | The program utilized the existing resources in the community health center. The additional costs included the salary of community health worker and time of supervision. |
Wohl, 2011/USA [37] | RCT | Sample size: 89 (43 vs 46) Age: not reported. Sex (female): 23.3 % vs 30.4 % Patients: Individuals with HIV released from prison Setting: community settings | Formerly incarcerated HIV patients | Bridge case management: - training of case managers prior to start working with incarcerated patients (focus on the identification of the talents, resources, goals in non-judgmental environment); - case managers were well aware of the services available in their home and neighboring counties; - regular meeting with incarcerated people prior to and after release to identify medical and non-medical needs; - development of care plan including housing, employment, medical care, substance abuse counseling; - transition to community case management and local services after 6 months of follow-up; - caseload of 15 clients per patient | |
Dorr, 2008/USA [49] | RCT | Sample size: 3,432 (1,144 vs 2,288) Age (mean): 76.2 ± 7.2 vs 76.2 ± 7.1 Sex (female): 64.6 % vs 64.6 % Patients: Elderly patients with chronic diseases Setting: primary care | Elderly patients with chronic diseases: diabetes, depression, hypertension, congestive heart failure | Care Management Plus: - training of care managers (nurses) on care for seniors, caregivers, chronic disease assessment, care standards; - integration of the information technology tools (structured protocols, guidelines, tracking database) and electronic health record system in primary care facilities; - placement of care managers in primary care facilities; - referral of patients with chronic care needs by PCPs to care managers for assessment and enrolment in care management services. | |
Sylvia, 2008/USA [39] | NRS | Sample size: 127 (62 vs 65) Age (mean): 74.1 vs 75.8 Sex (female): 60.3 % vs 47.7 % Patients: High risk elderly patients with chronic diseases Setting: primary care | Elderly patients with chronic diseases congestive heart failure, hypertension, diabetes, dementia, depression | Guided Care: Trained registered nurses working in primary care practices, in close collaboration with PCPs (1 nurse per 2 PCPs): - assess patient and caregiver needs; - develop an individualized care plan; - promote patient self-management; - monitor patient’s condition; - coordinate transitions between healthcare services; - facilitate access to community resources. | Lower insurance expenditures (p = 0.35) |
Gravelle, 2007/UK [60] | NRS | Sample size: 64 intervention primary care practices Age: not reported. Patients: Elderly patients (≥65 years old) and a history of emergency admission Setting: primary care | Elderly patients at high risk of emergency admission | Case management: - development of individualized care plan by the nurse practitioners in collaboration with PCP; - coordination of services to prevent fragmentation of services; - arrangement of access to community-based services. | |
Horwitz, 2005/USA [40] | RCT | Sample size: 230 (121 vs 109) Age (mean): 51.2 % vs 50.5 % (less than 30 years old) Patients: Uninsured population Setting: primary care | Uninsured patients (except substance abuse and mental health issues) | The Community Access Program: - identification of uninsured patients before discharge from the hospital who don’t have a PCP; - assistance with enrolment to one of four PCPs; - faxing the patient data to a case managers of the primary care facility; - case managers contacted the patients to arrange an appointment. | Reduction in average cost of an emergency room visit |
Palfrey, 2002/USA [32] | NRS | Sample size: 267 (150 vs 117) Age (0–5): 56 % vs 55.6 % Sex (female): 33.3 % vs 33.3 % Patients: Children with special health care needs Setting: primary care | Children with special health care needs | Pediatric Medical Home: - designation of a pediatric nurse practitioner (PNP); - designation of a lead PCP; - arrangement of the schedule for the PNP (8 h per week devoted to the management of children with special needs) by the lead physician; - in-home follow-up by the PNP; - assistance with appointments and medication supply; - development of the individualized health plan; - sharing of the health plan and evolution of the condition with specialists; - participation of a local parent consultant. | |
Farmer, 2005/USA [27] | NRS | Sample size: 102 (51 vs 51) Age: 7.4 ± 5.1 Participants: Children with special health care needs Setting: primary care | Children with special health care needs (mental and neurological disorders, congenital anomalies) | Medical home: - delivery of care by PCP, nurse practitioner, a parent consultant; - nurse practitioner provides: a home visit to conduct comprehensive assessment of medical and non-medical needs, a personalized letter describing health and services available to meet these needs, an individualized health plan for the child, at least 1 follow-up; - nurse practitioner acted as consultant for 3 primary care practices; - nurse practitioner interacts regularly with referring physicians and a designated nurse at each primary care practice; - medical care was provided by these practices; - a web-site was developed to ease access to additional supports and recourses by families and physicians. | |
Druss, 2001/USA [36] | RCT | Sample size: 120 (59 vs 61) Age (mean): 45.7 ± 8.4 vs 44.8 ± 8.0 Sex (female): 0 % vs 1.6 % Patients: Patients with mental disorders Setting: primary care | Patients with mental disorders: schizophrenia, posttraumatic stress disorder, major affective disorder, substance abuse | Integrated care: Integrated mental health service in the primary care (a multidisciplinary team of a nurse practitioner, PCP, a nurse case manager, physicians in the psychiatry and mental health clinics): - supervision of the nurse practitioner (providing basic medical care) by the primary care provider; - primary care provider is a liaison of primary and specialized services; - the nurse provides education, preventive services, follow-up (telephone, e-mail, face-to-face), schedules an appointment; - the nurse practitioner serves as a liaison of 3 mental health teams. | |
Counsell, 2007/USA [38] | RCT | Sample size: 951 (474 vs 477) Age (mean): 71.8 ± 5.6 vs 71.6 ± 5.8 Sex (female): 75.5 % vs 76.5 % Patients: Low-income seniors Setting: primary care | Low-income seniors (less than 200 % of the Federal Level of Poverty) with geriatric conditions such as difficulty walking, falls, pain, urinary incontinence, depression, vision and hearing problems, dementia | Geriatric Resources for Assessment and Care of Elders (GRACE): - in-home comprehensive geriatric assessment by a nurse/social worker; - development of individualized care plan by a multidisciplinary team (a geriatrician, pharmacist, physical therapist, mental health social worker, community-based services representatives); - regular meeting of the multidisciplinary team and PCP; - ongoing support via en electronic medical records and web-based tracking system. | |
Landi, 2001/Italy [63] | NRS | Sample size: 1204 (before-after) Age (mean): 77.4 ± 9.7 Sex (female): 58.5 % Patients: Frail older people Setting: primary care | Frail older people | Home care program: - development of the community Geriatric Evaluation Unit (“a single enter center”) consisting of a geriatrician, a social worker, a physiotherapist, nurses jointly with a PCP; - initial and follow-up assessments by case manager (a nurse); - coordination of services delivery; - facilitation of access to community-based services; - PCP involved directly in care planning, case finding, and emergency situations. | 27 % cost reduction with an estimated saving of $1,200 for each patient |
Callahan, 2006/USA [51] | RCT | Sample size: 153 (84 vs 69) Age (mean): 77.4 ± 5.9 vs 77.7 ± 5.7 Sex (female): 46.4 % vs 39.1 % Patients: dementia patients Setting: primary care | Patients with dementia living in the community | Collaborative care model: - development of individualized care plan for the patient-caregiver dyad; - regular assessment of patients’ condition; - medication management by PCP; - weekly review of care and adherence to guidelines by multidisciplinary team (geriatric nurse practitioner, PCP, geriatrician, geriatric psychiatrist, psychologist) - monitoring of health condition and communication of healthcare professionals via web-based system. | $1000 annual cost of the case manager per patient (75 patients per year) |
Continuity of care via arrangement for follow-up | |||||
Sin, 2004/Canada [57] | NRS | Sample size: 125 (63 vs 62) Age: 22.5 ± 13.7 vs 22.7 ± 12.6 Sex (female): 46 % vs 74 % Patients: Patients with asthma Setting: primary care | Patients with asthma | Enhanced care: - follow-up appointment with PCP within 4 weeks of discharge; - a study coordinator makes an appointment on behalf of the patient; - in case a patient does not have a PCP, he is offered to choose from a list of physicians willing to accept new patients; - a reminder telephone call 1 or 2 days before the scheduled follow-up visit; | |
DeHaven, 2012/ USA [48] | NRS | Sample size: 574 (265 vs 309) Age: 35.7 ± 12 vs 35 ± 12.1 Participants: Uninsured adults Setting: primary care | Uninsured low-income working individuals | Project Access Dallas: - monthly meeting with a community health worker; - patients assigned to a PCP; - referral to the specialist if needed; - pharmacy benefits ($750 a year); - PCPs and specialists donated their services depending on their capacity | The intervention resulted in less direct (p < 0.01) and indirect costs (p < 0.01). |
Institution incentivesa | |||||
Addink, 2011/UK [58] | NRS | Sample size: 24 practices in three local primary care trusts Age: not reported. Participants: Ethnic minority. Setting: primary care | Patients from ethnic minority groups (non-white ethnicity) | Pay for performance scheme: Primary care practices received payment according to their performance based on the reporting of their patients. | - £36 million received for participation; - £72 million received based on the positive responses of patients (£1.37 per highly satisfied registered patient). |
Tan, 2012/New Zealand [66] | Mixed methods study (convergent parallel design) | Sample size: the whole population Age: not reported. Patients: Ethnic and refugee communities, young people Setting: primary care | Prioritized population: high deprivation, Maori, Pacific communities, refugees, young people | Primary care framework: Sustained and targeted investments over five years in: - development of service delivery for equitable access (community health workers, additional nurses and outreach services, youth service); - engagement of healthcare professionals to develop these services; - development of health approaches in collaboration with ethnic groups (e.g., iwi); - information sharing across the range of support services; - building on intersectoral relationships; - promotion of preventive programs (e.g., increase of physical activity); - support of leadership by clinicians in more community-based care. | $6 M of annual funding over five years |
Feinglass, 2014/USA [28] | NRS | Sample size: 293 (138 vs 158) Age (45–64): 48.8 % vs 58.8 % Sex (female): 68 % vs 60 % Participants: Uninsured adults Setting: primary care | Uninsured adults with a household income below 200 % of Federal Poverty Level. | County Health Care program (Access DuPage): - assigns patients to PCPs; - pays a small capitated fee to primary care clinics and PCPs while most of funding comes from county hospitals, county government, and foundations; - coordinates purchase of medications with small enrollee copays; - handles applications for Drug Assistance Programs which provides enrollees with medications. | Decrease of amount of payment/copayment for a visit (p < 0.0001). |
Capitationa | |||||
NRS | Sample size: 574 (265 vs 309) Age: 2–17 Participants: Children with chronic health conditions Setting: primary care | Children with common chronic health conditions such as attention deficit disorder, mental retardation, Down syndrome, asthma, cerebral palsy, sickle cell anemia, muscular dystrophy, autism, congenital or other heart diseases, diabetes. | Primary care case management: - PCPs are paid for care coordination to serve as “gatekeeper” for referrals to specialty services; - care provided by PCPs is focused on early intervention, appropriateness, and coordination. |