|Study ID||Dimensions of access of primary care services||Dimensions of ability of consumers||Outcomes|
|Approachability||Acceptability||Availability and Accommodation||Affordability||Appropriateness||Ability to (1) Perceive; (2) Seek; (3) Reach; (4) Pay; (5) Engage||Avoidable hospitalization||Avoidable ED admission||Unmet health care needs|
|Revision of professional roles|
|Gray, 2013 ||Students with symptoms of sore throat and skin infection were regularly searched||The social worker providing health care services was the same ethnic group||Health care services delivered directly at primary school, at home (for household members), regular phone contacts.||Free health care program||
Ability to perceive: education of parents on the importance of the provided services;|
Ability to reach: availability of the health care program in the primary school.
Ability to pay: free health care program
|Health care service received in a timely manner.|
|Clinical multidisciplinary teams|
|Doey, 2008 ||“One-stop shopping for clients” – co-location of primary health services with mental care.||Intervention in public health care system||Timeliness of primary health services delivery (preventive measures)||75 % decrease of hospitalization||
- 51.6 % decrease in the number of emergency visits;|
- 38 % never used emergency services.
|Crustolo, 2005 ||Referral to the dietitian by the PCP if nutrition-related problems were present||Location of dietitian in primary care.||Intervention in public health care system||Intervention was offered at an early stage of the health condition (e.g., priority to prevent childhood obesity).||
Patients were satisfied with:|
- length of wait for appointment;
- getting through by phone;
- length of time waiting;
- time spent with healthcare professional;
- explanation of what was done;
- personal manner of healthcare professional;
- major health concerns were addressed.
|McCuloch, 2000 ||Patients identified through diabetes registers||Available assessment by specialists in primary care practice||Timely assessment of patients to avoid complications (retinal screening, screening for microalbuminuria, hyperglycemia)||Decrease by 17 %||No difference|
|Michelen, 2006 ||Information about frequent users of ED (3 or more times in the past 6 months) was e-mailed to healthcare professionals who contacted them thereafter.||Healthcare professionals providing the intervention were from the same ethnical background||Patients living in three neighborhoods (Harlem, Washington Heights, Inwood) were enrolled||Ability to reach: primary care services available in the geographic catch area (neighborhood) of the intervention.||Decrease at 3 months (p = 0.002), no difference at 6 month|
|Driscoll, 2013 ||Payers are Indian Health Services, Medicaid/Medicare, independent insurers||Decrease (p < 0.001)|
|Formal integration of services|
|Day, 2006 ||Location of specialized mental health services in primary care practice.||
- length of wait prior to the first appointment (85.1 %);
- location (95.5 %);
- quality of venue (89.5 %);
- duration of the appointment (92.7 %);
- 94 % found the appointment convenient.
|Garg, 2012 ||Community services were provided appropriate to the needs (e.g., employment to unemployed participants).||Reduction of unmet social needs (50 % of families enrolled in at least one community-based resources).|
|Lamothe, 2006 ||The monitoring of health condition was from home of participants.||Timely delivery of services based on the alerts received from patients.||Ability to engage: participation of patients and healthcare professionals in decision-making regarding of the treatment options based on the measurements of vital signs.||Decrease in the number of emergency visits||
- no need to travel to physician’s office for blood pressure reading;|
- absence of waiting time to have blood pressure read by a nurse;
- better access to services and easier access to nursing and medical expertise.
|Tourigny, 2004; Hebert, 2010 [53, 64]||24/7 access to the Health Info Line for the assessment of needs.||“The single entry point” mechanism for accessing the services in the area for frail seniors with complex needs.||Intervention in public health care system||The continuous nature of the intervention (close collaborative work of PCP, case manager, and multidisciplinary team).||
- increase of hospitalization within 10 days (p = 0.043);|
- no difference within 30 or 90 days;
- higher in year 1 (31 % vs 28 %, p = 0.281);
- no difference over 4 years (p = 0.113).
- no difference within 10 days;|
- higher in year 1 and 2 (p < 0.001);
- no difference in year 3 and 4.
|Levkoff, 2004; Chen, 2006 [41, 42]||Referral to the mental health services based on the screening by primary care providers||Co-location of primary care services with mental health services||
- got the service patients wanted (p = 0.01);|
- service received met patients needs (p = 0.0001).
|Brown, 2005 ||Referral to the mental health services by the PCP; identification in the database patients with a large number of hospitalizations.||Co-location of primary care services with mental health services||Decrease (p = 0.02)||Decrease (p = 0.05)|
|MacKinney, 2013 ||Contact of identified people without insurance by the county social worker to offer an access to primary health services||Absence of co-payment for basic medical services||Decrease (13 % vs 6 %; p < 0.03)||Decrease (32 % vs 19 %; p < 0.0001)|
|Bradley, 2012 ||Contact of identified people without insurance to offer an access to primary health services||Primary care providers located near the residence of patients||Absence of payment for primary care services||Decrease (p < 0.01)||Decrease (p < 0.01)|
|Kaufman, 2000 ||Uninsured patients according the eligibility criteria were enrolled.||The program was eligible for the residents of New Mexico county only.||Small copayment depending on the poverty level (ranged from no premium to $10 per patient per month)||Ability to pay: ranged from no payment to a small monthly premium.||Decrease (p < 0.0001)||Decrease (p < 0.0001)||Decrease of time for the first appointment with PCP (from 45 to 28 days).|
|Roby, 2010 ||Uninsured patients were enrolled at the time they sought for health services.||Decrease (p < 0.05)|
|Continuity of care via case management|
|Beland, 2006 ||Intervention delivered through the public community organizations responsible for home care||The intervention team physically was located in the public community organizations||Intervention in public health care system||50 % reduction in the number of “bed-blockers” (p < 0.05) but no overall effect on hospitalization.||Trend for 10 % lower utilization (p = NS)|
|Glendenning-Napoli, 2012 ||Uninsured patients with frequent hospital and emergency use were contacted by the phone to enroll in the program.||
Ability to perceive: assessment of patient health literacy level and ability to manage health condition is a part of the intervention;|
Ability to engage: participants were involved in the development of the preventive care plan tailored to their needs.
|Decrease (p < 0.0001)||Decrease (p < 0.0007)|
|Leff, 2009; Boult, 2011 [35, 59]||Insured older patients at high risk of health service use were contacted (screening based on the insurance claims)||In-home assessment of needs||Eligible patients were those with existing insurance.||
Ability to reach: some elements of the intervention were delivered at home (e.g., assessment of needs)|
Ability to engage: involvement in the development of individual care plan.
|Decrease (p = NS)||Decrease (p = NS)|
|Shah, 2011 ||Uninsured frequent ED users were identified and enrolled||
Ability to reach: follow-up at home and during hospitalization;|
Ability to engage: involvement in the development of the individual care plan.
|Decrease (p < 0.0001)||Decrease (p < 0.0001)|
|Wang, 2012 ||Mandatory attendance of an appointment with a community health worker within 2 weeks of the release date from the prison||Health care services were provided and coordinated by a healthcare professional with a history of incarceration.||No difference (p = 0.34)||Decrease (p < 0.04)|
|Wohl, 2011 ||Services were offered to HIV patients prior their release from the prison||Services were identified in the neighborhood||Individualized care plans were developed according to the needs||Ability to engage: clients were actively involved in the development of care plan for short and long-term objectives.||No difference||No difference|
|Sylvia, 2008 ||Patients referred by PCPs||Individualized care plans were developed according to the needs||Ability to engage: patients were actively involved in the development of care plan.||Decrease (p = 0.19)||Decrease (p = 0.20)|
|Horwitz, 2005 ||Patients identified at discharge||Intervention was offered to patients living in the proximity of primary care facilitates||No difference||No difference|
|Palfrey, 2002; 2004 ||Children already receiving care in pediatric primary care practices were approached||
- In-home assessment of needs and regular home follow-up;|
- Intervention was designed for the residents of the particular neighborhood.
Ability to reach: some elements of the intervention were delivered at home (e.g., assessment of needs);|
Ability to engage: involvement in the development of the individual care plan; participation of a local parent consultant in the development and amendment of the intervention.
|Decrease (p < 0.01)||No difference||
Decrease of unmet health care needs:|
- getting a phone calls returned (61 %);
- getting an appointment (60.9 %);
- getting early medical care (61.4 %);
- getting resources for a child (59.7 %);
- getting letters of medical necessity (66.9 %);
- communicating with a child’s doctor (60.9 %);
- getting referral to doctors (60.5 %).
|Farmer, 2005 ||Patients referred to the program according to the eligibility criteria||Children residing in the region primary care clinics provide health services for.||Participants were enrolled in Medicaid fee-for-service, Medicaid managed care, and commercial health insurance||
Ability to perceive: children were already involved in the services provided by multiple medical specialists due to severe health disorder/s interfering their everyday functioning;|
Ability to reach: comprehensive assessment of needs was provided at home; a web site to ease access to additional support services online.
Ability to engage: involvement in the development of individual short-term family goals.
|Decrease (p = 0.55)||
Less need for:|
- social support (p = 0.03);
- help with family relationship (p = 0.015).
|Druss, 2001 ||Referral of patients to primary care by mental health providers||Primary care clinic located contiguous to the mental health clinics||Development of the individualized care plan according to the needs of patients.||Decrease (8.5 % vs 18 %; p = 0.12)||Decrease (11.9 % vs 26.2 %; p = 0.04)||
Fewer problems with:|
- access to care (p < 0.01);
- attention to patient preferences (p = 0.03);
- courtesy (p = 0.046);
- coordination of services (p = 0.01);
- continuity of care (p < 0.001).
|Counsell, 2007 ||Patients referred by PCPs||Individualized care plans were developed according to the needs||Ability to engage: patients were actively involved in the development of care plan||No difference except for high risk patients (decrease, p = 0.03).||Decrease (p = 0.03)|
|Callahan, 2006 ||Patients referred by PCPs||Individualized care plans were developed according to the needs||Ability to engage: patients were actively involved in the development of care plan||No difference (29.8 % vs 24.6 %, p = 0.59)|
|Continuity of care via arrangements for follow-up|
|Sin, 2004 ||Patients approached at discharge to make an appointment with their PCP||Intervention in public health care system||Continuous nature of care: from discharge to asthma control by PCP||Decrease at 3 (p = 0.53) and 6 months (p = 0.27) but no difference at 12 months (p = 0.63).|
|DeHaven, 2012 ||Patients were contacted to be enrolled in the intervention program after ED admission||To have an access to the health services, patients have to reside in the target area zip code.||Free access to health care services||Decrease (p < 0.01)|
|Feinglass, 2014 ||Uninsured residents of suburban DuPage County with a household income below 200 % of Federal Poverty Level were assigned.||Program was implemented in 45 sites across the county.||County hospitals, county government, and other foundations financially supported the program. Moreover, the Access DuPage program pays a small capitated fee to clinics and PCPs.||Ability to pay: only a small copayment was required for the prescribed medications.||Increase by 14 %.||Increase by 9 %.||
- decrease of waiting time to see a doctor/nurse (p = NS);|
- increase of clinic working hours (p < 0.0001);
- increase access trough the phone (p < 0.05);
- increase of ease to get an appointment (p < 0.05);
- increase of ease to get transportation (p < 0.05);
- increase of receiving care participants thought they needed (e.g., blood tests, appointment with a doctor) (p < 0.0001);
- increase of satisfaction to communicate with a doctor/nurse (due to language barrier) (p < 0.0001);
- increase of satisfaction with explanations doctors/nurses give (p < 0.05);
- increase of time healthcare professionals spend with patients (p < 0.05);
- satisfaction with respect healthcare professionals show (p < 0.05)