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Table 4 Characteristics of included studies (local/regional intervention): Access dimension and outcome

From: Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review

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 [61] 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 [54]    “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 [52] 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 [45] 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 [44] 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 [50]     Payers are Indian Health Services, Medicaid/Medicare, independent insurers     Decrease (p < 0.001)  
Formal integration of services
 Day, 2006 [65]    Location of specialized mental health services in primary care practice.       Satisfied with:
- 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 [26]      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 [56]    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 [29] 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 [33] 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 [34] 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 [31] 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 [46] Uninsured patients were enrolled at the time they sought for health services.        Decrease (p < 0.05)  
Continuity of care via case management
 Beland, 2006 [55] 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 [30] 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 [47] 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 [43] 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 [37] 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 [39] 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 [40] Patients identified at discharge   Intervention was offered to patients living in the proximity of primary care facilitates     No difference No difference  
 Palfrey, 2002; 2004 [32] 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 [27] 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 [36] 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 [38] 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 [51] 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 [57] 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 [48] 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)  
Institution incentives
 Feinglass, 2014 [28] 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)