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Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations

International Journal for Equity in Health volume 19, Article number: 174 (2020) Cite this article

Abstract

Background

Achieving equity of access to primary healthcare requires organizations to implement innovations tailored to the specific needs and abilities of vulnerable populations. However, designing pro-vulnerable innovations is challenging without knowledge of the range of possible innovations tailored to vulnerable populations’ needs. To better support decision-makers, we aimed to develop a typology of pro-vulnerable organizational innovation components – akin to “building blocks” that could be combined in different ways into new complex innovations or added to existing organizational processes to improve access to primary healthcare.

Methods

To develop the typology, we used data from a previously conducted a) scoping review (2000–2014, searched Medline, Embase, CINAHL, citation tracking, n = 90 articles selected), and b) environmental scan (2014, online survey via social networks, n = 240 innovations). We conducted a typological analysis of the data. Our initial typology yielded 48 components, classified according to accessibility dimensions from the Patient-Centred Accessibility Framework. The initial typology was then field-tested for relevance and usability by health system stakeholders and refined from 2014 to 2018 (e.g., combined similar components, excluded non-organizational components).

Results

The selected articles (n = 90 studies) and survey responses (n = 240 innovations) were mostly from the USA, Canada, Australia and the UK. Innovations targeted populations with various vulnerabilities (e.g., low income, chronic illness, Indigenous, homeless, migrants, refugees, ethnic minorities, uninsured, marginalized groups, mental illness, etc.). Our final typology had 18 components of organizational innovations, which principally addressed Availability & Accommodation (7/18), Approachability (6/18), and Acceptability (3/18). Components included navigation & information, community health worker, one-stop-shop, case management, group visits, defraying costs, primary healthcare brokerage, etc.

Conclusions

This typology offers a comprehensive menu of potential components that can help inform the design of pro-vulnerable organizational innovations. Component classification according to the accessibility dimensions of the Patient-Centred Accessibility Framework is useful to help target access needs. Components can be combined into complex innovations or added to existing organizational processes to meet the access needs of vulnerable populations in specific contexts.

Background

Equity of access to healthcare – and specifically, to primary healthcare – is a core value in public policy and a feature of highly-performing health systems in many high-income countries [1,2,3]. Although reforms to strengthen primary healthcare often invoke equity as a principal goal, they rarely succeed in adequately reaching vulnerable populations whose needs tend to be more complex than those of the general population [4,5,6,7,8,9]. Indeed, many innovations to improve access to care tend to favour the wealthiest or most educated segments of the population – as famously captured by the Inverse Care Law [10]. Achieving healthcare equity, therefore, requires organizations to implement pro-vulnerable innovations, tailored to reach and meet vulnerable populations’ specific needs [11].

Vulnerable populations are groups or individuals who are more susceptible to harm because they lack the personal, material, and social resources to successfully cope with the challenges they face and to counter potential harm [12]. These populations are at higher risk for poor health status and problematic access to healthcare [4, 13]. Vulnerable populations include: Aboriginal or Indigenous communities, refugees, visible ethnic minorities, individuals living in poverty, people experiencing homelessness, people with disabilities, people with limited social support, those with complex health conditions, certain age groups; and many other marginalized and underserved populations [4, 13,14,15,16,17]. Inequitable access to healthcare stems from gaps between vulnerable populations’ abilities to access care, and healthcare organizations’ accessibility (see Fig. 1) [18]. To close these gaps, healthcare organizations must adapt their accessibility to vulnerable populations’ abilities. However, designing pro-vulnerable innovations is challenging for decision-makers, providers, and other health system stakeholders, as they may lack knowledge of the range of possible innovations to address vulnerable populations’ specific needs.

Fig. 1
figure 1

Patient-Centred Accessibility Framework [18]

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This challenge of designing pro-vulnerable innovations was highlighted in our “Innovative Models Promoting Access-to-Care Transformation” (IMPACT) research program [19]. IMPACT brought together local health system decision-makers, providers, primary healthcare researchers, community members, and other stakeholders in six regions in Canada and Australia. In each region, a local multi-stakeholder partnership designed and piloted an organizational innovation aiming to improve access to primary healthcare for vulnerable populations. A foundational premise of the IMPACT program was that innovations should aim to adapt primary care organizations and service delivery arrangements to meet vulnerable populations’ needs, rather than placing the onus solely on vulnerable populations to improve their abilities to access care. To inspire local health system partners, the research team was to provide a menu of existing pro-vulnerable organizational innovations to improve access to primary care.

Substantial research has been conducted on interventions to improve the delivery of care – most notably the taxonomy produced by the Effective Practice and Organisation of Care (EPOC) Group Cochrane Review Group [20]. However, they provide an overview of general interventions that, for the reasons highlighted above, may not address the specific needs of vulnerable populations. Early in the IMPACT program, members of the team conducted a scoping review of studies that described organizational innovations that improved vulnerable populations’ access to primary healthcare – significantly reducing unmet need for care, use of hospital emergency rooms or hospital admissions [17]. This scoping review [17] presented complex interventions, mapped onto the EPOC taxonomy, in which various components of interventions appeared across different interventions. While decision-makers appreciated having results specific to vulnerable populations, they found transposing the results to their contexts challenging and, therefore, of limited use to inform the design of organizational pro-vulnerable innovations.

To better support decision-makers, we aimed to develop a typology of pro-vulnerable organizational innovation components – akin to “building blocks” that could be combined in different ways into new complex innovations or added to existing organizational processes. This typology is intended to provide a comprehensive range of components of organizational innovations to be considered by health service decision-makers as options to address the primary healthcare access needs of vulnerable populations.

Methods

Design: typology

We developed a typology of components of organizational innovations. A typology is a description and categorization of complex organizational forms [21] developed using qualitative (or quantitative) analysis [22]. The goal of a typology is to divide a whole phenomenon – in our case, organizational innovations to improve access to primary healthcare for vulnerable populations – into distinct but related categories [22, 23]. Typologies have been used in primary healthcare with the intent of guiding organizational change and can provide a “menu” of items to inform the design of interventions [24,25,26,27,28,29]. In a “typology” – as opposed to a “taxonomy” – items are not ordered hierarchically and are not entirely mutually exclusive.

A qualitative typology is generally structured around a conceptual framework that helps classify emerging categories [22, 23]. In the IMPACT research program, access to primary healthcare for vulnerable populations was conceptualized primarily based on the Patient-Centred Accessibility Framework [18]. This framework posits that access to healthcare results from the interaction, at different stages, between organizational dimensions of healthcare and patients’ abilities (Fig. 1). We focused on the dimensions of accessibility on the organizational side of the framework (i.e., Approachability, Acceptability, Availability & Accommodation, Affordability, and Appropriateness).

Inspired by Greenhalgh et al. [30], we defined organizational innovations as: “a novel set of organizational behaviours, routines, and ways of working that are directed at [a common objective] and that are implemented by planned and coordinated actions.” Organizational innovations to improve access to primary healthcare for vulnerable populations were identified from two complementary sources of data: a) a scoping review of the peer-reviewed literature [17] and b) an environmental scan [16]. Both are described briefly below and have been described in detail elsewhere [16, 17]. The scoping review and scan were conducted as part of the IMPACT research program [19].

Data source: a) scoping review

A scoping review was conducted to explore the breadth of available evidence on organizational innovations in primary healthcare [17]. The search focused on academic, peer-reviewed literature and was conducted in three of the largest and most relevant databases for studies related to primary healthcare (Medline, Embase, and CINAHL). The search was performed by a specialized librarian (see an example of the search strategy in Additional file 1). In addition to the database searches, four primary care experts from the IMPACT team (including JH) were asked to share their personal primary care reference files, from which citation tracking was performed to identify additional relevant studies. The search was limited to articles published between January 2000 and March 2014, a period corresponding to an international commitment to strengthening primary healthcare, up to the beginning of the IMPACT program. One researcher (VK) scanned 8694 titles and abstracts for relevance, then assessed 1760 potentially relevant studies for eligibility. For the typology, we selected any quantitative, qualitative, or mixed methods studies carried out in Organization for Economic Cooperation and Development (OECD) countries and published in English or French that met all four of the following eligibility criteria:

  1. (1)

    involved at least one organization at the primary healthcare level in the health system;

  2. (2)

    was organizational (not directed at the system as a whole or only to the population);

  3. (3)

    had an explicit objective to improve access to care;

  4. (4)

    was directed to a vulnerable population.

The 129 eligible full texts were read by three team members (MAS, JH, SD) to select 90 articles where innovations were described in detail.

Data source: b) environmental scan

The environmental scan was conducted after the review. It was designed to capture organizational innovations that had not been published in the academic literature [16]. Briefly, a 5-min online survey was disseminated using a social network approach over 6 weeks between July 10 and August 21, 2014. Primary healthcare informants known to the research team were sent a link to the online survey by email and, in turn, were asked to share the survey link within their social networks. The survey was also promoted on social media through 248 posts on Twitter linked to findings of interest and emerging findings from the survey. Participants were invited to identify a program, service, approach, or model of care that they considered innovative in helping vulnerable populations access primary healthcare. They were encouraged to provide links to any available description, such as websites or documents. The definition of an organizational innovation was left to the discretion of the respondents to ease the response burden. We received 744 survey responses. After screening innovations for eligibility and redundancy, 240 unique innovations were retained for the typology.

Typological analysis

We conducted a typological analysis [22, 23]: first, a) of the selected peer-reviewed articles (n = 90) and, subsequently, b) of the selected survey responses (n = 240). Each article (n = 90) was carefully read independently by two individuals (MAS, SD), who focused on the ‘types’ of organizational innovations that addressed accessibility and highlighting all passages describing the innovation. The highlighted passages were used to draft a detailed description of each innovation in an Excel document. For each article, we also extracted information about the setting, target population, and vulnerabilities addressed (e.g., frail elderly, homeless, Aboriginal, low income). Reading the detailed description of each innovation, we used a predominantly inductive approach, grouping similar components recurring across organizational innovations. The unit of analysis was a distinct component that could either be a stand-alone intervention (navigation & information), or a combination of components consistently occurring together (e.g., case management, advanced access). We applied standard labels to components where possible (e.g., community health worker) and descriptive labels to others (e.g., proactive identification of need, cultural adaptation).

Subsequently, the emerging typology components were tested by coding the survey responses (n = 240) from the scan. Two individuals (MAS, LR) independently coded the responses in an Excel document, then met to resolve discrepancies and discuss possible additions and clarifications to the typology components.

Our initial analysis yielded 48 unique innovation components. Most of the innovations reported in the studies were complex interventions that involved 1–14 components, with an average of six components each. Almost all components were established in the first 40 published studies; analysis of additional published studies and the environmental scan led to refinements. The scoping review and scan data coding were reviewed based on this initial typology and adjusted for consistency and to ensure all relevant components had been captured. We then reviewed the innovations coded to each component of the typology to write a short general description of the component and to select illustrative examples of the component.

Two individuals (MAS, JH) then reviewed the initial typology components, descriptions, and examples and mapped them to the organizational dimensions of the Patient-Centred Accessibility Framework [18]. The classifications were based on principal and secondary dimensions of accessibility addressed by the component. Discrepancies in classification were resolved through discussion and checked by the rest of the team.

Typology field-testing and refinement

The scoping review and environmental scan were conducted in 2014. From 2014 to 2018, the initial typology was presented to academic audiences and field-tested with local partners (e.g., decision-makers, patients, health professionals, researchers) to help them design pro-vulnerable organizational innovations to improve access to primary healthcare. When these initial components were presented to local partners and peers at conferences, they affirmed that the initial 48 components were useful for expanding the options to be considered when designing an innovation. However, they also perceived redundancy between components or lack of direct relevance to accessibility. Therefore, we excluded components that were not organizational components per se, but rather resourcing mechanisms: student health professionals, financial incentives, organizational networks, and provider education. We also excluded components that are, in fact, care attributes, such as transparency, advocacy, patient-centred care, and empowerment. Finally, we excluded a few components that applied more to the content or quality of care, such as quality improvement initiatives or self-management education. Components of a similar nature were further collapsed into 18 components of organizational innovations.

Results

Organizational innovation characteristics

The 90 selected peer-reviewed studies were set in: the USA (n = 60) [31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90], Canada (n = 9) [91,92,93,94,95,96,97,98,99], Australia (n = 8) [100,101,102,103,104,105,106,107], UK (n = 6) [108,109,110,111,112,113], New Zealand (n = 2) [114, 115], Israel (n = 2) [116, 117], Italy (n = 1) [118], Mexico (n = 1) [119], and Germany (n = 1) [120]. For the environmental scan survey, 45.0% of responses originated from Canada, 40.8% from Australia, 9.4% from others countries (e.g., Ireland, UK, USA, Netherlands, Italy, Israel, Switzerland, Cameroon, India, Indonesia, Sudan) and 4.8% were missing country information [16].

The organizational innovations identified in our data targeted a wide variety of vulnerable populations. Targeted populations typically combined various vulnerabilities, most commonly: low-income, chronic illnesses, Indigenous populations, homeless, migrant or refugee status, ethnic minorities, uninsured or underinsured, marginalized groups (drug users, recently incarcerated), persons with mental illness, the frail elderly, at risk youth, and frequent users of emergency departments.

Typology

The final typology was comprised of 18 components of organizational innovations, presented with examples [42,43,44, 54,55,56,57,58,59,60,61, 78,79,80,81,82,83, 94,95,96, 105, 110, 113, 119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136] in Table 1. The innovation components are organized by the principal accessibility dimension they address. The 18 components principally addressed the dimensions of Availability & Accommodation (7/18), Approachability (6/18), and Acceptability (3/18). Only one component addressed each of Affordability and Appropriateness as principal dimensions, although these were addressed as secondary dimensions as part of other innovation components.

Table 1 Typology of organizational innovation components to improve access to primary healthcare for vulnerable populationsa
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Discussion

The integration of the scoping review and environmental scan of innovations along with field-testing resulted in a typology of 18 components of organizational innovations to enhance the accessibility of primary healthcare for vulnerable populations. The typology was based on both published and unpublished innovations. It offers a comprehensive menu of potential components that can help inform the design of innovations and can be combined into complex interventions or added to existing organizational processes to meet the access needs of vulnerable populations. Mapping of the components to the accessibility dimensions of the Patient-Centred Accessibility Framework [18] allows health service designers to match appropriate innovations to identified access needs.

The typology offers a categorization of health service delivery arrangements inspired by the Cochrane taxonomy of EPOC [20], but tailored to the needs of service designers and specific to the domain of access for vulnerable populations. The ultimate goal is to improve healthcare equity through pro-vulnerable innovation design. A few components are similar to those found in the EPOC and are not specific to vulnerable populations, including group visits, expanded hours, advanced access, virtual health services, one-stop-shops, and role expansion. However, they have been demonstrated to be well-suited to address the needs of specific vulnerable populations, although organizations still have to be intentional about a pro-vulnerable focus to achieve healthcare equity. Other components in the typology are specifically designed to address the needs of vulnerable populations and differ from the EPOC taxonomy. Proactive identification of need, proactive appointment making and contact, and outreach pull vulnerable persons into primary healthcare and maintain contact rather than placing the onus on vulnerable populations to perceive their needs and navigate the care-seeking process. Similarly, community health workers, service brokerage, and transportation services bridge the gap between the health system and vulnerable populations.

Despite the intention to make labels and descriptions as mutually exclusive as possible, there was considerable overlap between some components. For instance, navigation and information and proactive identification of need, although implemented as stand-alone innovations, are also functions of community health workers and case managers. Likewise, culturally adapted services or inter-organizational pathways are functions of community health workers or role expansion innovations; these can be implemented as stand-alone interventions or added to existing organizational processes to address an accessibility need.

Using the typology in the design of innovations

This typology is intended to provide “building blocks” that can be combined into complex innovations or added to existing organizational processes to address specific access needs of vulnerable populations. The analysis done by Khanassov et al. [17] emphasizes that interventions are most effective in reducing unmet needs, emergency department visits, and hospitalizations when the intervention components are formally coordinated or integrated with other parts of the health system. Integration and coordination are critical considerations in implementing any of these interventions.

The Patient-Centered Accessibility Framework [18] is helpful in both identifying the access needs of the population and the components that are most appropriate to address those needs. For example, a population that frequently visits the emergency department may require an innovation that targets Approachability or Acceptability (e.g., navigation & information, proactive identification of need, culturally adapted services). Conversely, if the target population is seeking services but is disengaged from ongoing care, then Appropriateness-related components such as proactive appointment-making, case management, or one-stop shops may be better suited.

It is not surprising that most of the innovation components pertain to Approachability and Availability & Accommodation. Several studies have highlighted that vulnerable populations often face difficulties perceiving health needs, navigating the health system to find services, finding time to obtain services, making an appointment, and finding transportation to reach services [18, 137,138,139]. This typology emphasizes the importance of addressing barriers early in the care-seeking trajectory and provides a range of potential solutions to mitigate these barriers.

Although other components addressed Affordability as a secondary dimension, it is surprising that only one component in the typology (defraying costs to patients) related principally to Affordability, especially given the importance of direct and indirect cost as a barrier to care for vulnerable populations [140,141,142,143]. This result is partly due to our focus on identifying organizational innovations that can be implemented by a single organization or sub-system. Macro-level ‘innovations,’ such as universal health insurance and the Affordable Care Act, were excluded from our analysis because they are country-level legislative policies rather than organizational innovations.

Example of how the typology has been used

As mentioned, the typology was field-tested for relevance and usability in our local partnerships between 2014 and 2018 as they designed and piloted innovations to address local access priorities for vulnerable populations. In the local partnership in Quebec (Canada), a preliminary version of the typology was used to inform discussions about the design of an innovation for patients from disadvantaged neighbourhoods who face barriers connecting with a regular primary care provider. The innovation was a combination of several components: trained volunteer community members (inspired by community health workers) reached out to patients from disadvantaged neighbourhoods who were on the provincial centralized waiting list to find a primary care provider (existing primary healthcare brokerage) to screen for potential access barriers (proactive identification of need). These volunteers provided support by telephone before and after their first visit with their new primary care provider, including discussing the importance of attending the first visit, offering information about the clinic, giving visit preparation materials, and providing general information about the health system (navigation & information). Stakeholders in the local partnership perceived the typology as a useful tool to expand the menu of innovations and to reflect on how components could be added to existing organizational processes. Furthermore, we used the typology and the Patient-Centred Access Framework [18] to describe each local partnership’s innovations. This tool allowed the IMPACT research team, which spanned six sites in Canada and Australia with different contexts, languages, and terminology, to clarify their aims, improve mutual understanding across sites, and compare their innovations.

Implementing components of an innovation

The selection of components as part of a complex innovation also depends on the resources and implementation control available to innovation designers. The decision to implement components such as group visits, drop-in services, facilitated appointment making, expanded hours, culturally adapted services, case management, or advanced access are generally within the control of a single primary healthcare organization and can be resourced through the reorganization of existing resources. In contrast, components such as outreach of primary healthcare services, transportation, and navigation & information services require investment of new resources that may be possible for a single organization with a strong commitment and sufficient resources. Other components, such as role expansion and virtual health services, may require changes at a higher level since they involve changes beyond the reach of a single organization. For instance, role expansion – such as nurses working at the top of their scope of practice or empowering front office staff to refer patients to social workers – may require collaboration with professional associations to modify regulations governing professional practice. Similarly, implementing a community health worker may require collaboration with other organizations to set up certified training programs or to secure funding to cover salaries. Similarly, one-stop shops or inter-organizational pathways are based on collaborations between various organizations outside of primary healthcare and require substantial support and political will from local or regional health authorities for implementation.

Strengths and limitations

Because we achieved saturation with the peer-reviewed articles from the scoping review and descriptions of innovations from the environmental scan, we are reasonably confident that this typology reflects the most common innovation components to improve access for vulnerable populations. We recognize that we have excluded innovations outside the study period. Yet, as 2000 to 2014 represents a period of renewal and reform for primary healthcare marked by an effervescence of innovations, we believe that we have captured the most common components to improve access to primary care. Since 2014, we have continued to test the comprehensiveness of our typology by informally comparing it to innovations described in more recent peer-reviewed studies (although we did not use the systematic approach applied to the literature of the study period). In subsequent presentations to international audiences at conferences, we heard of additional examples of innovations, such as organizational arrangements between hospitals and farmers’ markets, but were able to locate them within typology components. We have not found any new components emerging from more recent literature or examples of innovations to add to our typology. An additional strength of this study is that from 2014 to 2018, the typology was field-tested for usability and relevance with local partners to design pro-vulnerable innovations. We are therefore reasonably confident that, although a new scan or scoping review would add detail and examples to the typology, it would not fundamentally change the components.

We also recognize that our scoping review data, from which we developed our initial typology components, described innovations in only nine OECD countries (Canada, USA, UK, Australia, Germany, New Zealand, Italy, Israel, and Mexico). We minimized the effect of publication bias by doing an environmental scan to identify unpublished innovations, but this method is susceptible to selection bias. Most responses came from Australia and Canada, and running the survey during the Northern Hemisphere’s summer may have limited responses from Europe and the USA. We also have no way of assessing the response rate or comprehensiveness of responses gathered using the social media approach. Although we did have a small number of respondents from low-income countries in our environmental scan, our approach may have excluded some innovative initiatives in low- and middle-income countries (e.g., community-based insurance plans [144], identification of accredited clinics [145], and subsidized payments for primary healthcare services [146]. Another example is the well-known hub-and-spoke models in India [147], which combine role expansion with inter-organizational pathways to provide low-cost, high-quality services to underserved populations [148].

A final limitation is that the typology labels reflect available examples and the judgment and language of the analysts. Labels such as proactive identification of need are clumsy but they circumscribe a unique set of examples.

Conclusions

This typology is unique as it presents components of innovations that can be put in place by primary healthcare organizations or other health system stakeholders to improve access to primary healthcare for vulnerable populations. Further research on the effectiveness of combining different components may help inform efforts to improve access for vulnerable populations.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

EPOC:

Effective Practice and Organization of Care

IMPACT:

Innovative Models Promoting Access-to-Care Transformation

OECD:

Organization for Economic Cooperation and Development

References

  1. World Health Organization. Declaration of Alma-Ata. International Conference on Primary Health Care. Alma-Ata, USSR; 1978.

    Google Scholar 

  2. World Health Organization. Primary care, now more than ever. Geneva: World Health Organization; 2008.

  3. World Health Organization. Health systems financing: the path to universal coverage. Geneva: World Health Organization; 2010.

  4. Harris MF, Harris E, Roland M. Access to primary health care: three challenges to equity. Aust J Prim Health. 2004;10(3):21–9.

    Article  Google Scholar 

  5. Bowen S. Access to health services for underserved populations in Canada. In: Health Canada. "Certain circumstances": issues in equity and responsiveness in access to health care in Canada. Ottawa: Health Canada; 2001. p. 1–60.

  6. Spike EA, Smith MM, Harris MF. Access to primary health care services by community-based asylum seekers. Med J Aust. 2011;195(4):188–91.

    Article  PubMed  Google Scholar 

  7. Khandor E, Mason K, Chambers C, Rossiter K, Cowan L, Hwang SW. Access to primary health care among homeless adults in Toronto, Canada: results from the street health survey. Open Med. 2011;5(2):e94–e103.

    PubMed  PubMed Central  Google Scholar 

  8. Hutchison B, Levesque J, Strumpf E, Coyle N. Primary health care in Canada: systems in motion. Milbank Q. 2011;89(2):256–88.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bennett CC. A healthier future for all Australians: an overview of the final report of the National Health and hospitals reform commission. Med J Aust. 2009;191(7):383–7.

    Article  PubMed  Google Scholar 

  10. Hart JT. The inverse care law. Lancet. 1971;297(7696):405–12.

    Article  Google Scholar 

  11. Haggerty J, Chin MH, Katz A, Young K, Foley J, Groulx A, et al. Proactive strategies to address health equity and disparities: recommendations from a bi-national symposium. J Am Board Fam Med. 2018;31(3):479–83.

    Article  PubMed  Google Scholar 

  12. Mechanic D, Tanner J. Vulnerable people, groups, and populations: societal view. Health Aff. 2007;26(5):1220–30.

    Article  Google Scholar 

  13. Shi L, Stevens GD. Vulnerability and unmet health care needs. The influence of multiple risk factors. J Gen Intern Med. 2005;20(2):148–54.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Meyer SB, Luong TC, Mamerow L, Ward PR. Inequities in access to healthcare: analysis of national survey data across six Asia-Pacific countries. BMC Health Serv Res. 2013;13:238.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Comino EJ, Davies GP, Krastev Y, Haas M, Christl B, Furler J, et al. A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care. BMC Health Serv Res. 2012;12:415.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Richard L, Furler J, Densley K, Haggerty J, Russell G, Levesque J-F, et al. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. Int J Equity Health. 2016;15:64.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Khanassov V, Pluye P, Descoteaux S, Haggerty JL, Russell G, Gunn J, et al. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review. Int J Equity Health. 2016;15:168.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Russell G, Kunin M, Harris M, Levesque J-F, Descôteaux S, Scott C, et al. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open. 2019;9(7):e027869.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Effective Practice and Organisation of Care Cochrane Review Group. EPOC Taxonomy. 2015. https://epoc.cochrane.org/epoc-taxonomy.

    Google Scholar 

  21. Doty DH, Glick WH. Typologies as a unique form of theory building: toward improved understanding and modeling. Acad Manag Rev. 1994;19(2):230–51.

    Article  Google Scholar 

  22. Ayres L, Knaft KA. Typological analysis. In: Given LM, editor. The SAGE encyclopedia of qualitative research methods. Volumes 1 & 2. Thousand Oaks: SAGE; 2008. p. 900–1.

    Google Scholar 

  23. Hatch J. Typological analysis. Doing qualitative research in education settings. Aelbany: State University of New York Press; 2002. p. 152–61.

    Google Scholar 

  24. Glenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Tropical Med Int Health. 2011;16(9):1044–53.

    Article  Google Scholar 

  25. D'Amour D, Goulet L, Labadie J-F, San Martín-Rodriguez L, Pineault R. A model and typology of collaboration between professionals in healthcare organizations. BMC Health Serv Res. 2008;8:1–14.

    Article  Google Scholar 

  26. Taggart J, Williams A, Dennis S, Newall A, Shortus T, Zwar N, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract. 2012;13:49.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wakerman J, Humphreys JS, Wells R, Kuipers P, Entwistle P, Jones J. Primary health care delivery models in rural and remote Australia–a systematic review. BMC Health Serv Res. 2008;8:276.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Davis LL. Dementia caregiving studies: a typology for family interventions. J Fam Nurs. 1996;2(1):30–55.

    Article  Google Scholar 

  29. Preston R, Waugh H, Larkins S, Taylor J. Community participation in rural primary health care: intervention or approach? Aust J Prim Health. 2010;16(1):4–16.

    Article  PubMed  Google Scholar 

  30. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bradley CJ, Gandhi SO, Neumark D, Garland S, Retchin SM. Lessons for coverage expansion: a Virginia primary care program for the uninsured reduced utilization and cut costs. Health Aff. 2012;31(2):350–9.

    Article  Google Scholar 

  32. Brown K, Levine J, Fiellin D, O’Connor P, Sledge W. Primary intensive care: pilot study of a primary care-based intervention for high-utilizing patients. Dis Manag. 2005;8(3):169–77.

    Article  PubMed  Google Scholar 

  33. Callahan CM, Boustani MA, Unverzagt FW, Austrom MG, Damush TM, Perkins AJ, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2012;295(18):2148–57.

    Article  Google Scholar 

  34. Counsell SR, Callahan CM, Clark DO, Tu W, Buttar AB, Stump TE, et al. Geriatric care management for low-income seniors. A randomized controlled trial. JAMA. 2007;298(22):2623–33.

    Article  CAS  PubMed  Google Scholar 

  35. DeHaven M, Kitzman-Ulrich H, Gimpel N, Culica D, O'Neil L, Marcee A, et al. The effects of a community-based partnership, project access Dallas (PAD), on emergency department utilization and costs among the uninsured. J Public Health. 2012;34(4):577–83.

    Article  CAS  Google Scholar 

  36. Dorr DA, Wilcox AB, Brunker CP, Burdon RE, Donnelly SM. The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. J Am Geriatr Soc. 2008;56(12):2195–202.

    Article  PubMed  Google Scholar 

  37. Driscoll DL, Hiratsuka V, Johnston JM, Norman S, Reilly KM, Shaw J, et al. Process and outcomes of patient-centered medical care with Alaska native people at Southcentral Foundation. Ann Fam Med. 2013;11(Suppl 1):S41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Integrated medical care for patients with serious psychiatric illness. JAMA. 2001;58:861–8.

    CAS  Google Scholar 

  39. Farmer JE, Clark MJ, Sherman A, Marien WE, Selva TJ. Comprehensive primary care for children with special health care needs in rural areas. Pediatrics. 2005;116(3):649–56.

    Article  PubMed  Google Scholar 

  40. Feinglass J, Nonzee NJ, Murphy KR, Endress R, Simon MA. Access to care outcomes: a telephone interview study of a suburban safety net program for the uninsured. J Community Health. 2014;39(1):108–17.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Glendenning-Napoli A, Dowling B, Pulvino J, Baillargeon G, Raimer BG. Community-based case management for uninsured patients with chronic diseases: effects on acute care utilization and costs. Prof Case Manag. 2012;17(6):267–75.

    Article  PubMed  Google Scholar 

  42. Garg A, Marino M, Vikani AR, Solomon BS. Addressing families' unmet social needs within pediatric primary care: the health leads model. Clin Pediatr. 2012;51(12):1191–3.

    Article  Google Scholar 

  43. Horwitz SM, Busch SH, Balestracci KMB, Ellingson KD, Rawlings J. Intensive intervention improves primary care follow-up for uninsured emergency department patients. Acad Emerg Med. 2005;12(7):647–52.

    Article  PubMed  Google Scholar 

  44. Kaufman A, Derksen D, McKernan S, Galbraith P, Sava S, Wills J, et al. Managed care for uninsured patients at an academic health center: a case study. Acad Med. 2000;75(4):323–30.

    Article  CAS  PubMed  Google Scholar 

  45. Leff B, Reider L, Frick KD, Scharfstein DO, Boyd CM, Frey K, et al. Guided care and the cost of complex healthcare: a preliminary report. Am J Manag Care. 2009;15(8):555–60.

    PubMed  Google Scholar 

  46. Levkoff SE, Chen H, Coakley E, McDonel Herr EC, Oslin DW, Katz I, et al. Design and sample characteristics of the PRISM-E multisite randomized trial to improve behavioral health care for the elderly. J Aging Health. 2004;16(1):3–27.

    Article  PubMed  Google Scholar 

  47. Mackinney T, Visotcky AM, Tarima S, Whittle J. Does providing care for uninsured patients decrease emergency room visits and hospitalizations? J Prim Care Community Health. 2013;4(2):135–42.

    Article  PubMed  Google Scholar 

  48. McCulloch DK, Price MJ, Hindmarsh M, Wagner EH. Improvement in diabetes care using an integrated population-based approach in a primary care setting. Dis Manag. 2000;3(2):75–82.

    Article  Google Scholar 

  49. Michelen W, Martinez J, Lee A, Wheeler DP. Reducing frequent flyer emergency department visits. J Health Care Poor Underserved. 2006;17(1 Suppl):59–69.

    Article  PubMed  Google Scholar 

  50. Palfrey JS, Sofis LA, Davidson EJ, Liu J, Freeman L, Ganz ML, et al. The pediatric alliance for coordinated care: evaluation of a medical home model. Pediatrics. 2004;113(5 Suppl):1507–16.

    PubMed  Google Scholar 

  51. Roby DH, Pourat N, Pirritano MJ, Vrungos SM, Dajee H, Castillo D, et al. Impact of patient-centered medical home assignment on emergency room visits among uninsured patients in a county health system. Med Care Res Rev. 2010;67(4):412–30.

    Article  PubMed  Google Scholar 

  52. Shah R, Chen C, Rourke SO, Lee M, Mohanty SA, Abraham J. Evaluation of care management for the uninsured. Med Care. 2011;49(2):166–71.

    Article  PubMed  Google Scholar 

  53. Wohl DA, Scheyett A, Golin CE, White B, Matuszewski J, Bowling M, et al. Intensive case management before and after prison release is no more effective than comprehensive pre-release discharge planning in linking HIV-infected prisoners to care: a randomized trial. AIDS Behav. 2011;15(2):356–64.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Wang EA, Hong CS, Shavit S, Sanders R, Kessell E, Kushel MB. Engaging individuals recently released from prison into primary care: a randomized trial. Am J Public Health. 2012;102(9):e22–9.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Abreu M, Hynes HP. The Latino health insurance program: a pilot intervention for enrolling Latino families in health insurance programs, East Boston, Massachusetts, 2006-2007. Prev Chronic Dis. 2009;6(4):A129.

    PubMed  PubMed Central  Google Scholar 

  56. Alexander L, Landis S. Low-income uninsured patient health and access to health care through a community health program in NC. J Community Health. 2012;37(1):105–12.

    Article  PubMed  Google Scholar 

  57. Arora S, Kalishman S, Thornton K, Dion D, Murata G, Deming P, et al. Expanding access to hepatitis C virus treatment--extension for community healthcare outcomes (ECHO) project: disruptive innovation in specialty care. Hepatology. 2010;52(3):1124–33.

    Article  PubMed  Google Scholar 

  58. Dang MT, Whitney KD, Virata MCD, Binger MM, Miller E. A web-based personal health information system for homeless youth and young adults. Public Health Nurs. 2011;29(4):313–9.

    Article  PubMed  Google Scholar 

  59. Connor A, Layne L, Thomisee K. Providing care for migrant farm worker families in their unique sociocultural context and environment. J Transcult Nurs. 2010;21(2):159–66.

    Article  PubMed  Google Scholar 

  60. Felix HC, Mays GP, Stewart MK, Cottoms N, Olson M. The care span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Aff. 2011;30(7):1366–74.

    Article  Google Scholar 

  61. Heller D, McCoy K, Cunningham C. An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models. Public Health Rep. 2004;119(1):32–9.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Brown LD, Stevens B. Charge of the right brigade? Communities, coverage, and care for the uninsured. Health Aff. 2006;25(3):w150–61.

    Article  Google Scholar 

  63. Brown LD. Impermanent politics: the Hillsborough County health care plan and community innovation for the uninsured. Health Aff. 2006;25(3):w162–72.

    Article  Google Scholar 

  64. De Leon SF, Pauls L, Shih SC, Cannell T, Wang JJ. Early assessment of health care utilization among a workforce population with access to primary care practices with electronic health records. J Ambul Care Manage. 2013;36(3):260–8.

    Article  PubMed  Google Scholar 

  65. Desai NR, Smith KL, Boal J. The positive financial contribution of home-based primary care programs: the case of the Mount Sinai visiting doctors. J Am Geriatr Soc. 2008;56(4):744–9.

    Article  PubMed  Google Scholar 

  66. Devoe JE, Gold R, Spofford M, Chauvie S, Muench J, Turner A, et al. Developing a network of community health centers with a common electronic health record: description of the safety net west practice-based research network (SNW-PBRN). J Am Board Fam Med. 2011;24(5):597–604.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Diamant AL, Brook RH, Fink A, Gelberg L. Assessing use of primary health care services by very low-income adults in a managed care program. Arch Intern Med. 2001;161(9):1222–7.

    Article  CAS  PubMed  Google Scholar 

  68. Diaz-Perez MDJ, Farley T, Cabanis CM. A program to improve access to health care among Mexican immigrants in rural Colorado. J Rural Health. 2004;20(3):258–64.

    Article  Google Scholar 

  69. Dow AW, Bohannon A, Garland S, Mazmanian PE, Retchin SM. The effects of expanding primary care access for the uninsured: implications for the health care workforce under health reform. Acad Med. 2013;88(12):1855–61.

    Article  PubMed  Google Scholar 

  70. Dulin MF, Ludden TM, Tapp H, Smith HA, de Hernandez BU, Blackwell J, et al. Geographic information systems (GIS) demonstrating primary care needs for a transitioning hispanic community. J Am Board Fam Med. 2010;23(1):109–20.

    Article  PubMed  Google Scholar 

  71. Cady R, Kelly A, Finkelstein S. Home telehealth for children with special health-care needs. J Telemed Telecare. 2008;14(4):173–7.

    Article  PubMed  Google Scholar 

  72. Hamilton LJ, Lerner CF, Presson AP, Klitzner TS. Effects of a medical home program for children with special health care needs on parental perceptions of care in an ethnically diverse patient population. Matern Child Health J. 2013;17(3):463–9.

    Article  PubMed  Google Scholar 

  73. Carey M. The role of a statewide information and referral (I&R) system in enhancing the access of children and their families to developmental programs and services. J Dev Behav Pediatr. 2006;27(1 Suppl):S13–6.

    Article  PubMed  Google Scholar 

  74. Kahn LS, Aiello J, Berdine DE, Fox CH. The use of telephonic case management to link a special-needs population with a primary care physician. J Am Board Fam Med. 2009;22(5):585–7.

    Article  PubMed  Google Scholar 

  75. Kane RL, Homyak P, Bershadsky B, Lum Y-S. Consumer responses to the Wisconsin partnership program for elderly persons: a variation on the PACE model. J Gerontol A Biol Sci Med Sci. 2002;57(4):M250–8.

    Article  PubMed  Google Scholar 

  76. McCann E. Building a community-academic partnership to improve health outcomes in an underserved community. Public Health Nurs. 2010;27(1):32–40.

    Article  PubMed  Google Scholar 

  77. Malvey D, Hyde JC, Topping S, Woodrell FD. Getting off the bandwagon an academic health center takes a different strategic path. J Healthc Manag. 2000;45(6):381–93.

    CAS  PubMed  Google Scholar 

  78. Luzinski CH, Stockbridge E, Craighead J, Bayliss D, Schmidt M, Seideman J. The community case management program: for 12 years, caring at its best. Geriatr Nurs. 2008;29(3):207–15.

    Article  PubMed  Google Scholar 

  79. Mayernik D, Resick LK, Skomo ML, Mandock K. Parish nurse-initiated interdisciplinary mobile health care delivery project. J Obstet Gynecol Neonatal Nurs. 2010;39(2):227–334.

    Article  PubMed  Google Scholar 

  80. McCloskey J. Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Fam Community Health. 2009;32(1):48–57.

    Article  PubMed  Google Scholar 

  81. Miller D, Zantop V, Hammer H, Faust S, Grumbach K. Group medical visits for low-income women with chronic disease: a feasibility study. J Women's Health. 2004;13(2):217–25.

    Article  Google Scholar 

  82. Venters H, Adekugbe O, Massaquoi J, Nadeau C, Saul J, Gany F. Mental health concerns among African immigrants. J Immigr Minor Health. 2011;13(4):795–7.

    Article  PubMed  Google Scholar 

  83. Watts BV, Shiner B, Pomerantz A, Stender P, Weeks WB. Outcomes of a quality improvement project integrating mental health into primary care. Qual Saf Health Care. 2007;16(5):378–81.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Randolph F, Blasinsky M, Morrissey JP, Rosenheck RA, Cocozza J, Goldman HH. Overview of the ACCESS program. Access to community care and effective services and supports. Psychiatr Serv. 2002;53(8):945–8.

    Article  PubMed  Google Scholar 

  85. Reavy K, Hobbs J, Hereford M, Crosby K. A new clinic model for refugee health care: adaptation of cultural safety. Rural Remote Health. 2012;12:1826.

    PubMed  Google Scholar 

  86. Savage RM, Dillon JM, Hammel JC, Lewis TC, Johnson NC, Barlow LM, et al. The Alabama Coalition for a Healthier Black belt: a proof of concept project. Community Ment Health J. 2013;49(1):79–85.

    Article  PubMed  Google Scholar 

  87. Scotten ESL, Absher AC. Creating community-based access to primary healthcare for the uninsured through strategic alliances and restructuring local health department programs. J Public Health Manag Pract. 2006;12(5):446–51.

    Article  PubMed  Google Scholar 

  88. Padwa H, Urada D, Antonini VP, Ober A, Crèvecoeur-MacPhail DA, Rawson RA. Integrating substance use disorder services with primary care: the experience in California. J Psychoactive Drugs. 2012;44(4):299–306.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Wang I, Dopheide JA, Gregerson P. Role of a psychiatric pharmacist in a Los Angeles "skid-row" safety-net clinic. J Urban Health. 2011;88(4):718–23.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Hockman EM, Andersen M, Smereck GAD. The impact of an intervention program for HIV-positive women on well-being, substance use, physical symptoms, and depression. Drugs Soc. 2001;16(1–2):145–61.

    Article  Google Scholar 

  91. Beland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos A-P, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2006;61(4):367–73.

    Article  PubMed  Google Scholar 

  92. Crustolo AM, Kates N, Ackerman S, Schamehorn S. Integrating nutrition services into primary care: experience in Hamilton. Ont Can Fam Physician. 2005;51(12):1647–53.

    PubMed  Google Scholar 

  93. Doey T, Hines P, Myslik B, Leavey JE, Seabrook JA. Creating primary care access for mental health care clients in a community mental health setting. Can J Community Ment Health. 2008;27(2):129–38.

    Article  Google Scholar 

  94. Lamothe L, Fortin J-P, Labbé F, Gagnon M-P, Messikh D. Impacts of telehomecare on patients, providers, and organizations. TTelemed J E Health. 2006;12(3):363–9.

    Article  Google Scholar 

  95. Moore A, Patterson C, White J, House ST, Riva JJ, Nair K, et al. Interprofessional and integrated care of the elderly in a family health team. Can Fam Physician. 2012;58(8):436–41.

    Google Scholar 

  96. Tourigny A, Durand PJ, Bonin L, Hébert R, Rochette L. Quasi-experimental study of the effectiveness of an integrated service delivery network for the frail elderly. Can J Aging. 2004;23(3):231–46.

    Article  PubMed  Google Scholar 

  97. Davachi S, Ferrari I. Homelessness and diabetes: reducing disparities in diabetes care through innovations and partnerships. Can J Diabetes. 2012;36(2):75–82.

    Article  Google Scholar 

  98. Sin DD, Bell NR, Man SFP. Effects of increased primary care access on process of care and health outcomes among patients with asthma who frequent emergency departments. Am J Med. 2004;117(7):479–83.

    Article  PubMed  Google Scholar 

  99. Nardi D. Integrated physical and mental health care at a nurse-managed clinic. J Psychosoc Nurs Ment Health Serv. 2011;49(7):28–34.

    Article  PubMed  Google Scholar 

  100. McDermott R, Tulip F, Schmidt B, Sinha A. Sustaining better diabetes care in remote indigenous Australian communities. BMJ. 2003;327(7412):428–30.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Anikeeva O. The closing the gap initiative - sucesses and ongoing challenges for divisions of general practice. Aust Fam Physician. 2012;41(7):523–7.

    PubMed  Google Scholar 

  102. Carey TA. A qualitative study of a social and emotional well-being service for a remote indigenous Australian community: implications for access, effectiveness, and sustainability. BMC Health Serv Res. 2013;13:80.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Gould G, Viney K, Greenwood M, Kramer J, Corben P. A multidisciplinary primary healthcare clinic for newly arrived humanitarian entrants in regional NSW: model of service delivery and summary of preliminary findings. Aust N Z J Public Health. 2010;34(3):326–9.

    Article  PubMed  Google Scholar 

  104. Happell B, Platania-Phung C, Scott D. Mental health nurse incentive program: facilitating physical health care for people with mental illness? Int J Ment Health Nurs. 2013;22(5):399–408.

    Article  PubMed  Google Scholar 

  105. Hayman NE, White NE, Spurling GK. Improving indigenous patients' access to mainstream services: the Inala experience. Med J Aust. 2009;190(10):604–6.

    Article  PubMed  Google Scholar 

  106. Kay M, Jackson C, Nicholson C. Refugee health: a new model for delivering primary health care. Aust J Prim Health. 2010;16(1):98–103.

    Article  PubMed  Google Scholar 

  107. Laurence C, Gialamas A, Yelland L, Bubner T, Ryan P, Willson K, et al. A pragmatic cluster randomised controlled trial to evaluate the safety, clinical effectiveness, cost effectiveness and satisfaction with point of care testing in a general practice setting - rationale, design and baseline characteristics. Trials. 2008;9:50.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Carver H, Douglas MJ, Tomlinson JEM. The outreach worker role in an anticipatory care programme: a valuable resource for linking and supporting. Public Health. 2012;126(Suppl 1):S47–52.

    Article  PubMed  Google Scholar 

  109. Day C, Davis H. The effectiveness and quality of routine child and adolescent mental health care outreach clinics. Br J Clin Psychol. 2006;45(Pt 4):439–52.

    Article  PubMed  Google Scholar 

  110. Gravelle H, Dusheiko M, Sheaff R, Sargent P, Boaden R, Pickard S, et al. Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ. 2007;334(7583):31.

    Article  PubMed  Google Scholar 

  111. Le Feuvre P. How primary care services can incorporate refugee health care. Med Confl Surviv. 2001;17(2):131–6.

    Article  PubMed  Google Scholar 

  112. Sylvia ML, Griswold M, Dunbar L, Boyd CM, Park M, Boult C. Guided care: cost and utilization outcomes in a pilot study. Dis Manag. 2008;11(1):29–36.

    Article  PubMed  Google Scholar 

  113. Symons L, Tylee A, Mann A, Jones R, Plummer S, Walker M, et al. Improving access to depression care: descriptive report of a multidisciplinary primary care pilot service. Br J Gen Pract. 2004;54(506):679–83.

    PubMed  PubMed Central  Google Scholar 

  114. Gray S, Lennon D, Anderson P, Stewart J, Farrell E. Nurse-led school-based clinics for skin infections and rheumatic fever prevention: results from a pilot study in South Auckland. N Z Med J. 2013;126(1373):53–61.

    PubMed  Google Scholar 

  115. Maniapoto T, Gribben B. Establishing a Maori case management clinic. N Z Med J. 2003;116(1169):U328.

    PubMed  Google Scholar 

  116. Knishkowy B, Schein M, Kiderman A, Velber A, Edman R, Yaphe J. Preventive adolescent health care in family practice: a program summary. ScientificWorldJournal. 2006;6:619–27.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Levin-Zamir D, Keret S, Yaakovson O, Lev B, Kay C, Verber G, et al. Refuah Shlema: a cross-cultural programme for promoting communication and health among Ethiopian immigrants in the primary health care setting in Israel: evidence and lessons learned from over a decade of implementation. Glob Health Promot. 2011;18(1):51–4.

    Article  PubMed  Google Scholar 

  118. Landi F, Onder G, Russo A, Tabaccanti S, Rollo R, Federici S, et al. A new model of integrated home care for the elderly: impact on hospital use. J Clin Epidemiol. 2001;54(9):968–70.

    Article  CAS  PubMed  Google Scholar 

  119. Pelcastre-Villafuerte B, Ruiz M, Meneses S, Amaya C, Márquez M, Taboada A, et al. Community-based health care for indigenous women in Mexico: a qualitative evaluation. Int J Equity Health. 2014;13(2):1–9.

    Google Scholar 

  120. Große J, Daufratshofer C, Igel U, Grande G. Community-based health promotion for socially disadvantaged mothers as health managers of their families: strategies for accessing the target group and their effectiveness. J Public Health. 2012;20(2):193–202.

    Article  Google Scholar 

  121. Alberta Health Services. Community Paramedics. 2017. http://albertahealthservices.ca/info/Page12557.aspx.

    Google Scholar 

  122. Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–207.

    Article  CAS  PubMed  Google Scholar 

  123. Department of Health & Human Services. Police, Ambulance and Clinical Early Response (PACER) evaluation report. Victoria State Government; 2012.

    Google Scholar 

  124. Huppert D, Griffiths M. Police mental health partnership project: police ambulance crisis emergency response (PACER) model development. Australas Psychiatry. 2015;23(5):520–3.

    Article  PubMed  Google Scholar 

  125. Fiore F. La clinique de transition: un pas vers un médecin de famille. Le Médecin du Québec. 2013;48(6):21–5.

    Google Scholar 

  126. Healthy Families BC. Nurse-family partnership. 2016. https://www.healthyfamiliesbc.ca/nurse-family-partnership.

    Google Scholar 

  127. Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Integrated medical care for patients with serious psychiatric illness: a randomized trial. Arch Gen Psychiatry. 2001;58(9):861–8.

    Article  CAS  PubMed  Google Scholar 

  128. JPS Health Network. Behavioral Medicine. 2019. https://www.jpshealthnet.org/academics_research/residency_programs/family_medicine/unique_aspects_of_the_program.

    Google Scholar 

  129. Khan G. Written Medicine. 2017. https://www.writtenmedicine.com/.

    Google Scholar 

  130. Northside Clinic. Northside Clinic. 2016. http://northsideclinic.net.au/.

    Google Scholar 

  131. Pariser P, Khakoo A, Pham T. Urban Telemedicine IMPACT Plus. 2015. https://www.afhto.ca/wp-content/uploads/F2-telemedicine-impact-plus.pdf.

    Google Scholar 

  132. SABSA. Super-infiermière, Clinique, Coopérative de solidarité SABSA. 2018. https://www.sabsa.ca.

    Google Scholar 

  133. Safetynet. Services. 2017. https://www.primarycaresafetynet.ie/services.

    Google Scholar 

  134. The Alex. Mobile Health at The Alex: Compassionate Care on Wheels. 2018. https://www.thealex.ca/mobile_impact/.

  135. Vancouver Coastal Health. Youth Health. 2014. http://www.vch.ca/public-health/children-youth-schools/youth-health.

    Google Scholar 

  136. Youth Projects. The living room. 2017. https://www.youthprojects.org.au/the-living-room.

    Google Scholar 

  137. Hirmas Adauy M, Poffald Angulo L, Jasmen Sepulveda AM, Aguilera Sanhueza X, Delgado Becerra I, Vega MJ. Health care access barriers and facilitators: a qualitative systematic review. Rev Panam Salud Publica. 2013;33(3):223–9.

    Article  PubMed  Google Scholar 

  138. Johannes B, Graaf D, Blatt B, George D, Gonzalo JD. A multi-site exploration of barriers faced by vulnerable patient populations: a qualitative analysis exploring the needs of patients for targeted interventions in new models of care delivery. Prim Health Care Res Dev. 2019;20(e6):1–11.

  139. Powell RE, Doty A, Casten RJ, Rovner BW, Rising KL. A qualitative analysis of interprofessional healthcare team members’ perceptions of patient barriers to healthcare engagement. BMC Health Serv Res. 2016;16:493.

    Article  PubMed  PubMed Central  Google Scholar 

  140. Blendon RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common concerns amid diverse systems: health care experiences in five countries. Health Aff. 2003;22(3):106–21.

    Article  Google Scholar 

  141. Corscadden L, Levesque JF, Lewis V, Breton M, Sutherland K, Weenink JW, et al. Barriers to accessing primary health care: comparing Australian experiences internationally. Aust J Prim Health. 2017;23(3):223–8.

    Article  PubMed  Google Scholar 

  142. Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health. 2018;17(1):28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  143. Davis K, Ballreich J. Equitable access to care--how the United States ranks internationally. New Engl J Med. 2014;371(17):1567–70.

    Article  PubMed  Google Scholar 

  144. Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy Plan. 2004;19(5):249–70.

    Article  PubMed  Google Scholar 

  145. Hall CS, Fottrell E, Wilkinson S, Byass P. Assessing the impact of mHealth interventions in low- and middle-income countries – what has been shown to work? Glob Health Action. 2014;7:25606.

    Article  PubMed  Google Scholar 

  146. Asante A, Price J, Hayen A, Jan S, Wiseman V. Equity in health care financing in low- and middle-income countries: a systematic review of evidence from studies using benefit and financing incidence analyses. PLoS One. 2016;11(4):e0152866.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  147. Devarakonda S. Hub and spoke model: making rural healthcare in India affordable, available and accessible. Rural Remote Health. 2016;16(1):3476.

    PubMed  Google Scholar 

  148. Kapoor A, Goyal S. Inclusive healthcare at base of the pyramid (BoP) in India. Int J Trade and Global Markets. 2013;6(1):22–39.

    Article  Google Scholar 

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Acknowledgements

In addition to the authors listed, the IMPACT study acknowledges the commitment provided by the entire research team and stakeholders in local partnerships in Canada and Australia. A special thanks to Pierre Pluye, who co-designed the scoping review with Vladimir Khanassov and to Jane Gunn, who co-designed the environmental scan with Lauralie Richard. Jean-Frédéric Levesque, Grant Russell, Virginia Lewis, and Cathie Scott facilitated workshops with different audiences to test the relevance and salience of the initial typology. Lisa Starr helped with editing the manuscript and with references.

Funding

This project was part of the IMPACT research program, funded by Canadian Institutes of Health Research (TTF-130729) Signature Initiative in Community-Based Primary Healthcare, the Fonds de recherche Québec – Santé, and the Australian Primary Healthcare Research Institute, which was supported by a grant from the Australian Government Department of Health under the Primary Healthcare Research, Evaluation and Development Strategy. The information and opinions contained in this paper do not necessarily reflect the views or policy of these funding agencies or the Australian Government Department of Health.

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Authors and Affiliations

  1. Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil, Québec, Canada

    Mélanie Ann Smithman

  2. St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada

    Sarah Descôteaux & Émilie Dionne

  3. Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

    Lauralie Richard

  4. Department of Community Health, Université de Sherbrooke, Longueuil, Quebec, Canada

    Mylaine Breton

  5. Department of Family Medicine, McGill University, Montreal, Quebec, Canada

    Vladimir Khanassov & Jeannie L. Haggerty

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  1. Mélanie Ann Smithman
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  2. Sarah Descôteaux
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  3. Émilie Dionne
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  4. Lauralie Richard
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  5. Mylaine Breton
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  6. Vladimir Khanassov
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  7. Jeannie L. Haggerty
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Data for the typology were planned and collected by VK (scoping review) and LR (environmental scan). VK assessed the eligibility criteria for potentially relevant studies. JH, MAS, and SD selected eligible studies from the database of studies screened for the scoping review. MAS extracted data and coded all selected studies in the scoping review and all survey entries from the environmental scan. JH and MAS led the inductive analysis to identify emerging components and further refine the typology. SD proposed a set of reduced categories. MB reviewed French survey responses at a preliminary stage of the environmental scan and participated in the application of the typology to health system decision-makers. JH and MAS drafted the manuscript, and ED contributed. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jeannie L. Haggerty.

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Ethics approval and consent to participate

The environmental scan received full ethics approval from the University of Melbourne Human Research Ethics Committee (1442125.1). Participation in the survey was voluntary, and consent was obtained by respondents filling out and submitting their survey.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Smithman, M.A., Descôteaux, S., Dionne, É. et al. Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations. Int J Equity Health 19, 174 (2020). https://doi.org/10.1186/s12939-020-01263-8

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  • DOI: https://doi.org/10.1186/s12939-020-01263-8

Keywords

  • Primary healthcare
  • Vulnerable population
  • Health services accessibility
  • Multiple classification analyses
  • Organizational innovation

International Journal for Equity in Health

ISSN: 1475-9276

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