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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2012
Autoren:
Elizabeth Jean Comino, Gawaine Powell Davies, Yordanka Krastev, Marion Haas, Bettina Christl, John Furler, Anthony Raymont, Mark F Harris
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-415) contains supplementary material, which is available to authorized users.

Competing interests

There are not competing interests.

Authors’ contributions

EC led the research. She was responsible for all stages of the research including conceptualising the project, successfully applying for funding, employing the project staff, implementing the GPD this paper. PGPD was a senior member of the research group. He has contributed to all aspects of the implementation of the project, participated in the preparation of the report and conceptualisation and preparation of this paper. He was a member of the study advisory group. YK was employed as Research Fellow. She was responsible for the day to day implementation of the research, extraction and analysis of project data, preparation of the report with responsibility for specific sections, and preparation of this paper. MH was a senior member of the research group. She provided expert advice on economic aspects of the research. She was a member of the study advisory group and has made a significant contribution to the preparation of this paper. BC was employed as Project Officer. She was responsible, with the Research Fellow, for the day to day implementation of the research, extraction and analysis of project data, preparation of the report with responsibility for specific sections, and preparation of this paper. JF was a member of the research group. He was a member of the study advisory group and made a significant contribution to the conceptualisation and implementation of the project. He has contributed to all aspects of the implementation of the project and to the preparation of this paper. AR was a member of the research group. He was a member of the study advisory group and made a significant contribution to the conceptualisation and implementation of the project. He has contributed to all aspects of the implementation of the project and to the preparation of this paper. MFH was a senior member of the research group. He has contributed to all aspects of the implementation of the project, participated in the conceptualisation and implementation of the data extraction, preparation of the report and conceptualisation and preparation of this paper. He was a member of the study advisory group. All authors read and approved the final manuscript.

Abstract

Background

Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care.

Methods

An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions).

Results

The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n = 45), episodic care (n = 19), and chronic disease management (n = 11). They were undertaken in a number of countries including Australia (n = 25), USA (n = 25), and UK (n = 15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n = 46 studies) or as a combination of two (n = 20) or more strategies (n = 9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n = 43 studies), patient support (n = 29), provision of new services (n = 19), workforce development (n = 11), and financial incentives (n = 9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results.

Conclusions

This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these.
Zusatzmaterial
Additional file 1: Appendix 1. Search strategy for Chronic Disease papers (diabetes). (DOC 38 KB)
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Additional file 2: Appendix 2. Organisations and web pages searched for grey literature. (DOC 60 KB)
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Additional file 3: Appendix 3. Summary of evaluated intervention studies. (DOC 336 KB)
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Authors’ original file for figure 1
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Authors’ original file for figure 2
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