Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.
Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.
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DOI：
10.1186/s12939-016-0459-9
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发表时间：
2016-10-10
影响因子：
4.8
通讯作者：
Levesque JF
中科院分区：
文献类型：
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作者：
Khanassov V;Pluye P;Descoteaux S;Haggerty JL;Russell G;Gunn J;Levesque JF
获得基于社区的初级卫生保健（以下简称“初级保健”）是许多国家的优先事项。医疗保健系统强调帮助社区“在正确的时间、正确的地点获得正确的服务”的政策。然而，人们对初级保健的组织干预措施知之甚少，这些干预措施旨在改善弱势群体（例如，社会经济弱势群体）的获得机会，以及这些干预措施的成功程度。本次范围审查的目的是绘制有关组织干预措施的现有证据，以改善弱势群体获得初级保健服务的机会。范围界定审查遵循一个迭代过程。资格标准：在经济合作与发展组织（OECD）国家进行组织干预；旨在改善弱势群体获得初级保健的机会；所有研究设计； 2000 年起以英文或法文出版；报告至少一种结果（可避免的住院治疗、急诊科入院或未满足的医疗保健需求）。来源：主要书目数据库（Medline、Embase、CINAHL）和团队成员的个人档案。研究选择：一名研究人员选择了相关摘要和全文论文。理论驱动的综合：研究人员使用（i）“以患者为中心的医疗保健获取”概念框架（获得初级保健的维度和结果）和（ii）Cochrane有效实践和护理组织的干预措施分类对包括的研究进行分类。使用模式分析，根据“维度结果”模式的存在/不存在来绘制干预措施。在 8,694 条记录（标题/摘要）中，纳入了 39 项具有不同设计的研究。分析揭示了以下模式。 10 项被归类为“服务正式整合”干预措施的研究结果表明，这些干预措施与可及性（可及性、可用性和可负担性）和减少住院（四/四项研究）、急诊科入院（六/六项研究）和未满足的医疗保健需求（五/六项研究）三个维度相关。这 10 项研究包括 7 项非随机研究、一项随机对照试验、一项定量描述性研究和一项混合方法研究。我们的研究结果表明，这一领域的研究广度有限，对正式服务整合的有效性研究进行全面系统的审查是可行的，以改善弱势群体获得初级保健服务的机会。
Access to community-based primary health care (hereafter, ‘primary care’) is a priority in many countries. Health care systems have emphasized policies that help the community ‘get the right service in the right place at the right time’. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs). Sources: Main bibliographic databases (Medline, Embase, CINAHL) and team members’ personal files. Study selection: One researcher selected relevant abstracts and full text papers. Theory-driven synthesis: The researcher classified included studies using (i) the ‘Patient Centered Access to Healthcare’ conceptual framework (dimensions and outcomes of access to primary care), and (ii) the classification of interventions of the Cochrane Effective Practice and Organization of Care. Using pattern analysis, interventions were mapped in accordance with the presence/absence of ‘dimension-outcome’ patterns. Out of 8,694 records (title/abstract), 39 studies with varying designs were included. The analysis revealed the following pattern. Results of 10 studies on interventions classified as ‘Formal integration of services’ suggested that these interventions were associated with three dimensions of access (approachability, availability and affordability) and reduction of hospitalizations (four/four studies), emergency department admissions (six/six studies), and unmet healthcare needs (five/six studies). These 10 studies included seven non-randomized studies, one randomized controlled trial, one quantitative descriptive study, and one mixed methods study. Our results suggest the limited breadth of research in this area, and that it will be feasible to conduct a full systematic review of studies on the effectiveness of the formal integration of services to improve access to primary care services for vulnerable populations.
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