At a minimum, deliberative processes within each LIP should be used to address two questions:
- Which vulnerable population would most benefit from innovative approaches to addressing access to CBPHC?
- What are critical elements to be incorporated into the design of a local organisational innovation to address the access-related needs of the target population?
groups whose demographic, geographic, economic and/or cultural characteristics impede or compromise their access to community-based primary health care services
community-based primary healthcare
a novel set of behaviours or routines implemented through planned and coordinated actions (based on Greenhalgh, 2004)
Excludes innovation aimed at individual practitioner behaviour changes (e.g., clinical practice, treatment innovation) if they are not intended to address one of the dimensions of service accessibility
Excludes innovations aimed at community members (e.g., general health literacy strategies)
Requires action to be planned and coordinated
May include behaviours or routines provided off-site or externally that improves accessibility of the community-based primary health care organisation (e.g., routine access to telephone translation services).
the consequence of the interface between the five dimensions of consumer ability and five dimensions of service accessibility (Levesque, Harris & Russell, 2013)
Access is a consequence of a dynamic process. See proposed primary health care model (Levesque et al., 2013 & Obrist et al., 2007).
Contextual and demographic factors are assumed to influence the service and consumer dimensions and need to be measured/monitored in each partnership.
The 5 dimensions of accessibility of services:
1) Approachability;
2) Acceptability;
3) Availability and accommodation;
4) Affordability;
5) Appropriateness.
The 5 dimensions of ability of consumers:
1) Ability to perceive;
2) Ability to seek;
3) Ability to reach;
4) Ability to pay;
5) Ability to engage.
Access to community-based primary health care is indicated by first-contact accessibility (primary indicator of access): The ease with which a person can obtain needed community-based primary health care (including advice and support) within a time frame appropriate to the urgency of the problem (Haggerty et al., 2007).
At a population level, access to community-based primary health care is indicated by assumed outcomes of poor access (secondary indicator of access): high rates of emergency department visits, avoidable hospitalizations and emergency department presentations for Ambulatory Care Sensitive Conditions.
