title: A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.
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.
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2052, Australia. E.Comino@unsw.edu.au
authors.forename: Elizabeth Jean
authors.initials: EJ
authors.lastname: Comino
authors.forename: Gawaine Powell
authors.initials: GP
authors.lastname: Davies
authors.forename: Yordanka
authors.initials: Y
authors.lastname: Krastev
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.forename: Bettina
authors.initials: B
authors.lastname: Christl
authors.forename: John
authors.initials: J
authors.lastname: Furler
authors.forename: Anthony
authors.initials: A
authors.lastname: Raymont
authors.forename: Mark F
authors.initials: MF
authors.lastname: Harris
mesh_terms: D019985:Benchmarking; D002908:Chronic Disease / Q000517:prevention & control*; D017050:Episode of Care; D014943:Global Health; D006293:Health Promotion / Q000706:statistics & numerical data; D006801:Humans; D009936:Organizational Innovation; D010934:Planning Techniques; D011159:Population Surveillance; D011320:Primary Health Care / Q000592:standards*