title: Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations.
abstract: BACKGROUND
  Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field.
  
  
  METHODS
  We distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation.
  
  
  RESULTS
  Seven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations were developed to enhance patients' or populations' abilities to access services (demand-side), and rarely did initiatives target both supply- and demand-side determinants of access.
  
  
  CONCLUSIONS
  A wide range of innovations improving access to PHC were identified. The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention to close the equity gap for vulnerable populations in accessing PHC services that correspond to their needs.
authors.affiliation: Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC, 3004, Australia. lauralierichard@gmail.com.
authors.forename: Lauralie
authors.initials: L
authors.lastname: Richard
authors.affiliation: Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC, 3004, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Furler
authors.affiliation: Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC, 3004, Australia.
authors.forename: Konstancja
authors.initials: K
authors.lastname: Densley
authors.affiliation: St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, Qc, H3T 1M5, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.affiliation: School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: Bureau of Heath Information, Level 11, Sage Building, 67 Albert Avenue, Chatswood, NSW, 2067, Australia.|Centre for Primary Health Care and Equity, UNSW, Sydney, 2052, Australia.
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Levesque
authors.affiliation: Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC, 3004, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Gunn
mesh_terms: D000069576:Health Equity / Q000592:standards / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D062069:Inventions / Q000639:trends; D009936:Organizational Innovation; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: Access; Environmental scan; Innovations; Online survey; Primary healthcare; Vulnerable populations