title: Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.
abstract: 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).
  
  
  
  Main bibliographic databases (Medline, Embase, CINAHL) and team members' personal files.
  
  
  
  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.
authors.affiliation: Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC, H3S 1Z1, Canada. vladimir.khanassov@mail.mcgill.ca.
authors.forename: Vladimir
authors.identifier: 0000-0003-2609-241X
authors.initials: V
authors.lastname: Khanassov
authors.affiliation: Department of Family Medicine, McGill University, 5858 Côte-des-neiges, 3rd Floor, Suite 300, Montreal, QC, H3S 1Z1, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Pluye
authors.affiliation: St. Mary's Hospital Research Centre, 3830 Lacombe Ave, Montréal, QC, H3T1M5, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Descoteaux
authors.affiliation: Department of Family Medicine, McGill University, St. Mary's Hospital Research Centre, 3830 Lacombe Ave, Montréal, QC, H3T1M5, Canada.
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Haggerty
authors.affiliation: Southern Academic Primary Care Research Unit, Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, VIC, 3168, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: University of Melbourne, 200 Berkeley Street, Melbourne, VIC, 3053, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Gunn
authors.affiliation: Centre for Primary Health Care and Equity, University of New South Wales, Bureau of Health Information, 67 Albert Avenue, Chatswood, Sydney, NSW, 2067, Australia.
authors.forename: Jean-Frederic
authors.initials: JF
authors.lastname: Levesque
mesh_terms: D002170:Canada; D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: Accessibility to Health Services; Australia; Canada; Delivery of Health Care; Improve Access; Organizational Interventions; Underserved populations; Vulnerable populations