Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions

Abstract

IntroductionAccess to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations.Methods and analysisThe evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3–6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on individuals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices.Ethics and disseminationThe IMPACT research programme received initial ethics approval from St Mary’s Hospital (Montreal) SMHC #13–30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.

Does healthcare inequity reflect variations in peoples’ abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries

“…This is an exploratory analysis of pooled data collected in the IMPACT study prior to the implementation of study interventions. The methods for the broader study have been previously described [18].…”

Typology of organizational innovation components: building blocks to improve access to primary healthcare for vulnerable populations

“…Both are described briefly below and have been described in detail elsewhere [16,17]. The scoping review and scan were conducted as part of the IMPACT research program [19].…”

“…This challenge of designing pro-vulnerable innovations was highlighted in our "Innovative Models Promoting Access-to-Care Transformation" (IMPACT) research program [19]. IMPACT brought together local health system decision-makers, providers, primary healthcare researchers, community members, and other stakeholders in six regions in Canada and Australia.…”

“…perinatal home-visits for young mothers: Women under the age of19 or under 24 and experiencing social/financial issues and pregnant with their first child enroll in a free public health program. A nurse visits them at home regularly during their pregnancy and up to two years after the child is born.…”

Expectations and Needs of Socially Disadvantaged Patients for Navigational Support of Primary Health Care Services

“…Our sample includes patients living in a particular social context and receiving services from Quebec's public health care system, whose organization differs from that of other countries in several fundamental aspects. Our methods were also designed to ask questions speci cally pertaining to the conceptual construct of access to care used in the larger study (31) as well as the speci cities of the situation of our participants, i.e. who had been on a centralized wait list to receive a family doctor and had been assigned to one.…”