The Concept of Access

Penchansky, Roy; Thomas, John W.

doi:10.1097/00005650-198102000-00001

Cited by 2,372 publications

(773 citation statements)

References 18 publications

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“…11 Their fifth dimension (accommodation) was not included here as it relates to issues associated with a specific health service, such as hours of operation and appointment systems.…”

Section: Methodsmentioning

confidence: 99%

Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?

Ward¹,

Humphreys²,

McGrail³

et al. 2015

Aust. Health Review

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Objective. Access to primary healthcare (PHC) services is key to improving health outcomes in rural areas. Unfortunately, little is known about which aspect of access is most important. The objective of this study was to determine the relative importance of different dimensions of access in the decisions of rural Australians to utilise PHC provided by general practitioners (GP).Methods. Data were collected from residents of five communities located in 'closely' settled and 'sparsely' settled rural regions. A paired-comparison methodology was used to quantify the relative importance of availability, distance, affordability (cost) and acceptability (preference) in relation to respondents' decisions to utilise a GP service for nonemergency care.Results. Consumers reported that preference for a GP and GP availability are far more important than distance to and cost of the service when deciding to visit a GP for non-emergency care. Important differences in rankings emerged by geographic context, gender and age.Conclusions. Understanding how different dimensions of access influence the utilisation of PHC services is critical in planning the provision of PHC services. This study reports how consumers 'trade-off' the different dimensions of access when accessing GP care in rural Australia. The results show that ensuring 'good' access requires that policymakers and planners should consider other dimensions of access to services besides geography.What is known about the topic? Research indicates that poorer 'access' to GPs, an impediment to seeking primary care at times of need, is the most important factor distinguishing rural from urban health service utilisation behaviour, which undoubtedly contributes to the poorer health outcomes characterising rural and remote populations. Much of the policy on access to date has focussed on increasing the number of GP located in rural and remote areas that are characterised by acute medical workforce shortages. What does this paper add? This study provides empirical data to show how different dimensions of access influence rural Australians' decisions to utilise a GP service. Overall, rural Australians rank preference for a GP as the most important factor in their decision to visit a doctor for a non-emergency consultation. Important differences in rankings emerged by geographic context, gender and age. Distance to a GP service ranks consistently as the third most important access factor and cost is rated the least important aspect of access. What are the implications for practitioners? Although current rural health policies and incentives should continue to target the need to increase the availability of GP in non-metropolitan areas, this alone may not be sufficient to improve GP service utilisation. Other dimensions of access, particularly consumer preference, which are amenable to interventions both nationally and locally, are equally important.

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“…11 Their fifth dimension (accommodation) was not included here as it relates to issues associated with a specific health service, such as hours of operation and appointment systems.…”

Section: Methodsmentioning

confidence: 99%

Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?

Ward¹,

Humphreys²,

McGrail³

et al. 2015

Aust. Health Review

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“…62 The availability of services (having access) and utilisation of services (gaining access) are generally seen as key dimensions. Pechansky and Thomas 63 suggested that the concept of access described the 'degree of fit' between clients and the health system. They identified five relevant dimensions to the client-service interaction: acceptability, affordability, availability, physical accessibility and accommodation.…”

Section: Access To Carementioning

confidence: 99%

“…63 For people with dementia the degree of fit may be poor because systems and the clinical environment do not meet their needs, leading to the exacerbation of symptoms and distress. There may be transferable learning from services for people with learning disability, who are another group who have problems with access and continuity.…”

Section: Access To Carementioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Access to primary health-care services is a complex concept and has been articulately discussed by other researchers. The definition has evolved from the original five dimensions of availability, accessibility, affordability, accommodation and acceptability, to include consideration of awareness, timeliness and perceived effectiveness (Penchansky and Thomas 1981;Levesque et al 2013;Russell et al 2013). All of these factors have overlying social and cultural components, with their interplay leading to the use or not of health clinics.…”

Section: Discussionmentioning

confidence: 99%

Understanding patient access patterns for primary health-care services for Aboriginal and Islander people in Queensland: a geospatial mapping approach

Panaretto

Dellit

Hollins

et al. 2017

Aust. J. Prim. Health

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Abstract. This paper explores the patterns of patients' accessing six Aboriginal and Islander Community Controlled Health Services (AICCHSs) in Queensland. Between August 2011 and February 2014, 26 199 patients made at least one visit over a 2-year period prior to at least one of six Queensland AICCHS -one urban service (RA 1) in south-east Queensland, and five services in regional towns (RA 3) in Far North Queensland. Geospatial mapping of addresses for these registered patients was undertaken. The outcomes analysed included travel times to, the proportion of catchment populations using each AICCHS and an assessment of alternative mainstream general practice availability to these patients was made. In brief, the use of AICCHS was higher than Australian Bureau of Statistics census data would suggest. Approximately 20% of clients travel more than 30 min to seek Aboriginal Health services, but only 8% of patients travelled longer than 60 min. In the major city site, many other general practitioner (GP) services were bypassed. The data suggest Aboriginal and Islander patients in Queensland appear to value community-controlled primary care services. The number of Indigenous clients in regional locations in the Far North Queensland registered with services is often higher than the estimated resident population numbers.

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The Concept of Access

Cited by 2,372 publications

References 18 publications

Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?

Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Understanding patient access patterns for primary health-care services for Aboriginal and Islander people in Queensland: a geospatial mapping approach

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