APHCRI Conversations was a regular program of presentations held at the Department of Health to facilitate exchange between APHCRI Network researchers and Department policymakers. Topics are developed jointly with the Department of Health and involve a range of speakers from APHCRI, including CRE invited experts, CRE Chief Investigators and stream project Chief Investigator

Haggerty, Jeannie

Russell, Grant

The Australian National University

Professor Grant Russell, Monash University, Australia Professor Jeannie Haggerty, McGill University, Canada Scarborough House Theatrette  July 22, 2014  IMPACT - An Australian and Canadian collaboration to improve access to primary health care for vulnerable populations WHY ACCESS TO PRIMARY HEALTH CARE FOR VULNERABLE POPULATIONS? Fundamental components of primary care  • First contact accessibility  • Continuity/personal care  • Comprehensiveness  • Coordination Primary care and the vulnerable  Consistent link between primary care development and better health for the disadvantaged and reduced health care inequality  • Shi and Starfield 2003 Access is a balance and an interaction… • Demand  o Perceived need o Ability to pay o Ability to reach  • Supply  o location,  o accommodation o cost and appropriateness of services.  Supply and demand: a conceptual model of access The vulnerable and access  • Vulnerable groups are   o more likely to report financial barriers to care; o less likely to receive access to appropriate prevention and chronic disease care.  • Same findings for o refugees; o Aboriginal populations; o for complex patients, and ; o the homeless.  • It is a major driver of inequity of health care delivery. • Poor primary care access increases the burden on emergency departments and hospitals.  • Interventions to improve access may increase inequity. The problem with access TWO HEALTH CARE SYSTEMS …with similar challenges Health system You are here   Canada Australia  Health insurance Universal insurance for medical and hospital care Universal insurance but physicians able to bill PHC Physician remuneration  Mostly fee for services, but increasing capitation and mixed payment Fee for service GPs, some blended payments for CDM, immunisation, access etc. Rostering Increasing use None Practice trends Solo moving to group models Increasing practice size, corporatization Reform agenda New primary care delivery models  • Incremental  • Primary care meso organisations • Practice accreditation Access challenges Undersupply of family physicians Financial barriers and copayments Rurality Access to Doctor or Nurse When Sick or Needed Care Access Percent of adults age 18 and older Source: 2013 International Health Policy Survey in Eleven Countries  Data collection: Social Science Research Solutions   Access to After-Hours Care Access Percent of adults age 18 and older Source: 2013 International Health Policy Survey in Eleven Countries  Data collection: Social Science Research Solutions   Cost-Related Access Problem 2013 Access Percent of adults age 18 and older Notes: *Did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care.  Source: 2013 International Health Policy Survey in Eleven Countries  Data collection: Social Science Research Solutions   Cost-Related Access Problems Among the Chronically Ill, by Income Level Costs Base: Adults with any chronic condition; Units: Percent of adults with any chronic condition who experienced access problem due to cost in past two years Sources: 2008 Commonwealth Fund International Health Policy Survey of Sicker Adults; C. Schoen et al., "In Chronic Condition: Experiences of Patients with Complex Health Care Needs, in Eight Countries, 2008." Health Affairs Web Exclusive, Nov 13, 2008  Data collection: Harris Interactive, Inc.   Indicators of worse timeliness, percentage with long wait times, 2010 Source: Fraser Institute - Lessons from Abroad - A Series on Health Care Reform http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/health-care-lessons-from-australia.pdf Access in each system     – and the gaps • Australia has better first-contact timeliness than Canada • Canada has fewer cost-related barriers to care than Australia • Both countries have room for improvement compared to other OECD countries   BOTH NATIONS COLLABORATING TO HELP SOLVE THE PROBLEM IMPACT – Innovative Models Promoting Access-to-Care Transformation A Call for proposals  – 5 years, $5 million • More than 40 investigators (Canada, Australia, UK, Switzerland, USA) oVaried and complementary skills; oA pool of expertise to answer various needs; oResearch interests focused on quality of primary care services. • Principal investigator’s affiliation: o 3 Canadian universities (McGill, Ottawa, Alberta); o 5 Australian universities (Monash, New South Wales, La Trobe, Melbourne, Adelaide).  An international research team IMPACT - NEW APPROACH TO ACCESS  IMPACT – our aim    To design and evaluate evidence informed robust systems-level PHC innovations to improve access to appropriate health care for members of vulnerable populations.  Aims in plain language… • To discover what communities, clinicians and policy makers see as regional access priorities for vulnerable populations;  • to identify the most promising access innovations in primary health care – (and their elements);  • to use this information to work with communities to design “ideal” program innovations;  • to study the implementation of these innovations. The platform –  Local Innovation Partnerships (LIPs) 6 Regions In each region o Forge relationships with researchers, policy/decision-makers, health professionals and consumers;  o Be part of a wider knowledge network.  Canada Alberta Ontario  Quebec Australia New South Wales South Australia Victoria Coordinated LIP activities  • Understand the demographic, economic and geographic characteristics of each LIP.  o Document access-related needs for the region’s vulnerable populations .  • Document access-related organisational innovations within the regions. o Hold Deliberative forums in the first year of activity to help each LIP decide on regional access priorities .   Alberta Ontario Quebec New South Wales South Australia Victoria All 6 LIPs will  Compile a community profile and document  • Access-related needs • Access-related innovations  1) Scoping best practice Find worlds best practice in improving PHC access for vulnerable populations Alberta Ontario Quebec New South Wales South Australia Victoria Two research teams will scope innovations… 1) Scoping best practice Find worlds best practice in improving PHC access for vulnerable populations Alberta Ontario Quebec New South Wales South Australia Victoria LIPs will use scoping data to prioritise access related needs 1) Scoping best practice Find worlds best practice in improving PHC access for vulnerable Alberta Ontario Quebec New South Wales South Australia Victoria Then another two teams will discover what works best and where… 2) Synthesis of effectiveness and implementation A realist review of interventions to address the priority areas of need Combined with further understanding of context 3) Mixed method analyses of surveys See how countries, provinces and regions are performing with PHC access Alberta Ontario Quebec New South Wales South Australia Victoria 1) Scoping best practice Find worlds best practice in improving PHC access for vulnerable 2) Synthesis of effectiveness and implementation A realist review of interventions to address the priority areas of need LIPs will make final decisions on innovations 3) Mixed method analyses of surveys See how countries, provinces and regions are performing with PHC access Alberta Ontario Quebec New South Wales South Australia Victoria 1) Scoping best practice Find worlds best practice in improving PHC access for vulnerable 2) Synthesis of effectiveness and implementation A realist review of interventions to address the priority areas of need 4) Evaluating access innovations The most appropriate innovations will be systematically trialled and evaluated in the LIPs.  Assess benefits of  innovations  Finally, innovations will be tested across the LIPs Alberta Ontario Quebec New South Wales South Australia Victoria Outputs • A deeper understanding of what really works. • Up to 8 rigorous, locally relevant interventions ready for scale-up • Capacity development • Links between research / policy / clinical practice and the community. Progress • Funding October 2013 • Governance, planning, structures, processes • Relationships • Ethics • Project 1 o Systematic review o Environmental scan of innovations • Getting the LIPs working • A new Access Model • Vulnerable populations have limited capacity to advocate for themselves in a complex and resource-constrained environment; innovations to improve access typically benefit most non-vulnerable • Ensuring equitable access implies modifying the organisational interface • A learning community of researchers, decision makers and consumers in various jurisdictions  broadens the conversation and deepens the exploration of organizational innovations to enhance access for vulnerable populations Why this research matters? • New policy and program options for improving access to care by vulnerable population groups  • Expand knowledge on how innovations work in different contexts and both their direct and indirect impacts (including unanticipated impacts)  • Generate sustainable, local, national and international communities of practice able to produce innovative solutions to hitherto intractable access barriers to appropriate PHC for vulnerable populations  Anticipated impacts • A diverse definition of vulnerability, but common approaches to organisational innovations  • Attention to context in the implementation of innovations  • Modus operandi of meaningful partnerships between researchers, decision-makers, care providers and community representatives  • Deliberative processes with local community and decision makers that inform the research process within a common goal of organizational innovations to improve PHC access for vulnerable populations Key opportunities This research is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Australian Government Department of Health and Ageing.  

IMPACT - An Australian and Canadian collaboration to improve access to primary health care for vulnerable populations

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