Crabtree, Benjamin F, PhD

Furler, John, FRACGP, MBBS, PhD

Gunn, Jane M, MBBS, PhD FRACGP

Haggerty, Jeannie, PhD

Levesque, Jean-Frédéric, MD, PhD, FRCP

Miller, William L, MD, MA

Pluye, Pierre, MD, PhD

Richard, Lauralie, PhD

Russell, Grant M, MBBS, PhD, FRACGP

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineInnovations to Improve Access to Primary HealthCare for Vulnerable Populations: Results from anEnvironmental Scan Using a Social MediaApproachLauralie Richard PhDJane M. Gunn MBBS, PhD FRACGPJohn Furler FRACGP, MBBS, PhDBenjamin F. Crabtree PhDJeannie Haggerty PhDSee next page for additional authorsFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicinePart of the Medical Specialties CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtRichard, L., Gunn, J., Furler, J., Crabtree, B., Haggerty, J., Pluye, P., Miller, W., Levesque, J.-F. & Russell, G. (2014, November, 21-25).Innovations to Improve Access to Primary Health Care for Vulnerable Populations: Results from an Environmental Scan Using a Social MediaApproach. Poster presented at the North American Primary Care Research Group, New York City, NY.AuthorsLauralie Richard PhD; Jane M. Gunn MBBS, PhD FRACGP; John Furler FRACGP, MBBS, PhD; Benjamin F.Crabtree PhD; Jeannie Haggerty PhD; Pierre Pluye MD, PhD; William L. Miller MD, MA; Jean-FrédéricLevesque MD, PhD, FRCP; and Grant M. Russell MBBS, PhD, FRACGPThis poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/family-medicine/187 u Key findingsu		Most innovations are delivered in the community health centre, the general practice setting and the mobile/outreach clinic.u		56% of the innovations target multiple settings.u		78% of the innovations target between 1 and 3 different settings.u		Most innovations were health sector focused only. Just over ¼ involved both social and health partners.Innovations to improve access to primary health care for vulnerable populations: results from an environmental scan using a social media approachRichard, L.,1 Gunn, J.,1 Furler, J.,1 Crabtree, B.F.,2 Haggerty, J.,3 Pluye P.,3 Miller, W.,4 Levesque, J-F,5 and Russell, G.6 on behalf of the IMPACT research teamTHE UNIVERSITY OF MELBOURNEINSTITUT DE RECHERCHEBRUYÈRERESEARCH INSTITUTEAffilié à l’Université d’OttawaAffiliated with the University of Ottawau		5-minute online survey (Qualtrics software) disseminated widely amongst an international audience of primary health care leaders, researchers, practitioners, policy makers and stakeholders.u		Survey promoted using a combined email approach and social media campaign on Twitter7 (open from July 10th to August 21st 2014).u		Respondents were invited to report on the most striking components or aspects of a program, service, approach or model of care that they considered innovative in helping vulnerable people to get access to primary health care services that meet their needs.u		Mixed qualitative and quantitative analysis was undertaken. Each description of innovation was analysed and coded with an access framework8 to identify key determinants addressed. Descriptive statistics were used to provide a snapshot of the characteristics of the innovations. Results are based on responses from survey participants.Low income individuals/familiesPeople living with chronic diseasesIndigenous peoplesHomeless peoplePeople living with a mental illnessRefugeesDrug usersElderly peopleCulturally and Linguistically Diverse (CALD) communitiesChildren/adolescentsNo particular group targetedPeople living with a disabilityVictims of violence/abuseLesbian/Gay/Bisexual/Transgender/Intersex peoplePregnant women/maternal healthRemote/rural communitiesOther0 5 10 15 20 25 30 35 40%Community health centreGeneral practiceMobile clinic/outreachHomeNGOTelephoneHospitalOnlineSchool/educational facilityShelterOther0 10 20 30 40 50 60%GovernmentNon-for-profit/charity organisationPrivate sectorFinanced by user paymentUnknownOther0 10 20 30 40 50 60 70 80 90%What population groups are being targeted?**The percentages do not necessarily add up to 100% as many initiatives target several population groups, settings and funding sources. u Key findingsu		Low income individuals and families is the most targeted group (36%).u		Half of the innovations target multiple populations.Where are the innovations being delivered?* How are the innovations funded?* u Key findingsu		Most initiatives were reported as government funded (77%).u		Non-for-profit organisations were involved in providing funding support for close to 30% of the innovations.u		Close to 1/3 of the innovations are financed by multiple funding sources (32%). u  What this survey has told usu		The Impact survey identified 251 unique examples of innovations aimed at improving access to primary health care for vulnerable populations.u		Most innovations are government funded, delivered in the community health centre or the general practice setting and target a wide variety of populations groups.u		Most innovations are health sector focused and can be implemented at the local/practice level.u		Most innovations address supply-side dimensions of accessibility of services.u		Less than ¼ of the innovations incorporate supply- and demand-side dimensions.u		The most commonly addressed dimensions are Appropriateness and Approachability (supply-side) and Ability to engage (demand-side). u  Questions arising from the findingsu		Are the reported initiatives effective? u		What is the optimal combination of supply- and demand-side dimensions? What might be the benefits or the risks of integrating supply- and demand-side dimensions?u		How can we decide which dimensions to target, based on what evidence?u		How can we make those choices taking into account particular settings? u  Methodological challengesu		The email dissemination strategy was the most efficient, with more than 80% of respondents who learned about the survey via this method. Qualtrics survey software helped in coordinating this strategy with pre-programmed emails and pre-scheduled mailing.u		The use of social media for survey promotion involved preparing a large number of tweets. Diversity was key, with sharing documents and research material with followers along the way to raise and maintain interest. However, engaging followers to retweet and participate in our social media campaign remained challenging.  u What’s next?u		Our survey results will be combined with a scoping review of published literature to inform decisions on future innovations to be implemented by 6 Local Innovation Partnerships (LIPs) working in collaboration in this 5-year research program.u	 Impact international research team Principal investigators: Jeannie Haggerty (Canada), Grant Russell (Australia). Project team and international chief investigators: Jean-Frederic Levesque, Simone Dahrouge, Virginia Lewis, Mark Harris, Benjamin Crabtree, Pierre Pluye, Catherine Scott, William Miller, Siaw-Teng Liaw, Mylaine Breton.	u		Funding bodies Australian Primary Health Care Research Institute and the Canadian Institutes for Health Research, together with the Fonds de recherche du Québec – Santé. u Referencesu		1. World Health Organization. (2008). A summary of the 2008 World Health Report "Primary Health Care: Now More Than Ever: World Health Organization”.u		2. Fiscella, K. (2011). Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions. Annals of Family Medecine, 9, 78-84.u		3. Hutchison, B., Levesque, J.F., Strumpf, E. and Coyle, N. (2011). Primary health care in Canada: systems in motion. Milbank Quarterly, 89, 256-288.u		4. Harris, M.F. (2012). Access to preventive care by immigrant populations. BMC Medicine, 10(55), 1-2.u		5. Spike, E.A., Smith, M.M., & Harris, M.F. (2011). Access to primary health care services by community-based asylum seekers. Medical Journal of Australia, 195(4), 188-191.u		6. Levesque, J-F., Pineault, R., Hamel, M., Roberge, D., Kapetanakis, C., Simard, B., & Prud'homme, A. (2012). Primary care affiliation and unmet needs for healthcare services for vulnerable populations: insights from a population-based survey in Quebec province. BMC Family Practice, 13(66), 1-11.u		7. Merolli, M., Martin-Sanchez, F., & Gray, K. (2014). Social media and Online survey: Tools for Knowledge management in Health Research. Conferences in Research and Practice in Information Technology (CRPIT), 153, 21-29.u		8. Levesque, J-F., Harris, M.F., & Russell, G. (2013). Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health, 12(1), 1-9. u Innovations’ target groups, settings and funding sources1 University of Melbourne, 2 Robert Wood Johnson Medical School, 3 McGill University, 4 University of South Florida, 5 Bureau of Health Information, 6 Monash University248 tweets were posted on Twitter, including the survey link, promotion of the research program, sharing papers of interest and emerging findings from the survey along the way 387 campaign followersAverage of 1189 views per week2103 emails sentSurvey respondents were invited to complete the survey and share the link withing their networkSurvey promotion via social media on TwitterEmail dissemination strategy744 survey responses251 unique examples of innovationsImpact survey approachSnowballing u MethodsWho did we survey? u Location of respondents*:u	Canada (47%)u	Australia (43%)u	Other (10%) u Most survey respondents were:u	Female (71%)u	Aged between 35-54 years old (47%) u  251 unique innovations from 20 countries were reported u Contextu		Improving access to primary health care (PHC) has been a focus of substantial health service reforms internationally1. However, many nations have struggled with achieving equitable access to comprehensive PHC services for vulnerable populations2-3-4-5. In the long run, poor access to PHC means unmet health care needs, worse health outcomes, increased health care costs, and potentially enhanced health inequities6.	u		IMPACT is a five year Australian-Canadian research collaboration that aims to identify, modify and implement best practice innovations to assist access to PHC for vulnerable populations. Here, we report on the findings of the Impact environmental scan survey as part of Project 1 – Scoping and mapping innovations research stream. u Objectiveu		The Impact survey aimed to provide a brief snapshot of the breadth of current examples of innovations that appear to be at the cutting edge of change in improving access to primary health care for vulnerable populations. u Most respondents**:u		Had completed a postgraduate degree (71%)u		Worked as a researcher (31%), nurse (26%), general practitioner (25%) or manager of primary health care services (18%)u		Reported an initiative that they designed, implemented or evaluated (46%), delivered as part of a program or service (46%), or used themselves (11%)*The percentages presented in this report are rounded up to the closest value. **The percentages do not necessarily add up to 100% as this was a multiple choice question.Health care needsPerception of needs and desire for careHealth care seekingHealth care reachingHealth care utilisation Primary access Secondary accessHealth care consequences Economic Satisfaction HealthTechnical and interpersonal qualityAdequacyCoordination and continuityEmpowermentInformationAdherenceCaregiver supportDirect costsIndirect costsOpportunity costsIncomeAssetsSocial capitalHealth insuranceProfessional values, norms, culture, genderPersonal and social values, culture, gender, autonomySupply-sideDemand-sideGeographic locationAccommodationHours of openingAppointments mechanismsLiving environmentsTransportMobilitySocial supportAbility to engageAbility to payAbility to seek Ability to reachAppropriatenessAffordabilityAcceptability Availability and accommodationTransparencyOutreach InformationScreeningHealth literacyHealth beliefsTrust and expectationsAbility to perceiveApproachability u Key findingsu		The  supply-side dimensions of accessibility of services were significantly more represented than the demand-side abilities of patients/populations to access services.u		Close to 1/4 of the innovations addressed both supply-side and demand-side dimensions. u Theoretical modelu		The access framework described by Levesque, Harris and Russell (2013) was used to analyse the descriptions of innovations reported in the survey.u		Supply-side relates to features of health systems, organisations and providers. Demand-side relates to abilities of patients/populations to interact with the dimensions of accessibility to generate access. 0 1  2 3 4Number of supply-side dimensions addressed per innovationThe majority of the innovations addressed between 1 and 3 supply-side dimensions.Demand-side abilities of patients to access the servicesAbility to engage was most frequently represented in the reported descriptions of innovations, followed by Ability to perceive and Ability to seek. Ability to engage Ability to perceive  Ability to seek Ability to pay Ability to reachNumber of demand-side abilities addressed per innovationThe majority of the descriptions provided by the respondents did not feature demand-side abilities of patients/populations to access the services. 0 1  2 3 4Number of access determinants addressed per innovation (supply-side and demand-side)Most innovations addressed 3 determinants of access or less. 1 2  3 4 5 6 8Paired supply-side and demand-side access determinantsThe most common pairs are Appropriateness & Ability to engage and Approachability & Ability to perceive.  Appropriateness & Ability to engage  Approachability & Ability to perceive   Acceptability & Ability to seek  Availability and Accommodation & Ability to reach  Affordability & Ability to pay Most innovations did not target paired dimensions of access (80%). Only 1/5 of innovations targeted 1 pair. Less than 3% targeted 2 pairs or more.Number of pairs targeted per innovation 0 1  2 4 Appropriateness Approachability   Availability and accommodation Acceptability AffordabilitySupply-side dimensions of accessibilty of servicesAppropriateness, Approachability, and Availability and accommodation appeared as the most striking dimensions of accessibility of services reported in the descriptions of innovations.

Innovations to Improve Access to Primary Health Care for Vulnerable Populations: Results from an Environmental Scan Using a Social Media Approach

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Innovations to Improve Access to Primary Health Care for Vulnerable Populations: Results from an Environmental Scan Using a Social Media Approach

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