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The article presents information on a pilot program which aims to assess the feasibility of employing and expanding remote physiologic monitoring (RPM) services at an academic medical center. Topics discussed include the overall flow of the project, patients eligible for enrollment in the program, and pharmacist intervention.

Background: The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access. Objective: To evaluate PC wait times before and after CRH implementation. Design: Comparative interrupted time series analysis among a retrospective observational cohort of PC clinics who did and did not use CRH during pre-implementation (October 2018–September 2019) and post-implementation (October 2019–February 2020) periods. Participants: Clinics completing ≥10 CRH visits per month for 2 consecutive months and propensity matched control clinics. Main Measures: Two measures of patient access (i.e., established, and new patient wait times) and one measure of clinic capacity (i.e., third next available appointment) were assessed. Clinics using CRH were 1:1 propensity score matched across clinical and demographic characteristics. Comparative interrupted time series models used linear mixed effects regression with random clinic-level intercepts and triple interaction (i.e., CRH use, pre- vs. post-implementation, and time) for trend and point estimations. Key Results: PC clinics using CRH (N = 79) were matched to clinics not using CRH (N = 79). In the 12-month pre-implementation, third next available time increased in CRH clinics (0.16 days/month; 95% CI = [0.07, 0.25]), and decreased in the 5 months post-implementation (−0.58 days/month; 95% CI = [−0.90, −0.27]). Post-implementation third next available time also decreased in control clinics (−0.48 days/month; 95% CI = [−0.81, −0.17]). Comparative differences remained non-significant. There were no statistical differences in established or new patient wait times by CRH user status, CRH implementation, or over time. Conclusions: In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary. [ABSTRACT FROM AUTHOR]

ABSTRACT Rationale Aims and Objectives Methods Results Conclusion Awareness of their standing relative to best practices motivates primary healthcare (PHC) teams to improve their practices. However, gathering the data necessary to create such a portrait is a challenge. An effective way to support the improvement of the practices of PHC teams is to simplify the availability of data portraying aspects of their practices that might need improvement. Timely access is one of the foremost challenges of PHC. Yet, very few tools supporting reflections on the implementation of best practices to improve access are available to PHC teams.To develop an online reflective tool that evaluates the state of a PHC team member's advanced access practice and formulates customized recommendations for improvement.This sequential multimethod study was informed by a literature review and an expert panel composed of researchers, patients, provincial and local decision‐makers, and PHC clinical and administrative staff in the province of Quebec, Canada. Consensus was reached on the content of the questionnaire and the prioritization of the recommendations.No reflective tool on advanced access practices was found in the literature review. Grey literature was used to create an initial version of the questionnaire. This version was revised and enriched through consultation phases with the expert panel. Then, five iterations of the tool were tested with 169 PHC team members, which led to the conception of two distinct versions: one for clinical staff and one for administrative agents responsible for appointment booking. The final versions of the reflective tool are available online in both English and French.This reflective tool provides a portrait of PHC team members' advanced access practices as well as an automated report that contains personalized and prioritized recommendations for improvement. Further developments are necessary for its optimal use among PHC professionals other than physicians and nurse practitioners. [ABSTRACT FROM AUTHOR]

Background: Individual perceptions, socio-cultural beliefs and health system factors are key determinants of people's health seeking behavior and are widely cited as the causes of delayed breast cancer diagnosis among women from structurally vulnerable settings. Asking: "how do women with a non-lived experience of cancer understand the disease and, what informs their health seeking behaviors?", we qualitatively explored, individual, sociocultural and health system elements from a conceptual model derived from the Socioecological, Health Belief and Cancer Stigma Frameworks, to understand perspectives of breast cancer in a South African urban community setting. Methods: Using a deductive approach and allowing new themes to emerge inductively, we investigated phenomenologically, breast cancer perceptions among 34 women from Soweto, Johannesburg (aged 35–74 years) in 6 Focus Group Discussions. We then conducted 20 follow-up semi-structured in-depth interviews to explore novel themes and suggestions for increasing breast cancer screening. Results: Findings revealed some awareness of breast and other cancers, but confusion and gaps in understanding of the disease, resulting in socio-culturally influenced misperceptions of risks, causes, and outcomes following treatment of breast cancer. This fueled perceptions of profound fear and stigma against people with breast and other cancers. These findings together with participant perceptions of primary healthcare providers being unwelcoming, under-resourced, and insufficiently trained to deal with breast cancer, resulted in women reporting being reluctant to participating in screening/early detection care seeking behavior. Women only accessed primary care when experiencing extreme pain or ill-health. Participants suggested as solutions for future interventions, the need for sustained community engagement, harnessing existing clinic and community stakeholders and resources to provide clear and understandable breast cancer information and encouragement for screening uptake. Conclusions: Health literacy gaps surrounding breast cancer fuels socio-culturally influenced misperceptions, fear, stigma, and fatalism among women from Soweto. Women perceive primary care providers of having insufficient knowledge, skills, and resources to provide effective breast cancer screening services. Participants suggested the need for greater community engagement involving primary clinics and existing community stakeholders working collaboratively. Clear, understandable, and consistent information about breast cancer must be regularly disseminated and communities must be regularly encouraged to utilize breast cancer screening services. [ABSTRACT FROM AUTHOR]

Background: Worldwide, rural populations are recognized to be exposed to increased health challenges due to their living and working environment, socioeconomic status, and access to health services. According to the Romanian Country Health Profile 2023, approximately 46% of all deaths recorded in Romania in 2019 could be attributed to behavioral risk factors such as tobacco smoking, dietary risks, alcohol consumption and low physical activity. No data on rural versus urban areas are available to date, and research is needed to document health inequalities, identify barriers to health services, and explore solutions. Methods: This study is an analysis of data collected during the Health Evaluation Survey carried out by the National Institute of Public Health in 2022 and aimed to reveal differences in health risk factors between rural and urban areas. The analysis was carried out under the methodological framework of the Health Evaluation Survey 2022, which is coordinated by the National Institute of Public Health. Results: Our study's objectively measured data revealed that the overall health profile of rural communities is characterized by lower education levels, lower incomes, and higher binge drinking rates than those of their urban counterparts. Additionally, rural inhabitants more often have high blood pressure, are more overweight and obese (per body mass index measurements) and have higher fasting plasma glucose. The health profile of the urban population revealed higher education levels and greater proportions of people with adequate monthly income, people with daily alcohol consumption, people who smoke, and people with hypercholesterolemia. Access to primary health care evaluated through proxy indicators was lower in rural areas but was relatively good overall. Conclusions: Our analysis of the health profile of rural communities revealed a greater prevalence of obesity and overweight, especially among women, and an increased prevalence of heavy drinking among men. Access to primary health care evaluated through proxy indicators is lower in rural areas but is relatively good overall. Lower education levels and the possibility of lower health literacy underpin the need for targeted health education campaigns. Sustainable strategies for rural health need to be identified, especially in the field of health promotion and disease prevention programs. Trial registration: This study is observational research involving human participants where no interventions were applied to the study population. [ABSTRACT FROM AUTHOR]

Background: Having a primary care provider is associated with better care experiences and lower care costs. In 2021, INSPIRE-PHC released Primary Care Data Reports - publicly available summaries of administrative billing data about how populations in each of Ontario's 60 health teams use primary care services. Given the characterization of Canadian primary care systems as 'in crisis', publicly available data about primary care at the regional level presented a significant opportunity for knowledge mobilization. An understandable resource could ground the public conversation about primary care access in data. Recognizing the role that lived experience plays in ensuring the public understands research findings, a partnership between patient advisors, Ontario Health Team representatives, researchers, and trainees was established to co-produce public-facing infographics based on primary care data. Methods: Evidence-based guidelines for public health infographic creation and elements of transformative action research guided a six-meeting process to engage up to 14 patient advisors, three Ontario Health Team staff and two primary care trainees. Patient advisors were affiliated with a provincial patient-oriented primary health care research group or a Hamilton-based Ontario Health Team. Ninety-minute meetings were conducted virtually, and notes were shared with attendees to ensure they accurately reflected the conversation. Two consultations with Ontario Health Team-affiliated primary care providers provided direction and ensured project outputs aligned with local priorities. Results: Project partners shared feedback on draft infographics, audience identification, priority elements from Primary Care Data Reports to include in the infographics, and aesthetic features (e.g., headings, colour scheme, charts). Project partners felt the most important metrics to convey to the public were those that simultaneously reinforced the benefits of primary care on individual health outcomes and health system costs. Conclusions: Patient engagement in research is becoming widespread, but co-developing knowledge products with patient and health system partners is less common. Our approach to engaging patients prevented both oversimplification and unnecessary complexity in a public-facing visual about attachment to primary care. Plain English summary: Primary care is the first point of contact for patients accessing the health care system. Primary care providers (i.e., family doctors and nurse practitioners – working individually or in teams of nurses, dieticians, pharmacists, social workers and others) – help patients and families manage health concerns over time by working to prevent, diagnose, and treat illnesses and link patients with specialist care when needed. Having a primary care provider is associated with better healthcare experiences and lower costs of care. In 2021, the Primary Care Data Reports were released to the public. The reports contain administrative data about how patients engage with primary care in each of the 58 Ontario Health Teams. Patient advisors, Ontario Health Team representatives, researchers, and trainees created an infographic to share this data in a way that can be understood by everyone. Infographics use images to help people process information faster, which can make health-related topics easier to understand. By understanding the value of primary care, people can participate in conversations about how to ensure primary care is accessible to everyone. Engaging patients is becoming common in research, but collaborating with patient advisors and health system partners to create visual summaries is less common. We had six virtual meetings that were 90 min each with up to 14 patient advisors, Ontario Health Team representatives, researchers and trainees. Patient advisors helped decide who the audience would be, which information from the Primary Care Data Reports to include, and how the infographic would look. Patient advisors felt it was most important to highlight the benefits patients can get from primary care, and the impact primary care can have to reduce health system costs. We consulted with primary care clinicians to ensure the infographic reflected local priorities. Working with patient advisors and Ontario Health Team representatives helped to create an infographic about Primary Care Data Reports data that is easy to understand by the public. [ABSTRACT FROM AUTHOR]

Integrated and collaborative care models, in which mental/behavioral health providers work closely with primary care providers within a primary care setting, help support the quadruple aim of improved health outcomes, patient satisfaction, provider experience, and lower cost. In this paper, we describe patients' general perspectives of integrated care and their unique experiences accessing this care within one health system. Qualitative (interviews with patients) and quantitative (surveys with patients) methods were used to collect and analyze these results separately and together. The results highlight important features to the provision of integrated care from the perspective of patients using integrated care. They include the importance and experience of access, whole-person care and a team-based approach, the availability and use of telehealth when appropriate, having high quality mental health providers, scheduling and service usage suggestions, and means to connect with longer-term services for ongoing mental health care when needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the factors affecting life satisfaction and its relationship with loneliness among older adults with home restrictions during the COVID-19 pandemic. The Participant Identification Form, which includes sociodemographic and health-related data, the Gierveld Loneliness Scale (GLS) to measure loneliness, and the Contentment with Life Assessment Scale (CLAS) were used for the data, which were collected from 253 individuals aged 65 years and older residing in two provinces in western Turkey between January and April 2021 after obtaining permissions. Loneliness and contentment with life scores of the older adults, most of whom were women and married, were found to be low. Loneliness alone explained 26.6% of contentment with life (p <.05). Linear regression analysis revealed that older age and being married were positive predictors of life satisfaction, while high loneliness level, presence of chronic disease and having COVID-19 infection were negative predictors (p <.05). Gender, employment status, education level, place of residence, and smoking habit were not statistically predictive of contentment with life (p >.05). In line with the findings, it can be recommended to provide support to older adults during periods of restrictions such as pandemics, as well as in normal times, to not disrupt primary health care and nursing care, to develop social support policies to increase life satisfaction and reduce loneliness. [ABSTRACT FROM AUTHOR]

Aim: To explore whether children in specialist care with COVID-19 have increased post-discharge health care use when compared with children in specialist care with 1) respiratory syncytial virus (RSV) infection, and 2) other respiratory tract infections (RTIs). Methods: In 34,214 children aged 1 month to 5 years who were registered as having one or more hospital visit (outpatient or inpatient) with a diagnosis of COVID-19 (N = 128), RSV infection (N = 4,009), or other RTIs (N = 34,458) from 2017 to 2021, we used a difference-in-differences study design to investigate individual all-cause primary and specialist health care use from 12 weeks prior to 12 weeks after the hospital visit, stratified by infants (1 to 11 months) and children (1 to 5 years). Results: We found a slight increase in primary health care use in the first 4 weeks after the hospital visit for infants with COVID-19 when compared with infants with RSV infection (6 per 10,000; 95% CI [2, 13], a 0.52% relative increase). For infants diagnosed with COVID-19, we found a similar post-visit increase in inpatients when compared with infants with RSV infection, which lasted for 12 weeks. Conclusions: Our findings imply a slightly increased health care use among infants after a hospital visit for COVID-19 than among infants with other RTIs, the potential etiological mechanisms of which deserve future clinical research. Severe COVID-19 in young children will not represent any markedly increased burden on the health services. [ABSTRACT FROM AUTHOR]

Study Design: Survey study. Objectives: People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. Methods: We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. Results: 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. Conclusions: Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, global trends of reduced healthcare-seeking behaviour were observed. This raises concerns about the consequences of healthcare avoidance for population health. Aim: To determine the association between healthcare avoidance during the early stages of the COVID-19 pandemic and all-cause mortality. Design and setting: This was a 32-month follow-up within the population-based Rotterdam Study, after sending a COVID-19 questionnaire at the onset of the pandemic in April 2020 to all communty dwelling participants (n = 6241/8732, response rate 71.5%). Method: Cox proportional hazards models assessed the risk of all-cause mortality among respondents who avoided health care because of the COVID-19 pandemic. Mortality status was collected through municipality registries and medical records. Results: Of 5656 respondents, one-fifth avoided health care because of the COVID-19 pandemic (n = 1143). Compared with non-avoiders, those who avoided health care more often reported symptoms of depression (n = 357, 31.2% versus n = 554, 12.3%) and anxiety (n = 340, 29.7% versus n = 549, 12.2%), and more often rated their health as poor to fair (n = 336, 29.4% versus n = 457, 10.1%). Those who avoided health care had an increased adjusted risk of all-cause mortality (hazard ratio [HR] 1.30, 95% confidence interval [CI] = 1.01 to 1.67), which remained nearly identical after adjustment for history of any non-communicable disease (HR 1.20, 95% CI = 0.93 to 1.54). However, this association attenuated after additional adjustment for mental and physical self-perceived health factors (HR 0.93, 95% CI = 0.71 to 1.20). Conclusion: This study found an increased risk of all-cause mortality among individuals who avoided health care during COVID-19. These individuals were characterised by poor mental and physical self-perceived health. Therefore, interventions should be targeted to these vulnerable individuals to safeguard their access to primary and specialist care to limit health disparities, inside and beyond healthcare crises. [ABSTRACT FROM AUTHOR]

The article discusses the upcoming National Health Reform Agreement in Australia, highlighting key themes such as intersectoral collaboration, optimal models of care, financing reform, and rural and remote service delivery. The review emphasizes the need for continuity of care, relevant key performance indicators, and incentivizing prevention to improve the health system. It also addresses challenges such as linking Commonwealth and state-funded services, supporting system-wide change management, and avoiding new bureaucracies. The article calls for broad discussion and policy reform to ensure equitable and accessible healthcare for all Australians. [Extracted from the article]

Introduction: Access to dental care may affect diagnosis of oral squamous cell carcinoma (OSCC). We tested whether the incidence rate of OSCC is higher in regions with less dental care access in the city of Chicago and state of Illinois. Study Design: Ecological cohort. Setting: Population, outpatients, and inpatients. Methods: We extracted 5‐year averages of the state‐wide county‐level and city‐level OSCC incidence rates from 2015 to 2019 from the Illinois Department of Public Health. Dental care access information was also collected for each county for the same period, as well as the percentage of people that had ≥1 visit to a dentist in the previous year in Chicago. Multivariate Poisson regression was used to investigate the relationship between county‐level access to dental care (and city‐level dentist visits) and OSCC incidence rate, controlling for confounders, with additional flexible semiparametric models for confirmatory sensitivity analysis. Results: In Illinois, higher 5‐year incidence rate of OSCC was significantly associated with low access to dental care by county (IRR = 0.96, 95% CI 0.91, 0.98). Southern/southwestern counties had higher incidence rates of OSCC (15.5%–28.4%) and the lowest rates of dental care access (47.5%–69.2%) compared to northern counties (10.3%–15% and 55.4%–80.6%, respectively). In Chicago, people with more dentist visits had a reduced chance of being diagnosed with OSCC (IRR = 0.97, 95% CI 0.91, 0.99), consistent with state‐wide analyses. Conclusion: OSCC incidence rate is closely associated with poor local dental healthcare access in a major state and urban city. Increasing dental access could improve cancer outcomes via improved oral health and earlier detection. [ABSTRACT FROM AUTHOR]

Essential workers were at increased risk during the COVID-19 pandemic, including seafood processors who are often rendered invisible within the public sphere. To examine the health and safety concerns of seafood processors, many who are low income or im/migrant workers on H-2B visas, our team conducted qualitative research with 44 participants. We found that in addition to high occupational health hazards that existed before the pandemic, COVID-19 increased workers’ financial risks, which put them in more dangerous health and safety positions, since they needed to work through physical and mental health illness. These financial risks can be seen through the themes of paid sick leave, mental health, economic duress, and primary care access. We conclude with three recommendations to the H-2B visa worker program, which will not only decrease health disparities for im/migrant workers, but also increase health equity across seafood worker populations. [ABSTRACT FROM AUTHOR]

Background: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. Methods and findings: A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. Conclusions: Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system. Author summary: Why was this study done?: Globalization has led to an increasing number of migrants who must navigate a new healthcare system in the countries they migrate to. Migrants have been shown to use specific health services, such as cancer screening or general practitioner use, at a lower rate than those born in the host country. Limited studies have been performed which have evaluated the longitudinal usage patterns of medical imaging of migrants compared with nonmigrants. What did the researchers do and find?: A retrospective cohort study of 1,848,222 migrants to Ontario, Canada were matched to an equal number of nonmigrants and evaluated for the utilization rates of computerized tomography, magnetic resonance imaging, radiography, and ultrasonography medical imaging. Usage rates of medical imaging were 20% to 30% lower in migrants compared with nonmigrants. A longer time since migration resulted in larger disparities in imaging use, with the largest age-related differences in utilization patterns observed in older migrants. What do these findings mean?: Large disparities in the utilization of medical imaging within this universal healthcare system exist which warrants further investigation to uncover mechanisms of action. These data may be used by healthcare policymakers and practitioners in regions where migration plays a significant role in its population. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion Elderly population is increasing in high‐income countries. For instance, by 2050, 21.4% of the United States population is expected to be 65+, thus making advance care planning (ACP) increasingly important. We aim to identify predictors of ACP completion in 11 high‐income countries and explore relationships between ACP and utilization factors.Using the 2021 International Health Policy (IHP) survey data, we assessed the relationship between sociodemographic factors, healthcare utilization, and ACP. The primary outcome variable was a composite of three ACP activities. A generalized linear mixed model (GLMM) was used to identify predictors of ACP completion.Analyses included 18,677 older adults who answered at least one ACP question. Only 5126 (27.4%) reported completion of three ACP activities. Germany (64.7%) showed the highest completion rates, while Sweden (5.0%) and France (5.0%) showed the lowest completion rates. Predictors of ACP completion identified in the GLMM were: increasing age (incidence rate ratio [IRR] range between 1.2 and 1.5), completion of high school education or more (IRR: 1.1, 95% CI: 1.1–1.1), higher income (IRR: 1.1, 95% CI: 1.1–1.2), presence of two or more health conditions (IRR: 1.1, 95% CI: 1.0–1.1), hospital stay in the past 2 years (IRR: 1.1, 95% CI: 1.1–1.1), and access to quality primary care (IRR: 1.0, 95% CI: 1.0–1.1). Male gender (IRR: 0.9, 95% CI: 0.8–0.9) had a negative association with ACP activity completion.Several patient‐specific and health system utilization factors were identified as predictors of ACP activity completion, which clinicians and policymakers could use to enhance ACP completion. [ABSTRACT FROM AUTHOR]

Background: This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective. Methods: A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups. Results: A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care. Conclusion: Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada. [ABSTRACT FROM AUTHOR]

Background: Being attached to a primary care (PC) provider is at the core of a strong primary health care system. Centralized waiting lists (CWL) for unattached patients have been implemented in eight provinces of Canada to support the attachment process. In Quebec, the Ministry of Health mandated the implementation of Primary Care Access Points (GAP) across the province to help unattached patients navigate the health system while awaiting attachment through the CWL. Several local health territories developed complementary innovations to the GAP to respond to local population needs. This paper aims to describe five organizational innovations implemented locally. Methods: This multi-case qualitative study was conducted in four local health territories in the province of Quebec. Fifty-two semi-structured interviews with healthcare managers, nurses, physicians, other health professionals and administrative staff were conducted between April 2023 and April 2024. An interview guide was developed based on existing frameworks on the implementation of innovations and the evaluation of the GAP. Thematic analysis was conducted using NVivo software. Inductive and deductive approaches were used to develop relevant codes and themes. Logic models were built to describe the organizational innovations. Results: Five organizational innovations are described. First, a multidisciplinary clinic aimed at responding to patients with mental health issues was implemented. Second, a nurse clinic was implemented to provide temporary care for patients with unstable chronic illnesses. The third innovation is a mobile proximity clinic where unattached GAP patients are first evaluated by a paramedic before receiving care from a nurse. Fourth, a pharmacist trajectory was implemented to increase engagement of community pharmacists to respond to GAP patients. The last innovation is a decentralized GAP offering in-person nursing care to unattached GAP patients. Conclusions: Descriptions of these five innovations are key to inform other territories and provinces on ways to improve access for unattached patients while they are waiting to be attached. The introduction of the GAP and the organizational innovations, suggests a transition where access to PC services does not rely solely on attachment status. [ABSTRACT FROM AUTHOR]

Background: Accessing sexual and reproductive health (SRH) services in rural Australia presents complex challenges that negatively impact women's health and exacerbate health inequities across the life course. This systematic review synthesises evidence on the barriers and facilitators to women's access to SRH services in rural Australia, considering both supply and demand dimensions. Methods: We systematically searched peer-reviewed literature published between 2013 and 2023. Search terms were derived from three major topics: (1) women living in rural Australia; (2) spatial or aspatial access to SRH services; and (3) barriers or facilitators. We adopted the "best fit" approach to framework synthesis using the patient-centred access to healthcare model. Results: Database searches retrieved 1,024 unique records, with 50 studies meeting the inclusion criteria. Most studies analysed access to primary care services (n = 29; 58%), followed by hospital services (n = 14; 28%), health promotion and prevention (n = 5; 10%), and specialist care (n = 2; 4%). The type of care accessed was mostly maternity care (n = 21; 42%), followed by abortion services (n = 11; 22%), screening and testing (n = 8; 16%), other women's health services (n = 6; 12%), and family planning (n = 4; 8%). There were numerous barriers and facilitators in access from supply and demand dimensions. Supply barriers included fragmented healthcare pathways, negative provider attitudes, limited availability of services and providers, and high costs. Demand barriers encompassed limited awareness, travel challenges, and financial burdens. Supply facilitators included health system improvements, inclusive practices, enhanced local services, and patient-centred care. Demand facilitators involved knowledge and awareness, care preferences, and telehealth accessibility. Conclusion: This review highlights the urgent need for targeted interventions to address SRH service access disparities in rural Australia. Understanding the barriers and facilitators women face in accessing SRH services within the rural context is necessary to develop comprehensive healthcare policies and interventions informed by a nuanced understanding of rural women's diverse needs. [ABSTRACT FROM AUTHOR]

Background: Vulnerable social groups have greater difficulty in accessing care and a lower quality of care. Health systems focused on primary care appear to be more effective, efficient and equitable. However, difficulties in accessing primary care are persisting. We focused on primary care screening for cervical cancer through Cervico-Uterine Smear (CUS), which has been shown to be effective in reducing disease incidence and mortality. In this study, we aimed to investigate the characteristics of women who undergo CUS according to the category of health professionals (general practitioners or gynaecologists) performing CUS and to analyse potential differences in access to care in terms of socioeconomic and geographical characteristics. Methods: This was a retrospective observational study based on data from the main health insurance schemes in France, allowing analysis of health care consumption according to socioeconomic levels and proximity to health care services. We included women aged 25 to 64 years in 2012 for whom CUS would be a relevant procedure (695,694). The sociodemographic and territorial indicators were age, geographical area deprivation, and the availability of gynaecological care. The analysis was performed using multinomial logistic regression. Results: A total of 202,271 (29%) patients underwent CUS; of whom 68% underwent CUS administered by gynaecologists and 28% were administered by general practitioners (GPs). However, inequalities in CUS screening rates were observed, with a decrease in the number of CUSs performed with increased age, a rural location, deprivation, and sparse health care provisions. Deprived people seemed less penalised by GPs. Conclusions: Involvement of General Practitioners may improve cervical screening equality in France. The organisation of health systems around primary care may allow a better access to care and to account for the specific needs of deprived populations. [ABSTRACT FROM AUTHOR]

More than 7 million people are released each year from U.S. jails or prisons, many with chronic diseases that would benefit from primary care in their returning communities. The objective of this study was to provide an in-depth, payer-agnostic description and associational analysis of primary care need and utilization by all individuals ever detained in one county detention facility over a 7-year period. Detention records 2014–2020 were merged with data from an electronic health record with excellent coverage of local primary care, emergency, and hospital services. We found low primary care participation for the group as a whole, with under three quarters of those with serious chronic diseases ever seeing a primary care provider over a 7-year period and less than half ever having a year with more than one visit. Multivariable regression models estimated associations between individual characteristics (demographic, detention-related, and clinical) and ever having access to primary care (logistic) and the number of primary care visits (zero-inflated negative binomial). We found that having more jail bookings was associated with fewer primary care visits, but not one-time access, even controlling for time out of community, age, insurance, and other demographic characteristics. This finding was driven by subgroups with chronic disease such as hypertension, obstructive lung disease, and diabetes, who most need regular primary care. Being Black retained an independent effect, even controlling for bookings and other variables, and was also associated with fewer primary care visits, though not one-time access. To promote primary care utilization among individuals who have the combined challenges of repeated jail involvement and chronic disease, it is crucial to focus on engagement, as much as formal access. Access to health insurance alone will not resolve the problem; Medicaid expansion should be coupled with specialized, tailored support to promote engagement in primary care. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion To investigate the perspectives of people accessing a general medical practitioner (GP)‐optometry model of collaborative care that was established to increase access to diabetes eye care.Qualitative study of patient barriers and facilitators to accessing primary diabetes eye care located in a metropolitan area in Australia. One‐on‐one interviews were recorded, transcribed and thematically analysed using a determinant framework on patient‐centred access to health care.Twenty‐four people with type 2 diabetes, including 15 males and 9 females, who accessed the service between September 2021 and June 2022 agreed to participate. Mean (SD) age of the participants was 52 (12) years and 50% had been diagnosed with diabetes for <2 years. Facilitators to accessing diabetes eye care included a referral from a GP or GP nurse, fee‐free consultations, availability of after‐hours appointments and short waiting times. Barriers to access included perceived out‐of‐pocket costs, competing responsibilities and lack of awareness of diabetic retinopathy screening recommendations.Considering diabetic retinopathy may present asymptomatically, primary health practitioners (optometrists and GPs) are well positioned to raise patient awareness of the importance of routine eye examinations. In Australia, access to routine screening could be facilitated by fee‐free eye checks and personalised text message reminders implemented at a health system level. [ABSTRACT FROM AUTHOR]

Despite its efficacy, pre-exposure prophylaxis (PrEP) for HIV has a low uptake, with many disparities remaining. This study aimed to assess the impact of Medicaid expansion and social determinants of health (SDOH) on PrEP prevalence and PrEP-to-need ratio (PnR) using county-level data from 2012 to 2022. Differences-in-differences regressions indicated that Medicaid expansion is associated with increased PnR but not PrEP prevalence. Linear regressions were conducted to evaluate the impact of county-level SDOH on PrEP outcomes. Rurality was associated with lower PnR and PrEP prevalence. Racial disparities were present, with areas with greater concentrations of non-Hispanic Black populations having lower PrEP prevalence and PnR. Greater concentrations of Hispanic populations were associated with lower PnR. Income inequality, socioeconomic status vulnerability, and primary care physician concentration were all associated with higher PnR. Medicaid expansion supports increasing PrEP use in the areas of greatest need. Efforts should be made to improve PrEP access, particularly in areas with high SDOH vulnerabilities. [ABSTRACT FROM AUTHOR]

Background: Despite primary care being largely free at the point of delivery, many Canadians experience challenges in accessing the services they need. A systematic review was conducted to summarize the evidence on the level of unmet need for primary care in Canada and its social determinants. Methods: MEDLINE, Embase, Cochrane, and Web of Science databases were screened from inception to December 2023 using relevant search terms for primary care and unmet healthcare needs. Quantitative observational studies in the English language that included Canadian adults aged 18 years and older and focused on unmet needs for primary care were included. The risk of bias in the studies was assessed using either the Joanna Briggs Institute (JBI) critical appraisal checklist or the Newcastle–Ottawa Scale. The included studies were synthesized narratively. Results: Forty-six studies met the inclusion criteria for this review. Of the included studies, 96% were cross-sectional in design and 91% had low risk of bias. The prevalence of unmet need, mostly self-reported, varied between 6.6% and 25.2% in national studies. Social determinants of unmet needs were heterogeneous across studies. Findings suggest that unmet need for primary care is related to having low income, mental health diagnoses, and chronic conditions, and negatively associated with older age, having better-perceived health, and having a family physician. Conclusions: Universal access to primary care is the founding principle of the Canadian healthcare system. However, we found evidence suggesting that the extent to which primary care needs are met is influenced by social determinants of health. Further research is needed to improve our understanding of the mechanisms of unmet primary care needs in Canada. Systematic review registration: PROSPERO CRD42021285074. [ABSTRACT FROM AUTHOR]

Background The coronavirus disease 2019 (COVID-19) pandemic impacted cancer services worldwide. We examined the effect of the first three pandemic waves on the number of electronic (e)-referrals to rapid access clinics (RACs) for breast, lung and prostate cancer in Ireland. Methods This study used a retrospective, repeated cross-sectional design. The predicted weekly number of e-referrals by suspected cancer types from March 2020 to May 2021 was calculated using the Holt-Winters seasonal smoothing method, based on the observed numbers from a representative pre-pandemic period (01 January 2019 to 01 March 2020) and compared this with the observed number across the first three pandemic waves (02 March 2020 to 09 May 2021). Percentage differences were calculated between observed and predicted numbers of e-referrals for the three RACs and patterns were examined in each wave. Results Observed e-referrals were lower than predicted for all three RACs in the first wave of the pandemic (15.7% lower for breast, 39.5% lower for lung and 28.1% lower for prostate) with varying levels of recovery in the second and third waves for the three e-referral types. Conclusions The COVID-19 pandemic impacted patterns of e-referrals to RACs in the first three pandemic waves in Ireland. Early identification of changes in engagement with health services, such as a decrease in primary care presentations with a resultant decrease in e-referrals to RACs can allow for a rapid response from cancer control programmes. Continued surveillance of the impact of service disruption on cancer services allows policy makers and strategic leaders in cancer control programmes to respond rapidly to mitigate the impact on cancer outcomes. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of telemedicine by a patient's own primary care provider (PCP) versus another available PCP is understudied. Objective: Examine the association between primary care visit modality with timeliness and follow-up in-person healthcare, including variation by visits with the patient's own PCP versus another PCP. Design and Participants: Cohort study including primary care visits in a large, integrated delivery system in 2022. Measures: Outcomes included timeliness (visit completed within 7 days of scheduling) and in-person follow-up (PCP visits, emergency department (ED) visits, hospitalizations) within 7 days of the index PCP visit. Logistic regression measured the association between visit modality (in-person, video, and audio-only telemedicine) with the patient's own PCP or another PCP and outcomes, adjusting for characteristics. Key Results: Among 4,817,317 primary care visits, 59% were in-person, 27% audio-only, and 14% video telemedicine. Most (71.3%) were with the patient's own PCP. Telemedicine visits were timelier, with modality having a larger association for visits with patient's own PCP versus another PCP (P < 0.001). For visits with patient's own PCPs, return office visit rates were 1.2% for in-person, 5.3% for video, and 6.1% for audio-only. For another PCP, rates were 2.2% for in-person, 7.3% for video, and 8.1% for audio. Follow-up ED visits ranged from 1.4% (in-person) to 1.6% (audio-only) with own PCP, compared to 1.9% (in-person) to 2.3% (audio-only) with another PCP. Differences in return office and ED visits between in-person and telemedicine were larger for visits with another PCP compared to their own PCP (P < 0.001). Follow-up hospitalizations were rare, ranging from 0.19% (in-person with own PCP) to 0.32% (video with another PCP). Conclusion: Differences in return office and ED visits between in-person and telemedicine were larger when patients saw a less familiar PCP compared to their own PCP, reinforcing the importance of care continuity. [ABSTRACT FROM AUTHOR]

Background: Telehealth services were used by healthcare centers during the COVID-19 pandemic in order to identify and manage patients at the forefront of the healthcare system. As one of these technologies, tele-triage refers to the assessment of a patient's health status through telephone or another means of communication and recommending treatment or providing appropriate referrals in emergency rooms and primary care offices. This study aimed to perform a systematic review of the evidence on the effectiveness of tele-triage, as one of these technologies, during the COVID-19 pandemic. Methods: Medline (via PubMed), Scopus, and Web of Science databases were searched for relevant English articles published since the pandemic's onset until December 30, 2021. Studies investigating the tele-triage's effect on patient safety, clinical outcomes, and patient satisfaction were included. Data on study characteristics, intervention characteristics, and their effects on study outcomes were extracted separately by two authors. A narrative synthesis of the included studies was ultimately performed. Results: Out of the 6312 retrieved studies, 14 met the inclusion criteria. The tele-triage intervention was offered by an algorithm-based system in eight studies (57.14%) and by healthcare providers in six other studies (42.86%) to determine the patient's level of care. According to the results, tele-triage interventions during COVID-19 can reduce unnecessary emergency room visits (by 1.2–22.2%), improve clinical outcomes after intervention (such as would closure in diabetic feet), reduce mortality and injuries, and ensure patient satisfaction with tele-triage (53–98%). Conclusions: This study found that tele-triage interventions reduced unnecessary visits, improved clinical outcomes, reduced mortality, and injuries, increased patient satisfaction, reduced healthcare provider workload, improved access to primary care consultation, and increased patient safety and satisfaction. Therefore, tele-triage systems are not only suitable for providing acute and emergency care remotely but they are also recommended as an alternative tool to monitor and diagnose COVID-19. [ABSTRACT FROM AUTHOR]

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Background: The COVID-19 pandemic necessitated the widespread roll-out of teleconsultations across primary care services in the UK. The media's depiction of remote consultations, especially regarding their safety, is not well established. These insights are important: newspapers' coverage of healthcare-related news can influence public perception, national policy, and clinicians' job satisfaction. Aim: To explore how the national newspapers in the UK depicted both the direct and indirect consequences of the remote-first approach on patient safety. Design and setting: We performed thematic analysis of newspaper articles that discussed patient safety in primary care teleconsultations, which were published between 21 January 2021 and 22 April 2022. Method: We identified relevant articles using the LexisNexis Academic UK database. We categorised data from these articles into codes before developing these into emergent themes through an iterative process. Results: Across the 57 articles identified, the main safety concern identified was missed and/or delayed diagnoses over tele-appointment(s), while isolated cases of inappropriate prescribing were also reported. The media reported that the transition to a remote-first approach reduced the accessibility to primary care appointments for some groups (especially patients with lower digital literacy or access) and heightened the burden on other healthcare services; in particular, there were reports of patient care being compromised across NHS emergency departments. Conclusion: The print media predominantly reported negative impacts of remote consultations on patient safety, particularly involving missed and/ or delayed diagnoses. Our work highlights the importance of further exploration into the safety of remote consultations, and the impact of erroneous media reporting on policies and policymakers. [ABSTRACT FROM AUTHOR]

Background: In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging focus on a major root cause of disparities—systemic racism. Current conceptual models of asthma disparities depict the historical and current effects of systemic racism as the foundation for unequal exposures to social determinants of health, environmental exposures, epigenetic factors, and differential healthcare access and quality. These ultimately lead to biologic changes over the life course resulting in asthma morbidity and mortality. Methods: At the 2022 American Thoracic Society International Conference, a diverse panel of experts was assembled to identify gaps and opportunities to address systemic racism in childhood asthma research. Panelists found that to examine and address the impacts of systemic racism on children with asthma, researchers and medical systems that support biomedical research will need to 1) address the current gaps in our understanding of how to conceptualize and characterize the impacts of systemic racism on child health, 2) design research studies that leverage diverse disciplines and engage the communities affected by systemic racism in identifying and designing studies to evaluate interventions that address the racialized system that contributes to disparities in asthma health outcomes, and 3) address funding mechanisms and institutional research practices that will be needed to promote antiracism practices in research and its dissemination. Results: A thorough literature review and expert opinion discussion demonstrated that there are few studies in childhood asthma that identify systemic racism as a root cause of many of the disparities seen in children with asthma. Community engagement and participation in research studies is essential to design interventions to address the racialized system in which patients and families live. Dissemination and implementation studies with an equity lens will provide the multilevel evaluations required to understand the impacts of interventions to address systemic racism and the downstream impacts. To address the impacts of systemic racism and childhood asthma, there needs to be increased training for research teams, funding for studies addressing research that evaluates the impacts of racism, funding for diverse and multidisciplinary research teams including community members, and institutional and financial support of advocating for policy changes based on study findings. Conclusions: Innovative study design, new tools to identify the impacts of systemic racism, community engagement, and improved infrastructure and funding are all needed to support research that will address impacts of systemic racism on childhood asthma outcomes. [ABSTRACT FROM AUTHOR]

Background: Telehealth uses Information and Communication Technologies (ICT) in distance health-related activities between professionals, managers, and patients of health services. This cross-sectional study compared the ICT infrastructure available in Brazilian Basic Health Units (BHU) for telehealth actions, along with evaluation cycles of the National Program for Improving Access and Quality of Primary Care (PMAQ-AB). Methods: Data from the second and third cycles of the PMAQ-AB were used. A total of 22,021 BHUs were evaluated concerning the availability of computers, cameras, stereo boxes, microphones, printers, television, and internet available. The presence of each ICT equipment assigned a score to each BHU. The sum of these scores assigned a final score to the BHU and was used for comparison among different Brazilian regions. The data were analyzed descriptively and by Wilcoxon test (p ≤ 0.05) using SPSS v. 25. Results: The increase in the median number of ICT equipment was statistically significant in the BHU in Brazil and the Brazilian regions (p < 0.001). The South, Southeast, and Midwest regions had the highest median scores in both cycles. Conclusions: The availability of ICT equipment for telehealth actions in BHU improved over the PMAQ-AB cycles, with differences in the ICT structure between Brazilian regions. [ABSTRACT FROM AUTHOR]

Improvements in health and mortality, known as the health transition, played important roles in the rise of modern contraceptive prevalence across countries. We describe key mechanisms and selected research evidence that show how health transitions helped shape contraceptive transitions around the world. Mechanisms include how decreases in child mortality rates affect the motivation to use contraception and how the organization and expansion of health care affect key barriers to contraceptive use. Substantial increases in child survival resulting from health transitions increase demand for deliberate fertility regulation and contraceptive use. Improved access to primary health care, particularly maternal and child health services and expansion into rural communities, was associated with increases in modern method use. Country‐specific policies that affected the organization and delivery of health care led to the dominance of particular modern methods in some countries. Empirical evidence is limited on how the quality of health care has affected aggregate level increases in modern method use. Using modern contraceptive prevalence to define the contraceptive transition reflects current data limitations but future research on the relationship of health transitions with macrolevel contraceptive prevalence trends may be able to incorporate more comprehensive aspects of how health transitions impact contraceptive choice and agency. [ABSTRACT FROM AUTHOR]

Background: Access of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist. Methods: We used Leveque's Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers. Results: Our results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations. Conclusion: Social health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations. Highlights: • The primary health needs of the poorest population of Khyber Pakhtunkhwa remain largely unmet or are met with difficulties, across the care-seeking pathway. • Major contributors to unmet primary healthcare needs in the study area are: low outreach, crowded facilities and, varying availability of medicines and diagnostics at facilities on the supply side, and difficulties in navigating care and inability to afford prescribed care on the demand side. • Social Health Protection is a crucial tool for advancing Universal Health Coverage and improving primary healthcare, however these needs cannot be met without quality service provision and outreach from facilities. • Levesque's framework of access to care (2013) can be effectively employed to identify broad-based unmet needs and assess gaps in primary healthcare systems. [ABSTRACT FROM AUTHOR]

This article explores the significance of comparative health systems research in gaining insights into healthcare systems worldwide. It emphasizes the role of organizations like the World Health Organization and the OECD in collecting and analyzing health-related data. The article identifies research gaps, including the need for standardized data collection methods, a better understanding of health systems, longitudinal studies, and the incorporation of social determinants of health. It concludes by summarizing three papers in a special section on international comparisons, which provide valuable insights into health expenditure, wealth-related health disparities, and the impact of the COVID-19 pandemic on healthcare systems. Additionally, the article presents a study comparing hospitalizations and emergency department visits for mental health conditions across eight high-income countries before and during the pandemic. The study reveals significant variations in acute mental health care utilization among the countries, with the United States having the highest rates and Finland having the lowest. It also highlights shifts in care settings during the pandemic, particularly in the US, where there was an increase in inpatient care and a decrease in ED visits. The study underscores the importance of international collaboration and comparative research in understanding health system resilience and improving global health outcomes. [Extracted from the article]

The need for equitable access to primary healthcare services in the current global context has attracted widespread attention, prompting nations to continuously enhance their grassroots medical service levels. In response, China launched the "Healthy China" initiative, which prioritizes the enhancement of national health as a core goal of the healthcare system and uses this opportunity to deepen reforms aimed at strengthening primary care. However, in remote and rural areas, the optimization of medical resource allocation and the achievement of balanced service development remain critical challenges owing to limited resources. This study selected Liannan Yao Autonomous County, which is situated in the northwestern corner of Guangdong Province, as a case study due to its remote mountainous location, underdeveloped economy, and minority region characteristics. Through field research and interviews, this study thoroughly explored the needs of both supply and demand, factoring in elements such as the service capability of healthcare facilities and residents' travel thresholds to enhance the two-step floating catchment area model, thus making it more applicable to remote villages. By integrating electric bikes and cars, which are the primary means of transportation in rural areas, this study conducted a thorough analysis and comparison of the accessibility of medical services in Liannan Yao Autonomous County (Liannan County). The results reveal significant disparities in healthcare accessibility, an uneven distribution of medical resources, and varying impacts of transportation conditions and facility service capabilities on accessibility. Notably, the study revealed that improving transportation conditions alone has limited effects in rural areas; the key lies in balancing medical service capabilities and the rationality of overall layouts. From the perspectives of equity and efficiency, this study employs the equitable coverage model and the efficiency-driven model to construct two scenarios, comparing accessibility changes in Liannan County under both conditions and proposing strategies to improve the spatial layout of local healthcare facilities. This research not only deepens the understanding of healthcare service accessibility in rural areas but also provides a scientific basis for optimizing resource allocation and enhancing primary medical services, offering valuable guidance and reference for Liannan County and other similar rural regions. [ABSTRACT FROM AUTHOR]

Background: Health care is not exempt from harboring social inequalities, including in those countries with a universal public system. The objective was to ascertain whether the population's assessment of primary care (PC) changed between 2006 and 2016, the decade that included the economic crisis of 2008, and also if it exhibited patterns of social inequality in Barcelona (Spain). Methods: This was a cross-sectional study using Barcelona Health Surveys 2006 and 2016. Samples (4027 and 3082 respectively) comprised residents in Barcelona, over 15 years old. Dependent variable: Primary Care (PC) index. Independent variables: age, social class, and birthplace. Analyses included means and percentiles of PC index, and Somers' D test to compare the distribution of the groups. Results: Comparing 2016 with 2006, the distribution of the PC index remained in women (median of 73.3) and improved in men (from 70 to 73.3). By social class, the pattern of inequality observed in 2006 in men with perceived poor health status disappeared in 2016. Inequalities according to birthplace persisted in women, regardless of perceived health status, but disappeared in men. Conclusions: In the 10 years between which the global economic crisis occurred, the assessment of PC did not worsen, and it did improve for men, but the study points to the need for more focus on people born abroad. [ABSTRACT FROM AUTHOR]

Background: The onset of the COVID-19 pandemic drove a rapid and widespread shift to virtual care, followed by a gradual return to in-person visits. Virtual visits may offer more convenient access to care for some, but others may experience challenges accessing care virtually, and some medical needs must be met in-person. Experiences of the shift to virtual care and benefits of in-person care may vary by immigration experience (immigration status and duration), official language level, and age. We examined use of virtual care and return to in-person visits in the Canadian province of British Columbia (BC), comparing patterns by age and across immigration groups, including length of time in Canada and language level (official languages English and French) at time of arrival. Methods: We used linked administrative health and immigration data to examine total primary care visits (virtual or in-person) and return to in-person visits during the COVID-19 pandemic (2019/20–2021/2) in BC. We examined the proportion of people with any primary care visits and with any in-person visits within each year as measures of access to primary care. We estimated the odds of any primary care visits and any in-person visits by immigration group and official language level assessed prior to arrival: non-immigrants, long-term immigrants, recent immigrants (< 5 years) with high assessed official language level and recent immigrants (< 5 years) with low assessed official language level (assessed prior to arrival), stratified by age. Results: In general, changes in access to primary care (odds of any visits and odds of any in-person visits) were similar across immigration groups over the study period. However, we observed substantial disparities in access to primary care by immigration group among people aged 60 + , particularly in recent immigrants with low official language level (0.42, 0.40–0.45). These disparities grew wider over the course of the pandemic. Conclusion: Though among younger adults changes in access to primary care between 2019–2021 were similar across immigration groups, we observed significant and growing inequities among older adults, with particularly limited access among adults who immigrated recently and with low assessed official language level. Targeted interventions to ensure acceptable, accessible care for older immigrants are needed. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONAlthough the need for rehabilitation is increasing in Zimbabwe, rehabilitation remains undervalued. Currently, Zimbabwe struggles to provide rehabilitation services at primary health care. To justify the need for establishing rehabilitation at this level of care, the demand for these services needs to be understood. This study describes the factors influencing the demand for rehabilitation by adults attending primary healthcare in Zimbabwe.The study used a qualitative descriptive approach. In-depth interviews were conducted with 18 purposefully selected patients in the Shona language and audio recorded. Transcribed data were translated and back-translated. Thematic analysis was done using Atlas.ti. version 22.2®.Most patients at primary health care were not actively seeking nor were they able to utilise rehabilitation services because of several factors. The factors identified from the patients’ responses were categorised into (i) patient and family-, (ii) healthcare professional-, and (iii) health system-related factors. Key factors included rehabilitation awareness and availability of rehabilitation.The identified factors may inform rehabilitation service and policy planners in improving primary health care patients’ access to rehabilitation in similar low-resource settings. Future studies may determine how the identified factors may be addressed to ensure that high need translates to high demand.Identifying factors influencing rehabilitation demand by adult primary health care patients in low-resource settings is a first step in developing strategies to increase access to quality services for underserved populations.Conducting patient education initiatives to increase awareness and understanding of rehabilitation may incite the patients to perceive their need for and actively seek rehabilitation services through their primary care providers.Primary care providers need to be provided with the knowledge on the scope and benefits of rehabilitation to enable identification of patients with functioning problems and adequate referral to rehabilitation.Prioritising financial investment to strengthen the primary healthcare systems in which rehabilitation is to be nested will create a solid foundation for integrating rehabilitation services.Meanwhile, there is need to develop cost-effective interventions that may bring rehabilitation services closer to patients’ homes, ensuring accessibility even in remote areas.Identifying factors influencing rehabilitation demand by adult primary health care patients in low-resource settings is a first step in developing strategies to increase access to quality services for underserved populations.Conducting patient education initiatives to increase awareness and understanding of rehabilitation may incite the patients to perceive their need for and actively seek rehabilitation services through their primary care providers.Primary care providers need to be provided with the knowledge on the scope and benefits of rehabilitation to enable identification of patients with functioning problems and adequate referral to rehabilitation.Prioritising financial investment to strengthen the primary healthcare systems in which rehabilitation is to be nested will create a solid foundation for integrating rehabilitation services.Meanwhile, there is need to develop cost-effective interventions that may bring rehabilitation services closer to patients’ homes, ensuring accessibility even in remote areas. [ABSTRACT FROM AUTHOR]

Background: Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. Methods: An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. Results: Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. Conclusions: Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia. Methods: This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation. Results: Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness. Conclusion: African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization's (WHO) Mental Health Gap Action Programme (mhGAP) aims to provide evidence-based guidelines for the management of mental, neurological, and substance use disorders in non-specialized healthcare settings. However, implementing these guidelines remains a challenge due to various factors, including limited training opportunities for primary care providers. This study con the effectiveness of a social media-delivered distance education program on the mhGAP intervention guide, to overcome barriers of technology access and digital literacy, providing a familiar and accessible platform for primary care providers in Jalisco. Methods: A quasi-experimental study with a pre-test/post-test design was conducted. Primary care providers from Jalisco were invited to participate in a distance education program on the mhGAP intervention guide. The program consisted of online modules, webinars, and discussion forums facilitated by mental health experts. Knowledge assessments were conducted before and after the intervention using a standardized questionnaire. Participant satisfaction and perceived utility were also evaluated through surveys and focus group discussions. Results: A total of 1,096 primary care providers completed the program. The mean knowledge score significantly improved from 58.2% (SD = 12.8%) in the pre-test to 81.4% (SD = 9.6%) in the post-test (p < 0.001), with a large effect size (Cohen's d = 2.04). Subgroup analyses revealed consistent knowledge gains across different demographic and professional characteristics. Participant satisfaction was high, with 92% rating the program's overall quality as "good" or "excellent." Qualitative findings highlighted the benefits of accessibility, flexibility, interactivity, and practical applicability of the distance education approach. Conclusions: The social media-delivered distance education program on the mhGAP intervention guide effectively improved the knowledge of primary care providers in Jalisco, Mexico. Participants reported high levels of satisfaction and perceived utility. This study demonstrates the potential of distance education strategies to disseminate evidence-based guidelines and enhance mental health service delivery in primary care settings, particularly in resource-limited areas. [ABSTRACT FROM AUTHOR]

In the landscape of American healthcare, the persistent disparity in the utilization of primary care services among different demographic groups remains a significant public health challenge. African-American men, in particular, are notably underrepresented in primary healthcare settings despite having higher rates of noncommunicable diseases (NCDs) such as hypertension, diabetes, and cardiovascular diseases compared to their counterparts from other racial groups (Stewart et al., 2019). This disparity has profound implications not only for the health outcomes of this group but also for the overall burden on the healthcare system. This paper explores the motivations behind primary care-seeking behaviors in urban-dwelling African American men, highlighting the critical need for enhanced engagement with primary care services to improve health outcomes and reduce disparities. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of primary palliative care and its essential role in ensuring accessibility for individuals facing life-threatening illnesses. Topics discussed include models of integrating palliative care in various settings, the significance of education and training for primary care providers, and the importance of continuity and patient-centered care in improving palliative care delivery.

The article focuses on the importance of integrating palliative care into primary health care as a key element of achieving Universal Health Coverage. Topics discussed include the need for a clear definition of primary palliative care, the shared strengths of primary care and palliative care in providing holistic and continuous care, and the role of primary care in early identification and coordination of palliative care needs.

Background: Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations. Aim: This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda. Design: Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation. Setting/participants: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities. Results: At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care. Conclusion: Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community. [ABSTRACT FROM AUTHOR]

Background: Medications for opioid use disorder (MOUD) including buprenorphine are effective, but underutilized. Rural patients experience pronounced disparities in access. To reach rural patients, the US Department of Veterans Affairs (VA) has sought to expand buprenorphine prescribing beyond specialty settings and into primary care. Objective: Although challenges remain, some rural VA health care systems have begun offering opioid use disorder (OUD) treatment with buprenorphine in primary care. We conducted interviews with clinicians, leaders, and staff within these systems to understand how this outcome had been achieved. Design: Using administrative data from the VA Corporate Data Warehouse (CDW), we identified rural VA health care systems that had improved their rate of primary care–based buprenorphine prescribing over the period 2015–2020. We conducted qualitative interviews (n = 30) with staff involved in implementing or prescribing buprenorphine in these systems to understand the processes that had facilitated implementation. Participants: Clinicians, staff, and leaders embedded within rural VA health care systems located in the Northwest, West, Midwest (2), South, and Northeast. Approach: Qualitative interviews were analyzed using a mixed inductive/deductive approach. Key Results: Interviews revealed the processes through which buprenorphine was integrated into primary care, as well as processes insufficient to enact change. Implementation was often initially catalyzed through a targeted hire. Champions then engaged clinicians and leaders one-on-one to "pitch" the case, describe concordance between buprenorphine prescribing and existing goals, and delineate the supportive role that they could provide. Sites were prepared for implementation by developing new clinical teams and redesigning clinical processes. Each of these processes was made possible with the active, instrumental support of leadership. Conclusions: Results suggest that rural systems seeking to improve buprenorphine accessibility in primary care may need to alter primary care structures to accommodate buprenorphine prescribing, whether through new hires, team development, or clinical redesign. [ABSTRACT FROM AUTHOR]

Background: Community health centers grapple with high no-show rates, posing challenges to patient access and primary care provider (PCP) utilization. Aim: To address these challenges, we implemented a virtual waiting room (VWR) program in April 2023 to enhance patient access and boost PCP utilization. Setting: Academic community health center in a small urban city in Massachusetts. Participants: Community health patients (n = 8706) and PCP (n = 14). Program Description: The VWR program, initiated in April 2023, involved nurse triage of same-day visit requests for telehealth appropriateness, then placing patients in a standby pool to fill in as a telehealth visit for no-shows or last-minute cancellations in PCP schedules. Program Evaluation: Post-implementation, clinic utilization rates between July and September improved from 75.2% in 2022 to 81.2% in 2023 (p < 0.01). PCP feedback was universally positive. Patients experienced a mean wait time of 1.9 h, offering a timely and convenient alternative to urgent care or the ER. Discussion: The VWR is aligned with the quadruple aim of improving patient experience, population health, cost-effectiveness, and PCP satisfaction through improving same-day access and improving PCP schedule utilization. This innovative and reproducible approach in outpatient offices utilizing telehealth holds the potential for enhancing timely access across various medical disciplines. [ABSTRACT FROM AUTHOR]

Background: The Veterans Health Administration increased synchronous telemedicine (video and telephone visits) in primary care in response to the COVID-19 pandemic. Objective: Our objective was to determine veteran use patterns of in-person and telemedicine primary care when all modalities were available. Design: A retrospective cohort analysis. We performed a latent class analysis of primary care visits over a 1-year period to identify veteran subgroup (i.e., class) membership based on amount of primary care use and modality used. Then, we used multinomial logistic regression with a categorical outcome to identify patient characteristics associated with class identification. Participants: A random national sample consisting of 564,580 primary care empaneled veterans in June 2021. Main Measures: Latent class membership. Key Results: We identified three latent classes: those with few primary care visits that were predominantly telephone-based (45%), intermediate number of visits of all modalities (50%), and many visits of all modalities (5%). In an adjusted model, characteristics associated with the "few" visits class, compared to the intermediate class, were older age, male sex, White race, further driving distance to primary care, higher Gagne, optimal internet speed, and unmarried status (OR 1.002, 1.52, 1.13, 1.004, 1.04, 1.05, 1.06, respectively; p <.05). Characteristics associated with membership in the "many" visits class, compared to the intermediate class, were Hispanic race, higher JEN Frailty Index and Gagne (OR 1.12, 1.11, 1.02, respectively; p <.05), and higher comorbidity by Care Assessment Need score quartile (Q2 1.73, Q3 2.80, Q4 4.12; p < 0.05). Conclusions: Veterans accessing primary care in-person or via telemedicine do so primarily in three ways: (1) few visits, predominantly telephone; (2) intermediate visits, all modalities, (3) many visits, all modalities. We found no groups of veterans receiving a majority of primary care through video. [ABSTRACT FROM AUTHOR]

The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities. [ABSTRACT FROM AUTHOR]

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse. Descriptive statistics and univariate analysis were performed. We identified 95,123 patients with a total of 251,310 emergency department visits. The annual number of visits increased over the study period, reaching 32,333 in 2019. Men aged 40–60 were the most common demographic group in the cohort (48% of all patients), and men made up a higher proportion of patients in the database (94%) than the VHA population overall (90%). A disproportionate number of visits (32%) came from the top 4.4% of most frequent visitors. Most of the emergency department visits in the database (68%) were associated with medical or psychiatric admission, or interfacility transfer for admission elsewhere. Patients in the cohort accounted for 1.3% of all VHA emergency department visits during the study period, a proportion that is somewhat smaller than what has been reported at non-VHA facilities, despite the high prevalence of addiction disorders in the VHA patient population. We submit that this lower-than-expected proportion of alcohol-related emergency department visits may be due to the access to primary and mental care which is afforded by VHA patient benefits. • From 2010 to 2019, there were 251,300 Veterans Health Administration emergency department visits for alcohol intoxication. • The annual rate of visits increased during the study period. • The majority of visits (68%) resulted in medical or psychiatric admission. • Visits for intoxication accounted for 1.3% of patients volume in the system, which is lower than other US health systems. [ABSTRACT FROM AUTHOR]