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Closing the health equity gap: evidence-based strategies for primary health care organizations.
- Source :
- International Journal for Equity in Health; 2012, Vol. 11 Issue 1, p59-73, 15p, 1 Diagram
- Publication Year :
- 2012
-
Abstract
- Introduction: International evidence shows that enhancement of primary health care (PHC) services for disadvantaged populations is essential to reducing health and health care inequities. However, little is known about how to enhance equity at the organizational level within the PHC sector. Drawing on research conducted at two PHC Centres in Canada whose explicit mandates are to provide services to marginalized populations, the purpose of this paper is to discuss (a) the key dimensions of equity-oriented services to guide PHC organizations, and (b) strategies for operationalizing equity-oriented PHC services, particularly for marginalized populations. Methods: The PHC Centres are located in two cities within urban neighborhoods recognized as among the poorest in Canada. Using a mixed methods ethnographic design, data were collected through intensive immersion in the Centres, and included: (a) in-depth interviews with a total of 114 participants (73 patients; 41 staff), (b) over 900 hours of participant observation, and (c) an analysis of key organizational documents, which shed light on the policy and funding environments. Results: Through our analysis, we identified four key dimensions of equity-oriented PHC services: inequity-responsive care; trauma- and violence-informed care; contextually-tailored care; and culturally-competent care. The operationalization of these key dimensions are identified as 10 strategies that intersect to optimize the effectiveness of PHC services, particularly through improvements in the quality of care, an improved 'fit' between people's needs and services, enhanced trust and engagement by patients, and a shift from crisis-oriented care to continuity of care. Using illustrative examples from the data, these strategies are discussed to illuminate their relevance at three inter-related levels: organizational, clinical programming, and patient-provider interactions. Conclusions: These evidence- and theoretically-informed key dimensions and strategies provide direction for PHC organizations aiming to redress the increasing levels of health and health care inequities across population groups. The findings provide a framework for conceptualizing and operationalizing the essential elements of equity-oriented PHC services when working with marginalized populations, and will have broad application to a wide range of settings, contexts and jurisdictions. Future research is needed to link these strategies to quantifiable process and outcome measures, and to test their impact in diverse PHC settings. [ABSTRACT FROM AUTHOR]
- Subjects :
- DOCUMENTATION
DECISION making methodology
HEALTH services accessibility
METROPOLITAN areas
COMMITMENT (Psychology)
CONCEPTUAL structures
CONTINUUM of care
HEALTH care rationing
HEALTH status indicators
INDIGENOUS peoples of the Americas
INTERVIEWING
RESEARCH methodology
MEDICAL cooperation
PATIENT-professional relations
ORGANIZATIONAL change
PARTICIPANT observation
PRIMARY health care
QUALITY assurance
RESEARCH
RESEARCH funding
TIME
VIOLENCE
WOUNDS & injuries
ETHNOLOGY research
SOCIOECONOMIC factors
THEMATIC analysis
CULTURAL competence
Subjects
Details
- Language :
- English
- ISSN :
- 14759276
- Volume :
- 11
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- International Journal for Equity in Health
- Publication Type :
- Academic Journal
- Accession number :
- 86187594
- Full Text :
- https://doi.org/10.1186/1475-9276-11-59