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Closing the health equity gap: evidence-based strategies for primary health care organizations

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...

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Autores principales: Browne, Annette J, Varcoe, Colleen M, Wong, Sabrina T, Smye, Victoria L, Lavoie, Josée, Littlejohn, Doreen, Tu, David, Godwin, Olive, Krause, Murry, Khan, Koushambhi B, Fridkin, Alycia, Rodney, Patricia, O’Neil, John, Lennox, Scott
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570279/
https://www.ncbi.nlm.nih.gov/pubmed/23061433
http://dx.doi.org/10.1186/1475-9276-11-59
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author Browne, Annette J
Varcoe, Colleen M
Wong, Sabrina T
Smye, Victoria L
Lavoie, Josée
Littlejohn, Doreen
Tu, David
Godwin, Olive
Krause, Murry
Khan, Koushambhi B
Fridkin, Alycia
Rodney, Patricia
O’Neil, John
Lennox, Scott
author_facet Browne, Annette J
Varcoe, Colleen M
Wong, Sabrina T
Smye, Victoria L
Lavoie, Josée
Littlejohn, Doreen
Tu, David
Godwin, Olive
Krause, Murry
Khan, Koushambhi B
Fridkin, Alycia
Rodney, Patricia
O’Neil, John
Lennox, Scott
author_sort Browne, Annette J
collection PubMed
description 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.
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spelling pubmed-35702792013-02-13 Closing the health equity gap: evidence-based strategies for primary health care organizations Browne, Annette J Varcoe, Colleen M Wong, Sabrina T Smye, Victoria L Lavoie, Josée Littlejohn, Doreen Tu, David Godwin, Olive Krause, Murry Khan, Koushambhi B Fridkin, Alycia Rodney, Patricia O’Neil, John Lennox, Scott Int J Equity Health Research 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. BioMed Central 2012-10-13 /pmc/articles/PMC3570279/ /pubmed/23061433 http://dx.doi.org/10.1186/1475-9276-11-59 Text en Copyright ©2012 Browne et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Browne, Annette J
Varcoe, Colleen M
Wong, Sabrina T
Smye, Victoria L
Lavoie, Josée
Littlejohn, Doreen
Tu, David
Godwin, Olive
Krause, Murry
Khan, Koushambhi B
Fridkin, Alycia
Rodney, Patricia
O’Neil, John
Lennox, Scott
Closing the health equity gap: evidence-based strategies for primary health care organizations
title Closing the health equity gap: evidence-based strategies for primary health care organizations
title_full Closing the health equity gap: evidence-based strategies for primary health care organizations
title_fullStr Closing the health equity gap: evidence-based strategies for primary health care organizations
title_full_unstemmed Closing the health equity gap: evidence-based strategies for primary health care organizations
title_short Closing the health equity gap: evidence-based strategies for primary health care organizations
title_sort closing the health equity gap: evidence-based strategies for primary health care organizations
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570279/
https://www.ncbi.nlm.nih.gov/pubmed/23061433
http://dx.doi.org/10.1186/1475-9276-11-59
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