Lecture 19: Impact Of Access Flashcards
What is the working definition of “access”?
“Access is viewed as a set of more specific areas of fit between a patient and the health care system”
What are the 5 areas of access?
- Availability
- Accessibility
- Accommodation
- Affordability
- Acceptability
What is the definition of availability?
“The relationship of the volume and type of existing services (and resources) to the clients’ volume and type of need”
So supply and demand
How much confidence do you have in being able to get good medical care for you and your family when you need it?
Availability
How satisfied are you with being able to find one good doctor to treat the whole family?
Availability
How satisfied are you with your knowledge of where to get health care?
Availability
How satisfied are you with your ability to get medical care in an emergency?
Availability
What data suggests a (lack of) availability of health care?
Maori vs non-Maori ischaemic heart disease graph
Define accommodation
Aka organisational barriers
“The relationship between the manner in which supply resources are organised and the expectations of clients”
How satisfied are you with how long you have to wait to get an appointment?
Accommodation
How satisfied are you with how convenient physicians office hours are?
Accommodation
How satisfied are you with how long you have to wait in the waiting room?
Accommodation
How satisfied are you with how easy it is to get in touch with your physician?
Accommodation
Define acceptability
Aka psychological barriers
“The relationship between clients’ and providers’ attitudes to what constitutes appropriate care”
How satisfied are you with the appearance of the doctor’s office?
Acceptability
How satisfied are you with the neighbourhoods the doctor’s office is in?
Acceptability
How satisfied are you with the other patients you usually see in the doctor’s office?
Acceptability
Define accessibility
Aka geographical resources
“The relationship between the location of supply and the location of clients, taking into account client transportation resources and travel time, distance and cost”
How satisfied are you with how convenient your physician’s offices are to your home?
Accessibility
How difficult is it for you to get to your physician’s office?
Accessibility
Define affordability
Aka financial barriers
“The cost of provider services in relation to the client’s ability and willingness to pay for these services”
How satisfied are you with your health insurance?
Affordability
How satisfied are you with the doctor’s prices?
Affordability
How satisfied are you with how soon you need to pay the bill?
Affordability
What type of surveys were the youth2000 surveys?
Cross sectional, with random secondary school students
“I don’t know how to”
Availability
“I had no transport to get there”
Accessibility
“I couldn’t get an appointment”
Accommodation
“I couldn’t get in touch with the health care professional or person I usually see”
Accommodation
“I didn’t feel comfortable with the person”
Acceptability
“I couldn’t be bothered”
Acceptability
“I was hoping the problem would go away or get better with time”
Acceptability
“The staff were unfriendly”
Acceptability
“Costs too much”
Affordability
Is there are relationship between deprivation and barriers?
Yes
What qualitative study investigated barriers to a health care service?
One that investigated the barriers experienced by Chinese when accessing ACC related services
How many participants in the Chinese ACC study?
32: 3 focus groups and 8 interviews
How is availability discussed in relation to Chinese and ACC use?
- Types of health services available
- Not all services are recognised and subsidised by ACC (eg Chinese medicine)
- Lack of knowledge of the services and eligibility of ACC (potential and realised access)
How is accessibility related to Chinese and ACC services?
Transportation for elderly
Difference between qualitative and quantitative studies?
Quantitative tells the story, qualitative is just numbers
What is potential access vs. realised access?
Potential access= you should be able to use the service as it is available
Realised access= knowing and actually utilising the access
How is affordability related to Chinese and ACC?
Direct vs indirect costs
GP surcharge
Value of cost
Eg having to take time off work
How is accommodation related to Chinese and ACC?
Opening hours of the service (eg after school? Links to affordability if costs more after hours)
Interpretation services
How is acceptability related to Chinese and ACC?
Use of an interpreter Health beliefs (is it a serious injury?) Cultural appropriate services vs. guidelines ie: you are told what entitlements are and they must be the same for everyone etc clashes with culturally appropriate services
How many people had tuberculosis in 2014 and how many died?
9.6 million cases, 1.5 million dead
How much has the tuberculosis death rate dropped since 1990?
47%
How many lives were saved through tb diagnosis and treatment since 2000?
43 million
What is FIDELIS?
A case-finding initiative to rapidly assess and implement innovative local TB control activities designed to find and cure smear positive patients
What does FIDELIS stand for?
The fund for innovative DOTS expansion through local initiatives to stop TB
Who funded FIDELIS?
CIDA (Canadian International Development Agency)
Where was FIDELIS implemented in the study?
Anhui, China
(A pretty rural area and poor)
Around 62.6 million people
Discuss how FIDELIS was implemented in Anhui
Family cough/symptoms card given to students to take home and return to school. Teachers trained to identify TB, GPs sent to homes with suspected cases. Health services integrated new cases into TB programme
How does FIDELIS fit into the D&W model Socioeconomic, cultural and environmental level?
- Political environment: political and environmental commitment (eg DOTS)
- Rural and scattered housing in mountainous area (living/work conditions)
How how does FIDELIS study fit into D&W model social and community networks level?
Family value towards children
Sputum smear test and anti-TB treatment (living/work conditions)
Define DOTS?
Directly Observed Treatments
