Lecture 19: Impact Of Access

Question 1

What is the working definition of “access”?

Answer 1

“Access is viewed as a set of more specific areas of fit between a patient and the health care system”

Question 2

What are the 5 areas of access?

Answer 2

1. Availability
2. Accessibility
3. Accommodation
4. Affordability
5. Acceptability

Question 3

What is the definition of availability?

Answer 3

“The relationship of the volume and type of existing services (and resources) to the clients’ volume and type of need”

So supply and demand

Question 4

How much confidence do you have in being able to get good medical care for you and your family when you need it?

Answer 4

Availability

Question 5

How satisfied are you with being able to find one good doctor to treat the whole family?

Answer 5

Availability

Question 6

How satisfied are you with your knowledge of where to get health care?

Answer 6

Availability

Question 7

How satisfied are you with your ability to get medical care in an emergency?

Answer 7

Availability

Question 8

What data suggests a (lack of) availability of health care?

Answer 8

Maori vs non-Maori ischaemic heart disease graph

Question 9

Define accommodation

Answer 9

Aka organisational barriers

“The relationship between the manner in which supply resources are organised and the expectations of clients”

Question 10

How satisfied are you with how long you have to wait to get an appointment?

Answer 10

Accommodation

Question 11

How satisfied are you with how convenient physicians office hours are?

Answer 11

Accommodation

Question 12

How satisfied are you with how long you have to wait in the waiting room?

Answer 12

Accommodation

Question 13

How satisfied are you with how easy it is to get in touch with your physician?

Answer 13

Accommodation

Question 14

Define acceptability

Answer 14

Aka psychological barriers

“The relationship between clients’ and providers’ attitudes to what constitutes appropriate care”

Question 15

How satisfied are you with the appearance of the doctor’s office?

Answer 15

Acceptability

Question 16

How satisfied are you with the neighbourhoods the doctor’s office is in?

Answer 16

Acceptability

Question 17

How satisfied are you with the other patients you usually see in the doctor’s office?

Answer 17

Acceptability

Question 18

Define accessibility

Answer 18

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”

Question 19

How satisfied are you with how convenient your physician’s offices are to your home?

Answer 19

Accessibility

Question 20

How difficult is it for you to get to your physician’s office?

Answer 20

Accessibility

Question 21

Define affordability

Answer 21

Aka financial barriers

“The cost of provider services in relation to the client’s ability and willingness to pay for these services”

Question 22

How satisfied are you with your health insurance?

Answer 22

Affordability

Question 23

How satisfied are you with the doctor’s prices?

Answer 23

Affordability

Question 24

How satisfied are you with how soon you need to pay the bill?

Answer 24

Affordability

Question 25

What type of surveys were the youth2000 surveys?

Answer 25

Cross sectional, with random secondary school students

Question 26

"I don't know how to"

Answer 26

Availability

Question 27

"I had no transport to get there"

Answer 27

Accessibility

Question 28

"I couldn't get an appointment"

Answer 28

Accommodation

Question 29

"I couldn't get in touch with the health care professional or person I usually see"

Answer 29

Accommodation

Question 30

"I didn't feel comfortable with the person"

Answer 30

Acceptability

Question 31

"I couldn't be bothered"

Answer 31

Acceptability

Question 32

"I was hoping the problem would go away or get better with time"

Answer 32

Acceptability

Question 33

"The staff were unfriendly"

Answer 33

Acceptability

Question 34

"Costs too much"

Answer 34

Affordability

Question 35

Is there are relationship between deprivation and barriers?

Answer 35

Yes

Question 36

What qualitative study investigated barriers to a health care service?

Answer 36

One that investigated the barriers experienced by Chinese when accessing ACC related services

Question 37

How many participants in the Chinese ACC study?

Answer 37

32: 3 focus groups and 8 interviews

Question 38

How is availability discussed in relation to Chinese and ACC use?

Answer 38

- 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)

Question 39

How is accessibility related to Chinese and ACC services?

Answer 39

Transportation for elderly

Question 40

Difference between qualitative and quantitative studies?

Answer 40

Quantitative tells the story, qualitative is just numbers

Question 41

What is potential access vs. realised access?

Answer 41

Potential access= you should be able to use the service as it is available Realised access= knowing and actually utilising the access

Question 42

How is affordability related to Chinese and ACC?

Answer 42

Direct vs indirect costs GP surcharge Value of cost Eg having to take time off work

Question 43

How is accommodation related to Chinese and ACC?

Answer 43

Opening hours of the service (eg after school? Links to affordability if costs more after hours) Interpretation services

Question 44

How is acceptability related to Chinese and ACC?

Answer 44

``` 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 ```

Question 45

How many people had tuberculosis in 2014 and how many died?

Answer 45

9.6 million cases, 1.5 million dead

Question 46

How much has the tuberculosis death rate dropped since 1990?

Answer 46

47%

Question 47

How many lives were saved through tb diagnosis and treatment since 2000?

Answer 47

43 million

Question 48

What is FIDELIS?

Answer 48

A case-finding initiative to rapidly assess and implement innovative local TB control activities designed to find and cure smear positive patients

Question 49

What does FIDELIS stand for?

Answer 49

The fund for innovative DOTS expansion through local initiatives to stop TB

Question 50

Who funded FIDELIS?

Answer 50

CIDA (Canadian International Development Agency)

Question 51

Where was FIDELIS implemented in the study?

Answer 51

Anhui, China (A pretty rural area and poor) Around 62.6 million people

Question 52

Discuss how FIDELIS was implemented in Anhui

Answer 52

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

Question 53

How does FIDELIS fit into the D&W model Socioeconomic, cultural and environmental level?

Answer 53

1. Political environment: political and environmental commitment (eg DOTS) 2. Rural and scattered housing in mountainous area (living/work conditions)

Question 54

How how does FIDELIS study fit into D&W model social and community networks level?

Answer 54

Family value towards children | Sputum smear test and anti-TB treatment (living/work conditions)

Question 55

Define DOTS?

Answer 55

Directly Observed Treatments