None listed
Conditions
Brief summary
This study aims to assess whether access to free primary health care reduces secondary care use in vulnerable patient groups. Primary care and secondary care datasets will be joined using record linkage. Secondary care use for patients at Dunedin's free clinic will be compared before and after enrolment at the clinic. Secondary care use by patients at local clinics serving low income areas will also be studied to take into account the effect of temporal trends and external factors such as changes in hospital policy. A mixed methods study is being proposed, in which patient interviews in a qualitative phase are used to explain and interpret findings from the earlier quantitative phase. Factors associated with high usage of secondary care, other than the cost barrier to primary care, will be explored during these interviews.
Interventions
Free primary health care access at Dunedin's free clinic (Servants Health Centre). The free clinic opened in January 2010, so the intervention period is January 2010 to December 2012. This "after" phase will be compared with the "before" phase, in which patients were receiving primary health care at other clinics from January 2007 to December 2012.
Sponsors
University of Otago
Eligibility
Sex/Gender
All
Age
0 to 100 Years
Healthy volunteers
Yes
Inclusion criteria
Enrolment at Dunedin's free clinic. A gatekeeping role is performed by the practice manager: criteria for enrolment include possession of a current Community Services Card (CSC, which is means-tested), and a variety of social vulnerability characteristics such as having a mental illness, substance abuse, an imprisonment record, prior child abuse. There is a degree of discretion with regards to the latter. Therefore, enrolment at the free clinic is implicitly associated with both socioeconomic deprivation and social vulnerability.
Exclusion criteria
Not being resident in Dunedin prior to enrolment at the free clinic. Since there is almost certainly no fully appropriate comparator group, even among patients at Dunedin clinics serving low income catchment neighbourhoods, the primary outcome (secondary care usage) is being compared for free clinic patients pre- and post-enrolment (constituting in essence a before-and-after study). For this reason, study participants need to be resident in Dunedin during the pre-enrolment phase of the study period.
Outcome results
None listed