[State of knowledge: mechanisms for accessing local services]

I. Boisvert
Record ID 32018000888
Original Title: État des connaissances: mécanismes d’accès aux services de proximité
Authors' objectives: To support its reflection regarding establishing a standardized single point of access to the health-care and social-services continuum, the Ministère de la Santé et des Services sociaux (MSSS) sought the Institut national d’excellence en santé et en services sociaux (INESSS)’s expertise, asking it to prepare a report of the current state of knowledge regarding mechanisms for accessing local services. This report describes the different mechanisms found in the scientific and grey literatures. An access mechanism is defined, here, as “a modality or set of modalities by which a person can enter into contact with local services in his or her community, and have a health or well-being need met within a reasonable amount of time”. This report is the result of a nonsystematic review of relevant research. It is enriched with the research of the working committee members, qualitative studies about contextual and experiential aspects of local health and social services access, and grey literature, which provided examples of the implementation of various access mechanisms.
Authors' results and conclusions: • The literature describes an array of mechanisms for accessing local services, but of no system that integrates them in order to meet all of the population’s needs. • A number of contextual barriers can hinder access to local services for users, such as professionals’ limited hours, difficulty planning an appointment, issues relating to a low socioeconomic status, culture, religion and language, individual attitudes (e.g., shame), and a lack of knowledge regarding available services. • Since no one mechanism can provide complete access to local services for the entire population, a system integrating an array of mechanisms could make it easier to achieve this objective. • The access mechanisms examined in this report are complementary and can be put in place so that 1) users can obtain services as needed, and that 2) the health and social services system can reach vulnerable populations. • There are access mechanisms at different levels of the health care and social services system. Their purpose is, among other things, to help navigate the services continuum, to facilitate coordination between services and to reach socially vulnerable populations. • Certain mechanisms are tailored to socially vulnerable populations and can promote their initial contact with local services, such as outreach, community health workers and mobile clinics. • Mechanisms can be incorporated into a standardized single point of access to make it easier for users to access local services. Examples include mechanisms for centralized waitlist management, patient portals, and telephone advice and referrals. • Advanced access is based on five guiding principles that can promote the timely use of local services: 1) the balance between supply and demand, 2) reducing backlogs, 3) revising the appointment system, 4) integrating interdiciplinary practice, and 5) developing contingency plans. • Some of the obstacles encountered during the rollout of advanced access in Québec include difficulty providing follow-up for certain users given that the responsibility for booking medical appointments was transferred to patients.
Authors' methods: Two main types of access mechanisms were found: 1) those where the user takes the initiative to make the initial contact with the health and social services system, and 2) those where the health and social services system takes the initiative to make the initial contact with the user.
Project Status: Completed
Year Published: 2019
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Delivery of Health Care
  • Health Services Accessibility
  • Models, Organizational
  • Vulnerable Populations
  • Delivery of Health Care, Integrated
  • Proximity services
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.