Access

Policy

We recognise that Māori and other ethnicities face significant barriers to access when using mainstream health services. We are committed to identifying and minimising these barriers at our facility wherever possible.

Barriers to access fall into two categories:

• patient-centred barriers

  Patient-centred barriers include:

  • cost
  • transport cost/availability
  • geographical location
  • language difficulties
  • physical/mental condition
  • lack of comfort with the health system
  • motivation to pick up prescriptions/attend appointments
  • persistence with medications.

  Source: PHARMAC

• health system barriers.

  Health system barriers include:

  • convenience/availability of services
  • cultural competence
  • bias
  • paper-based prescriptions
  • unwarranted variance from prescribing protocol
  • medicine suitability and side-effects.

  Source: PHARMAC

Identifying and reducing barriers to access where possible forms a key part of our quality improvement activities:

• We use data to identify the gaps between who should receive care and who does receive care.

  See also Equity Audits.

• Where possible, we identify how barriers to access contribute to any gaps we uncover, and take steps to minimise those gaps.
• To raise awareness and promote learning, we discuss issues that affect access at team meetings.

An excellent resource for understanding barriers to access is PHARMAC: Achieving Medicine Access Inequity in Aotearoa New Zealand.

Understanding the barriers to access

The main barriers that prevent someone from accessing effective health care are called primary drivers of access equity. It is important to understand the different kinds of barriers that exist so they can be identified and addressed where possible:

• Availability: Everyone who is eligible must be able to receive effective, funded treatments.

  For example, consider:

  • Are funded medications available that will help the patient?
  • Are clinicians up-to-date with changes in medicine availability or brands?
  • Does the practice have a close relationship with the local pharmacy?
  • Is there a funded treatment programme patients could be referred to?
• Affordability: Patients must be able to afford their health care.

  For example, consider:

  • Can our service be provided at no cost, or lower cost?
  • What indirect costs do patients face when seeking treatment, e.g. time off work or childcare costs?
  • Are patients receiving all subsidies they are entitled to?
  • Do clinicians check that patients can afford any medications or treatment prescribed?
  • Can we increase our use of standing orders so patients don't need to see a prescriber?
• Accessibility: Patients should not face face challenges to see a provider.

  For example, consider:

  • Do our opening hours allow patients to access our services?
  • Are appointments available when patients need them?
  • Can patients get time off work to come to the practice?
  • Is transport an issue?
  • Can the patient physically get to a pharmacy, lab services, or secondary care?
  • Can we reduce the need for rural patients to go to a pharmacy?

    For example, by:

    • extending our use of MPSO.
    • delivering medications to the patient or to a pick-up depot.
  • Can we use technology to improve accessibility, e.g. telehealth consultations or ePrescribing?
• Acceptability: The patient should trust the health system so they can be informed and engaged.

  For example, consider:

  • Is the patient experiencing bias from the practice team or the system?
  • Is the clinician able to take the time to build a genuine relationship with the patient?
  • Is the practice team able to interact with the patient appropriately?
  • Are the patient and their whānau fully involved in the decision-making process?
  • Do staff acknowledge the patient's beliefs, views, and perceptions, and make them feel culturally safe?
  • Can the practice work with community organisations to provide services within the patient's cultural framework?
  • Have the patient and their whānau been given appropriate information in a way they can understand?

    For example, do they know:

    • name of their condition and any prescribed medications
    • reason for prescribing these medications – how does each one work?
    • what to expect from treatment
    • next steps if a referral has been made
    • what to do if they experience something unexpected
    • how to take the medication to get the best outcome.
• Appropriateness: Treatment must be appropriate and effective to ensure equitable outcomes. This isn't always under the prescriber's control.

  For example, consider:

  • Is the patient receiving continuity of care?
  • Can other health services also support the patient with ongoing monitoring and review, e.g. pharmacy or nurses?
  • Do clinicians gather all relevant information from the patient and whānau before deciding on treatment?
  • Is the prescription legible, unambiguous, and without errors?
  • Have triggers for referral and further action been clearly communicated and documented?

  Treatment must be appropriate and effective, to ensure equitable outcomes. This isn't always under the prescriber's control. It can also be a result of health system factors such as available models of care.

  For example, consider:

  • Is the patient receiving continuity of care?
  • Can other health services also support the patient with ongoing monitoring and review, e.g. pharmacy or nurses?
  • Do clinicians gather all relevant information from the patient and whānau before deciding on treatment?
  • Is the prescription legible, unambiguous, and without errors?
  • Have triggers for referral and further action been clearly communicated and documented?