A review of literature on access to primary health care

The purpose of this review was to acquaint health care planners, policy-makers and health services researchers with the complexities and dimensions of the concept of access to primary health care as reflected in the international medical literature of the past three decades. The review provides a comprehensive and accessible summary of the numerous definitions and ideas about access, which have been suggested over this time, together with a synthesis of current thinking informed by these past perspectives. Critical Interpretive Synthesis (CIS) methodology was used to review the literature on access. Medline and Australasian Medical Index were searched for English-language articles published between 19 70 and August 2005. The results were supplemented by an internet search of the World Wide Web, augmented by manual scans of material from deeper levels within the sites. The process by which the initial list of 665 potential references was reduced to the final list of 48 references was based on manual inspection of both abstracts and full articles using specific prioritisation criteria. Inter-observer agreement for reference selection using these criteria was checked by two investigators and found to be good (Kappa=0.83). Measuring and monitoring access to primary health care is challenging due to the complexity of the concept of access. To address this shortcoming, a single outcome-based measure of access to primary health care is proposed, pointing to a possible way forward for the concept of access as a practical tool with significant application to future health policy.