Optimising Access to Best Practice Primary Health Care: A Systematic Review

Project Number

Project Status

Chief Investigators
Elizabeth Comino, Mark Harris, Marion Haas, John Furler, Gawaine Powell Davies, Antony Raymont, Jane Hall

Other Team Members
Yordanka Krastev, Bettina Christl, Nighat Faruqi


Ensuring that Australians have access to health care is an integral component of Australian health care policy. Although Australia has had almost universal access to publicly funded medical, public hospital, and some community health services care under Medicare since 1984, the health system is still fragmented through multiple funding and service delivery mechanisms, the exclusion of many primary health care (PHC) services from Medicare funding, and uneven distribution of services. Consequently there is unequal access to health care driven by factors such as out of pocket costs, availability of PHC, and distribution of services. Growing awareness of the importance of PHC in delivering equitable and cost-effective care is creating interest in better understanding and addressing access to best practice PHC.


The systematic review examined evidence from the literature regarding access to ‘best practice’ primary health care with a focus on interventions that are relevant to the Australian PHC system.

The review questions were:

1. What factors (barriers and facilitators) are associated with differences in access to ‘best practice’ PHC?

2. What interventions aimed at improving access to ‘best practice’ PHC have been tested?

3. How effective are these interventions in enhancing access to ‘best practice’ PHC and reducing differences in access across population groups?

4. What is known about the cost and benefits of these interventions?

5. What are the implications for policies and strategies in the Australian context?

Design and Method

A systematic review of the published literature examined three areas of PHC: chronic disease management, prevention and episodic care, with a focus on diabetes prevention and management, screening for cervical cancer (PAP testing) and episodic care (timely appointments, out-of-hours care and continuity). The published literature (black and grey) was systematically reviewed to examine factors (both facilitators and barriers) that influence access to best practice PHC and to identify effective strategies to address these factors. Of the 317 identified studies, 192 described facilitators and barriers, 121 were intervention studies and 4 systematic and non-systematic reviews. Our description of access to “best practice” PHC and interest in exploring evidence for impact of interventions to address access to PHC for populations in terms of their impact on use of services did not favour traditional randomised trial designs. Access for specific groups such as people living in rural and remote locations or for Aboriginal populations was not specifically explored, although literature relevant to our inclusion criteria was included. An ecological model was developed to inform the research.

Key Publications

Comino E, Harris M, Haas M, Furler J, Powell Davies G, Raymont A, Hall J, Krastev Y, Christl B. Optimizing access to ‘best practice” primary health care – a systematic review, January 2010, ANU – APHCRI, Canberra, Australia

Full report is available upon request. Please contact A/Prof E. Comino at: e.comino@unsw.edu.au

Conference Presentations:

1. Comino, E, Krastev,Y, Christl, B, Haas, M, Furler, J, Harris, M; Access to best practice primary health care for older Australians with diabetes, PH CRIS conference, 14-17 July 2009, Melbourne, Victoria, Australia


2. Krastev,Y, Comino, E, Christl, B, Haas, M, Furler, J, Harris, M; Optimizing access to best practice primary health care, PH CRIS conference, 14-17 July 2009, Melbourne, Victoria, Australia, 14-17 July 2009


3. Comino, EJ, Christl, B, Krastev, Y, Powell Davies, PG, et al, 2009, 'Optimising access to “best practice” primary health care', Health Services Research Reforming, Responding, Rewarding: 6th Health Service and Policy Research Conference, Brisbane, Australia, 25-27 November 2009