Impact of Enhanced Primary Care on equitable access to and economic efficiency of allied health services: a qualitative investigation
Bibliographic record
Abstract
Objective. To evaluate new pathways to access allied health services introduced by the Enhanced Primary Care/Chronic Disease Management (EPC/CDM) initiative that may both increase or decrease equity to and efficiency in access. Design. A qualitative study consisting of semi-structured in-depth interviews with a purposively selected group of allied health practitioners. Participants and setting. Allied health practitioners in private practice in Queensland, Australia, from physiotherapy, occupational therapy, speech pathology, and exercise physiology backgrounds (n = 15). Main outcome measures. Interviews focused upon several issues including how referrals are made under the EPC/CDM initiative and what happens for patients once their five allotted sessions are expended. Results. The EPC/CDM initiative appeared to address two key barriers of access to allied health services – costs to patient of access and patient awareness of benefits. However, gap payments may still be deterring economically disadvantaged patients from attending. Discussion. The EPC/CDM initiative is increasing access to allied health services for people with chronic diseases. However, it is evident that this initiative may still not be meeting the needs of those most disadvantaged economically, and may lead to duplication of efforts by allied health practitioners when patients move between private and public health care sectors. What is known about the topic? Publicly funded subsidy of allied health services for people with chronic disease is a relatively new policy initiative in Australia. The success of such policy hinges on several factors, notably, its ability to improve equity of access to appropriate health care, generate improved health outcomes, and to do so efficiently. What does this paper add? This paper demonstrates how health professionals and patients are actually using the Enhanced Primary Care/Chronic Disease Management initiative to access allied health services. The strengths and weaknesses of current policy identified will inform future policy development and funding decisions. What are the implications for practitioners? Equitable access to allied health services for people with economic disadvantage is still limited due to gap payments. This initiative has facilitated patient exposure to the benefits of allied health services first hand, prompting some to continue paying for these services privately once the annual number of sessions permitted are exhausted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.024 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.007 | 0.009 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.002 | 0.007 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".