Equity of access to health services is a key goal for primary health care internationally and in Australia (WHO, 1978). The systems used to gain entry to health services can impede or facilitate access, engagement and health outcomes. Equity of access is a key factor in the social determinants of health (Freeman et al, 2011). Rural people are among those living with disadvantage who have poorer health and are more likely to be dependent on free public services. People who live with disadvantage experience more social exclusion, and stress and have less control in their lives, the social determinants of health.
A rural Australian study (Duncombe 2008) consulted people who were active participants in a service entry system (system participants). The system participants were; people referring in, people seeking a service, and people taking initial inquiries. The study found that the inclusion of system participants in health service planning and delivery, could inform local action to make services more accessible.
Individual interviews were based on the question, “What for you, are the features of a good intake system?” The themes that came out were: the vulnerability of the people seeking public health counselling; the need for prompt, reliable first contact; the need for clear, consistent information; the preference for direct contact between professionals; the quality of first contact; and problems arising from unfilled positions (Duncombe 2011).
Some of the problems were readily addressed by local management: clearer signs, not using answering machines, using on-site intake and responding on site rather than re-referring. Information about service entry from system participants identified important issues. Research in health can be extended beyond the people using the services to include other people, in this case, referring professionals and reception staff. If primary health counselling services are to be accessible under Australia’s new private and non-government delivery model, it will be important for the Primary Health Networks (PHN) to make their services accessible to the most needy and the most easily deterred.
This study suggests that consulting with system participants can provide information about the impact of health service entry systems on the most vulnerable. Involving system participants in the design of the entry system is inclusive practice. In this instance it alerted the local service to issues, some of which were readily addressed, and in doing so contributed to local action on the social determinants of health.