Literature review

The first step of the AIR project has been a systematic literature review of interventions related to the primary care settings evaluated in order to reduce health inequalities

Methods: 123 articles published after 2000, were selected in Medline, the Cochrane Library databases, the Health Policy Monitor and Determine websites, Nber publications and the Eurothine report, if they reported a quantitative evaluation of a primary care intervention on health process or outcome measures among socio-economic groups. Primary care interventions were defined as either related to primary care services (i.e. access to care and prevention for common disease, maternal care…) or organization (i.e. first contact, comprehensive, coordinated care...). 

Results: 107 evaluated interventions were analyzed to build a typology. Three broad types of interventions were identified: health promotion interventions in the community setting; interventions aiming at improving financial access to care either by providing free care, free or subsidized health insurance; and health care organization interventions. Overall, 74% of interventions were effective in reducing health inequalities, with comparable results for each type of intervention. 

Conclusion: Primary care interventions can successfully reduce socio-economic health inequalities. Improving financial access to care increases health care utilization and health outcomes. Universal access to care should be completed with tailored, culturally adapted health promotion interventions led by peer educators. ”Umbrella” interventions can provide a framework to implement several health promotion interventions. Finally, health care organization interventions such as teamwork or disease management can successfully reduce health inequalities.