The effectiveness of policies to improve primary care access for underserved populations: An assessment of the literature

Primary care is a critical tool to prevent illness and death and to improve equitable distribution of health in populations. However, access to this important source of care is lacking, especially for many underresourced groups, such as communities of color and in rural areas. In 1981, researchers Roy Penchansky and J. William Thomas developed a model that breaks down the concept of primary care access into five composite and interconnected dimensions: availability of primary care clinicians; accessibility of primary care services geographically; accommodation in terms of appointment availability and hours; affordability; and acceptability in terms of comfort and communication between patient and clinician. The authors of this report reviewed the research literature to assess the evidence supporting whether policy initiatives targeting primary care access in each of these five dimensions have been effective in reducing health care disparities. The policy initiatives we considered vary widely in terms of the decision makers best suited to implement them and therefore will require multi-sector collaborative solutions to improve access to primary care in underserved areas.