Centre of Research Excellence :Innovative Models Promoting Access-to-Care Transformation (IMPACT)



Chief Investigator: Professor Grant Russell, email: Grant.Russell@monash.edu

CRE Manager / co-ordinator: Dr Phillip Thompson, email: phil.thompson@monash.edu


Recent and widespread reforms in primary health care (PHC) in western countries reflect a growing concern that health systems should become more affordable, inclusive and fair. In Australia and Canada PHC reforms have prioritised access to effective and high-quality health services, with equity being at the heart of that system.

Despite these reforms, meaningful gaps in equitable access to Community-based Primary Health Care (CBPHC) remain. These gaps particularly affect vulnerable groups, such as the poor, refugees and indigenous communities. These problems translate into unmet needs for care, delayed or inappropriate treatments and avoidable emergency department consultations and hospitalisations. Many of the myriad PHC innovations and pilot projects have been limited in their ability to generate transformative change throughout health care systems.

Innovative Models Promoting Access and Coverage Transformation (IMPACT) program aims to generate organisational innovations to promote access to PHC for vulnerable populations, more specifically the poor, refugees and people from indigenous communities. Activities will be conducted through a learning network of administrative regions within three Canadian provinces and three Australian states.

Like many, these regions are grappling with the challenges of optimising access for vulnerable populations to quality CBPHC. In partnership, the multidisciplinary team (including care providers and community representatives) will work with the regions to identify and perform an in-depth and rigorous assessment of existing system-level organisational innovations that address access to vulnerable populations. Then, informed by state of the art evidence on these potential interventions, teams will select, adapt, and implement/evaluate approaches that best address their needs and context.

Research aim & objectives

The aim is to transform the PHC organisational structure to improve access to appropriate care for vulnerable populations resulting in reduced unmet need, avoidable emergency department visits and avoidable hospitalisations for vulnerable populations.

The program’s three main objectives are to:

  1. develop a network of partnerships between decision makers, researchers and community members to support the improvement of access to PHC for vulnerable populations
  2. identify organisational, system level CBPHC innovations designed to improve access to appropriate care for vulnerable populations, and establish the effectiveness and scalability of the most promising innovations
  3. support the selection, adaptation and implementation of innovations that align with the regional partners local populations’ needs and priorities and evaluate the effectiveness and efficiency and further scalability of these innovations.

Expected outcomes & impact

The five-year program will empower vulnerable health consumers and develop capacity among academics, clinicians and decision-makers about research on and implementation of organisational innovations in CBPHC.

The research will address important challenges or barriers in the delivery of CBPHC. The program is centred on producing evidence to support decision makers in addressing the CBPHC access gaps facing their region, and to support policy makers in creating the environment to help this occur.

The research will provide new policy and program options for improving access to care by vulnerable population groups through interventions in and with CBPHC. Options for policy and practice will be communicated through various means to managers and policy makers for more widespread implementation.

Research activities

Description of projects

Establishing a learning

network of Local

Innovation Partnerships


Identification of needs and access gaps in


  • Understand local organisational context and emergent innovations
  • Select potential Innovations for scoping, knowledge syntheses and implementation
  • Adapt and implement intervention model in the LIPs
  • Assess benefits of innovations for the LIPs and broader health systems

Stream one:

Identifying and understanding access-related

organisational CBPHC innovations

Project 1 Scoping the innovations: A review of academic and grey literature relating to organisational innovations to improve Community-Based Primary Hhealth Care access (Complete at March 2017)


Project 2 Effectiveness and scalability: Syntheses of factors related to the implementation and effectiveness of innovations to improve access for vulnerable populations (Complete at March 2017)


Project 3 Mixed-method analysis of currently existing population-based surveys (Complete at March 2017)

Stream two:

Adapting, implementing and evaluating promising organisational CBPHC innovations

Project 4 A mixed-method evaluation of the impact of organisational innovations to improve access for vulnerable populations (in process at March 2017)


  1. Khanassov V; Pluye P; Descoteaux S; Haggerty J; Russell GM; Gunn JM and Levesque J-F. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review. International Journal of Equity Health 2016; 15: 168. Published online 2016 Oct 10
  2. Advocat J, Russell GM and Mathews M. Building links between town and gown: an innovative organisation in south-eastern Melbourne. Australian Journal of Primary Health, 2016, 22, 71–76 Forum; http://dx.doi.org/10.1071/PY14148
  3. Harris MF, Advocat J, Crabtree BF, Levesque J-F, Miller WL, Gunn JM, Hogg W, Scott CM, Chase SM, Halma L and Russell GM. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries. Journal of Multidisciplinary Healthcare. 2016:9 35–46; http://dx.doi.org/10.2147/JMDH.S97371
  4. Richard L, Furler J, Densley K, Haggerty J, Russell GM, Levesque J-F and Gunn JM. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. International Journal for Equity in Health. (2016) 15:64; DOI 10.1186/s12939-016-0351-7
  5. Dahrouge S, Hogg W, Younger J, Muggah E, Russell GM and Glazier RH. Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada. Annals of Family Medicine. 2016 Jan-Feb;14(1):26-33. doi: 10.1370/afm.1864.
  6. Dahrouge S, Muldoon L, Ward N, Hogg W, Russell GM and Taylor-Sussex R. Roles of nurse practitioners and family physicians in community health centres. Canadian Family Physician. 2014 Nov;60(11):1020-7.
  7. Muggah E, Hogg W, Dahrouge S, Russell GM, Kristjansson E, Muldoon L and Devlin RA. Patient-reported access to primary care in Ontario: effect of organizational characteristics. Canadian Family Physician. 2014 Jan;60(1):e24-31.
  8. Ambresin G, Chondros P, Dowrick C, Herrman H, Gunn JM. Self-Rated Health and Long-Term Prognosis of Depression. Annals of Family Medicine. January/February 2014.  129(1): 57-65 http://doi: 10.1370/afm.1562 .
  9. Yeung A, Temple-Smith M, Fairley C, Vaisey AM, Guy R, Law M, Low N, Bingham A, Gunn JM, Kaldor J, Donovan B and Hocking J. Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey. Medical Journal of Australia. 17 February 2014. 200(3): 170-175 http://doi:10.5694/mja13.10729 .
  10. Small R, Watson LF, Gunn JM, Mitchell C and Brown SJ. Improving population-level maternal health: a hard nut to crack? Long term findings and reflections on a 16-community randomised trial in Australia to improve maternal emotional and physical health after birth. PLOS One. February 2014.  9(2): e88457.
  11. Middleton A, Gunn JM, Bassilios B and Pirkis J. Systematic review of research into frequent callers to crisis helplines. Journal of Telemedicine and Telecare. 2014. 20(2):89-98.
  12. Brown SJ, Sutherland GA, Gunn JM and Yelland JS. Changing models of public antenatal care in Australia: Is current practice meeting the needs of vulnerable populations? Midwifery. 30(2014): 303-309. http://dx.doi.org/10.1016/j.midw.2013.10.018
  13. Ambresin G and Gunn JM.  Does agomelatine have a place in the treatment of depression? British Medical Journal. 2014.  348:G2156.  DOI://10.1136/BMJ.G2157 .
  14. Bousman C, Gunn JM, Everall I and Potiriadis M. G-protein B3 subunit genetic variation moderates five-year depressive symptom trajectories of primary care attendees. Journal of Affective Disorders. 2014.  165: 64-68.  http://dx.doi.org/10.1016/j.jad.2014.04.044 .
  15. Dowsey M, Gunn JM and Choong P. Selecting those to refer for joint replacement; who will likely benefit and who will not? Best Practice and Research Clinical Rheumatology. 2014. 28(1):157-171.
  16. Pirotta M, Densley K, Forsdike K, Carter M and Gunn JM. St John’s wort use in Australian general practice patients with depressive symptoms: their characteristics and use of other health services. BMC Complementary and Alternative Medicine. 2014. 14:204. http://www.biomedcentral.com/1472-6882/14/204/ .
  17. Spittal M, Fedyszyn I, Middleton A, Bassilios B, Gunn JM, Woodward A and Pirkis J. Frequent callers to crisis helplines: Who are they and why do they call? Australian and New Zealand Journal of Psychiatry (ANZJP). 2014. 1(11). http://DOI: 10.1177/0004867414541154 .
  18. Hetrick S, Simmons MB, Sanci LA and Gunn JM. 2014. Primary care monitoring of depressive symptoms in young people. Australian Family Physician. 2014. 43 (3): 147-150.
  19. McLean G, Gunn J, Wyke S, Guthrie B, Watt GCM, Blane DN and Mercer SW. The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study. British Journal of General Practice. 2014. 64(624): e440-e447. http://doi/10.3399/bjgp14X680545
  20. Palmer V, Dowrick C and Gunn JM. Mandalas as a visual research method for understanding primary care for depression. International Journal of Social Research Methodology. 2014. 17(5): 527-541. http://dx.doi.org/10.1080/13645579.2013.796764
  21. Pirotta M, Willis K, Carter M, Forsdike K, Newton D and Gunn JM. 'Less like a drug than a drug': the use of St John's Wort among people who self-identify as having depression and/or anxiety symptoms. Complementary Therapies in Medicine. July. 2014. http://dx.doi.org/10.1016/j.ctim.2014.07.007
  22. Gunn JM and Palmer V. Visions of generalism – what does the future hold? Australian Family Physician. 2014. 43(9): 649-651.
  23. Bassilios B, Pirkis J, Harris MF, Gunn JM and Middleton A. Characteristics of repeat callers to crisis helplines: findings from a population-based study. Administration and Policy in Mental Health and Mental Health Services Research. September 2014. DOI:10.1007/s10488-014-0595-8
  24. Smith DJ, Court H, McLean G, Martin D, Langan Martin J, Guthrie B, Gunn JM and Mercer S. Depression and multimorbidity: a cross-sectional study of 1,751,841 patients in primary care. The Journal of clinical psychiatry. 11/2014; 75(11):1202-8. DOI: 10.4088/JCP.14m09147
  25. Sullivan S, Stocks NP and Chilver M. Influenza vaccine effectiveness in Australia: results from the Australian Sentinel Practices Research Network. Medical Journal of Australia 2014 201 (2): 109-111.
  26. Taylor K, Marshall H, Stocks NP. The missing link: family physician perspectives on barriers and enablers to prescribing a new Meningococcal B vaccine and other recommended, non-government funded vaccines. Vaccine 2014 32 (33), 4214-4219.
  27. Stuart KL, Wyld B, Bastiaans K, Stocks NP, Brinkworth G, Mohr P and Noakes M. A telephone-supported cardiovascular lifestyle programme (CLIP) for lipid reduction and weight loss in general practice patients: a randomised controlled pilot trial. Public Health Nutrition 2014 17(3) 640-647.
  28. Smithers LG, Chittleborough CR, Stocks NP, Sawyer MG and Lynch JW. Can items used in 4-year-old well-child visits predict children's health and school outcomes? Maternal and Child Health Journal. 2014 18 (6): 1345-1353.
  29. Frank O, Stocks NP and Aylward P. Development of a pre-consultation prevention summary and reminder sheets for patients: Preliminary study of acceptability and sustainability. Australian Family Physician 2014 43(5): 310-314.
  30. Ruel G, Lévesque J-F, Stocks NP, Sirois C, Kroger E, Adams RJ, Doucet M and Taylor AW. Understanding the evolution of multimorbidity: evidences from the North West Adelaide Health Longitudinal Study (NWAHS). PLOS One 2014. 9(5); 5 May 2014, Article number e96291.
  31. Kerr KP, Mate KE, Magin PJ Marley J, Stocks NP, Disler P and Pond CD. The prevalence of co-prescription of clinically relevant CYP enzyme inhibitor and substrate drugs in community-dwelling elderly Australians. Journal of Clinical Pharmacy and Therapeutics, 2014 doi: 10.1111/jcpt.12163 .
  32. Si, Si, Moss, JR, Sullivan TR, Newton SS and Stocks NP. Effectiveness of general practice-based health checks: A systematic review and meta-analysis. British Journal of General Practice 2014. 64 (618); e47 - e53.
  33. Stewart S, Carrington MJ, Swemmer CH, Kurstjens NP, Brown A, Burrell LM, Nelson M, Stocks NP, Jennings GL; VIPER-BP Study Investigator. More rigorous protocol adherence to intensive structured management improves blood pressure control in primary care: Results from the VIPER-BP Study. Journal of Hypertension 2014 32 (6) June;1342-1350.
  34. Peiyuan H, Zhaokang Y, Yong L, Guoqing L, Huanhuan L, Ji Y and Harris MF. An evaluation of a tailored intervention on village doctors use of electronic health records. BMC Health Services Research 2014, 14:217.
  35. Faruki N, Lloyd J, Ahmad R, Leong L, Harris MF. Feasibility of an intervention to enhance preventive care for people with low health literacy, in primary health care. Australian Journal of Primary Health, 2014; http://dx.doi.org/10.1071/PY14061
  36. Rose V and Harris MF. Experiences of self-management support from GPs among Australian ethnically diverse diabetes patients: a qualitative study. Psychology, Health and Medicine; 2014. epub 1-7:  DOI: 10.1080/13548506.2014.897915\
  37. Harris MF and Zwar NA. Reflections on the history of general practice in Australia. Medical Journal of Australia 2014; 201(1): S37-40.
  38. Arora A, Lam ASF, Karami Z, Do L and Harris MF. How readable are Australian paediatric oral health education materials. BMC Oral Health. 14: 111 DOI 10.1186/1472-6831-14-111
  39. Joshi J, Jayasinghe UW, Del Mar C, Russell GM, Llloyd J, Parker S, Mazza D, Denney-Wilson E, van Driel M, Taylor R and Harris MF. Does health literacy affect patients' receipt of preventative primary care? A multilevel analysis. BMC Family Practice 2014, 15:171 DOI: 10.1186/s12875-014-0171-z http://www.biomedcentral.com/1471-2296/15/171
  40. Patel B, Patel A, Jan S, Usherwood T, Harris MF, Panaretto K, Zwar N, Redfern J, Jansen J, Doust J and Peiris D. A multifaceted quality improvement intervention for CVD risk management in Australian primary healthcare: A protocol for a process evaluation. Implementation Science 2014, 9:187.


Updated:  20 September 2017/Responsible Officer:  Director, APHCRI/Page Contact:  Web Admin, APHCRI