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Review of the research on the effectiveness of health service interventions to reduce variations in health.

Abstract (adapted) OBJECTIVE: To review the available research in order to identify evaluations of interventions which the NHS alone or in collaboration with other agencies could use to reduce variations in health. 94 studies were identified which satisfied all the inclusion criteria.

Characteristics of interventions which appear to have been successful at reducing variations in health or improving the health of high-risk groups include: systematic and intensive approaches to delivering effective interventions, improvement of accessibility to services, prompts to encourage use of services, multifaceted strategies, strategies involving collaboration between interest groups, ensuring interventions address the expressed or identified needs of the target population, and the involvement of peers in the delivery of interventions such as home visiting. However, these characteristics alone are not sufficient for success; there are examples of interventions with these attributes in which the evaluation showed no reduction in health variations. A comparison of these results with other reviews, including observational studies, did not indicate that any significant type of intervention which might be effective at reducing variations in health had been overlooked.

CONCLUSIONS: There are interventions which the NHS, either alone or in combination with other agencies, can use to reduce variations in health. Whilst removal of the financial barriers to accessing health care can make an important contribution to reducing variations in health, this is not in itself sufficient to prevent all avoidable variation. Commissioners of health services could additionally undertake an "equity audit" of the services they commission to identify priority areas for interventions and monitor change. It is

hoped that the effective interventions identified in the review will help purchasers and providers of health services at local level use

their resources more equitably and assist in the shaping and evaluation of future initiatives designed to address variations in health.