From access to impact: a continuum framework for prevention-oriented, equity-centred primary care

Primary care and family medicine are repeatedly promoted as the natural setting for prevention, surveillance and equity-oriented care, yet evaluations of digitally enabled and prevention-oriented interventions in this setting rarely trace effects beyond initial contact with services. This Perspective argues that the field conflates structural access, coverage, utilization, the quality, continuity and coordination of care delivery, clinical effectiveness and population-level impact, and that this conflation obscures whether primary-care innovations actually narrow health inequities or merely increase low-value contact with the health system. We propose the Access-to-Impact Continuum, a six-stage framework that requires equity to be assessed as a cross-cutting stratifying lens at every stage rather than treated as a single downstream outcome. Applying the framework to four domains—vaccination equity, antimicrobial stewardship and healthcare-associated infection prevention, telemedicine and the digital divide, and hospital-to-community transition in an ageing, multimorbid population—we illustrate that most current evidence clusters at the access and utilization stages, while equity-stratified effectiveness and population-impact evidence remains sparse. We outline implementation, policy and research priorities, including standardized equity-stratified indicators, integration of clinical decision support and team-based care, and a staged evaluation agenda, to move prevention-oriented primary care from documented contact to demonstrated, equitably distributed impact.