Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.

Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012. We conducted a qualitative analysis of PFs\' narrative reports using a multiple case study design. We used a combined purposeful sampling approach to identify cases that 1) reflected experiences typical of the broader sample and 2) presented sufficient breadth of experience from each project step and family practice model. Sampling continued until data saturation was reached. Team members conducted a qualitative analysis of reports using an open and axial coding style and a constant comparative approach. Barriers and enablers were divided into five constructs: structural, organizational, provider, patient, and innovation. Narratives from 13 practice sites were reviewed. A total of 8 barriers and 11 enablers were consistently identified across practices. Barriers were most commonly reported at the organizational (n = 3) and structural level, (n = 2) while enablers were most common at the innovation level (n = 6). While physicians responded positively to PFs\' presence and largely supported their recommendations for practice change, organizational and structural aspects such as lack of time, minimal staff engagement, and provider reimbursement remained too great for practices to successfully implement practice-level changes. Trial Registration: ClinicalTrials.gov, NCT00574808.