|
Title |
Features of effective primary health care models
in rural and remote Australia: a case-study analysis |
Author(s) |
John Wakerman, John S Humphreys, Robert Wells,et al - Personal Name
|
Subject |
Rural Health |
Publisher |
Medical Journal of Australia |
Publishing Year |
2009 |
Specific Detail Info |
Objective: To describe the factors and processes that facilitate or inhibit
implementation, sustainability and generalisation of effective models of primary
health care (PHC) service delivery in rural and remote Australia.
Design: Case-study approach, including review of relevant literature, interviews with
key informants, site visits and direct observation. Thematic analysis and template
analysis were used with interview transcripts. An expert reference group provided
feedback and advice on policy relevance.
Setting and participants: Six PHC services in small communities across rural and
remote Australia were selected based on results of a previous systematic review; they
reflected diverse rural and remote settings and PHC models, and the multidisciplinary
nature of PHC. Sites were visited, and 55 individuals associated with the establishment
and operation of these services were interviewed between July 2006 and December
2007.
Results: Independent and template analysis confirmed the usefulness of a conceptual
framework, which identified three key “environmental enablers” — supportive policy;
federal and state/territory relations; and community readiness — and five essential
service requirements — governance, management and leadership; funding; linkages;
infrastructure; and workforce supply. Systematically addressing each of these factors
improves effectiveness and lessens the threat to service sustainability.
Conclusions: Evidence from existing effective rural and remote PHC services can inform
the health care reform agenda, in Australia and other countries. The evidence highlights
the need for improved governance, management and community involvement, as well
as strong, visionary political leadership to achieve a more responsive and better
coordinated health system which could help eliminate existing health status differentials
between cities and rural areas. In Australia, establishment of a single national health
system, operationalised at a regional level, would obviate much of the current inefficiency and poor coordination. |
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