Fuller J, Bentley M, Shotton D
South Australian Centre for Rural and Remote Health, The University of Adelaide, South Australia, Australia.
Aust J Rural Health. 2001 Feb;9(1):12-7. doi: 10.1046/j.1440-1584.2001.00353.x.
This study examined the impact of community health needs assessments used in country South Australian health service planning between 1995 and 1999. Data were collected from regional health planning officers during a Search Conference and a series of Delphi rounds. The needs assessments were found to vary from regionally to locally driven approaches. Locally driven approaches ensured local involvement but the process was slower and required more effort from the planner. It was also felt that locally driven approaches could exacerbate tension between a community's imperatives and the regional focus of regional decision-makers. In the overall regional budgets, the reallocation of health service funds according to the needs assessment findings was only small because of difficulties in refocusing from traditional clinical services in the short term. In contrast, the impact on health service thinking about population health issues was thought to have been more significant, for example, in the development of regional women's health plans. The use of community health needs assessments was useful, but for greater impact these should not now be so 'broad-brushed', but be more focused on feasible changes that health services could support. Other priority-setting techniques, such as marginal analysis, should also be used to determine where maximum health gains can be obtained.
本研究考察了1995年至1999年间在南澳大利亚州卫生服务规划中使用的社区卫生需求评估的影响。在一次研讨会议和一系列德尔菲轮次中，从地区卫生规划官员那里收集了数据。发现需求评估在从地区驱动到地方驱动的方法上存在差异。地方驱动的方法确保了地方参与，但过程较慢，且规划者需要付出更多努力。还感觉到地方驱动的方法可能会加剧社区需求与地区决策者的地区重点之间的紧张关系。在总体地区预算中，由于短期内难以从传统临床服务重新聚焦，根据需求评估结果重新分配卫生服务资金的幅度很小。相比之下，对卫生服务在人口健康问题方面的思维影响被认为更为显著，例如在制定地区妇女健康计划方面。社区卫生需求评估的使用是有用的，但为了产生更大影响，现在不应如此“笼统”，而应更专注于卫生服务能够支持的可行变革。还应使用其他确定优先事项的技术，如边际分析，来确定在何处可以获得最大的健康收益。
