Gruen R L, Weeramanthri T S, Bailie R S
Flinders University Northern Territory Clinical School and Menzies School of Health Research, Darwin, Northern Territory, Australia.
J Epidemiol Community Health. 2002 Jul;56(7):517-21. doi: 10.1136/jech.56.7.517.
To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability.
A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients.
The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care.
Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities.
The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation.
In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.
探讨专科医生外展服务在支持初级卫生保健以及克服澳大利亚偏远地区原住民所面临的医疗保健障碍方面的作用，并研究影响其可持续性的问题。
采用卫生服务利用数据以及对卫生专业人员和患者进行访谈的方式，对一项专科医生外展服务进行过程评估。
澳大利亚北领地的顶端地区，达尔文市是该地区的首府以及医院和专科服务的主要基地。在达尔文市以外的农村和偏远地区，有许多主要为原住民的小社区，这些社区因疾病负担沉重和获得医疗服务的机会有限而处于极为不利的地位。
17名偏远地区的卫生从业人员、5名进行外展服务的专科医生、5名地区卫生管理人员以及3名来自偏远社区的患者。
许多偏远地区的原住民在获得专科和医院护理方面面临巨大障碍。专科服务的外展提供克服了一些与距离、沟通以及服务文化不适应性相关的障碍，并使来自偏远社区的人员的会诊次数增加了四倍多。影响可持续性的关键问题包括：充足的专科医生队伍；初级保健未满足的需求；与以初级保健为中心的多学科框架的整合、问责制以及能力建设；良好的沟通；定期且可预测的出诊；认识到对医院和初级保健部门双方责任的资金和协调；以及定期评估。
在存在弱势群体且获得医疗服务机会不足的情况下，与仅依靠医院服务相比，地区中心的专科医生外展服务可以提供一种更公平的服务提供方式。一项组织得当、响应当地社区需求且拥有充足地区专科医生队伍的可持续外展服务可以有效地与初级卫生保健过程整合并提供支持。然而，规划和实施不当的外展服务可能会分散资源并损害初级卫生保健。
