Asthana Sheena, Halliday Joyce
School of Sociology, Politics and Law, University of Plymouth, Plymouth, UK.
Health Soc Care Community. 2004 Nov;12(6):457-65. doi: 10.1111/j.1365-2524.2004.00518.x.
There is a national commitment to ensuring that, regardless of where patients live, they should be provided with an acceptable level of service in terms of quality, effectiveness and accessibility. Because of differences in the distributions of their populations, rural and urban areas present quite different challenges for the optimal design of health services and social care. However, this has not been fully acknowledged in the development of national policies to unify service standards. The problems of providing services in sparsely populated areas are not new. However, until the case for a rural premium in English health resource allocation is accepted, rural agencies must either tolerate lower levels of services (an option made difficult by the introduction of national service standards) or develop very different approaches to service delivery. To date, there has been little systematic knowledge about the extent of innovative rural practice, a paucity of evaluation of such initiatives and few opportunities to disseminate learning from one area to another. The present paper begins to address this deficit. Drawing upon a review of the formal literature and a comprehensive evaluation of projects developed within a rural Health Action Zone, it presents a typology of innovative responses at the health/social care interface. Examples of service innovations which fall into six broad categories are provided. These not only suggest possibilities for the transfer of good practice, but also the potential for future research.
国家致力于确保无论患者居住在何处，都能在质量、有效性和可及性方面获得可接受的服务水平。由于城乡人口分布不同，农村和城市地区在卫生服务和社会护理的优化设计方面面临截然不同的挑战。然而，在制定统一服务标准的国家政策时，这一点尚未得到充分认识。在人口稀少地区提供服务的问题并非新鲜事。然而，在英国卫生资源分配中农村补贴的情况被认可之前，农村机构要么容忍较低水平的服务（由于引入国家标准，这种选择变得困难），要么开发截然不同的服务提供方式。迄今为止，关于农村创新实践的程度，几乎没有系统的知识，对这类举措的评估很少，也几乎没有机会将一个地区的经验推广到另一个地区。本文开始着手解决这一不足。通过对正式文献的回顾以及对农村卫生行动区内开展的项目进行全面评估，本文提出了卫生/社会护理界面创新应对措施的类型学。提供了属于六大类别的服务创新示例。这些示例不仅为良好实践的推广提供了可能性，也为未来研究提供了潜力。
