Wakerman John, Humphreys John S, Wells Robert, Kuipers Pim, Jones Judith A, Entwistle Philip, Kinsman Leigh
Centre for Remote Health, Flinders University, Alice Springs, NT, Australia.
Med J Aust. 2009 Jul 20;191(2):88-91. doi: 10.5694/j.1326-5377.2009.tb02700.x.
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.
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.
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.
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.
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.
描述促进或阻碍澳大利亚农村和偏远地区初级卫生保健（PHC）服务有效提供模式的实施、可持续性及推广的因素和过程。
案例研究方法，包括相关文献回顾、关键信息提供者访谈、实地考察和直接观察。对访谈记录采用主题分析和模板分析。一个专家咨询小组就政策相关性提供反馈和建议。
根据之前一项系统评价的结果，在澳大利亚农村和偏远地区的六个小社区选取了六个初级卫生保健服务机构；它们反映了不同的农村和偏远地区环境、初级卫生保健模式以及初级卫生保健的多学科性质。对这些机构进行了实地考察，并在2006年7月至2007年12月期间，对与这些服务机构的设立和运营相关的55人进行了访谈。
独立分析和模板分析证实了一个概念框架的有用性，该框架确定了三个关键的“环境促进因素”——支持性政策；联邦与州/领地关系；以及社区准备情况——和五个基本服务要求——治理、管理与领导；资金；联系；基础设施；以及劳动力供应。系统地处理这些因素中的每一个都能提高效率，并减少对服务可持续性的威胁。
来自澳大利亚农村和偏远地区现有有效初级卫生保健服务的证据可为澳大利亚及其他国家的医疗改革议程提供参考。该证据强调了改善治理、管理和社区参与的必要性，以及强有力的、有远见的政治领导，以实现一个更具响应性和协调性更好的卫生系统，这有助于消除城乡之间现有的健康状况差异。在澳大利亚，建立一个在区域层面运作的单一国家卫生系统将消除目前的许多低效率和协调不善的问题。
