McDonald John, Ollerenshaw Alison
School of Behavioural and Social Sciences and Humanities, University of Ballarat, Ballarat, Victoria, Australia.
Rural Remote Health. 2011;11(2):1714. Epub 2011 Jun 6.
Managers and staff in primary health care partnerships in local catchments, particularly in regional areas, are periodically required to work collaboratively to set health priorities. Setting priorities involves making decisions about which health needs are most important and what programs will be funded to address them. There is no universally agreed set of decision-making rules for setting priorities. Dominant approaches prioritise health economics, and have favoured expert knowledge drawn from technical-rational methodologies rather than consumer involvement and community action. However, research reveals that setting priorities is a complex, value laden, contested process buffeted by competing objectives and political interests. As such, an interdisciplinary, collaborative approach is called for. Using reflective practice from a priority setting project for a primary care partnership in a local, regional catchment in Victoria, Australia, a conceptual framework for priority setting is presented that identifies 13 interconnected factors spanning economic, political, policy, epidemiological, moral, evidentiary and evaluative domains. This interdisciplinary framework extends current knowledge about the considerations and trade-offs in setting priorities among collaborating primary health care agencies. It offers a potentially valuable heuristic tool for healthcare decision-makers in rural areas.
地方集水区，特别是偏远地区的初级卫生保健合作关系中的管理人员和工作人员，需要定期协同工作以确定卫生工作重点。确定重点工作涉及就哪些卫生需求最为重要以及将资助哪些项目来满足这些需求做出决策。目前尚无一套普遍认可的确定重点工作的决策规则。主流方法将卫生经济学作为优先事项，并倾向于从技术理性方法中获取的专家知识，而非消费者参与和社区行动。然而，研究表明，确定重点工作是一个复杂、充满价值考量且存在争议的过程，受到相互竞争的目标和政治利益的影响。因此，需要一种跨学科的协作方法。通过对澳大利亚维多利亚州一个地方偏远集水区初级保健合作关系的重点确定项目进行反思性实践，本文提出了一个重点确定的概念框架，该框架识别了涵盖经济、政治、政策、流行病学、道德、证据和评估领域的13个相互关联的因素。这个跨学科框架扩展了当前关于合作的初级卫生保健机构在确定重点工作时的考量因素和权衡取舍的知识。它为农村地区的医疗决策者提供了一个潜在有价值的启发式工具。
