Menzies School of Health Research, Charles Darwin University, 1/147 Wharf Street, Brisbane, Spring Hill, Australia.
Implement Sci. 2013 Dec 17;8:143. doi: 10.1186/1748-5908-8-143.
Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems.Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research.
IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM.
This paper draws together several different previously described concepts and extends the understanding of how PHC systems can be strengthened through systematic and partnership-based approaches. We describe a model developed from these concepts and its application in the Australian Indigenous primary healthcare context, and raise questions about sustainability and wider relevance of the model.
加强基层医疗保健系统对于改善健康结果和减少不平等至关重要。然而，发表的文献中几乎没有工具和模型可以展示如何在大规模上实现基层医疗保健系统的加强。加强基层医疗保健（PHC）系统的挑战包括基层医疗保健提供者的分散、多样性和相对独立性；PHC 的范围和复杂性；支持人口健康方法的基础设施有限；以及一般较差和零碎的 PHC 信息系统。借鉴综合 PHC 的概念、综合质量改进（IQI）方法、基于系统的研究网络和基于系统的参与式行动研究，我们描述了一种用于加强 PHC 的学习模型，以应对这些挑战。我们描述了该模型在澳大利亚原住民和托雷斯海峡岛民基层医疗保健背景下的演变，以及在应用过程中的成功和挑战，以及进一步研究的关键问题。
IQI 方法结合基于系统的参与式行动研究和基于系统的研究网络为支持广泛的基层医疗保健实践和大规模的计划实施和持续学习提供了潜力。伙伴关系学习模型（PLM）可以被视为跨越 PHC 优先方面范围的大规模知识转化的综合模型。通过适当吸引相关利益攸关方，该模型可能适用于广泛的环境。在 IQI 中，特别是在 PLM 中，研究在改进和评估现有工具和流程以及开发和试验创新方面有明确的作用。在为常规服务提供资金的同时，为 IQI 活动提供资金并为 IQI 相关研究提供资金之间取得适当平衡，对于开发和维持这种类型的 PLM 至关重要。
本文汇集了几个以前描述的不同概念，并扩展了对如何通过系统和伙伴关系方法加强基层医疗保健系统的理解。我们描述了一个从这些概念中发展而来的模型及其在澳大利亚土著基层医疗保健背景下的应用，并提出了关于该模型的可持续性和更广泛相关性的问题。
