Robinson Suzanne, Varhol Richard, Ramamurthy Vijaya, Denehy Melissa, Hendrie Delia, O'Leary Peter, Selvey Linda
Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Western Australia Department of Health, Perth, Western Australia, Australia.
BMJ Open. 2015 Mar 27;5(3):e007191. doi: 10.1136/bmjopen-2014-007191.
The objectives of this study are to evaluate the development and implementation of Medicare Locals as new primary care organisations and consider the implications of these findings for the wider challenge of strengthening primary healthcare in Australia and internationally.
National survey of Medicare Locals which involved the use of content analysis and a descriptive survey tool.
61 Medicare Locals in Australia.
The survey was distributed electronically to all 61 Medicare Local Chief Executive Officers (CEOs) between October and December 2013.
The research was interested in exploring the following areas; the form and function of Medicare Locals; the confidence and capacity of Medicare Locals to perform against their objectives around population planning and system integration; their ability to engage relevant stakeholder groups; and the barriers and facilitators to reform.
A total of 43 (70%) of Medicare Locals completed the survey with representation from six of the eight Australian states and Territories. Results suggest differences in the form and function of the Medicare Local organisations and considerable diversity in the implementation of Medicare Local organisations across Australia. This diversity and lack of guidance from government impacted on the overall success of the reform. Other barriers to reform included difficulties in stakeholder relationships and limited incentives (financial and other) to drive and influence change.
Findings from this study produce important insights for primary care reform in Australia; and internationally it adds to the growing body of knowledge around primary care reform.
本研究旨在评估作为新型初级保健组织的医疗保险地区机构的发展与实施情况，并探讨这些研究结果对澳大利亚及国际上加强初级卫生保健这一更广泛挑战的启示。
对医疗保险地区机构进行全国性调查，采用内容分析法和描述性调查工具。
澳大利亚的61个医疗保险地区机构。
2013年10月至12月期间，通过电子邮件向所有61位医疗保险地区机构首席执行官发放调查问卷。
本研究旨在探讨以下几个方面；医疗保险地区机构的形式与功能；医疗保险地区机构围绕人口规划和系统整合实现其目标的信心与能力；它们与相关利益相关群体合作的能力；以及改革的障碍和促进因素。
共有43个（70%）医疗保险地区机构完成了调查，来自澳大利亚八个州和领地中的六个。结果表明，医疗保险地区机构组织的形式与功能存在差异，且澳大利亚各地医疗保险地区机构的实施情况存在很大差异。这种多样性以及缺乏政府指导影响了改革的整体成效。改革的其他障碍包括利益相关者关系方面的困难以及推动和影响变革的激励措施（财务和其他方面）有限。
本研究结果为澳大利亚的初级保健改革提供了重要见解；在国际上，它也为围绕初级保健改革的不断增长的知识体系增添了内容。
