Fitzpatrick Scott J, Perkins David, Luland Teresa, Brown Dale, Corvan Eamonn
Centre for Rural and Remote Mental Health, The University of Newcastle, Locked Bag 6005, Orange, NSW 2800, Australia.
Centre for Rural and Remote Mental Health, The University of Newcastle, Locked Bag 6005, Orange, NSW 2800, Australia.
Health Place. 2017 May;45:70-76. doi: 10.1016/j.healthplace.2017.03.004. Epub 2017 Mar 10.
Unequal health care outcomes for those with mental illness mean that access to integrated models is critical to supporting good physical and mental health care. This is especially so in rural areas where geographic and structural issues constrain the provision of health services. Guided by a conceptual framework about rural and remote health, this study draws on interviews with health providers and other staff and examines the dynamics of integrated primary and community-based specialist care for people with severe and persistent mental illnesses living in rural Australia. Findings show that the facilitation of sustainable linkages between general practice and community mental health requires the skilful exercise of power, knowledge, and resources by partners in order to address the social and structural factors that influence local health situations. These findings suggest that incremental processes of integration that are responsive to patients' and stakeholders' needs and that build on success and increased trust may be more effective than those imposed from the 'top down' that pay insufficient attention to local contexts.
精神疾病患者的医疗保健结果不平等，这意味着采用综合模式对于支持良好的身心健康护理至关重要。在农村地区尤其如此，因为地理和结构问题限制了医疗服务的提供。本研究以一个关于农村和偏远地区健康的概念框架为指导，通过对医疗服务提供者和其他工作人员的访谈，考察了为生活在澳大利亚农村的严重和持续性精神疾病患者提供综合基层和社区专科护理的动态情况。研究结果表明，促进全科医疗与社区心理健康之间的可持续联系需要合作伙伴巧妙地运用权力、知识和资源，以解决影响当地健康状况的社会和结构因素。这些研究结果表明，根据患者和利益相关者的需求逐步推进整合过程，并基于成功经验和增强的信任，可能比那些“自上而下”强加的、对当地情况关注不足的整合过程更有效。
