a Southgate Institute , Flinders University , Adelaide , Australia.
b School of Nursing & Midwifery , Flinders University , Adelaide , Australia.
Aging Ment Health. 2018 Aug;22(8):1025-1031. doi: 10.1080/13607863.2017.1320702. Epub 2017 May 2.
Integrated care has been identified as means of managing the demands on the healthcare budget while improving access to and quality of services. It is particularly pertinent to rural health services, which face limited access to specialist and support services. This paper explores the capacity of three rural communities in South Australia to deliver integrated mental health support for older people.
Thirty-one interviews were conducted with local health and social service providers from mental health, community health, general practice, residential aged care, private practice, NGOs and local government as part of a larger action research project on service integration.
Participants highlighted differences in service delivery between the communities related to size of the community and access to services. Three structural barriers to delivery of integrated care were identified. These are as follows: fragmentation of governmental responsibility, the current funding climate, and centralisation and standardisation of service delivery.
We conclude that despite a focus upon integrated care in mental health policy, many features of current service delivery undermine the flexibility and informal relationships that typically underpin integration in rural communities.
综合护理被认为是一种管理医疗预算需求的手段，同时可以提高服务的可及性和质量。它对于农村卫生服务特别相关，因为农村卫生服务面临着专业和支持服务获取途径有限的问题。本文探讨了南澳大利亚州的三个农村社区为老年人提供综合心理健康支持的能力。
作为一项关于服务整合的大型行动研究项目的一部分，对来自心理健康、社区卫生、全科医疗、养老院、私人执业、非政府组织和地方政府的当地卫生和社会服务提供者进行了 31 次访谈。
参与者强调了社区之间服务提供方面的差异，这些差异与社区的规模和服务的可及性有关。确定了提供综合护理的三个结构性障碍。这些障碍如下：政府责任的分散、当前的资金环境以及服务提供的集中化和标准化。
我们的结论是，尽管精神卫生政策强调综合护理，但当前服务提供的许多特征破坏了农村社区中综合护理通常所依赖的灵活性和非正式关系。
