Reddy Sandeep, Orpin Victoria, Herring Sally, Mackie-Schneider Stephanie, Struber Janet
Centre for Remote Health, Flinders University, Australia.
J Eval Clin Pract. 2018 Feb;24(1):152-158. doi: 10.1111/jep.12772. Epub 2017 May 24.
The aim of this evaluation was to assess the acceptability, accessibility, and compliance with the 2014 editions of the Remote Primary Health Care Manuals (RPHCM) in health care centres across remote areas of Northern and Central Australia.
To undertake a comprehensive evaluation that considered context, the evaluation used a realist evaluation framework. The evaluation used a variety of methods including interviews and survey to develop and test a programme theory.
Many remote health practitioners have adopted standardized, evidence-based practice because of the use of the RPHCM. The mechanisms that led to the use of the manuals include acceptance of the worth of the protocols to their clinical practice, reliance on manual content to guide their practice, the perception of credibility, the applicability of RPHCM content to the context, and a fear of the consequences of not using the RPHCMs. Some remote health practitioners are less inclined to use the RPHCM regularly because of a perception that the content is less suited to their needs and daily practice or it is hard to navigate or understand.
The evaluation concluded that there is work to be done to widen the RPHCM user base, and organizations need to increase support for their staff to use the RPHCM protocols better. These measures are expected to enable standardized clinical practice in the remote context.
本次评估旨在评估澳大利亚北部和中部偏远地区各医疗中心对2014年版《远程初级卫生保健手册》（RPHCM）的可接受性、可及性及遵循情况。
为进行一项考虑实际情况的全面评估，该评估采用了现实主义评估框架。评估运用了多种方法，包括访谈和调查，以制定和检验一个项目理论。
由于使用了RPHCM，许多偏远地区的医疗从业者采用了标准化的循证实践。促使手册得以使用的机制包括认可协议对其临床实践的价值、依靠手册内容指导实践、对其可信度的认知、RPHCM内容对实际情况的适用性，以及对不使用RPHCM后果的担忧。一些偏远地区的医疗从业者不太倾向于经常使用RPHCM，因为他们认为其内容不太适合他们的需求和日常实践，或者难以查找或理解。
评估得出结论，要扩大RPHCM的用户群体仍有工作要做，各组织需要加强对员工的支持，以便更好地使用RPHCM协议。预计这些措施将在偏远地区实现标准化临床实践。
