提高澳大利亚原住民医疗服务的成效。

Improving the efficacy of healthcare services for Aboriginal Australians.

作者信息

Gwynne Kylie, Jeffries Thomas, Lincoln Michelle

机构信息

Poche Centre for Indigenous Health, Room 223, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia.

Syndey Medical School, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia. Email.

出版信息

Aust Health Rev. 2019 Jul;43(3):314-322. doi: 10.1071/AH17142.

DOI:10.1071/AH17142

PMID:29335090

Abstract

Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.

摘要

目的本系统评价旨在探讨促进为澳大利亚原住民有效提供卫生服务的因素。方法本系统评价按照系统评价与Meta分析的首选报告项目（PRISMA）声明进行。纳入的论文需包含与澳大利亚原住民卫生服务相关的数据，且发表于2000年至2015年之间。使用有效公共卫生实践项目定量研究质量评估工具对符合纳入标准的21篇论文进行评估。随后，由于方法学方法薄弱，排除了7篇论文。结果本研究有两项发现：（1）在获得常规医疗服务方面，原住民的情况比非原住民更差；（2）有五个因素可促进为澳大利亚原住民提供有效的医疗服务：文化能力、参与率、组织、临床治理与合规以及服务可及性。结论为澳大利亚原住民提供的卫生服务必须量身定制，实施这五个促进因素可能会影响原住民卫生服务的有效性。本研究结果对指导未来澳大利亚原住民医疗服务的设计、资金投入、提供和评估具有重要意义。关于该主题已知哪些信息？有大量证据表明原住民健康状况不佳，且原住民与非原住民之间预期寿命存在10年差距，而关于提高卫生服务效果的证据有限。本文补充了哪些内容？本系统评价发现，在常规卫生服务提供方面，原住民的健康状况更差。本文确定了文献中提高针对原住民的医疗服务有效性的五项策略。对从业者有何启示？原住民在获得常规护理服务时，体验和结果都更差。针对原住民的卫生服务应利用这五个促进因素进行量身定制，以提供及时、文化上安全且高质量的护理。