Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Global Health. 2018 Jan 25;14(1):12. doi: 10.1186/s12992-018-0332-2.
Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models.
This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models.
Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment.
While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.
与非原住民相比，原住民的健康状况较差。原住民初级卫生保健服务的发展源于主流卫生服务无法充分满足原住民社区的需求，而原住民往往被主流卫生服务所排斥和边缘化。解决方案的一部分是建立由原住民人民管理的针对和服务于原住民的特定的初级卫生保健服务。原住民初级卫生保健服务比主流服务更有可能改善原住民社区健康状况的原因有很多。它们的成功部分归因于这样一个事实，即它们通常提供全面的计划，其中包括治疗和管理、预防和健康促进，以及解决健康的社会决定因素。然而，在证据基础中存在差距，包括有助于原住民初级卫生保健服务在提供全面初级卫生保健方面取得成功的特征。本系统范围综述旨在确定原住民初级卫生保健服务提供模式的特征。
这项系统范围综述由一位土著研究人员领导，采用 Joanna Briggs 研究所范围综述方法学。从 1978 年 9 月至 2015 年 5 月，审查了所有已发表的同行评议和灰色文献，这些文献均来自 PubMed、EBSCO CINAHL、Embase、Informit、Mednar 和 Trove 数据库，并被纳入索引。如果研究描述了在原住民初级卫生保健服务中实施的服务提供模式的特征，则将其纳入研究。有 62 项研究符合纳入标准。提取数据后，对其进行主题分析，以确定原住民 PHC 服务提供模式的特征。
文化是所有其他七个特征的基础，这七个特征包括：可及的卫生服务、社区参与、持续质量改进、文化上合适和熟练的劳动力、灵活的护理方法、整体医疗保健以及自决和赋权。
虽然在综述中清楚地区分了这八个特征，但每个特征之间的相互依存关系也很明显。这些发现被用于开发一种新的原住民 PHC 服务提供模型，该模型清楚地展示了一些原住民特定模型的独特特征。
