Penrose Lisa, Roe Yvette, Johnson Natalie A, James Erica L
Institute for Urban Indigenous Health, 22 Cox Road, Windsor, Qld 4030, Australia.
University of Newcastle, School of Medicine and Public Health, HMRI West Wing, University Drive, Callaghan, NSW 2308, Australia.
Aust J Prim Health. 2018 May;24(2):135-140. doi: 10.1071/PY17039.
The Institute for Urban Indigenous Health (IUIH) aimed to improve access to cataract surgery in urban South East Queensland (SEQ) for Indigenous Australians, without compromising clinical visual outcomes. The Penchansky and Levesque concept of access as the 'fit' between the patient's needs and the ability of the system to meet those needs was used to inform the redesign of the mainstream cataract surgical pathway. The IUIH staff and community stakeholders mapped the traditional external cataract surgical pathway and then innovatively redesigned it to reduce the number of patients being removed by the system at key transition points. The integration of eye health within the primary health care (PHC) clinic has improved the continuity and coordination of care along the surgical pathway, and ensured the sustainability of collaborative partnerships with key external organisations. Audit data demonstrated a significant increase in utilisation of cataract surgical services after the process redesign. Previous studies have found that PHC models involving integration, coordination and continuity of care enhance patient health outcomes; however, the IUIH surgical model extends this to tertiary care. There is scope to apply this model to other surgical pathways and communities who experience access inequity.
城市原住民健康研究所（IUIH）旨在改善澳大利亚原住民在昆士兰州东南部城市地区获得白内障手术的机会，同时不影响临床视觉效果。采用彭钱斯基和莱韦斯克提出的“可及性”概念，即患者需求与系统满足这些需求的能力之间的“匹配度”，为重新设计主流白内障手术路径提供参考。IUIH的工作人员和社区利益相关者绘制了传统的外部白内障手术路径，然后进行创新设计，以减少在关键过渡点被系统排除在外的患者数量。将眼部健康纳入初级卫生保健（PHC）诊所，改善了手术路径上护理的连续性和协调性，并确保了与关键外部组织合作关系的可持续性。审计数据显示，流程重新设计后，白内障手术服务的利用率显著提高。先前的研究发现，涉及护理整合、协调和连续性的初级卫生保健模式可改善患者健康结果；然而，IUIH的手术模式将此扩展到了三级护理。有机会将该模式应用于其他经历可及性不平等的手术路径和社区。
