Buote Richard, Asghari Shabnam, Aubrey-Bassler Kris, Knight John C, Lukewich Julia
Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL.
Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
CMAJ Open. 2019 Jan 15;7(1):E8-E14. doi: 10.9778/cmajo.20180091. Print 2019 Jan-Mar.
Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province.
We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services.
Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites.
Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs.
纽芬兰与拉布拉多省人口老龄化迅速，其中大部分为农村人口，健康行为不佳且慢性病发病率高。这些因素给医疗服务带来了独特挑战。我们的目的是描述该省各地区域卫生当局提供的公共资助初级卫生保健项目和服务的可及情况。
我们使用在纽芬兰与拉布拉多省开展的一项省级初级卫生保健横断面调查数据进行描述性分析。调查数据包括地点、特定疾病的慢性病预防规划、常规初级保健类型、联合健康预防与促进、慢性病预防与管理服务以及团队式护理。确定了大多数项目和服务的服务提供模式。
153个地点返回了调查问卷（回复率99.4%）。66%（95/145）的地点提供家庭医生服务，51%（74/144）的地点提供执业护士服务。除各种自我管理和教育服务外，许多地点还提供宫颈癌（60%，86/144）、结肠癌（42%，59/142）和前列腺癌（43%，60/141）筛查。许多地点提供联合健康服务，如临床营养咨询（47%，68/146）和职业治疗（46%，68/147）。现有的医疗服务大多由现场工作人员提供，很少有地点通过远程医疗提供初级卫生保健服务。总体而言，农村地点提供的服务种类比城市地点更多。
纽芬兰与拉布拉多省各地初级卫生保健服务的范围存在很大差异，一些项目和服务的提供有限。未来的研究应考察项目和服务的可及情况如何影响健康结果和成本。
