School of Public Health and Social Work, Faculty of Health, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia.
School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Int J Health Plann Manage. 2019 Apr;34(2):e1247-e1256. doi: 10.1002/hpm.2770. Epub 2019 Mar 22.
A key to achieving the goal of hepatitis C virus (HCV) elimination is the provision of its treatment in community settings. This study aimed to identify the important organisational and operational elements of community-based models for treating HCV and their feasibility in the Australian context.
A Delphi study was conducted with 33 experts from Australia. The questionnaire included 13 elements drawn from the literature. Participants rated each element on a five-point Likert scale for importance and feasibility and suggested additional elements. Consensus was identified when the sum of categories 1 and 2 or 4 and 5 of the five-point Likert scale reached greater than or equal to 70%.
Eight elements reached consensus in regard to importance including "Safe and enabling environment," "Training and support for healthcare providers," "Open referral policy," "Linkage with or providing outreach services," "Person-centred approach," "On-site screening and assessment," "Linkage or co-location with harm reduction services," and "Linkage or co-location with drug and alcohol services." At least 65% of participants agreed implementing elements of open referral policy, Training and support for healthcare providers, and Person-centred approach are usually or always/very feasible. For the other five elements, this was agreed to by a range of 15.2%-57.6% of participants.
Successful community-based models for treating HCV in Australia are dependent on the integration and coordination of care and the support provided for both patients and healthcare providers. Substantial work is required across policy and health service planning to integrate these highly rated elements into Australian primary health care.
实现丙型肝炎病毒 (HCV) 消除目标的关键是在社区环境中提供其治疗。本研究旨在确定基于社区的 HCV 治疗模式的重要组织和运营要素及其在澳大利亚环境中的可行性。
采用德尔菲法对来自澳大利亚的 33 名专家进行研究。问卷包括从文献中提取的 13 个要素。参与者对每个要素的重要性和可行性进行了五分制 Likert 评分,并提出了其他要素。当五分制 Likert 量表的第 1 类和第 2 类或第 4 类和第 5 类的总和大于或等于 70%时,即可达成共识。
有 8 个要素在重要性方面达成共识,包括“安全和有利的环境”、“医疗保健提供者的培训和支持”、“开放转诊政策”、“与外展服务建立联系或提供外展服务”、“以人为本的方法”、“现场筛查和评估”、“与减少伤害服务建立联系或共同定位”以及“与毒品和酒精服务建立联系或共同定位”。至少有 65%的参与者同意实施开放转诊政策、医疗保健提供者培训和支持以及以人为本的方法通常或总是/非常可行。对于其他五个要素,有 15.2%-57.6%的参与者表示同意。
澳大利亚成功的基于社区的 HCV 治疗模式依赖于医疗保健的整合和协调以及对患者和医疗保健提供者的支持。需要在政策和卫生服务规划方面开展大量工作,将这些评价较高的要素纳入澳大利亚初级卫生保健。