Goodyear-Smith Felicity, Bazemore Andrew, Coffman Megan, Fortier Richard, Howe Amanda, Kidd Michael, Phillips Robert, Rouleau Katherine, van Weel Chris
Department of General practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Robert Graham Center Policy Studies in Family Medicine & Primary Care, Washington, DC, USA.
BMJ Glob Health. 2019 Aug 16;4(Suppl 8):e001483. doi: 10.1136/bmjgh-2019-001483. eCollection 2019.
Financing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC.
Three-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance.
A diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions.
This novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.
初级卫生保健（PHC）的筹资是提供公平的全民医疗服务的关键。我们旨在确定并优先考虑初级卫生保健从业者和研究人员对低收入和中等收入国家（LMIC）初级卫生保健筹资新研究的感知需求。
通过对从全球网络中抽取的低收入和中等收入国家初级卫生保健从业者、学者和政策制定者进行基于网络的调查，开展三轮专家小组咨询。同时并行进行迭代文献综述。第一轮（预德尔菲调查）引出可能解决筹资知识差距的研究问题。对回答进行独立编码、归纳并综合为两份问题清单。第二轮（德尔菲第一轮）邀请小组成员对每个问题的重要性进行评分。在第三轮（德尔菲第二轮）中，小组成员按重要性顺序对问题进行排序。
来自所有全球区域的低收入和中等收入国家的各类初级卫生保健从业者、学者和政策制定者确定了479个知识差距，这些差距对改善初级卫生保健筹资可能至关重要。第二轮提供了31个关于筹资的综合问题以供评分。在第三轮中对前16个问题进行排序，得出四个优先研究问题。
这项新颖的活动创建了一份关于初级卫生保健筹资研究问题中关键知识差距的广泛且优先排序的清单。这为初级保健评估和实施的全球支持者提供了有价值的指导，包括研究资助者和寻求研究重点的学者。这项研究的来源和背景特异性，在全球和地方层面上由低收入和中等收入国家的从业者和学者提供信息，应会增加研究结果与当地相关性以及最终成功实施的可能性。
