College of Medicine and Public Health, Southgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia.
Discipline of General Practice, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Health Res Policy Syst. 2021 Feb 18;19(1):25. doi: 10.1186/s12961-021-00682-5.
Many nations have established primary health care (PHC) organizations that conduct PHC planning for defined geographical areas. The Australian Government established Primary Health Networks (PHNs) in 2015 to develop and commission PHC strategies to address local needs. There has been little written about the capacity of such organizations for evidence-informed planning, and no tools have been developed to assess this capacity, despite their potential to contribute to a comprehensive effective and efficient PHC sector.
We adapted the ORACLe tool, originally designed to examine evidence-informed policy-making capacity, to examine organizational capacity for evidence-informed planning in meso-level PHC organizations, using PHNs as an example. Semi-structured interviews were conducted with 14 participants from five PHNs, using the ORACLe tool, and scores assigned to responses, in seven domains of capacity.
There was considerable variation between PHNs and capacity domains. Generally, higher capacity was demonstrated in regard to mechanisms which could inform planning through research, and support relationships with researchers. PHNs showed lower capacity for evaluating initiatives, tools and support for staff, and staff training.
We critique the importance of weightings and scope of some capacity domains in the ORACLe tool. Despite this, with some minor modifications, we conclude the ORACLe tool can identify capacity strengths and limitations in meso-level PHC organizations. Well-targeted capacity development enables PHC organizations' strategies to be better informed by evidence, for optimal impact on PHC and population health outcomes.
许多国家都建立了基层医疗保健(PHC)组织,负责为特定地理区域进行 PHC 规划。澳大利亚政府于 2015 年成立了初级保健网络(PHN),以制定和委托满足当地需求的 PHC 战略。尽管这些组织有可能为全面、有效和高效的 PHC 部门做出贡献,但对于此类组织进行循证规划的能力,几乎没有任何相关文献,也没有开发任何工具来评估这种能力。
我们改编了最初用于检验循证决策能力的 ORACLe 工具,以检验中观层面的 PHC 组织在循证规划方面的组织能力,以 PHN 为例。我们使用 ORACLe 工具对来自五个 PHN 的 14 名参与者进行了半结构化访谈,并对七个能力领域的回答进行了评分。
PHN 之间以及能力领域之间存在相当大的差异。一般来说,通过研究为规划提供信息的机制以及支持与研究人员的关系方面,能力较高。PHN 在评估举措、工具以及为员工提供的支持和员工培训方面的能力较低。
我们对 ORACLe 工具中某些能力领域的权重和范围提出了批评。尽管如此,我们还是得出结论,ORACLe 工具可以识别中观层面 PHC 组织的能力优势和局限性。有针对性的能力发展使 PHC 组织的战略能够更好地获得循证支持,从而对 PHC 和人口健康结果产生最佳影响。