Ariadne Labs, Boston, MA, USA.
Boston University School of Public Health, Boston, MA, USA.
J Prim Care Community Health. 2022 Jan-Dec;13:21501319221102041. doi: 10.1177/21501319221102041.
Both rural residents and state government leaders describe a need to redesign rural health care systems. Community members should be at the center of this effort.
We conducted 46 in-depth interviews of direct service providers between September and November 2020 in Washington County, Maine. Data were analyzed using a thematic analysis approach.
Existing strengths included collaboration between government and health systems, and community-based services. Gaps included insufficient workforce, restricted scope of licensing and poor reimbursement, lack of coordination between health systems, and limited paramedicine capacity. Strategies for health system redesign included addressing maldistribution of services and resource optimization, changing federal and state legislation around insurance and scope of practice, and moving toward value-based purchasing models.
Participants provided pragmatic recommendations based on their deep understanding of the community context. Lessons learned are likely to be salient in areas with similar profiles regarding rurality and poverty.
农村居民和州政府领导人均表示需要重新设计农村医疗保健系统。社区成员应该成为这一努力的核心。
我们于 2020 年 9 月至 11 月在缅因州华盛顿县对 46 名直接服务提供者进行了深入访谈。使用主题分析方法对数据进行了分析。
现有优势包括政府与卫生系统之间的协作以及基于社区的服务。差距包括劳动力不足、许可证范围受限且报酬低、卫生系统之间缺乏协调以及辅助医疗能力有限。卫生系统重新设计的策略包括解决服务和资源配置不均的问题、调整联邦和州的保险和执业范围立法，以及转向基于价值的购买模式。
参与者根据对社区背景的深入了解提供了务实的建议。从农村和贫困地区的相似情况来看，这些经验教训可能具有重要意义。
