Health Social Science and Development Research Institute, Kathmandu, Nepal.
School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.
Biomed Res Int. 2023 Oct 20;2023:6648138. doi: 10.1155/2023/6648138. eCollection 2023.
Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia.
We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level).
A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations).
Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
澳大利亚在实现普及初级卫生保健（PHC）服务方面取得了重大进展。然而，在利用卫生服务和健康状况方面仍存在差异，这是实现全民健康覆盖（UHC）全球目标的挑战。本范围综述旨在综合澳大利亚实现 UHC 的 PHC 服务驱动因素。
我们对 2010 年 1 月 1 日至 2021 年 7 月 30 日在三个数据库中发表的文献进行了范围综述：PubMed、Scopus 和 Embase。搜索词根据四个主题确定：卫生服务、澳大利亚、UHC 和成功或挑战。使用归纳主题分析方法分析数据。通过采用包括近端水平（在用户和提供者层面）、中间水平（组织和社区层面）和远端水平（宏观系统或远端/结构层面）的多层次框架，解释了 PHC 服务的驱动因素（促进因素和障碍）。
综述共纳入 114 项研究。澳大利亚在增加 PHC 服务的利用率方面取得了多项成功，总体上改善了健康状况。然而，在弱势/优先人群（例如移民和土著群体）、患有慢性疾病（多种慢性疾病）以及居住在农村和偏远地区的人群中，仍然存在服务获取和未满足需求方面的挑战。在多水平卫生系统中，有几个驱动因素促进了卫生服务的获取和利用（尤其是在优先人群中），例如近端水平驱动因素（健康素养、用户语言、卫生设施的可及性、提供者的行为、卫生劳动力的数量和能力、以及卫生设施的服务提供）、中间水平驱动因素（社区参与、卫生规划、监测和资金）和远端（结构）驱动因素（社会经济差距和歧视）。
澳大利亚在实现 UHC 方面取得了多项成功。然而，特定优先人群和农村居民在获得卫生服务方面仍面临重大挑战。为了实现卫生服务的普遍性和平等性，需要在多水平卫生系统中实施卫生系统努力（供应和需求方面的政策、规划和服务干预措施）。需要实施有针对性的卫生政策和方案方法，提供全面的 PHC 服务，并解决结构性差距的影响。
