Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians.
Determinants of access to chronic illness care: a mixed-methods evaluation of a national multifaceted chronic disease package for Indigenous Australians.
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DOI：
10.1136/bmjopen-2015-008103
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发表时间：
2015-11-27
期刊：
影响因子：
2.9
通讯作者：
Bailie R
中科院分区：
文献类型：
--
作者：
Bailie J;Schierhout G;Laycock A;Kelaher M;Percival N;O'Donoghue L;McNeair T;Bailie R
澳大利亚土著居民的慢性病负担不成比例地高，获得医疗保健的机会相对较少。本文探讨了一个旨在改善澳大利亚土著人民慢性病预防和管理的国家多组分方案如何解决获得的各个方面。根据一个界定获得服务的供应和需求方面的框架，分析了基于地点的混合方法形成性评价的数据。该评估包括24个地理上有界的“哨点”，其中包括一系列初级保健服务组织。它利用了2010年至2013年期间关于服务利用率的行政数据、关于社区成员和服务提供者对慢性病护理的看法的焦点小组和访谈数据。澳大利亚土著人口相对较多的城市、地区和偏远地区。670名社区成员参加了焦点小组; 374名从业人员和区域初级保健支持组织的代表参加了深入访谈。该方案主要处理供应方面的获取问题，对需求方面的关注或影响较少。利用框架的应用突出了利用各方面之间复杂的相互关系。目前面临的主要挑战是通过国家方案实现人口覆盖率，帮助高需求群体，并确保提供持续护理。改善这一人群获得慢性病护理的战略需要适合当地情况，并解决供需双方获得服务的各个方面。这些调查结果突出表明，国家方案指导方针必须具有灵活性，以支持地方确定的战略。
Indigenous Australians have a disproportionately high burden of chronic illness, and relatively poor access to healthcare. This paper examines how a national multicomponent programme aimed at improving prevention and management of chronic disease among Australian Indigenous people addressed various dimensions of access. Data from a place-based, mixed-methods formative evaluation were analysed against a framework that defines supply and demand-side dimensions to access. The evaluation included 24 geographically bounded ‘sentinel sites’ that included a range of primary care service organisations. It drew on administrative data on service utilisation, focus group and interview data on community members’ and service providers’ perceptions of chronic illness care between 2010 and 2013. Urban, regional and remote areas of Australia that have relatively large Indigenous populations. 670 community members participated in focus groups; 374 practitioners and representatives of regional primary care support organisations participated in in-depth interviews. The programme largely addressed supply-side dimensions of access with less focus or impact on demand-side dimensions. Application of the access framework highlighted the complex inter-relationships between dimensions of access. Key ongoing challenges are achieving population coverage through a national programme, reaching high-need groups and ensuring provision of ongoing care. Strategies to improve access to chronic illness care for this population need to be tailored to local circumstances and address the range of dimensions of access on both the demand and supply sides. These findings highlight the importance of flexibility in national programme guidelines to support locally determined strategies.