Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability
Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability
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DOI：
10.1136/jech.56.7.517
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发表时间：
2002-07-01
影响因子：
6.3
通讯作者：
Bailie, RS
中科院分区：
文献类型：
--
作者：
Gruen, RL;Weeramanthri, TS;Bailie, RS
研究目标：研究专科外展服务在支持初级卫生保健和克服澳大利亚偏远地区土著人口面临的卫生保健障碍方面的作用，并检查影响其可持续性的问题。设计：使用卫生服务利用率数据和对卫生专业人员和患者的采访，对专科外展服务进行过程评估。背景：澳大利亚北领地的高端，达尔文是该地的首府和医院和专科服务的主要基地。在达尔文以外的农村和偏远地区，有许多以土著为主的小社区，由于严重的疾病负担和获得医疗保健的机会有限，这些社区处于极大的不利地位。参与者：17名远程医疗从业者、5名从事外展工作的专家、5名地区卫生行政人员和3名来自偏远社区的患者。主要结果：许多偏远的土著人民在获得专家和医院护理方面面临着巨大的障碍。通过外展提供专家服务，克服了与距离、沟通和服务的文化不相称有关的一些障碍，并使来自偏远社区的咨询人数增加了四倍以上。影响可持续性的关键问题包括：充足的专科基础；初级保健未得到满足的需求；与以初级保健为中心的多学科框架的整合、问责和能力建设；良好的沟通；定期和可预测的访问；资金和协调，承认对医院和初级保健部门的责任；以及定期评估。结论：在一个弱势群体没有足够的机会获得医疗保健的情况下，区域中心的专科外展可以提供比单独以医院为基础的服务更公平的服务提供方式。组织得当、对当地社区需求作出反应并拥有足够的区域专家基础的可持续的外展服务可以有效地与初级卫生保健进程相结合并为其提供支持。然而，计划和实施不当的外展活动可能会占用资源，并影响初级卫生保健。
Study objective: To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability.Design: A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients.Setting: The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care.Participants: Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities.Main results: The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination, that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation.Conclusions: In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.