Primary health care delivery models in rural and remote Australia – a systematic review

Abstract

Background: One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993Strategy ( -2006. The study aimed to describe what health service models were reported to work, where they worked and why.

Does Australia have the appropriate health reform agenda to close the gap in Indigenous health?

“…13,14 To date however, comprehensive PHC has not been practised in any extensive way in Australia, with some elements only evident in the Aboriginal Community Controlled Health Services (ACCHS) -the Indigenous-specific health sector (discussed later). 13,15 International studies reveal that just as primary healthcare has improved health of populations in general, better access to primary healthcare has also improved outcomes for Indigenous populations. 7,16 In the case of Australia, there is now recognition that the poor performance in alleviating Indigenous health inequality is, in part, the result of inadequate investment in primary healthcare given the very high burden of morbidity and mortality experienced by Indigenous Australians.…”

“…18,21 Despite attempts over the past decade to improve PHC in Australia there is general acknowledgement that a limit has been reached regarding what can be achieved through a piecemeal approach and that more fundamental structural reforms is required. 15,[22][23][24] In particular, it is widely recognised that the fragmented funding arrangements and differing jurisdictional responsibilities between state and Commonwealth governments have contributed to poor collaboration between GP and allied and community services and has represented a considerable barrier to the delivery of coordinated multidisciplinary care. 25,26 Researchers have argued that key structural reforms to PHC in Australia are required that centre on unifying the funding arrangements of PHC as a necessary prerequisite, combined with the devolution of fund-holding and purchasing responsibilities to regionally based primary care organisations.…”

Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study

“…on the ground to engage with local staff, 19 work in a culturally sensitive way, use local referral networks, provide high-quality team-based handovers to conclude each visit 20 and allow for local staff to contact them between visits. 2 Given that 20% of Australia's rural population resides in 1500 communities of fewer than 5000 people, 8 deciding about where to provide FIFO services also needs to be sensitive to sustainability, efficiency and equity principles. The large number of DIDO services provided by metropolitan specialists is likely to be related to delivering services to larger regional centres near major cities.…”

“…Several outreach models have been loosely described, including huband-spoke, fly-in, fly-out (FIFO) and drive-in, drive-out (DI-DO), 8,9 but they remain to be defined and quantified, including whether their prevalence varies by location. Conceptually, they relate to different structural configurations of services delivered within or beyond regional boundaries, via different modes of transport.…”

Qualitative Evaluation of a Complex Intervention to Improve Rheumatic Heart Disease Secondary Prophylaxis

“…Quotations from the client and healthcare provider interviews related earlier provide clear examples of failures in implementation of genuine self‐management support. Major revisions in models of care are needed in the Australian NT context to better meet the needs of Aboriginal people 20, 21. Healthcare providers operating in this culturally and linguistically unique environment require far more training about how to engage effectively with their clients.…”