Study protocol: Evaluating the impact of a rural Australian primary health care service on rural health

Abstract

BackgroundRural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements.Methods/DesignThe evaluation framework aims to examine the health service over a six-year period in terms of: (a) Structural domains (health service performance; sustainability; and quality of care); (b) Process domains (health service utilisation and satisfaction); and (c) Outcome domains (health behaviours, health outcomes and community viability). Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions.DiscussionThis iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how; what benefits have been realised and for whom; the level of community satisfaction with the service; and the impact of a health service on community viability. While the need to reduce the rural-urban health service disparity in Australia is pressing, the evidence regarding how to move forward is inadequate. This comprehensive evaluation will add significant new knowledge regarding the characteristics associated with a sustainable rural primary health care service.

Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis

“…Criteria of the intervention in the primary and target context Descriptive theme: 2.1 Characteristics of the evidence base for comparison of primary and target context in terms of the following: Criterion: …utility/usefulness of primary evidence particularly with regard to the following: Sub-criteria: • Level of transfer [ 7 , 8 , 16 , 17 , 26 , 38 , 39 , 41 , 45 , 46 , 56 , 64 ] • Clearness and relevance of the research question/problem for decision-making [ 7 , 40 , 73 ] • Detailed description and relevance of the population/sample for decision-making [ 25 , 37 , 45 , 48 , 72 , 73 ] • Relevance of the outcome measurement for the target population and environment [ 7 , 37 , 49 , 73 ] • Up-to-dateness of the intervention and relevance of the results for decision-making [ 7 , 8 , 10 , 17 , 25 , 37 , 39 , 40 , 53 , 64 , 72 , 73 ] • (Anticipated) Applicability of the intervention to the target population/groups and setting [ 7 , 8 , 10 , 37 , 39 , 40 , 74 ] • Sufficient description of environmental conditio...…”

“…Criteria of the environment in the primary and target context Descriptive theme: 3.1 Characteristics of policy and legislation in the primary and target context in terms of the following: Criteria: …national policy and political programs [ 7 , 8 , 18 , 38 , 50 , 56 , 71 ] …political climate and will [ 7 , 10 , 37 , 38 , 60 , 64 , 69 ] …local policy [ 7 , 8 , 18 , 37 , 39 , 56 ] …legislation relevant to transferability of the intervention [ 18 , 75 ] Descriptive theme: 3.2 Characteristics of coordination players in the primary and target context in terms of the following: Criteria: …types of partners, networks, and their (formal or informal) involvement [ 9 , 16 , 18 , 37 , 38 , 40 , 45 – 47 , 49 , 50 , 52 , 56 ] …different personal and professional interests of stakeholders [ 8 , 16 , 18 , 25 , 37 , 40 , 56 , 60 ] Descriptive theme: 3.3 Characteristics of the health care system and service provision in the primary and target context in terms of the following: Criterion: ...…”

Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury

“…Geographical isolation, the distance from both health care and support networks, as well as long distance travel, have a physical and a psychological impact on people living in rural and remote locations. 9,17,18 Complex hand injuries in Australia are treated in metropolitan and larger regional facilities, and people from rural and remote areas are generally referred back to their local community to be treated by local occupational therapists or physiotherapists (therapists) following the acute surgical phase. The large caseloads managed by rural therapists and lack of resources to provide a hand therapy service often means that patients have to travel back to the metropolitan or regional facility for therapy and surgical reviews.…”

The Informal Caregiver: A Qualitative Assessment of Needs and Requirements

“…The government is charged with the task to ensure operational efficiency and cost-minimisation, whilst maintaining equitable access and quality of health services. Nevertheless, as a consequence, rural communities are struggling to maintain viable health care services and face significant disadvantages compared with urban regions [8]. While…”