Abstract
BackgroundAustralians living in rural and remote areas experience poorer access to primary health care (PHC) and poorer health outcomes compared to metropolitan populations. Current health reform in Australia aims to ensure all Australians, regardless of where they live, have access to essential PHC services. However, at a national level policy makers and health planners lack an evidence-based set of core PHC services to assist in implementing this goal.MethodsA Delphi method was used to reach consensus on an evidence-based list of core PHC services to which all Australians should have access and their necessary support functions. Experts in rural and remote and/or Indigenous PHC, including policy-makers, academics, clinicians and consumers, were invited to consider a list of core services derived from the literature.ResultsThirty nine experts agreed to participate. After three survey rounds there was a strong consensus (≥80% agreement) on core PHC services namely; ‘care of the sick and injured’, ‘mental health’, ‘maternal/child health’, ‘allied health’, ‘sexual/reproductive health’, ‘rehabilitation’, ‘oral/dental health’ and ‘public health/illness prevention’; and on the PHC support functions of; ‘management/governance/leadership’, ‘coordination’, ‘health infrastructure’, ‘quality systems’, ‘data systems’, ‘professional development’ and ‘community participation’. Themes emerging from qualitative data included challenges in providing equitable PHC in rural and remote areas, the importance of service coordination and diverse strategies to overcome access barriers.ConclusionThis study identifies a basket of PHC services that consumers in rural and remote communities can expect to access. It provides rigorously derived evidence that will contribute to a more systematic approach to PHC service planning and availability and will assist policy makers in the allocation of scarce resources necessary to improve the health outcomes of residents of rural and remote areas.
Highlights
Australians living in rural and remote areas experience poorer access to primary health care (PHC) and poorer health outcomes compared to metropolitan populations
People living in rural and remote areas in Australia experience poorer access to health care services, exhibit a higher prevalence of health risk factors and greater rates of illness, hospitalisation and death compared to metropolitan populations
Primary health care (PHC) is an effective and efficient model for providing a range of basic health services and access to essential PHC services is a factor in improving health outcomes [4,5,6,7]
Summary
Australians living in rural and remote areas experience poorer access to primary health care (PHC) and poorer health outcomes compared to metropolitan populations. People living in rural and remote areas in Australia experience poorer access to health care services, exhibit a higher prevalence of health risk factors and greater rates of illness, hospitalisation and death compared to metropolitan populations. These health outcomes generally worsen with distance from capital cities [1]. Australia recently released its first national PHC strategy (Building a 21st Century Primary Health Care System; Australia’s First National Primary Health Care Strategy, 2010) It aims to ensure PHC services are better able to respond to local needs, and to provide a coordinated, comprehensive service that functions to promote health, prevent illness and reduce the current over-reliance on hospital services [11]. How best to provide equitable access to PHC services in rural and remote areas of Australia is a central policy issue
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