What do evaluations tell us about implementing new models in rural and remote primary health care? Findings from a narrative analysis of seven service evaluations conducted by an Australian Centre of Research Excellence

David Lyle,Sue Kirby,Emily Saurman,John Wakerman,Debra Jones,John Humphreys

doi:10.22605/rrh3926

Abstract

A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia. This article reports on the key findings from seven CRE service evaluations to better understand what made these primary health care (PHC) models work where they worked, and why.We conducted a narrative synthesis of 15 articles reporting on seven CRE service evaluations of different PHC models published between 2012 and 2015.Three different contexts for PHC reform were evaluated: community, regional and clinic based. Themes identified were factors that enabled changes to PHC delivery, processes that supported services to improve access to PHC and requirements for service adaptation to promote sustainability. In both Indigenous and mainstream community settings, the active engagement with local communities, and their participation in, or leadership of, shared decision-making was reported across the three themes. In addition, local governance processes, informed by service activity and impact data, enabled these service changes to be sustained over time. The considerations were different for the outreach, regional and clinic services that relied on internal processes to drive change because they did not require the cooperation of multiple organisations to succeed.The review highlighted that shared decision-making, negotiation and consultation with communities is important and should be used to promote feasible strategies that improve access to community-based PHC services. There is a growing need for service evaluations to report on the feasibility, acceptability and fit of successful service models within context, in addition to reach and effectiveness in order to provide evidence for local dissemination, adaption and implementation strategies.

Highlights

A Centre of Research Excellence (CRE) in Rural and Remote Primary Healthcare was established in 2012 with the goal of providing evidence to inform policy development to increase equity of access to quality health care and the identification of services that should be available to the diverse communities characterising Australia
Three themes were identified from the evaluation reports: enabling changes to primary health care (PHC) delivery that resulted in more appropriate PHC services, processes that support services to improve access to PHC, and requirements for service adaptation to promote sustainability in changing internal and external environments
Community-based reform: Four of the seven evaluations reported on community-based services: two innovative comprehensive PHC services - one in a remote Western Australian Indigenous community[911] and the other in a small rural community in Victoria[7,8], and one aged care service and one social and emotional wellbeing service – in remote Indigenous communities from the Northern Territory and Kimberley region of Western Australia respectively[12,13]