Features of effective primary health care models in rural and remote Australia: a case-study analysis.
OBJECTIVE
To describe the factors and processes that facilitate or inhibit implementation, sustainability and generalisation of effective models of primary health care (PHC) service delivery in rural and remote Australia.


METHODS
Case-study approach, including review of relevant literature, interviews with key informants, site visits and direct observation. Thematic analysis and template analysis were used with interview transcripts. An expert reference group provided feedback and advice on policy relevance.


METHODS
Six PHC services in small communities across rural and remote Australia were selected based on results of a previous systematic review; they reflected diverse rural and remote settings and PHC models, and the multidisciplinary nature of PHC. Sites were visited, and 55 individuals associated with the establishment and operation of these services were interviewed between July 2006 and December 2007.


RESULTS
Independent and template analysis confirmed the usefulness of a conceptual framework, which identified three key "environmental enablers" - supportive policy; federal and state/territory relations; and community readiness - and five essential service requirements - governance, management and leadership; funding; linkages; infrastructure; and workforce supply. Systematically addressing each of these factors improves effectiveness and lessens the threat to service sustainability.


CONCLUSIONS
Evidence from existing effective rural and remote PHC services can inform the health care reform agenda, in Australia and other countries. The evidence highlights the need for improved governance, management and community involvement, as well as strong, visionary political leadership to achieve a more responsive and better coordinated health system which could help eliminate existing health status differentials between cities and rural areas. In Australia, establishment of a single national health system, operationalised at a regional level, would obviate much of the current inefficiency and poor coordination.
Wakerman
John
J
Centre for Remote Health, Flinders University, Alice Springs, NT, Australia. john.wakerman@flinders.edu.au
Humphreys
John S
JS
Wells
Robert
R
Kuipers
Pim
P
Jones
Judith A
JA
Entwistle
Philip
P
Kinsman
Leigh
L
D001315:Australia; D007407:Interviews as Topic; D008962:Models, Theoretical; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*