title: Features of effective primary health care models in rural and remote Australia: a case-study analysis.
abstract: 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.
authors.affiliation: Centre for Remote Health, Flinders University, Alice Springs, NT, Australia. john.wakerman@flinders.edu.au
authors.forename: John
authors.initials: J
authors.lastname: Wakerman
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
authors.forename: Robert
authors.initials: R
authors.lastname: Wells
authors.forename: Pim
authors.initials: P
authors.lastname: Kuipers
authors.forename: Judith A
authors.initials: JA
authors.lastname: Jones
authors.forename: Philip
authors.initials: P
authors.lastname: Entwistle
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
mesh_terms: D001315:Australia; D007407:Interviews as Topic; D008962:Models, Theoretical; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*