Innovations in health service organization and delivery in northern rural and remote regions: a review of the literature.
OBJECTIVE
To identify and review innovations relevant to improving access, quality, efficiency and/or effectiveness in the organization and delivery of health care services in rural and remote areas.


METHODS
Literature review.


METHODS
Key bibliographic databases that index health research were searched: MEDLINE, EMBASE and CINAHL. Other databases relevant to Arctic health were also accessed. Abstracts were assessed for relevancy and full articles were reviewed and categorized according to emergent themes.


RESULTS
Many innovations in delivering services to rural and remote areas were identified, particularly in the public health realm. These innovations were grouped into 4 key themes: organizational structure of health services; utilization of telehealth and ehealth; medical transportation; and public health challenges.


CONCLUSIONS
Despite the challenges facing rural and remote regions, there is a distinctly positive message from this broad literature review. Evidence-based initiatives exist across a range of areas - which include operational efficiency and integration, access to care, organizational structure, public health, continuing education and workforce composition - that have the potential to positively impact health care quality and health-related outcomes.
School of Population and Public Health, University of British Columbia, Vancouver, Canada. craig.mitton@ubc.ca
Craig
C
Mitton
Francois
F
Dionne
Lisa
L
Masucci
Sabrina
S
Wong
Susan
S
Law
D000553:Ambulatory Care / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008507:Medically Underserved Area; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*; D012426:Russia / Q000453:epidemiology