title: What core primary health care services should be available to Australians living in rural and remote communities?
abstract: BACKGROUND
  Australians 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Thirty 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Centre for Remote Health, Flinders University and Charles Darwin University, PO Box 4066, Northern Territory 0871, Alice Springs, Australia. s.thomas@flinders.edu.au.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Thomas
authors.forename: John
authors.initials: J
authors.lastname: Wakerman
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
mesh_terms: D000328:Adult; D001315:Australia; D002648:Child; D002662:Child Health Services / Q000592:standards; D003697:Delphi Technique; D003752:Dental Health Services / Q000592:standards; D018166:Health Care Reform; D006285:Health Planning / Q000592:standards*; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards*; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services / Q000592:standards; D008605:Mental Health Services / Q000592:standards; D011314:Preventive Health Services / Q000592:standards; D011320:Primary Health Care; D034121:Reproductive Health Services / Q000592:standards; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population