title: Making sense of health care delivery Where does the close to community health care worker fit in? - The case for congestive heart failure.
abstract: Close to community health care workers (CTC-HCW) is an increasingly used term to describe the emergence of a new partner in health services delivery. In strengthening arguments for this part of the health workforce the authorities, health staffers, supporters, sceptics and perhaps clients will look to the academicians and the evidence base to determine the fate of this group. There is no doubt, CTC-HCW are a vital resource, whose importance is tied to socio-demo-geographic variables. Regardless of what the common perceptions of its importance are, the evolving evidence base could suggest either way. In this short commentary we would like to highlight the importance of a balanced and common sense approach in these arguments. An important example is heart failure where the majority have an associated comorbidity and one in four would also suffer with cognitive or mood disturbances. It is unclear how the CTC-HCW would fare for this devastating syndrome. In moving forward it is important we understand there are: strengths and limitations in the evidence gathering processes; indecision as to the questions; uncertainty of the starting points to gather evidence; and sociodemogeographic biases, which have to be factored before determining the fate of this much needed health care resource.
authors.affiliation: Consultant Cardiologist, Research Fellow & Senior Lecturer Flinders University, NT Medical School, Darwin, Australia. Electronic address: balaniyngkaran@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Iyngkaran
authors.affiliation: A/Prof eHealth Research, Medical School Flinders University, Australia; Manager, Mental Health Observatory Research Unit, Country Health SALHN Margaret Tobin Centre, GPO Box 2100, Adelaide 5001, South Australia, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Biddargardi
authors.affiliation: Clinical Director, Southern Adelaide Mental Health Services, Australia; Associate Professor, Mental Health Flinders University, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Bastiampillai
authors.affiliation: Chief Medical Officer, Commonwealth of the Bahamas, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Beneby
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D012423:Rural Health
keywords: Community health care worker; Congestive heart failure; Health system; Human resources; Remote and rural health