Table 3

Essential service requirements and environmental enablers for PHC models in rural and remote communities

CONTEXT Rural-Remote continuum

SERVICE OPTIONS

Environmental enablers

Essential service requirements


Supportive policy

Common-wealth State relations

Community readiness

Work-force organis-ation

Work-force supply

Funding

Governance, management & leadership

Linkages

Infra-structure


RURAL

(Characterised by larger, more closely settled communities)

Discrete

eg: 'Easy Entry-Gracious Exit' model

The option for discrete primary health care services exists because community population catchments are sufficiently large to support them. The role of environmental enablers (while important) is less influential than in remote communities, and essential service requirements are more easily met even though supports are needed to address some aspects of services (such as workforce recruitment and retention).

Integrated

eg: Multi-Purpose Services, Shared Care, Coordinated Care models

The need for service integration increases in order to maximise economies of scale and efficiencies in communities where individual services or competing services are not sustainable; single point of entry to the health system through locally available access pathways is important to co-ordinate patient care and reduce the need for patients to travel extensive distances; and maximise the range of locally available services.

Comprehens-ive PHC

eg: Aboriginal Community Controlled Health Service model

This option ensures a comprehensive primary health care service is available in small, isolated, high-need communities where there are few, if any, alternative ways for delivering appropriate health care. The need to ensure that environmental enablers facilitate the delivery of appropriate care, minimise cost-shifting and duplication of activity and reporting, and maximise community participation in the service development are paramount. Flexibility in meeting essential service requirements is essential to take account of local needs and circumstances.

REMOTE

(Characterised by small populations dispersed over vast areas)

Outreach/Virtual Outreach

eg: Hub and spoke; Fly-in, fly-out; Virtual clinics; Telehealth models

This option addresses the health needs of communities with populations too small to support permanent local services by providing access through virtual or periodic visiting services. Opportunities for community involvement and management will be more limited than with locally-based services, while co-ordination with any existing services is critical. Outreach models often co-exist with other model types- discrete, integrated and comprehensive PHC services.


Wakerman et al. BMC Health Services Research 2008 8:276   doi:10.1186/1472-6963-8-276

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