Primary health care delivery models in rural and remote Australia – a systematic review

© 2008 Wakerman et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993–2006). The study aimed to describe what health service models were reported to work, where they worked and why. Methods A reference group of experts in rural health assisted in the development and implementation of the study. Peer-reviewed publications were identified from the relevant electronic databases. 'Grey' literature was identified pragmatically from works known to the researchers, reference lists and from relevant websites. Data were extracted and synthesised from papers meeting inclusion criteria. Results A total of 5391 abstracts were reviewed. Data were extracted finally from 76 'rural' and 17 'remote' papers. Synthesis of extracted data resulted in a typology of models with five broad groupings: discrete services, integrated services, comprehensive PHC, outreach models and virtual outreach models. Different model types assume prominence with increasing remoteness and decreasing population density. Whilst different models suit different locations, a number of 'environmental enablers' and 'essential service requirements' are common across all model types. Conclusion Synthesised data suggest that, moving away from Australian coastal population centres, sustainable models are able to address diseconomies of scale which result from large distances and small dispersed populations. Based on the service requirements and enablers derived from analysis of reported successful PHC service models, we have developed a conceptual framework that is particularly useful in underpinning the development of sustainable PHC models in rural and remote communities

The problem of workforce for the social world of Australian rural nurses: a collective action frame analysis

Aim and background: Globally, nursing workforce shortages are a hot topic for discussion among politicians, academics and clinicians. This paper uses collective action framing to analyse the literature about the problem of workforce for Australian rural nurses. Evaluation: As part of a larger constructivist grounded theory study, we utilize collective action framing to bridge social world mapping and the literature. Data sources included journal databases, newspapers, newsletters and websites. We limited the years searched from 2000 to 2005. This analytical heuristic categorizes text into three main categories: diagnoses of a problem, postulations of solutions and actions to motivate change. Key issues: Having mapped the social world of Australian rural nurses as comprising four groups of collective actors – community, advocates, academics and government – we trace the texts that they have produced with a focus on mentoring as a potential solution to the problem of workforce. Conclusions: Mentoring entered the literature about the problem of workforce for Australian rural nurses because of a combination of political and academic will. These collective groups are now changing how they are framing the problem of workforce to focus instead on the globalization of nursing workforce shortages, which is resulting in diminished support for mentoring activities in clinical practice