NDLI: Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Gruen, R. L. Weeramanthri, T. S. Bailie, R. S.
Spatial Coverage	Northern Territory
Description	Country affiliation: Australia Author Affiliation: Gruen RL ( Flinders University Northern Territory Clinical School and Menzies School of Health Research, Darwin, Northern Territory, Australia. russg@menzies.edu.au)
Abstract	STUDY OBJECTIVE: To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability. DESIGN: A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients. SETTING: The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care. PARTICIPANTS: Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities. MAIN RESULTS: The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation. CONCLUSIONS: In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.
File Format	HTM / HTML
ISSN	0143005X
e-ISSN	14702738
Journal	Journal of Epidemiology & Community Health
Issue Number	7
Volume Number	56
Language	English
Publisher	BMJ Group
Publisher Date	2002-07-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Health__semicolon__epidemiology Health Services Accessibility Organization & Administration Health Services, Indigenous Medically Underserved Area Primary Health Care Community-institutional Relations Health Care Costs Supply & Distribution Utilization Northern Territory Oceanic Ancestry Group Outcome And Process Assessment (health Care) Patient Acceptance Of Health Care Ethnology Program Evaluation Referral And Consultation Statistics & Numerical Data Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health Epidemiology

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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