Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care). In all countries, shortfalls in patient engagement and chronic care management were reported, and at least one in five adults experienced a care coordination problem. Problems were often particularly acute for low-income adults. Overall, the Netherlands performed at the top of the eleven-country range on most measures of access, engagement, and coordination.

In New Survey Of Eleven Countries, US Adults Still Struggle With Access To And Affordability Of Health Care

Purpose: Practice-based research networks (PBRNs) have developed dynamically across the world, paralleling the emergence of the primary care discipline. While this review focuses on the internal environment of PBRNs, the complete framework will be presented incrementally in future publications. Methods: We conducted a scoping review of the published and gray literature. Electronic databases, including MEDLINE (PubMed), OVID, CINAHL (EBSCOhost), Scopus, and SAGE Premier, were searched for publications between January 1, 1965 and December 31, 2020 for English-language articles. Rigorous inclusion/exclusion criteria were implemented to identify relevant publications, and inductive thematic analysis was applied to elucidate key elements, subthemes, and themes. Social network theory was used to synthesize findings. Results: A total of 229 publications described the establishment of 93 PBRNs in 15 countries that met the inclusion criteria. The overall framework yielded 3 main themes, 12 subthemes, and 57 key elements. Key PBRN activities included relationship building between academia and practitioners and development of a learning environment through multidirectional communication. Conclusions: PBRNs across many countries contributed significantly to shaping the landscape of primary health care and became an integral part of it. Many common features within the sphere of PBRNs can be identified that seem to promote their establishment across the world.

A Review of 50-Years of International Literature on the Internal Environment of Building Practice-Based Research Networks (PBRNs)

Background:The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular diseas...

https://journals.sagepub.com/doi/pdf/10.1177/2050312116681224

Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

INTRODUCTION AND AIMS Governments across the globe invest considerable amounts in funding alcohol and other drug (AOD) treatment. Little attention however has been paid to the ways AOD service providers are chosen and how they are paid. This study sought to examine the perceptions of Australian AOD treatment purchasers and providers regarding different purchasing and payment mechanisms. DESIGN AND METHODS Qualitative interviews with AOD treatment providers and purchasers (N = 197) were undertaken across the eight Australian states/territories and the Commonwealth. Data were collated against six main AOD treatment purchasing and payment mechanisms (as identified in the literature), then an inductive, comparative analysis to assign codes was conducted, followed by interpretive analysis to explore emergent themes. RESULTS Five main themes were identified in relation to AOD treatment payment and purchasing mechanisms: (i) applying private sector principles to purchasing; (ii) innovation, sector stability and addressing client needs; (iii) performance monitoring and measuring outcomes; (iv) the threat to designated funding for AOD treatment; and (v) the costs and benefits of having multiple funding sources. DISCUSSION AND CONCLUSIONS In many countries reforms are taking place in the health sector consistent with New Public Management principles. These principles, when applied to AOD treatment, have included introducing competition, output and outcomes-based funding models, standards and accountability. Purchaser and providers identified both strengths and weaknesses and highlighted the overarching concern that implementation of any (mix) of these mechanisms should always be underpinned by a client-centred and not a finance-centred approach.

Perceptions of purchasing and payment mechanisms in alcohol and other drug treatment services in Australia: A qualitative study involving alcohol and other drug service providers and purchasers of treatment.

Background: Australian policies for Aboriginal and Torres Strait Islander well-being outline the importance of local community-based interventions; for adolescents, school-based programs have been identified as beneficial. However, there is a lack of localized data to determine levels of resilience and risk and thus whether programs are effective. This paper describes the challenges and opportunities in collaboratively designing and piloting a localized survey instrument to measure Indigenous students’ resilience and upstream risk factors for self-harm and the resultant instrument.

Methods: A participatory action research approach was used to engage education staff, health-care providers, students, and researchers to design and pilot the survey instrument. A six-phased process facilitated survey development: (1) defining the logic and exploring the evidence; (2) understanding and tailoring for context; (3) testing for feasibility and relevance; (4) testing for appropriateness and comprehension; (5) facilitating survey administration; and (6) refining the instrument. Processes in each phase were recorded and transcribed with thematic analysis used to identify key challenges and opportunities arising during development.

Results: Four key challenges and opportunities were identified: (1) the relevance of international survey instruments for Indigenous Australian students; (2) accounting for distinct environments; (3) the balance between assessing risk and protective factors; and (4) tailoring for literacy levels and school engagement. The final Student Survey instrument comprised 4 demographic and 56 resilience, risk, service use, and satisfaction questions. The T4S will be administered routinely on annual student intake.

Discussion and conclusion: The six-phased participatory processes resulted in a tailored instrument that could identify the critical resilience and upstream risk factors facing a cohort of Indigenous students who attend boarding schools for secondary education. Challenges were resolved collaboratively and the pilot results were directly translated to education practice and its integration with health services. Our results suggest that both the phased process of developing the T4S and the instrument itself can be adapted for other Indigenous adolescent well-being and/or self-harm prevention programs.

/pdf/the-development-of-a-survey-instrument-to-assess-aboriginal-16rtnr34mw.pdf

The Development of a Survey Instrument to Assess Aboriginal and Torres Strait Islander Students’ Resilience and Risk for Self-Harm

On 1 July 2015, the Australian Government established 31 new Primary Health Networks (PHNs), following a review by its former Chief Medical Officer, John Horvath, of 61 Medicare Locals created under the previous Labor administration. The Horvath review recommended, among other things, that new, larger primary health organisations be established to reduce fragmentation of care by integrating and coordinating health services, supporting the role of general practice, and leveraging and administering health program funding. The two main objectives of the new PHNs, as stated on the Department of Health's website, are "increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time". Below are three viewpoints, commissioned for this primary health care themed issue of Public Health Research & Practice, from the Australian Government Department of Health, the Public Health Association of Australia and a Sydney-based PHN. We asked the authors to focus particularly on how the newly established networks might help to integrate public health within the primary health care landscape. Our authors have pointed out the huge overlap between public health and primary care and looked at evidence showing the great benefits for health systems of collaboration between the two. Challenges ahead include a possible government focus on delivery of 'frontline' medical services, which may come at the expense of population health, and the complexity of dealing with all primary health care stakeholders, including health professionals, Local Health Districts, nongovernment organisations, research institutions and local communities.

/pdf/the-new-australian-primary-health-networks-how-will-they-2lucrqcfhs.pdf

The new Australian Primary Health Networks: how will they integrate public health and primary care?

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The new Australian Primary Health Networks: how will they integrate public health and primary care?