scholarly journals Rural health care in New Zealand: the case of Coast to Coast Health Centre, Wellsford, an early Integrated Family Health Centre

2015 ◽  
Vol 7 (4) ◽  
pp. 309 ◽  
Author(s):  
Antony Raymont ◽  
Mary-Anne Boyd ◽  
Timothy Malloy ◽  
Nancy Malloy
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Service ◽  
Rural Health ◽  
Service Providers ◽  
Health Centre ◽  
Service Utilisation ◽  
Primary Health ◽  
Wide Range

INTRODUCTION: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. KEYWORDS: Interdisciplinary; New Zealand; primary health care; rural health services

Sustaining Chronic Disease Management in Primary Care: Lessons from a Demonstration Project

2007 ◽  
Vol 13 (2) ◽  
pp. 121 ◽  
Author(s):  
Anna Williams ◽  
Mark Harris ◽  
Kathy Daffurn ◽  
Gawaine Powell Davies ◽  
Shane Pascoe ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Chronic Disease ◽  
Health Service ◽  
Service Providers ◽  
Care Delivery ◽  
Demonstration Project ◽  
Service Utilisation ◽  
Primary Health

Chronic disease self-management (CDSM) programs have been found effective in improving clinical, behavioural, and self-efficacy outcomes associated with a range of chronic illnesses, and evidence suggests that CDSM is effective in reducing health care costs and health service utilisation. As the setting where most chronic disease is managed, primary health care is an ideal setting for supporting CDSM. This study aimed to explore the uptake and sustainability of CDSM within routine activities of primary health care clinicians involved in the implementation of a demonstration project within an Area Health Service in Sydney NSW. Interviews and focus groups were conducted with managers and clinicians involved in the project. Findings included (1) widespread support from participants for CDSM (2) participating clinicians thought that CDSM was valuable to themselves, their clients and the health system (3) the program required clients to be able to speak and understand English and so presented many barriers for implementation in CALD communities, and (4) the program was not effective in engaging some key members of the primary care team; in particular, general practitioners. The study highlights system design issues including communication and continuity of care between service providers, workforce supply and demands of acute care delivery in the community that will need to be addressed for sustainable and effective CDSM to be achieved.

A Round Peg in a Square Hole: Changes in a Rural Health Service

1996 ◽  
Vol 2 (2) ◽  
pp. 63 ◽  
Author(s):  
Debra Smith ◽  
Catherine Wilkin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Service ◽  
Rural Health ◽  
Local Level ◽  
Health Care Service ◽  
Health Staff ◽  
Primary Health ◽  
Rural Health Service ◽  
Service Staff

The cultural partnerships which have been formed as a result of the decision to restructure a rural health service are discussed here. Previously, some aged care services and allied health staff in hospitals were responsible to the medical superintendent, and community health services answered to hospital chief executive officers in each location. The organisational principles, key elements of the structure, and changes in management are analysed using change management and primary care literature. The changes have been implemented within the context of several health cultures, which are often not only different by definition, but are also in direct competition with each other. Twelve months after restructuring the service, staff have responded positively to the changes so that now a partnership exists between management and staff. It is clear, however, that primary socialisation had made it difficult for the system to cope with these changes. Funding of primary health care remains an issue, and although there is an increasing reliance by medical services on the primary health care service system, there has not been a corresponding shift in resources. Changes have been significant at the local level, although much remains to be resolved before the health service becomes a health promoting service rather than a medically dominated sickness service.

scholarly journals Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

2021 ◽  
Author(s):  
◽  
Carolyn Joy Cordery
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Service Providers ◽  
Balance Control ◽  
Primary Health Care System ◽  
Multiple Stakeholders ◽  
Public Funds ◽  
Primary Health ◽  
The Government

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>

1997 Awards for Innovation and Excellence in Primary Health Care Awards - Alliances and Collaboration: Refugee Health Program

1997 ◽  
Vol 3 (3) ◽  
pp. 83
Author(s):  
Jenny Mitchell
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Health Service ◽  
Health Program ◽  
Health Centre ◽  
Western Region ◽  
Primary Health ◽  
Survivors Of Torture ◽  
The Western Region

Brief Description of the Program: This article describes the ways in which three agencies in the Western Region of Melbourne have joined forces to deliver a co-ordinated health service to newly arrived refugees. The three agencies are: ? the Victorian Foundation for Survivors of Torture ? the Western Region Health Centre ? the Western Melbourne Division of General Practice.

scholarly journals Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

2021 ◽  
Author(s):  
◽  
Carolyn Joy Cordery
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Service Providers ◽  
Balance Control ◽  
Primary Health Care System ◽  
Multiple Stakeholders ◽  
Public Funds ◽  
Primary Health ◽  
The Government

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>

Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

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