What primary health care services should residents of rural and remote Australia be able to access? A systematic review of "core" primary health care services

Background: There are significant health statusinequalities in Australia between those people living in rural and remotelocations and people living in metropolitan centres. Since almost ninetypercent of the population use some form of primary health care serviceannually, a logical initial step in reducing the disparity in health status isto improve access to health care by specifying those primary health careservices that should be considered as “core” and therefore readily available toall Australians regardless of where they live. A systematic review wasundertaken to define these “core” services.

Using the question “Whatprimary health care services should residents of rural and remote Australia beable to access?”, the objective of this paper is to delineate those primaryhealth care core services that should be readily available to all regardless ofgeography.

Method: A systematic review of peer-reviewed literature from establisheddatabases was undertaken. Relevant websites were also searched for greyliterature. Key informants were accessed to identify other relevant referencematerial. All papers were assessed by at least two assessors according toagreed inclusion criteria.

Results: Data were extracted from 19 papers (7 papers from the peer-revieweddatabase search and 12 from other grey sources) which met the inclusioncriteria. The 19 papers demonstrated substantial variability in both the numberand nature of core services. Given this variation, the specification orsynthesis of a universal set of core services proved to be a complex andarguably contentious task. Nonetheless, the different primary health caredimensions that should be met through the provision of core services weredeveloped. In addition, the process of identifying core services providedimportant insights about the need to deliver these services in ways that are“fit-for–purpose” in widely differing geographic contexts.

Conclusions: Defining a suite of core primary health careservices is a difficult process. Such a suite should be fit-for-purpose,relevant to the context, and its development should be methodologically clear,appropriate, and evidence-based. The value of identifying core PHC services toboth consumers and providers for service planning and monitoring and consequenthealth outcomes is paramount.