想象一下,如果我们有实际的服务......":对澳大利亚农村初级保健中人工流产获取挑战的定性探索。

IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Rural and remote health Pub Date : 2024-11-01 Epub Date: 2024-11-05 DOI:10.22605/RRH9229
Anna Noonan, Erica Millar, Jane Elizabeth Tomnay, Georgina M Luscombe, Kirsten I Black
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引用次数: 0

摘要

导言:澳大利亚的农村人口依赖当地初级医疗保健机构提供药物流产服务。然而,人们对基层医疗服务提供者自身如何应对农村医疗系统的独特复杂性以提供本地人工流产服务却知之甚少:为了填补这一空白,我们对新南威尔士州(NSW)农村地区的初级医疗保健提供者进行了半结构化定性访谈。招募策略包括向新南威尔士州西部的所有全科医生诊所发出邀请,通过专业网络和社交媒体发布传单,以及滚雪球式招募。采用框架法进行归纳式主题分析:我们采访了 16 名乡村全科医生、护士、助产士和妇女健康诊所的业务人员。确定了四个主题(1)稀缺的人工流产服务过度依赖当地处方医生的可用性和善意;(2)缺乏后备支持、经济激励和培训使提供者望而却步;(3)存在跨专业的污名化、保密和阻碍;以及(4)当地人工流产服务需要通过非正式的农村网络变通。与会者认为,澳大利亚医疗系统中的堕胎特殊性以及农村地区劳动力的长期短缺是当地提供堕胎服务所面临的独特而复杂的挑战。相反,强大的农村社区网络被认为是在系统性障碍内或绕过系统性障碍的非正式堕胎途径的重要促进因素:结论:要改善澳大利亚农村地区的堕胎机会,就必须关注当地初级医疗服务提供者本身在不适应的医疗系统外围提供服务时所面临的众多交叉障碍。
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'Imagine if we had an actual service ...': a qualitative exploration of abortion access challenges in Australian rural primary care.

Introduction: Rural populations in Australia rely upon local primary health care for medication abortion access. Yet little is known about how individual primary healthcare providers themselves negotiate the unique complexities of the rural health system to provide local abortion services.

Methods: To address this gap, we conducted qualitative, semi-structured interviews with primary healthcare providers in rural New South Wales (NSW). Recruitment strategies included sending invitations to all GP clinics in Western NSW, distribution of flyers via professional networks and social media posts as well as snowballing. The Framework Method was used to conduct an inductive thematic analysis.

Results: We interviewed 16 rural GPs, nurses, midwives and women's health clinic operational staff. Four themes were identified: (1) scarce abortion services place overreliance on availability and goodwill of local prescribers; (2) lack of back-up support, financial incentives and training deters providers; (3) there is interprofessional stigma, secrecy and obstruction; and (4) local abortion access requires workarounds through informal rural networks. Participants described abortion exceptionalism within Australia's health system and chronic rural workforce shortages in rural settings as unique and compounding challenges to local provision. Conversely, strong rural community networks were identified as important enablers of informal pathways to abortion within or around systemic barriers.

Conclusion: Improving rural abortion access in Australia requires attention to the numerous intersecting barriers that local primary care providers themselves face when providing services at the periphery of an unaccommodating health system.

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来源期刊
Rural and remote health
Rural and remote health Rural Health-
CiteScore
2.00
自引率
9.50%
发文量
145
审稿时长
8 weeks
期刊介绍: Rural and Remote Health is a not-for-profit, online-only, peer-reviewed academic publication. It aims to further rural and remote health education, research and practice. The primary purpose of the Journal is to publish and so provide an international knowledge-base of peer-reviewed material from rural health practitioners (medical, nursing and allied health professionals and health workers), educators, researchers and policy makers.
期刊最新文献
'Imagine if we had an actual service ...': a qualitative exploration of abortion access challenges in Australian rural primary care. Characteristics and outcomes of patients with cardiac conditions requiring emergency medical retrieval from the Great Barrier Reef, Australia. Transitioning to rural practice together: a rural fellowship model (in 6 Ps). Community paramedicine program and outcomes of referred coronary artery bypass grafting patients. It's more than just a rural GP shortage: challenging a dominant construction of the rural health workforce 'problem'.
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