A comprehensive search strategy was developed to find relevant articles from medical literature databases using MeSH Headings and key words. Grey literature was searched at target websites including government agencies, research centres, Indigenous health portals, and non-government health-related or Indigenous advocacy organisations.
All literature (1990-2013) describing existing rural and remote health services, health service use or needs in relation to Indigenous children (0-18 years) was included. Papers were excluded if they focused on: health services in foreign countries or large metropolitan areas; adult, dental and oral, or sexual health; education of children or health professionals; social or cultural issues; attraction and retention of health professionals; substance abuse and misuse; child care centres; the judicial system; health policy; or papers not written in English (Figure 1).
Abstracts or summaries were reviewed to determine relevance and suitability for inclusion. Data from all relevant papers were extracted and summarised by two authors (Appendix includes further details).
Databases searched
Electronic databases of medical literature (Medline, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Psychological Information Abstracts Services (PsycINFO), Web of Knowledge, Excerpta Medica Database (EMBASE), Educational Resources Information Centre (ERIC), and Scopus) were searched for relevant publications. Health department and other relevant websites were also searched (Figure 1).
Literature Search
A search strategy was developed with a medical librarian. MeSH headings were identified, and key words were formatted to ensure derivatives of words were not excluded (e.g. a*). The use of “AND” or “OR” strengthened the sensitivity and specificity of the search. If this search strategy was not possible due to the capacity of particular search engines, then the best possible combinations of words were selected relevant to different subjects.
MeSH Headings
The MeSH Headings used in this search included Health Services; Community Health Services; Primary Health Care; Family Practice; Child Health Services; Adolescent Medicine; Health Services, Indigenous; Rural Health; Rural Health Services; Rural Population; Rural; Child; Pediatrics; Oceanic Ancestry Group; and Australia were used in the search.
Key Words
The key words searched were: Health services; community health services; primary health care; family practice; adolescent medicine; Indigenous health; Indigenous health services; rural; remote; rural health services; child; infant; paediatrics; paediatrics; Indigen*; Aborigin*; Oceanic Ancestry group; allied health; Australia.
Searching the Grey Literature
A list of target websites was devised, including those of government agencies, research centres, Indigenous health portals, and non-government health-related or Indigenous advocacy organisations. Commonwealth and State/Territory websites were also searched, as were relevant university-based research centres, private research agencies, NGOs and international bodies. National databases focusing specifically on health or Indigenous people were also searched. Online searches were conducted using key words and terms similar to those used to search the academic literature.
The following websites and databases were searched: Informit Indigenous Collection (IIC); Lowitja Institute, Australian Institute of Aboriginal and Torres Strait Islander Studies (AIATSIS) and Australian Aboriginal Health Info-net. Websites of the Federal and State Governments Health departments and associated agencies; Parliamentary Hearings and Senate committees, Commonwealth and State; Aboriginal medical services; regional health services; Australian Human Rights Commission; National Health and Medical Research Council (NHMRC) of Australia; Royal Australasian College of Physicians; Royal College of Paediatrics and Child Health (UK); Australian Bureau of Statistics, Australian Institute of Health and Welfare (AIHW), Research Institutes focussing in Indigenous health e.g. Menzies, Centre for Aboriginal Economic Policy Research at Australian National University, Telethon Institute for Child Health Research (Western Australia), Centre for Remote Health, and Australian Primary health care research institute (APHCRI).
Many grey literature documents published by government agencies, including policy or strategy documents, draw on peer-reviewed literature. Online documents, which were not simply summaries of the issues, but provided original insights or evidence regarding the best approach for delivering health services to Indigenous people living in remote areas, were included in the review (Table 2).
Table 2. Summary of literature included in this paper.
Focus of Paper
|
References
|
Health services in Australia
|
(35, 85)
|
Child health services
|
(20, 41, 71, 72, 86, 87)
|
Health service utilisation and access
|
(3, 8, 23, 24, 66, 88-98)
|
Rural health care services or primary health care in a rural setting
|
(58, 59, 62, 67, 68, 78, 99-103)
|
Ambulatory services
|
(2, 31, 32)
|
Emergency department presentation patterns
|
(104-107)
|
Telehealth
|
(108-112)
|
Other, including the remote nursing workforce, specialist outreach services, multidisciplinary teams, allied health services, fly-in-fly-out (FIFO) models, the Royal Flying Doctors Service and barriers to providing effective primary health care for children
|
|
Inclusion Criteria
Medical publications and grey literature produced between 1990 and 2013 were included if they described existing rural and remote health services, health service use or needs in relation to Indigenous children (0-18 years).
Exclusion Criteria
Papers were excluded if they focused on: health services in foreign countries or large metropolitan areas; adult, dental and oral health, sexual health, education of children or health professionals, or social or cultural issues; attracting or retaining health professionals to rural and remote locations; substance abuse and misuse; child care centres; the judicial system; health policy or papers not written in English (Figure 1) because the breadth of literature on these topics was too extensive to incorporate into this review paper.
Review Process
Two authors reviewed abstracts or summaries of publications identified in the search to determine their relevance and suitability for inclusion. If there was doubt about the suitability of a paper, the full text was retrieved and evaluated. If there was a dispute about relevance of a paper a third author assessed the paper. The reference lists of all relevant papers or reports were also reviewed for additional relevant citations. Data from all relevant papers were extracted and summarised.
Defining Health Services
We defined ‘health services’ as any primary, secondary or tertiary paediatric health services, including paediatric specialists, remote nursing clinics, allied health professionals, hospital inpatient and emergency departments, patient retrieval through the Royal Flying Doctor Service, fly-in-fly-out (FIFO) services, paediatric outreach services, multidisciplinary teams, tele-paediatrics and videoconferencing systems. Additionally, the public health approach to health services provides surveillance of the health service through the consideration of epidemiology, health and ill-health.
Defining Health Systems
We defined ‘health systems’ or ‘healthcare systems’ around the definition supplied by WHO. A good health system incorporates the organisation of people, institutions and resources to deliver health services, which meet the needs of all people. This requires resilient and considered financial procedures, a qualified and well-paid workforce, reliable evidence-based information on which to base decision and policies, adequate and well-maintained facilities and logistics allowing the delivery of quality medicine and technologies.
Defining Rural and Remote
The classification scale used to define rural and remote varied between papers, however the Rural, Remote and Metropolitan Areas classification (RRMA) and the Accessibility/Remoteness Index of Australia (ARIA) scales were most commonly used (21, 22). Papers that focused on metropolitan hospitals, populations or health services were excluded.