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Needs assessments in primary health care


Needs assessments in primary health care provide information to plan and change services, with the ultimate goal of improving the health of a population.

Source: Stevens A, & Gillam S. (1998). Needs assessment: From theory to practice. British Medical Journal, 316(7142), 1448-1452.
Stevens A, & Raftery J. (Eds). (1994). Health care needs assessment: The epidemiologically based needs assessment reviews (Vol. 1). Oxon: Radcliffe Medical Press.

sources of health data and information in Australia

National health data and other information relevant to needs assessments can be accessed from a number of sources. These include:

MEDICARE LOCALS AND NEEDS ASSESSMENTS

A key objective of Medicare Locals operations will be to undertake needs assessments in primary health care for their local areas. More information on Medicare Locals and needs assessments can be found in the Medicare Local guidelines.

Lead Clinician Groups will provide expert input into these needs assessments.

Medicare Locals are required to undertake needs assessments relevant to the programs they are funded to deliver, such as the After Hours Program.

Further reading on Needs assessments

The British Medical Journal published a series of seven articles dedicated to primary health care needs assessments, with the first in issue 7140.

Dr Greg Coster has written extensively on New Zealand's experience with needs assessments:

Professor Andrew Stevens from the University of Birmingham has produced a website and book focusing on the practical aspect of needs assessments.

related resources

Introduction to Medicare Locals

Introduction to Australian health reform

What is "need" in the context of needs assessments?

A simple and widely accepted definition of need in the health care context is "the population's ability to benefit from health care". This definition distinguishes need from demand, which is potentially infinite, and supply, which is what is being provided. It is linked to health services in that it depends on the potential of health services (across the continuum of care) to manage health problems and acknowledges that the ability to fund health care services is limited.

Source: Stevens A, Raftery J, Mant J. (2010). The epidemiological approach to health care needs assessment. Health Care Needs Assessment (HCNA).

Different approaches to needs assessments

There are a number of different approaches to undertaking needs assessments. Each approach differs in its use of quantitative, economic and qualitative information.

Approach type Premise

Pros

Cons

Global

Focuses on available health services and identifying 'gaps' using epidemiological data. Priorities & cost-utility trade-off determines commissioning decisions.

Comprehensive, well-rounded. Considers financial implications.

Likely to be time and resource intensive. Does not include community perspectives.

Epidemiology

Focuses on disease incidence & mapping service availability.

Effectively identifies areas of need in great detail.

Time consuming. No focus on community/national priorities.

Community

Based on community perspectives of need, using a community development type approach.

Garners local support and perspectives effectively.

Can neglect national priorities, quantitative data. Time consuming.

Comparative

Reviews services in one area compared to services in another area.

Useful in the absence of relevant data.

Unreliable method of determining need.

Corporate

Based on 'expert' perspectives.

Good for understanding local circumstances.

Can neglect consumers and data-informed priorities.

Life course

Looks at the stages and risks of the development of chronic disease.

Only method with a developed approach to tackling chronic disease.

Views disease development as a linear process, which is not always accurate.

Source: Ben-Shlomo Y, & Kuh D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31, 285-293.
Coster G. (2000). Health needs assessment for New Zealand: Background paper and literature review. Wellington: Ministry of Health, New Zealand.

Considerations when undertaking needs assessments

There are a number of factors which should be considered when undertaking needs assessments. These include:

  1. The legislation, policy, national health priorities and other general strategic documents which should guide the framework for the needs assessment.
  2. The data types and sources which are necessary to conduct the needs assessment, and investigation of what is available. This should include research or economic evaluations.
  3. The process, timing and scope of community and expert consultation processes.
  4. The skills required (and available) to undertake the needs assessment.
  5. Process for prioritising the needs that are identified in the assessment.

Source: UK Department of Health. (2007). Guidance on Joint Strategic Needs Assessment. London: Department of Health.

How are needs assessments undertaken overseas?

Needs assessments characterise the strategic planning of many countries' regional health organisations. Needs assessments have been undertaken in England, Scotland, some provinces in Canada, and New Zealand for approximately a decade. The table below outlines the purpose of needs assessments in these countries, and how they are utilised by the regional health organisations.

 

Organisations responsible for needs assessments

Purpose of needs assessments

How needs assessments are utilised

England

Primary Care Trusts

Informs the regional strategic planning (including non-health areas) and commissioning decisions.

Informs the regional strategic planning (including non-health areas) and commissioning decisions.

Scotland

National Health Service Boards

Engage in collaborative decision-making on service provision and integration.

Mostly nationally focused. Is linked to performance targets.

Ontario, Canada

Local Health Integration Networks

Community and provider consultation.

Informs an Integrated Health Service Plan and an Annual Service Plan.

New Zealand

District Health Boards

Assessment of population's capacity to benefit from health services prioritised within cost constraints.

Feeds into a prioritisation process and into strategic and annual plans.

compiled by Rachel Katterl
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