Successes and challenges of primary health care in Australia: A scoping review and comparative analysis

Introduction Australia has achieved universal health insurance for its popu-lation since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, includ-ing inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key charac-teristics of good PC.Methods We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key char-acteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings accord-ing to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centered-ness and service coordination indicators with exemplary evidence-base practice/ knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adop-tion of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Conclusion Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-cul-turally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged popula-tions, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural-and remote-residents. These challenges could be mitigat-ed through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.