Week 6: Rural Health Services

Question 1

What qualification does a rural area nurse have?

Answer 1

• Are nurse that is quite experienced with some extra training for an extended scope of practice
• Mostly are employed in primary care clinics and small rural/remote hospitals

Question 2

What qualification does a nurse practioner have?

Answer 2

• Are nurses with skills in diagnosis and treatment
• These have finished their nursing degree and masters degree plus 5 years of experience
• Are used to fill gaps, however this is significant potential in Australia

Question 3

What qualification does a physicans assistant have?

Answer 3

• Are health care workers that provide primary healthcare services in collaboration with Drs.
• They are trained as generalists
• The things that fall under their scope include patient examinations, order and interpret tests and imaging, diagnose, order treatment, formulate management plans and review patients
• The biggest thing to note is they do this under the supervision of a Dr.
• Are used to fill gaps

Question 4

What are the 3 main approaches to improve access to health care?

Answer 4

1. Organising health services in different ways
2. Making specialist services (and primary care) more accessible to rural people
3. Use of technology and telemedicine

Question 5

What are the 4 aspects to organising health services in different ways?

Answer 5

1. Supplementary primary care services
2. Establishing specialist services in regional centres
3. Integrating and coordinating services, including health, aged care and community services

Providing culturally appropriate care to remote indigenous communities

Question 6

Explain what supplementary primary care services under organising health services in different ways is

Answer 6

• In an urban setting, primary care services are mainly considered to be private GPs
• As we go more rural, access is improved through the supplementation of these services with other services like; RFDS (which run a primary care clinics), primary care clinics in public hospitals, delegated practice
• Another way this is done is through the easy entry, gracious exit model which towns implement. Basically, this negates the risk of a doctor coming in and investing money in a practice, and instead the practice is owned and operated by the local government, and simply employs the doctor (meaning they can come and go as they please)
• Another way access is improved is through the networked model, where clinics across several towns are linked (which are serviced by a pool of employees and resources)

Question 7

Explain what establishing specialist services in regional centres under organising health services in different ways is

Answer 7

• T he best example of this is the regional cancer centres
• This strategy provides care to patients that would otherwise be unavailable except in metropolitan centres (best practice care, pool of oncologists, access to clinical trials)
• Because they offer all of this, it attracts specialists (especially for training programs)

Question 8

Explain what integrating and coordinating services, inclduing health, aged care and community services under organising health services in different ways is

Answer 8

• This can be done through multipurpose health centres
• Historically has only really been unsuccessful due to political reasons
• It would incorporate a range of services co-located under one roof
• As resources are shared, costs are cut
• Can be used when there is insufficient catchment populations to sustain separate hospitals, residential aged care, community health etc.
• It is seen as a way of saving threatened hospitals and of continuing a level of service to smaller communities

Question 9

Explain what providing culturally appropriate care to remote indigenous communities under organising health services in different ways is

Answer 9

• Examples include ACCHS’s, aboriginal liaison officers, aboriginal health workers
• Can be done through cross cultural training for students and workforces

Question 10

What are the 3 aspects to making specialist services more accesible

Answer 10

1. Bringing patients to the service

Taking services to the patient

supporting emergency retrieval services

Question 11

Explain what the patient travel subsidy scheme is and what problem is creates/faces

Answer 11

• This can be achieved through patient assisted travel scheme
• In QLD, this is known as the Patient Travel Subsidy Scheme (PTSS), a scheme which is funded by the commonwealth, and administered by the state
• This scheme works by subsidising travel to a referred specialist appointment if you live greater than 50km from the nearest public hospital
• In terms of actual specifics, it covers some transport (fuel subsidy or air subsidy if greater than 16 hours by road) and accommodation ($60 per night)
• The problem with the PTSS is that the subsidy is usually much lower than the actual cost to patients, and that the cost is covered by the hospital nearest the place of residence thus places a significant burden on the hospitals

Question 12

What is one stratergy that is used to take health services to the patient?

Answer 12

• This can be achieved through specialist outreach services
• This works best if the services are frequent and predictable, have a continuity of care (same specialists comes each time), good communication (between specialists and GP)
• These outreach clinics are done by private specialists, a hub and spoke model (specialist who is based at a centre, and does regular outreach services in the district)
• This is supported by the Rural Health Outreach Fund which is government funding to cover the transport costs of people doing these outreach services

Question 13

What are specialist outreach services supported by in terms of funding?

Answer 13

• This is supported by the Rural Health Outreach Fund which is government funding to cover the transport costs of people doing these outreach services

Question 14

What are the factors that need to be in place to support the strategies to improve access to health care for rural communites

Answer 14

1. Government policy committed to providing rural services, including willingness to fund (e.g. rural health outreach fund)
2. Sympathetic, flexible and supportive health department administration
3. Workforce training and supply with long term perspective, not just gap filling
4. Community readiness, involvement and leadership
5. Infrastructure
6. Economic viability

Question 15

There is an apparent shortage of rural health workers in rural communites. What is this mainly due to?

Answer 15

• The reason for this, is a geographic maldistribution, which shows the amount of medical practitioners decrease substantially with increased rurality
• Another factor which has led to this maldistribution is the increasing specialisation of medical practitioners and inefficient models of care
• Eventually, this oversupply is going to lead to increased future health care costs (as a result of oversupply)

Question 16

What are the 4 stratergies put into place by the government to fix rural medical practioner shortage and what policies have actually been put in place?

Answer 16

1. Education
   - Pick students from rural backgrounds
   - Locate health professional schools, campuses, residency programmes outside of capital cities
2. Regulatory
   - Introduce enhanced scope of practice
   - Introduce different types of health workers
   - Provide scholarships, bursaries with enforceable agreements for return of service
3. Financial
   - Introduce incentives (like allowances, housing holidays etc.)
4. Personal and professional support
   - Better living conditions, safe working environment
   - Rural career pathways, rural networks and public recognition

In terms of actual policies that have been put in place include;

1. University departments of rural health
2. Rural clinical schools
3. Regional training hubs
4. Return of service incentives / obligations