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This month’s edition of Healthcare Review – OnlineTM is the first in a two-part series examining rural health in New Zealand and Australia.
Rural health is of crucial importance in both countries as a significant proportion of the population reside in rural areas.
Similar issues affect the delivery of effective health services in the rural setting internationally and lessons from the Australian and New Zealand settings can be applied elsewhere.
The key issues facing rural general practice are largely related to the isolation resulting from geographical problems and the resultant "burn-out" and stress, the lack of availability of adequate and accessible quality continuing medical education, and the lack of availability of locum cover.
Team approaches are strongly promoted to overcome problems in delivery of health services in the rural setting. The resultant emphasis on collaboration and integration of services in the rural setting means that the increasingly integrated style of rural practice offers important lessons for general practice in urban settings, given increased interest in ’integrated’ approaches to health care.
As a special feature in the lead-up to the general election in New Zealand to be held on Saturday 27 November, we include in this edition an overview of rural health policy from the major political parties from Dr Pat Farry, Medical Director, Te Waipounamu Rural Health Unit. Dr Farry summarises, in priority order, those elements that are required to overcome the difficulties being faced by rural health and provides an interpretation of the position of the major political parties with respect to these requirements.
Dr Ron Janes, rural GP and rural hospital doctor, Jean Ross, Co-Director for the Centre of Rural Health in Christchurch and Jeanette Taylor, rural hospital nurse in Healthcare Hawke’s Bay, provide more detail on the issues facing rural general practice and a perspective on rural health services delivery in New Zealand.
In their article they discuss the components of a "quality" rural health service and consider these alongside a typical New Zealand rural area (Wairoa). They then examine the barriers to improving health services through better integration of providers.
In their definition of a "quality" rural service, Janes, Ross and Taylor incorporate the requirement for delivery of the correct service to the correct person, meeting individual as well as population needs. Their definition of a "quality" rural service also addresses the requirements of the service provider and, importantly, of service delivery timing, cost and outcomes.
Aspects such as evidence-based care, community input and accessibility are shown to be critical in the delivery of a "quality’ rural service. .
The article highlights that the elements of a quality rural health service are interlinked and that rural health providers need to work together to meet all the care requirements of patients. A "one stop shop" approach incorporating all relevant health professionals facilitates teamwork by bringing providers together for better communication, enables a population perspective and allows for more affordable purchase of expensive equipment needed for care and data collection. In turn, the approach provides an attractive working environment that assists in recruiting and retaining staff and attracting locums. Savings from efficiencies and economies of scale can then be reinvested to further improve local health services.
Despite the general agreement that better teamwork is needed in health care, barriers still continue to hinder its progress. Janes, Ross and Taylor highlight barriers to teamwork in rural primary health care including a lack of workforce planning, unsupportive Government policy and financial barriers. However, they note examples of areas where these barriers have been overcome to allow significant improvement in integration of health services.
Adrienne Harris is General Manager of the Northern Rural General Practice Consortium which was established by a group of rural general practitioners (GPs) in the far north of New Zealand to overcome ongoing problems associated with rural isolation and other pressures associated with the rural environment. The Consortium is a support organisation that aims to provide accessible and adequate continuing medical education, locum management and support services for rural GPs in the far north.
Two elements have been key to the Consortium’s success. The first is that its ownership rests in the hands of the rural practitioners that the Consortium serves; as a result, issues are addressed and changes are implemented by the right people at the right level. The second is the implementation of a "Total Package" concept which coordinates the provision of the required continuing medical education, locum management and support services.
The Consortium is seen as a strong vehicle from which to launch similar support initiatives around New Zealand. Indeed, it has supported isolated rural areas outside the far north through locum support. The group’s future goal is to assist with the establishment of similar initiatives throughout New Zealand to support rural general practice and ultimately benefit rural communities as a whole.
A subsequent edition on rural health will expand on the coverage in the current edition, reviewing approaches to improving rural health services outside New Zealand.
Professor Roger Strasser, Centre for Rural Health, Monash University will address the role of teams in rural practice and the importance of a collaborative approach.
A further contribution from Australia will further consider issues in rural health in that country, particularly in the area of emergency medicine in rural practice and the issues associated with emergency care in rural settings.
