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This month’s edition of Healthcare Review – OnlineTM is the second in a two-part series examining rural health in New Zealand and Australia.
The first edition in the rural health series considered the rural health scene in New Zealand. Papers considered issues faced in rural general practice and the components of a “quality†rural health service [Janes R, et al. Improving Rural Health Services Through Integration: What Are the Barriers?], the various elements required to overcome the difficulties faced in rural health from a political perspective [Farry P. An Overview of Rural Health Policy from the Major Political Parties] and a “Total Package†approach to rural health issues [Harris, A. Addressing the Issues in Rural General Practice by Offering a ’Total Package’ Solution].
The current edition expands on these papers, reviewing approaches to improving health services in rural Australia. Rural health services are of crucial importance in Australia where nearly 30 percent of the population reside in rural areas with poor geographic access to health services. In addition, lower socio-economic status and employment levels, and occupational health issues impact negatively on the health status of individuals in these areas.
Similar issues affect health status and the delivery of effective health services in the rural setting internationally. Thus, lessons from these Australian and New Zealand settings can be applied internationally.
Difficulty in recruiting and retaining a rural health workforce is a key issue in rural health and relates to a number of factors including long hours, and a lack of locum relief, backup, specialist services and continuing medical education.
In their paper, Gillian Durham and John Durham, Deputy Directors and Associate Professors, Combined Universities Centre for Rural Health, Geraldton, Western Australia, review various strategies for building the rural health workforce. These include recruitment of overseas trained doctors, efforts to recruit rural students into health courses and strategies to build and retain their commitment to rural health careers, increased emphasis on rural health in undergradute curricula, and vocational training in rural practice. They conclude that a comprehensive programme is required to build the workforce in a sustainable way.
Durham and Durham also consider the changing nature of rural health practice over the 20th century and review those unique features of rural practice that place rural health professionals in a strong position to respond to these changes. One such feature is the ability of rural health workers to work in multidisciplinary teams.
Professor Roger Strasser, Professor of Rural Health, Centre for Rural Health, Monash University, also emphasises the role of teams in rural practice and the importance of a collaborative approach.
He regards this interdisciplinary co-operation and teamwork between health workers in rural settings to be one level of teamwork in rural health. A second level of teamwork occurs between local generalists and distant specialists and a third level involves co-operation between health service agencies, general practitioners and other health care providers, and the rural community. In his experience, active local community participation in health services contributes significantly to the sustainability of these services.
Strasser also provides an overview of rural practice based on his experience and knowledge of rural practice in Australian and international settings. He describes rural medical practice as having three components: broad general practice/family care; procedural care in emergency situations and; community level care which can extend from dealing with environmental health issues through to preventive care and health promotion. He highlights that the credence given by rural people to health education received from general practitioners positions the rural general practitioner to significantly effect changes in health related behaviour at a community level.
In a later addition to the series, Dr David Rosenthal, General Practitioner in the rural setting of Renmark, South Australia will consider the development of emergency medicine curricula and regulation for intending and practising rural doctors. Dr Rosenthal is the past president of the Rural Doctors Association of Australia and the current Chair of the Rural Health Education Foundation. He has an active interest in the delineation of clinical privileges and educational support for rural doctors.
This month’s edition of Healthcare Review – OnlineTM also includes a [review of John Senneff’s ‘Numb Toes and Aching Soles: Coping with Peripheral Neuropathy’. The inclusion of book reviews is a new feature for Healthcare Review – OnlineTM and we trust that you will find these occasional reviews both valuable and informative.
