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IMPROVING HEALTH CARE IN RURAL AUSTRALIA

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IMPROVING HEALTH CARE IN RURAL AUSTRALIA New models for training and care in rural communities and their evaluation Critical strategies for improving health outcomes ... – PowerPoint PPT presentation

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Title: IMPROVING HEALTH CARE IN RURAL AUSTRALIA


1
IMPROVING HEALTH CARE IN RURAL AUSTRALIA
  • New models for training and care in rural
    communities and their evaluation
  • Critical strategies for improving health
    outcomes for Rural Australians

  • The Western Alliance initiative
  • Deakin University November 2014

2
Basic Principles
  • Health Care is a right not a privilege
  • Health, Happiness and Productivity are
    inextricably linked
  • The broad social determinants of health
    (education, workplace issues, transport, housing,
    law and order, etc) must be integrated with our
    Health System.

3
Health Care Reform
  • Our goal
  • A system focused on the individual that
    emphasises prevention is demonstrably equitable,
    sustainable and provides quality care in a timely
    manner available on the basis of need not
    personal financial wellbeing.
  • Inequity increasingly problematic

4
What about Rural Health Care?
  • More than 33 of Australians live in Rural or
    Remote communities
  • They produce 65 of the Nations wealth
  • There numbers are growing and feature many
    retirees!

5
Equity
  • What did the recent report from the Senate
    inquiry conclude about health care equity in
    rural Australia?

6
Unacceptable Health Outcomes
  • Australians living in rural and remote areas
    have much poorer access to local health services
  • 2 billion dollar Medicare gap
  • Significantly worse health outcomes
  • A significantly shorter life expectancy than
    Australians living in metropolitan areas

7
The Chronic Disease burden
  • The prevalence of chronic disease is troubling
  • data shows the incidence of cancer is about 4
    per cent higher than in major cities
  • Significantly higher incidence rates for
    preventable cancers
  • .

8
Disease burden
  • Lifestyle risk factors or health determining
    behaviours contribute to the burden of disease
    in these communities
  • People in remote areas found to engage in more
    behaviours that carry risks
  • Mental health problems common and have unique
    rural precipitants

9
Disease Burden
  • Compared with their city counterparts rural
    residents tend to exhibit
  • 10 percent higher levels of mortality
  • 20 percent higher rates of injury and
    disability
  • 32 percent higher rates of risky alcohol
    consumption and
  • 1070 percent higher rates of peri-natal death.

10
Health Workforce shortage serious and worsening
  • In rural communities not uncommon to wait 6 weeks
    for an appointment with your GP
  • We have an ageing workforce,
  • and inadequate numbers of GPs and other health
    professionals choosing rural practice.

11
Current situation
  • Extremely dependent on Overseas Trained Doctors
    and the Bonded medical student program.
  • About 47 of rural GPs are OTDs
  • Deloiite Access Economics reported to government
    that to have significantly more rural GPs the
    number of OTDs would have to significantly
    increase!

12
Overseas Trained Doctors
  • Use of so many OTDs problematic
  • Ethics? Needed at home
  • Developing countries want them back, the tap may
    be turned of
  • Many only in rural towns as they cannot work
    elsewhere
  • Problems with supervision and communication

13
Reasonable Expectations
  • Rural communities deserve and need to be cared
    for by Australian doctors who want to work in
    their community, love rural life and have been
    trained as generalists with a rural specific
    curriculum that included procedural skills and
    equipped them to handle the rural specific needs
    of their communities.

14
Government strategies.
  • Riding the OTD bonanza- cost effective
  • Bond medical students
  • Provide cash incentives for metro doctors to move
    to the country
  • Area of need payments
  • Double the number of Medical student places and
    market forces will take them to the country

15
Current Government Policies
  • Medical Education-----
  • 25 medical students Rural
  • Have lived in a rural post code for five years
    !!!
  • Establishment of Rural Clinical Schools
  • All students spend a minimum of 4 weeks in a
    rural clinical setting.

16
Policy failure noted in reports
  • Need at least 1800 more rural GPs
  • Financial incentives are not working
  • 13 of final year medical students planning
    careers as GPs and only 13 of them are thinking
    of a rural based career!
  • On average 5 of graduates practice in rural
    areas.

17
Turning the ship around
  • Is there an evidence based logic to introducing
    new policies for a new approach?
  • Telling observation---70-80 of non-medical rural
    health students trained in the country stay in
    the country. SO--------

18
Consensus
  • What policies to improve the availability of
    doctors to rural communities are now advocated by
    -------
  • The WHO. An international conference of medical
    educators, the recent Australian Senate inquiry,
    the standing committee on rural health of AHMAC,
    HWA 2025 and many others?

19
What does the evidence suggest?
  • Training many more rural medical students
  • A return of the GP proceduralist
  • Selected Rural students should have an
    intention to practice in the country
  • Rural students to be trained in rural
    universities with a rural specific curriculum
    featuring Inter-professional learning
  • Inter-professional learning

20
Inter-Professional Learning?
  • Silo mentality in the delivery of health care.
    Team Medicine much better.
  • Patients referred to professionals in
    geographically dispersed facilities
  • Insufficient mutual respect and knowledge of what
    other health professionals can offer
  • Very Dr centric system (Super-GP clinics etc).

21
INTEGRATED PRIMARY CARE
  • World wide shift
  • Team medicine Practice team consists of
    doctors, nurses and allied health professionals
    (including dentists) with team funded by
    extension of MBS
  • Team learning to prepare for IPC practice.

22
Contemporary Primary Care?
  • Enrolled patients
  • Personalised medicine to prevent illness
  • Early intervention strategies
  • Team Management of C C disease
  • Hub and Spoke models for better clinical,
    business and quality outcomes
  • Care in the community for many currently sent to
    hospital.

23
Primary Care?
  • Once we have settled on a clear vision for the
    model of care desired we must train/assemble the
    clinicians who can provide it

24
Evidence based reforms
  • Rurality not postcode all important
  • Affirmative action selection
  • Six year undergraduate program
  • Problem based learning featuring IPL
  • Rural specific curriculum
  • Early and extended acquisition of procedural
    skills

25
Evidence based reforms
  • Balanced hospital and community training
  • Create IPC Clinics for care and teaching
  • Positive small town experiences.
  • Hub and Spoke model
  • Final year a sub-intern year
  • Rural internship / accelerated vocational
    training
  • Health Services research unit

26
The Way Forward
  • Suggestions for discussion and further analysis
  • The definition of a rural student should be
    changed for next years intake
  • The quota for rural students should increase to
    30
  • Universities that do not meet the required quota
    for two consecutive years to lose unused rural
    places
  • Mandatory rural rotations for all students to
    cease

27
The Way Forward
  • The number of full fee paying students should be
    capped at present levels with planned expansion
    of this program diverted to rural students.

28
The Way Forward
  • New rural based medical programs should develop
    clinical services for the public and in so doing
    provide new clinical training opportunities.
  • Recognising rural educational disadvantage, rural
    based programs should use an affirmative action
    approach to enroll best suited students

29
The Way Forward
  • Rural based, whole of course education for
    students with a genuine rural identity will
    provide many more doctors for rural communities.
  • Graduates from such programs must be able to
    continue with rural based vocational training.
  • New initiative should facilitate the re-emergence
    of more GPs with procedural skills at the same
    time as we continue efforts to attract more
    specialists to rural practice

30
The Way Forward
  • Medical Schools , particularly any new rural
    based schools, should do more to improve the
    professional satisfaction of small town
    clinicians increasing the likelihood of students
    being attracted to such settings.
  • There is more than enough data for it to be
    unreasonable to ask rural communities to wait a
    few more years to better assess current programs
    before trying new initiatives.

31
The Way Forward
  • The Dangerous Dilemma
  • General acceptance that we need more rural based
    medical education for rural students
  • At least seven Universities interested in
    starting whole of course rural based programs. A
    clear recognition of dissatisfaction with the
    status quo.
  • BUT------

32
The Way Forward
  • Universities and their medical schools struggling
    financially
  • They would be very reluctant to give up any
    current student places
  • They warn that clinical training opportunities
    are saturated with more than 16000 students in
    training
  • They are struggling with the mandatory
    requirement for rural rotations and would not
    want to donate them to a new program

33
Community and University Advocacy
  • No vision or commitment to these structural
    reforms in Canberra.
  • Minister Crean advised-------
  • We listen to proposals that enjoy really strong
    community support
  • Dont be whiners, bring us solutions to your
    problems
  • Rural apathy must be reversed

34
Western Alliance Leadership
  • Working to improve the impact, quality and
    quantity of research in the region through
    strategies that promote
  • Translation of research evidence into practice to
    improve quality of care and health outcomes for
    regional and rural communities
  • Utilisation of multidisciplinary,
    cross-disciplinary and trans-disciplinary
    approaches

35
Western Alliance Leadership
  • Recruitment, training and up skilling our best
    junior and mid-career researchers and clinicians
    to help ensure the future leadership of health
    research in the region
  • Enhancement of advisory and quality assurance
    mechanisms.

36
Western Alliance Initiatives
  • Advocacy for structural reforms
  • Establish and assess proof of concept IPC
  • Champion Rurality of students / IPL learning
  • Facilitate procedural training for GPs
  • Hub and Spoke model IT,CPD,TeleHealth, small
    town assistance / documenting outcomes
  • Health research unit assessing and sharing

37
Summary
  • Status quo unacceptable, 4600 Australians dying
    each year because they live in the bush!
  • Rural Australians deserve efficient access to
    Australian doctors who have the special skills
    they need and love rural life.
  • Current programs will not deliver this outcome,
    new approaches must be tried. Good policy not
    politics should drive innovation.
  • A Continuing passionate partnership between
    community and university (e.g. The Western
    Alliance) needed to win the day
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