Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available?

Thomas, Susan; Wakerman, John; Humphreys, John Stirling

doi:10.1186/s12939-015-0228-1

Cited by 120 publications

(135 citation statements)

References 21 publications

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“…In times of economic downturn, people who are already most exposed to disadvantage may feel the effects more strongly than do others, health inequity may worsen, and more people may become vulnerable [17]. To ensure equity, health care policymakers should take into account that, beyond population size, the rural population may need more health-promoting efforts and prevention as well as maintained access to health care [17], and that services should be provided as close to home as possible [6]. Reducing health inequalities is in line with human rights and depends on our visions, actions and courage [5].…”

Section: Discussionmentioning

confidence: 99%

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Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

Gústafsdóttir

Fenger

Halldórsdóttir

et al. 2017

International Journal of Circumpolar Health

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Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users’ perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner’s Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.

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Section: Discussionmentioning

confidence: 99%

“…As an ethical concept equity is closely related to the fundamental human right to the highest attainable standard of health [2,4]. Equity is not something that is achieved once and for all; it is a moral imperative and an important indicator of the quality of countries and communities [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

Gústafsdóttir

Fenger

Halldórsdóttir

et al. 2017

International Journal of Circumpolar Health

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“…Accurately specifying the nature and scope of PHC services offered by the service Although core services were defined consistently with previously published research 7 , there was considerable variability from location to location in terms of what services were provided. This issue has also been recognised elsewhere…”

Section: Discussionmentioning

confidence: 99%

“…To date, rigorous empirical research has been undertaken into the first two questions [4][5][6][7][8] . In contrast, empirical evidence relating to the cost of delivering high quality PHC efficiently and effectively (and the extent to which these costs vary geographically) is virtually non-existent.…”

Section: Introductionmentioning

confidence: 99%

What does it cost to provide equity of access to high quality, comprehensive primary health care in rural Australia? A pilot study

Thomas

Wakerman

Humphreys³

2017

Rural Remote Health

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Introduction: Equity of access to primary health care (PHC) services is a fundamental goal of rural health policies and planning. Unfortunately, many rural and remote communities are characterised by significant inequities in PHC service availability, quality/performance and sustainability. This article investigates how best to ascertain the costs of delivering high quality PHC services across different geographical locations through reporting the research findings from a pilot study. The aim of the study was to ascertain whether it is possible to estimate the total, per capita and per consultation costs of providing high quality PHC services in rural locations of different population sizes, and to describe the methodological issues associated with such an exercise. Methods: A retrospective, top-down approach was used. A sample of high performing primary care practices in rural communities was identified using data from the Australian Primary Care Collaborative (APCC) program. The researchers selected practices in rural communities (Australian Standard Geographical Classification remoteness areas 2 and 3) and assigned a population count using Australian Bureau of Statistics census data (urban centre locality). Four population groups of different sizes were chosen: 101-500, 501-1000, 1001-3000 and 3001-5000. A data collection tool was developed to capture information describing annual operating costs (both capital and recurring), human resources, PHC services provided and reflections from practice principals on issues related to provision of sustainable high quality primary care in a changing environment. Financial data available from practice © SL Thomas, J Wakerman, JS Humphreys, 2017. A Licence to publish this material has been given to James Cook University, http://www.jcu.edu.au 2 taxation/accounting records for the 2012-13 financial year, measured in Australian dollars, was used. Practices were visited between March and July 2014. Results: Seven primary care practices agreed to participate. The data exhibited wide variation in total recurrent costs, capital and depreciation costs. There was a weak association between total annual costs and costs of practices grouped by the size of the local community. A stronger association was evident when the size of current patients registered with the practice was considered. The cost per person registered with the practice declines as the number of patients registered increases. Most of the recurrent costs for all practices were attributed to human resources and ranged from 69% to 85% with an average of 77%. Doctors' salaries accounted for 47-65% of total annual costs with an average of 53%. There was some evidence of an association between cost per consultation and the number of registered patients, with unit cost falling as the size of the registered patient population increased. Discussion: This research highlights several significant issues that need to be addressed in seeking to benchmark rural PHC services: (1) ensuring consistency across the particular services ...

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“…Although Melanoma represents only 2% of all skin cancers [4], it often leads to premature death [4] and is responsible for a majority of skin cancer deaths [5]. Compared to metropolitan populations, Australia's rural and remote communities experience inequities in access to care [6], leading to a higher incidence and mortality within 5 years. The median incidence ASR for Non-Indigenous Australians with CM is 32 per 100,000 across rural and remote areas and 27 per 100,000 in major cities.…”

Section: Introductionmentioning

confidence: 99%

Review of Use of Digital Health in Melanoma Post-Treatment Care for Rural and Remote Communities (Preprint)

Rollin¹,

Ridout²,

Campbell³

2018

Preprint

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Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services. Objective: To understand how digital health is currently used for melanoma post-treatment care and determine its benefits for Australian rural and remote areas. Methods: A systematic search of PubMed, Medline, Google Scholar, Scopus was conducted in March 2018. Findings were clustered per type of intervention and related-direct outcomes. Results: Five studies met the inclusion criteria, but none of them investigated the benefits of digital health for melanoma post-treatment care in rural and remote areas of Australia. A number of empirical studies demonstrated consumers' acceptance toward digital intervention for post-treatment care. Findings did not take into consideration individual, psychological and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare. Conclusions: Digital interventions may to be used as an adjunct service by clinicians during melanoma post-treatment care, especially in regions that are lower-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates and accessibility to post-treatment care management between urban and rural/remote populations.Keywords: Digital health; eHealth; Technology; Melanoma; Post-treatment care; Support care services; Rural areas; Remote communities; Patient centric; Oncology IntroductionAustralia remains a country with one of the highest levels of melanoma. In 2015, the worldwide average age-standardised incidence rate (ASR) for melanoma was 5 cases for 100,000, however the rates for Australia and New Zealand are over ten times that level (Table 1) , leading to a higher incidence and mortality within 5 years. The median incidence ASR for Non-Indigenous Australians with CM is 32 per 100,000 across rural and remote areas and 27 per 100,000 in major cities. In comparison, the median worldwide ARS mortality for CM is 5.4 per 100,000 across rural and remote areas and 4.6 per 100,000 in major cities [7].Melanoma treatment plans depend on (a) prognostic factors which are largely defined by the American Joint Committee on Cancer (AJCC) staging system [8], and (b) individual characteristics which will allow the clinicians to determine the type of Melanoma and the risk for recurrences. For example, patients previously treated for primary CM are at higher risk of recurrences and developing new primary melanomas and skin lesions [9]. However, early-detection can reduce mortality rates, as melanoma can be more effectively cured with simple and cheap treatments in the early stages [10]. In 1996, Berwick and colleagues reported that Total Self Skin-Examination (TSSE) may decrease melanoma mortality by 63% [11] and a 2003 study found that re...

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Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available?

Cited by 120 publications

References 21 publications

Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

What does it cost to provide equity of access to high quality, comprehensive primary health care in rural Australia? A pilot study

Review of Use of Digital Health in Melanoma Post-Treatment Care for Rural and Remote Communities (Preprint)

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