Aeromedical retrievals of people for mental health care and the low level of clinical support in rural and remote Australia

Abstract

Objectives:To characterise the people retrieved by the Royal Flying Doctor Service (RFDS) for treatment of mental and behavioural disorders, and to assess mental health care provision in rural and remote areas.Design: Prospective review of routinely collected RFDS and Health Direct data.

Aeromedical retrievals for gastrointestinal disorders in rural and remote Australia: the need for improved access to specialist advice

“…This finding is consistent with research that indicates that rural and remote populations have higher rates of untreated hepatitis C and increased prevalence of excessive alcohol consumption, both of which are linked to liver cirrhosis and cancer . This, coupled with the increasing rates of substance use disorders requiring aeromedical retrieval, indicates a complex clinical environment …”

“…Prevention of acute GI disease and acute worsening of chronic GI conditions is preferable to emergency presentation. Many of the areas serviced by the RFDS do not have regular access to general practitioner or nursing support, with no gastroenterology specialist nurse support . Many of the GI conditions resulting in the need for RFDS aeromedical transfer are chronic conditions that intermittently worsen and then improve with the appropriate care.…”

Aeromedical retrieval for suspected appendicitis in rural and remote paediatric patients

“…Rural and remote populations have been identified as having low service provision of health care, as compared to major cities. 4,15 Diagnostic imaging is recommended in suspected acute appendicitis in paediatric patients, to confirm the diagnosis and to differentiate complicated from uncomplicated appendicitis. 3,8,13 Anecdotally, we believe the provision of diagnostic imaging is significantly lower in rural and remote as compared to major cities in Australia.…”

TheMJAin 2019: going from very good to great!

“…In their prospective observational study including 500 Indigenous Australians from ten primary health care centres, they found that the aPHQ‐9 is an effective tool for screening for current major depressive episodes, and could help clinicians and researchers confidently identify depression in Indigenous patients, facilitating initiation of effective treatment. The dearth of dedicated clinical mental health support and intervention services in remote Australia can dissuade people from seeking help until they are in crisis. In an original prospective study during 2014–2017, Gardiner and his colleagues found that the Royal Flying Doctor Service transported 2257 people from rural and remote locations to larger towns and cities for the treatment of mental and behavioural disorders, the major diagnoses of patients including schizophrenia, bipolar affective disorder, depression, and, particularly among younger patients, substance misuse disorders. The most frequently implicated drug in fatal overdoses in Australia is paracetamol (acetaminophen). Cairns and her colleagues retrospectively reviewed paracetamol overdose‐related hospital admissions and deaths in Australia and the overdose sizes of intentional paracetamol overdoses, as reflected in data from several national databases.…”