Establishment of and first 20 months of operating an outreach geriatric clinic in a regional centre

Abstract

Providing geriatric assessments to older people residing in rural or remote areas is a challenge due to the complexities of distance and a declining medical workforce. This study aimed to develop a feasible model of service delivery in a rural area, delivering specialised falls and memory clinics similar to those available in the metropolitan area. At the end of the first 20 months we evaluated the service in terms of patient access and the satisfaction of the local health care providers. A meeting was held with key stakeholders to identify existing service provision in the region, and to determine which services were needed. Clinic attendance and information on services provided by the clinic were collected. Questionnaires regarding clinic performance were sent to health-care providers in the region. The stakeholder meeting identified communication, collaboration and continuing education as the main services required of the clinic. The clinic model included a specialist geriatrician and an extended practice nurse specialising in aged care. Between May 2003 and Dec 2004, 115 people were assessed by the extended practice nurse. Interventions relating to falls and cognition were accessed by clients. Time from referral to seeing a specialist and failure to attend rates were comparable to rates seen in the metropolitan clinics. All heath-care providers who responded to the survey found the service useful. Our clinic model is a possible mechanism for delivering ambulatory aged care services to rural and remote regions. This model of care did not improve access or shorten waiting times for attendees. Future models of specialised rural care need to explore innovative workforce strategies to improve access.