Family medicine in rural area- perspectives and development opportunities.

Abstract

Access to health care should be universal and equal regardless of health needs, socio- economic status and place of residence. Empirical research confirms, however, that there are differences in access to health care between urban and rural areas. 40% of Poles currently live in rural areas. Until 2050, 27% of them will be of post-productive age, compared to 19% in 2020. What’s important, access to health care in rural areas of Poland is diverse. In some provinces the availability of services is optimal, in others access is severely restricted. The main challenges for the health care system in rural areas are staff shortages, lack of coordination between primary care, outpatient specialized care and hospitals, greater distance from large hospitals, difficult access to specialist and preventive services, and lower effectiveness of emergency care. 
 Practical solutions that can help organization of care in primary healthcare in rural areas have been identified. 
 1.Horizontal and vertical collaboration between healthcare professionals (HCPs).
 Collaboration between HCPs should happen both at level of medical professionals within primary healthcare (PHC) and in collaboration with outpatient specialist care. Delegation of some of doctors’ responsibilities to other professions (nurses, midwifes, care coordinators) will allow for more effective use of recourses. Investing in correct skill-mix for PHC teams is also crucial. 
 2.Financial motivators for HCPs working in rural areas
 Additional financial motivation does not exist in Poland, but it’s implementation is crucial to motivate staff to work outside the larger centers, thus improving care for patients in rural areas. The reward for working in remote and sparsely populated areas should apply to all members of the PHC team – doctors, nurses, midwives, coordinators. An adjustment of the capital increase rate on the basis of three conditions, which add up depending on the circumstances, Degurba index, population density and distance from the Medical University, could be a good solution for the Polish system.
 3.Effective use of modern technologies
 Overcoming technical barriers and effectively implementing telemedicine services can dramatically improve the organization of care, particularly in rural areas facing shortages of staff. Many telemedicine solutions are already successfully introduced in Poland, such as e-prescriptions, e-referrals, phone consultation, electronic doctor’s note. Those should be supplemented by online patient case conferences, access to patients’ electronic health records (EHRs) and sharing of an individual patient plan. 
 Considering main challenges of rural areas, modern technologies based on self-care and remote monitoring of patients' health are likely to greatly improve quality of care received by patients. 
 Study analyzed practical solutions which could improve the organization of primary healthcare in rural areas. Effective and efficient care for the population must be consistent with the concept of care coordination.