Occupational therapy practice in rural and remote South Australia

Abstract

Health care delivery in rural and remote areas of Australia is a challenge because of the distances involved together with the sparse population cover. In this issue, health care delivery in rural and remote South Australia is tackled from the perspective of occupational therapy managers. Boshoff and Hartshorne1 describe the services provided by occupational therapists as well as the strategies employed by therapists to deliver services. They used surveys to gather the data. Survey data can provide a description of the ‘state of play’. What the Boshoff and Hartshorne article gives, together with other knowledge that is accumulating on the allied health professions in rural and remote areas,2 is a description of what is happening ‘on the ground’. Having worked as a therapist in a multidisciplinary team covering a large rural area with a high client–therapist caseload, the findings of this study raised issues I could identify with, for example, the variety of work and community settings used by therapists to deliver services. In order to deliver services across wide geographical areas, rural and remote therapists require in-depth knowledge of their community and the resources (both people and places) within that community. The professional knowledge of health professionals needed to service clients varies little between metropolitan and rural and remote areas. The challenge to health professionals outside metropolitan areas is the tension between specialist versus generalist knowledge and how to deliver services over vast areas. Mills and Millsteed3 described the knowledge used by occupational therapists in rural and remote areas as more generalist than specialist. Rural and remote therapists work over wide geographical regions, which results in the provision of services to a wide age range of people with a wide range of health conditions. This makes developing highly refined specialised knowledge of certain conditions or of population groups difficult, and this situation was identified by the South Australian occupational therapists. Boshoff and Hartshorne found that the knowledge base of occupational therapy worked well in rural areas because of its holistic, problem-solving stance, and this combined with other strategies, such as multiskilling of therapists and continuing professional development, were used to cope with the need for such a wide knowledge base. Health services in rural and remote areas cannot be provided without staff on the ground. Retention of rural and remote staff is an issue that is receiving more and more attention as service providers and governments seek information on what factors influence staff to stay or leave positions.2, 4 Maintaining health professionals ‘on the ground’ is a complex interplay between professional and personal needs. Boshoff and Hartshorne described a workforce where just over half of the respondents had 2 years or less of experience in a rural area. In Queensland, rural areas have been called ‘professional nurseries’5 with new graduates making up large proportions of the workforce. Retaining young professionals in rural and remote positions is a challenge. The Boshoff and Hartshorne study made the interesting finding that the vast majority of therapists felt adequately supported in the work place even though they were working with high client–therapist caseloads and covering large geographical regions. Support has been found to be an important indicator of retention in other studies.3, 6 A variety of strategies were used to provide a sense of support for therapists, such as student networks, networking, professional associations and communication (by various means) within the profession and across professions, local and regional meetings, continuing professional development and exchange of information and knowledge with therapists in metropolitan areas. Support of managers, other therapists, support from other disciplines, support for further training and up-skilling and support of allied health support staff were important to maintaining a sense of connection to the profession, the field and an increase in knowledge. Good networking reduces the sense of isolation and gives the feeling of being in a dynamic learning environment. Networking and networks are important to rural and remote therapists. Heath services that recognise the time and importance of networking and building up networks are organisations that support staff because networks assist in problem solving, can be a means to providing a variety of services, and also provide another level of social interaction for the therapist within the community. Allied health professionals provide important health services in primary, secondary and tertiary areas of health care. Maintaining a highly qualified and stable allied health service in rural and remote areas of Australia is important for Australians' health and well-being.