Abstract
BackgroundOutreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel. In Australia, rural outreach is commonly provided by specialist doctors who periodically visit the same community over time. However information about the level of participation and the distribution of these services nationally is limited. This paper outlines the proportion of Australian specialist doctors who participate in rural outreach, describes their characteristics and assesses how these characteristics influence remote outreach provision.MethodsWe used data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, collected between June and November 2008. Weighted logistic regression analyses examined the effect of covariates: sex, age, specialist residential location, rural background, practice arrangements and specialist group on rural outreach. A separate logistic regression analysis studied the effect of covariates on remote outreach compared with other rural outreach.ResultsOf 4,596 specialist doctors, 19% (n = 909) provided outreach; of which, 16% (n = 149) provided remote outreach. Most (75%) outreach providers were metropolitan specialists. In multivariate analysis, outreach was associated with being male (OR 1.38, 1.12 to 1.69), having a rural residence (both inner regional: OR 2.07, 1.68 to 2.54; and outer regional/remote: OR 3.40, 2.38 to 4.87) and working in private consulting rooms (OR 1.24, 1.01 to 1.53). Remote outreach was associated with increasing 5-year age (OR1.17, 1.05 to 1.31) and residing in an outer regional/remote location (OR 10.84, 5.82 to 20.19). Specialists based in inner regional areas were less likely than metropolitan-based specialists to provide remote outreach (OR 0.35, 0.17 to 0.70).ConclusionThere is a healthy level of interest in rural outreach work, but remote outreach is less common. Whilst most providers are metropolitan-based, rural doctors are more likely to provide outreach services. Remote distribution is influenced differently: inner regional specialists are less likely to provide remote services compared with metropolitan specialists. To benefit from outreach services and ensure adequate remote distribution, we need to promote coordinated delivery of services arising from metropolitan and rural locations according to rural and remote health need.
Highlights
Outreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel
Remote and outer regional locations have the smallest proportion of medical specialists [6].Outside of regional centres, nonmetropolitan Australia is a large country with vast stretches of uninhabited land and a large number of small and dispersed communities, which are located up to 1 000 km from service centres
Specialists who did not report the specific rural town/s they travelled to were excluded from all analyses because we considered this practice aligned with locum rather than outreach work, which comparatively involves a strong awareness of revisiting specific communities over time
Summary
Outreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel. Rural outreach by specialist doctors is supported by Australian policy [2,3] and research [4] to overcome workforce shortages, address priority areas of care and provide professional support and education for permanent rural health staff. It depends on health workers who are willing to travel and their distribution to areas of need. Remote outreach is challenging due to extreme distances, rugged terrain, more limited infrastructure and lower clinical throughput [9]
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