Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution

Human Resources for Health

Matthew R McGrail²  Catherine M Joyce¹  Belinda G O’Sullivan³ 

[1] Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Level 6, 99 Commercial Road, Melbourne, Victoria 3004, Australia;School of Rural Health, Monash University, Northways Road, Churchill, Victoria 3842, Australia;School of Rural Health, Office of Research, Monash University, Level 3, 26 Mercy St, PO Box 666, Bendigo, Victoria 3550, Australia

关键词: policy;    service planning;    hub;    workforce;    medical;    visiting;    outreach;    remote;    rural;   

Others  :  1139389
DOI  :  10.1186/1478-4491-12-50

 received in 2014-06-17, accepted in 2014-08-22,  发布年份 2014

【 摘 要 】

Background

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. 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.

Methods

We 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.

Results

Of 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).

Conclusion

There 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.

【 授权许可】

   
2014 O’Sullivan et al.; licensee BioMed Central Ltd.

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