ATH TV: Chronic Disease inquiry hears from Rural Doctors Association

ATH TV: Chronic Disease inquiry hears from Rural Doctors Association


Hello, and welcome
to About the House. Chronic disease is
defined as illness that is prolonged in
duration, doesn’t often result spontaneously, and
is rarely cured completely. The Standing Committee
on Health is currently conducting an inquiry into
chronic disease prevention and management in
primary health care. At a recent public hearing,
the committee heard from Dr. John Hall from the Rural Doctors
Association of Australia who has a practise in the
Queensland town of Oakey. I met with Dr.
Hall, and asked him why he believes the
burden of chronic disease is unevenly distributed. It’s been known for a
long time that people from country areas in Australia
have worse health outcomes, so they have shorter
life expectancies. They have a significant
increase in burden of disease, especially around
chronic diseases. So diabetes, skin
cancer, diseases involved around
mental health– also substance abuse,
tobacco smoking. We just know from
statistics that there’s a significant increase
in rural areas with these types of conditions. And we feel that in part this
is related to lack of access to care, lack of access to
programmes that might help people in these spaces. But also, we’re dealing with
a lower socioeconomic group of people, generally,
which means that all those social
determinants of health are affected, leading to this
increased burden of disease. We do have people with
more problems with obesity, problems with
diabetes, which we know is significantly more prevalent
in the indigenous community. And one of the real struggles
is that these people can’t access care. We have a good quality general
practise in the town and a good hospital, but there are
issues around transport– a lack of public transport–
difficulties socioeconomically where these people literally
can’t afford to travel. So it demands that the local
health service provides much higher level care. And we can provide that in
part, but it’s challenging. And it requires a lot of extra
time, a lot of extra support, and it costs a significant
amount more than, say, running a private practise
in a metropolitan area. When people get
care in the country we find that they’re
getting high quality care. So when people are able to
access that care and they attend a GP practise,
or a GP practise nurse, or diabetes educator, or
indigenous health worker, or working with the
local hospital– people can get high level care. When we’re talking
poorer health outcomes, it’s more of a
population statistic where per capita, these
people can access care. We know there’s a significant
Medicare underspend per capita for rural people, which
means that a lot of them just aren’t accessing care,
whether they can’t get in to see their GP
’cause it’s so busy, or they live so far away
that it’s prohibitive. Or they might need specialist
level care where they’ve been able to see their GP, but they
don’t have the capacity to go further afield, or go to a
major centre to have a procedure done, or the likes. So there’s some of the
challenges and barriers. But we feel strongly that
the rural model of care is a good one because it’s
a close knit community. You’ve got patients sticking
with the one doctor, generally. They get to know that
doctor really well. They get to know the practise
staff well, and the nurses. And when people
are in that system, they actually have really
good health outcomes. So we see locally in our
practise that people that are on our chronic disease
programmes that are having their diabetes
managed through us– we get over the challenges
around access to specialist care by involving specialists
with teleconference, or video conferencing, or
even just the doctor ringing, like the GP ringing and taking
specialist advice on the care of a patient can make
a huge difference to someone’s outcome. So whilst they might be able to
access specialty care because of the tyranny of
distance, they’re still getting
specialty level care by having a coordinated
multidisciplinary teamwork approach where we bring in
the specialist remotely. Look, there needs to be better
funding that reflects and makes that type of care possible. Currently, now, if I sit on
the phone for half an hour with a specialist taking
advice on a patient, that’s not funded. If I bring a patient who
lives out on a property and give them advice
over the phone because they can’t get
in, that’s not funded. It takes me time,
but it’s not funded. So that’s why there’s these
access to care problem, because my day might be fully
booked from 8:00 in the morning until 7:00 at night. And I’m spending some of
that time on the phone, or doing other work, sifting
through red tape and paperwork which is unfunded. So for us to provide that higher
level of care effectively, we need to see better
funding for the team, so better funding directly
for practise nurses. So I would support item numbers
that funded practise nurses, item numbers that supported
nurse practitioners better specifically rurally loaded. And also physician
assistants and indigenous health workers getting
better access to Medicare– also allied health. Often in country towns allied
health, we employ them, they use some of our space. And often they have
viability issues themselves. So if you could block fund–
if you could provide funding to country practises that
allowed them to then employ allied health
psychologists, podiatrists, physiotherapists– you would see
much more of that type of care delivered locally in the bush. But there are real
cost barriers to being able to provide the classic
super clinic in the bush because we just don’t have
the funding and the time, and the workforce to do it. If you’d like to
follow the inquiry, or read the submissions,
see the committee website.

Author: Kevin Mason

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