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Rural Health System Resources

BY RURAL PEOPLE FOR RURAL PEOPLE

What is the purpose of Rural Health Plus? Rural, remote and Aboriginal people cannot meaningfully participate in discussions about their health priorities, services, systems or structures without access to information and knowledge about how the system works, the needs of local towns, or what works and what doesn't work in our context.  Without health system literacy, there is a risk that community engagement becomes a one-way street, rather than a shared exploration of issues and opportunities.   This collection of resources, articles, toolkits and guides aims to help rural and remote people build their knowledge and literacy about the health system and what works in addressing the health needs and aspirations of rural and remote communities.

How are resources selected for inclusion? The resources have been selected by rural health experts who are committed to addressing rural health inequities.  The goal is to make it as easy as possible for rural and remote people to access the information they need to help make decisions and advocate for their own needs. Rural Health Plus has deliberately avoided including resources about things that have been proven not to work or where there no evidence of a systemic and meaningful impact on rural and remote access to primary care. The aim of Rural Heath Plus is to cut through all the noise and focus on things that work, that rural and remote people can control, and that deliver real improvements in access to local health care and jobs in local economies.  ​ For example, if two programs or approaches deliver similar outcomes in terms of rural health access but one is run out of the city and the other is run in a local rural community, we will only include a resource about the one run in the rural community because this delivers a wider range of flow-on benefits to our communities and delivers the same or similar outcomes. A core focus is on approaches that have been successfully tried elsewhere and/or evidence-based approaches to improving rural and remote access to health care.  There is a big focus on tools to help communities organise at a local level and advocate for changes in the way health care is delivered in their local community.

​​How do I use Rural Health Plus? Use the Keyword search below to select a topic and access a summary of articles, strategies, policies and programs.

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How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system

In Australia in 2020–21, 79% of all Australians had a chronic condition with 47% reporting one or more chronic conditions. The chronic conditions contributing to greatest burden of disease in 2018 were coronary heart disease, back pain and musculoskeletal problems, dementia, and lung cancer. Many of these conditions are amenable to evidence-based allied health interventions, especially musculoskeletal issues and respiratory conditions. Most people with chronic conditions are managed by their general practitioner (GP) with approximately 70% of Australian GP encounters primarily associated with the management of chronic conditions. With growing shortages of GPs the study aims to establish an evidence-base about the effectiveness of allied health interventions in improving the health outcomes of people with chronic diseases. The comprehensive study found that allied health programs for community dwelling adults improved health outcomes for most chronic conditions

Primary care payment models and avoidable hospitalizations in Ontario, Canada: A multivalued treatment effects analysis

A Canadian study found that a blended funding model (fee for service plus a payment for patient need and complexity of care) for chronic diseases could reduce preventable hospitalisations. The study analysed the effect on hospitalisation rates of different funding models. It found for example that hospitalisations from congestive heart failure were reduced by 30 per 100,000 patients under a blended funding model because it improved access to primary care and promoted team-based (a mix of GP and allied health practitioners caring for a patient) chronic disease management.

Healthy Tasmania 5 Year Strategic Plan

The Tasmanian Health Plan for 2022-26.

Integrating care in remote First Nation’s communities: Experience of health professionals, community services and allied health students.

Allied health services in rural and remote communities often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and First Nations communities. Integration can support primary care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. To respond to the context, a co-designed student-assisted, community rehabilitation and lifestyle service was developed to support very remote communities.

Taking on the Challenge: A Case Study on a Community Health Club for Noncommunicable Disease Control

From 2013 to 2021, the University of the Philippines Community Health and Development Program (UP CHDP) partnered with five municipalities to improve the control of hypertension and diabetes through interventions such as the organization of community health clubs. Most members were elderly, female, non-smoker, and hypertensive. The implementation of the Community Health Hub model resulted in an increase in proportion of members with controlled hypertension after two years. Perceived benefits for members were free, regular, and accessible services, improved knowledge and better control of their condition, and opportunity to socialize with others. Enabling factors were partnership with UP, teamwork and dedication of club leaders, effective management, and community support.

The Utilisation of Teledentistry in Australia: A Systematic Review and Meta-analysis, Journal of Dentistry.

The research examined the evidence for the effectiveness of Tele-dentistry in detection dental decay in rural and remote people.

Evidence base for additional investment in rural health in Australia

This report presents data on the expenditure gap in the Australian between rural and metropolitan areas. It demonstrates a $6.5 billion annual shortfall in health expenditure across hospital, community, aged care, the disability sector, and ancillary care in Australia’s regional and remote communities. The National Rural Health Alliance commissioned this report to better understand current healthcare expenditure and to inform discussions on the health needs of rural Australia.

A theory of how rural health services contribute to community sustainability

This paper examines how health services contribute to rural community sustainability. It establishes a framework for measuring the additional contributions of health services to rural communities over and above the direct provision of healthcare services; that is, their added- value contributions.

Moving from idea to reality: The barriers and enablers to implementing Child and Family Hubs policy into practice in NSW

Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs.

Interventions to improve primary healthcare in rural settings: A scoping review

Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. After reviewing 372 papers divided among quality (82%), access (20%) and efficiency (13%) categories, the majority completed in the USA (40%), Australia (15%), China (7%), Africa (9%) and Canada (6%) the authors found that despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature.

A nurse‐led model of care to improve access to contraception and abortion in rural general practice: Co‐design with consumers and providers

The research describes the key features of a co-designed nurse-led model of care intended to improve access to early medication abortion and long-acting reversible contraception in rural Australian general practice.

Empowering healthy communities and individuals: removing barriers through health literacy

Health literacy, as defined by the World Health Organization (WHO), refers to an individual’s ability to “gain access to, understand and use health information in ways which promote and maintain good health for themselves, their families and their communities.” It is a key driver of health outcomes, as it helps individuals to develop the necessary understanding and ability to make informed decisions about their health. Promoting health literacy also empowers societies to navigate their health and wellbeing when healthcare services may be lacking or hard to access, which reduces health disparities and builds resilient communities. Low health literacy is a global challenge. Populations with low health literacy have limited knowledge about where and when to seek appropriate healthcare services, are less likely to seek preventative care, manage their health poorly and often face higher mortality rates. The impact is extensive: the estimated annual cost is AU$5-10bn per year. Hospital readmissions are the primary driver of these costs, as patients struggle to self-manage their condition. Low health literacy also increases the incidence of preventable health issues, drives up reliance on emergency services and leads to poorer health outcomes.

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