Can the health care system for regional Australians be more patient-centric and personalised, delivering great health care inclusively, appropriately and efficiently? What can be done to make regional health care, in reality, more regional and local?
For many patients living outside metropolitan Australia the experience of advanced clinical health care is marked routinely by travelling long distances, life disruption, and social and familial dislocation, as well as (sometimes) personal disorientation and demoralisation.
In other cases, it is not the impact of travel, but the strain of personal isolation, limited resources, social stigma and lack of support that bears down particularly on families dealing with mental health, or drug and alcohol impacts.
Front line feedback about regional health care which fed into the Institute for Resilient Regions’ week long series of symposia back in July stressed the vital importance of patient-centric and personalised care for regional Australians.
The need for clinical practitioners to integrate the healthcare formula sensitively with the life experience, values and personal context of the patient was also highlighted.
This is particularly compelling in those cases involving regional patients who have travelled to receive advanced care in metropolitan facilities, often far from home and their familiar world.
For the clinical professions in their management of patients it requires giving far greater consideration to the logistics of travelling for treatment, including costs and time and the impact on the patient.
It also means taking closer account of the complexity and necessity of some medical procedures set in the context of the patient’s life story and the potential or likely outcomes of the treatment.
When suggesting opportunities for practical innovation in the system, a number of regional clinical participants emphasised the importance of the personal and social benefits of local follow-up treatment for those patients who had to travel for care.
Other contributors suggested the quality and effectiveness of health care support was better when clinicians understood and respected the particular circumstances of regional patients and their healthcare experiences.
Without greater engagement by clinicians in the personal stories of regional patients, some stakeholders argued the changes necessary to bring about positive impacts on regional health were unlikely to happen.
Clearly apparent from the tabling of a range of case examples and personal stories was the need for clinical and allied health services to better understand and consider the ‘regional patient’ identity and culture.
For that to happen, building cultural competence in regional health practitioners was considered to be essential.
Recruitment and maintenance of a quality regional healthcare workforce was also identified as being vital to this goal as was the development of strategies for adapting clinical practice to suit local needs.
One contributor summed up very succinctly the policy challenge for building a patient-centric and culturally-informed service delivery model:
“Building cultural competence and commitment to rural health and generalist medicine provides an opportunity to build services around the regional patient, rather than trying to fit the regional patient into metropolitan systems.”
For researchers the challenge in this juxtaposition of emphasis and approach is starkly evident.
At both the policy and practice level, making the regional dream of more health care being done in the regions needs research that will deliver innovation and new formats for:
- Implementing professional development programs strengthening the cultural competence of clinical practitioners;
- Tailoring healthcare systems for the regional patient informed by regional identify, culture and practice;
- Substantially increasing health literacy in regional communities.
Of course, there are many other things that can be improved also, starting with making the health care system more user friendly, better utilising the skills of regional clinical and allied health professionals, and engaging with the community more effectively and more deliberatively.
These are subjects for further posts soon.
These observations are drawn from a report about Resilient Regions Week 2017 prepared by Professor John Cole and Dr Sonja March drawing on notes of proceedings compiled by Dr Fiona Crawford-Williams, Dr Belinda Goodwin and Ms Arlen Rowe.
Professor John Cole 