Armidale NSW - Case Study Example

Case Study – Armidale NSW Institution Names Table of Contents Table of Contents 2 Introduction 3 Part 1 –Populations and health 3 Health and related services 3 Special populations 4 The elderly people 4 CALD Population 5 Social Determinants of health 5 Part 2 – Workforce and service models 6 Biomedical model 6 Primary health model 8 Departure of GP and Recruitment and retention strategies 8 Part 3 – Rural and Remote Practice 10 Adult with newly diagnosed type II diabetes 10 Cultural 10 Confidentiality 11 Community based health care 11 Inter-professional practice 12 Computer based technology 12 Conclusion 13 References 14 Introduction Armidale is faced with the rising demand for healthcare, amid limited resources and increased inequalities in health. The concept of need includes the needs expressed and felt by local communities that move beyond the concept of demand to the individual’s capacity, to take advantage of the public health initiatives and healthcare programmes. In the case of Armidale, the factors affecting health and which determine health needs, include, the physical environment, where people live, the social environment, household income, lifestyle and behaviours and the family genetics and individual biology. This paper explores the community health needs of the people of Armidale, workforce and service models applicable in the area, and a GPs rural and remote practice in supporting an adult with newly diagnosed type II diabetes. Part 1 –Populations and health Health and related services Armidale has public and private hospitals. It has eight medical practices with a sum of 12 medical specialists, 10 private dentists, 30 GPs, 5 anaesthetists and three orthodontists, as at the year 2010 (HNE Health, 2010). Additional healthcare professionals include some complementary healthcare practitioners, such as psychologists who also serve the Armidale community. Among the leading healthcare services providers include Amidale Hospital, John Hunter Hospital, Royal North Shore Hospital and Tamworth Hospital. Armidale hospital provides general medical services. As at 2010, it had 3.5 full-term equivalent (FTE) general staff specialist and one specialist for rehabilitation (HNE Health, 2010). The medical staff practices acute medicine, infectious disease, renal services, geriatrics, rehabilitation, paediatrics endocrinology and cardiology. John Hunter Hospital provides interventional cardiology. Special populations Armidale had a population of nearly 23,580 people, as at June 2011 (HNE Health, 2010). Of particular concern are two special populations: the elderly and the culturally diverse and linguistically diverse (CALD) population. The elderly people In order to ensure that the future service demand for healthcare, such as cancer, maternity, mental, mental disorder cardiology and general health, is addressed for both special populations, several projections have been made. The population of the elderly aged 65 and above is projected to increase by 56.8%, particularly those aged 85 years and above whose population will grow by 70.8 percent (See Table 1). Figure 1: Projections of population growth for Armidale Since older age groups need more frequent and longer health services -- due to higher levels of chronic disease and injuries due to falls -- there is a need for more residential homes and facilities for the elderly. A key area that needs growth is, therefore, the residential facilities for the aged people, between the ages of 65 years and above. CALD Population The Armidale population is either in decline or static. The Armidale catchment area is largely Australian born. Despite this, the number of populations settling in the area is constantly rising. Most of this population originates from non-English speaking countries, such as China, Germany and Saudi Arabia. Indeed, Armidale is a designated refugee resettlement region. The culturally diverse and linguistically diverse (CALD) people mostly suffer from poorer socio-economic status and ill-health. Hence, they need higher health needs compared to the general population. This is because of inadequate access to services, due to poor language skills, unfamiliar social systems and lack of information on healthcare services. They may also have divergent cultural perceptions on health. Social Determinants of health Social determinants of health determine the health status of populations. Among them include social status, income, education, personal health practices and employment conditions. Armidale has a high level of socio-economic advantage (Navarro, 2009). Most people earn high income, have higher educational level, and are in gainful employment. Over 37 percent of the population has attained Year 12 education. Additionally, 36 percent own homes while 49.4 percent of households have grossly weekly income of over $1000 a week. Additionally, only 3.7 percent are unemployed. This shows that the population is generally expected to have better health outcomes (HNE Health, 2010). A huge amount of evidence indicates that people with higher incomes and high educational levels, as well as higher levels of employment have better health outcomes compared to the poorer populations. However, there are disparities between the metropolitan and the remote regions of Armidale, in respect to socio-economic status, specifically when it concerns income levels. The health status disparity relates to the issues, such as differences in the income levels, as well as access to health and transport services (Katterl et al. 2011). It is well documented that the health status of individuals living in the remote and rural areas is poorer compared to the urban communities. The lifestyle also exposes the population to risks. For instance, a three-year longitudinal study, ended in 2010 by the University of New England and Armidale Dumaresq Council, revealed that Armidale suffers from problems of temperature inversion layers that trap significant amount of wood smoke (SmartBurn, 2014). It was further estimated that a third of the households in Armidale use wood for heating, which has adverse health risks, such as night-time coughs, colds, eye and ear infections, difficulties in breathing, heart attacks, stroke and cancers (Jeffery, 2012). Part 2 – Workforce and service models Biomedical model The ‘hub and spoke’ model is generally applied in Armidale. According to HNE Health (2010), the model has been effective since the place is classified as a rural community and far from major palliative healthcare service provider. In actual fact, the place is approximately 390 kilometres from John Hunter Hospital -- which is the nearest tertiary centre. It is also situated some 111 kilometres from Tamworth Rural Referral Hospital. Therefore, the major healthcare providers are situated far-flung from Armidale. Additionally, the health service delivery in Armidale’s rural nature and the neighbouring communities is hugely affected by the ‘rurality,’ which implies that the healthcare practitioners should expect more extensive and generalist roles in the region (HNE Health, 2010). The model encourages greater dependence on telehealth, visiting services and networking health services to promote appropriate access to services, so as to meet community needs and ensure the absence of pain or illnesses. While the ‘hub and spoke’ model is aimed at ameliorating a range of health issues affecting the Armidale, it is not consistently applied, particularly in the remote Aboriginal communities. An alternative could be having biomedical healthcare services and Aboriginal health services available at each primary hub or catchment area in Armidale, based on community need (Birks et al. 2012). Examples of services may include Aboriginal Services, dental health services, chronic disease management services and allied health and rehabilitation services (Neville, 1993). In remote Aboriginal communities in Armidale, community control of health services is insignificant than promoting their effectiveness and reliability. Hence, Aboriginal health services are used rather than the mainstream services. The interventionist model of secondary healthcare is also suggested. In this model, rather than provide proactive services to meet the identified palliative health needs, the health practitioners react to the healthcare crises that arise (Bidwell, 2001). Using this model, the registered nurse substitutes the general practitioner as primary care provider in the community. This is specifically the case for individuals whose registration is endorsed for rural and remote practice. To this end, the rural and remote practice nurses supply antibiotics, in addition to other medications; hence people would approach them rather than go to far-flung hospitals in towns or the GP. Primary health model Multipurpose centres (MPC) healthcare service model is designed to deliver various local services to small Armidale rural and remote communities, so as to ensure the limited health resources are co-ordinated and shared effectively. The multidisciplinary approach is provided in partnership with government agencies, NGOs and GPs. The model places emphasis on involvement of the communities in defining their health needs and preventing infections. However, it is less integrative and effective, since Armidale has CALD populations and a growing aged population. An alternative could be Multipurpose services (MPS) healthcare service model. MPS uses a more ‘one stop shop’ delivery model than MPC. Additionally, MPS includes the aged-care services while MPC can include any service. MPS also integrates several acute hospital services, based on aged and community care services and primary healthcare. Enhanced model of Primary Healthcare is also suggested for the indigenous communities and the CALD population, since it prioritises on promoting preventive health and education (Birks et al. 2012). This model mainly uses a strategy called “house health promotion.” In the case of reaching Aboriginal people, it involves the Indigenous health practitioners visiting the Indigenous people in their homes to engage in one-on-one health promotion or perform screening. The targeted areas involve the smoking mothers and alcohol and drug use. Departure of GP and Recruitment and retention strategies The general practitioner (GP) leaving Armidale without any replacement would have greater adverse effects than the impact of one leaving their practice in metropolitan areas. This is since replacing the rural GP would be difficult since there are substantially few GPs in the area. According to Hansen (2013), getting a GP from the metropolitan areas to work in the rural Armidale area would be difficult. This implies that unlike in metropolitan areas, Indigenous people would not have culturally pertinent services. There would also be increase inequalities in health services between the rural and town areas. Additionally, the rural areas would not have the required workforce to offer services. People in the remote areas of Armidale would also not have services that address their needs. Similarly, avoidable death cases may rise (Tessa et al. 2004; Miller, 2011). The recruitment should be based on rural pipeline, which should apply to home-grown locally trained health professionals. This proposition is premised on empirical evidences that suggest that students with rural origin are more motivated to work in rural settings, ethnicity students from CALD populations are more likely to practice in their communities, and students who are motivated to practice rural medicine from childhood are more likely to do so. Similarly, students who have volunteered to work in rural settings are more likely to work in these areas. An effective concept for recruiting and retaining rural health workforce is, therefore, that of rural pipeline. It describes a career pathway for the rural health workforce, which is perceived as a career continuum that begins at school and ends in a fully-committed, effectively trained and supported rural health workforce (Birks et al. 2012). Central to this strategy is the comprehensive, integrated series of interventions done overtime with the view of supporting certain individuals to develop motivated and well-trained rural health practitioners. The pipeline begins at school where students get exposed to information on health careers to hearten aspirations to seek entrance to health professional training and institutions, after finishing school. At the undergraduate stage, the aspiring health practitioners get exposure on rural placements that encourage them to work in the rural areas. Graduates who have chosen to work in the rural areas are retrained in the system, so as to remain in the pipeline. Once they take on specialist training and internships, they are recruited and retained in the rural areas. Once recruited into the rural workforce, retention strategies are to be used to increase the longevity in the rural and remote areas and to limit staff turnovers. Financial incentive programs can further be applied to increase longevity. Higher salaries and perks can greatly lead to retention of rural workforce (Hansen et al. 2013). Part 3 – Rural and Remote Practice Adult with newly diagnosed type II diabetes As a General Practioner (GP) practising in Armidale, I have a major role in assisting an adult with a newly diagnose type II diabetes to manage the disorder. My role would specificlaly be critical in the rural setting due to the limited allied professional workers and specialist services. Cultural It is perceived that engaging the patient with clinical services to manage Type II Diabetes is more likely to be successful when the cultural norms of the community and confidentiality are taken into perspective. Culturally sensitive intervention models would be appropriate for Indigenous communities in Armidale (Tripp-Reimer & Kelley, 2001). Hence, understanding the cultures of the Indigenous people or CALD population would be critical if the patient comes from these communities. As a GP, it would be critical to consult with the patient, his family or the larger community on the underlying lifestyles. This is since managing Type 2 Diabetes would require some lifestyle change (Azzopardi et al. 2012). For instance, some evidence suggest that specific Indigenous communities are not comfortable seeking advice on medicine and that they are hesitant to seek consumer medicine information or use manufactured drugs that are considered culturally inappropriate. The adult who does not attend her personal appointment may still give regard to the newly diagnosed diabetes. Therefore, non-attendance could trigger more engagement and social support with all the appropriate family (Thepwongsa et al., 2014). Confidentiality The GP is a major player in the therapeutic team and in most cases is the principal medical professional in rural settings. However, there may be shared-care arrangements in managing Type 2 Diabetes. This means instances of sharing information on the diabetic patient are vast. Confidentiality would be a critical component in providing health care to the patient, specifically in a small isolated area in Armidale community. While the patient family and indigenous health workers would be involved in the management, respecting the right to confidential healthcare for the adult patient would be critical (Department of Health Western Australia, 2009). This implies that sensitive health information on the patient should be kept confidential. Community based health care In managing adult Type 2 Diabetes, the chief emphasis should be on lifestyle change. At this stage, it is essential to engage the family and the overall community in ensuring lifestyle modification for the patient. Additionally, Type 2 Diabetes, during adulthood, presents significant consequences on their families and the general community (Harris et al. 2014). Engaging the patient’s family and his community increases the chances of the adult modifying his behaviour. It may further reduce the risk of diabetes and its implications in at-risk family or community. Therefore planned intervention should be undertaken with focus on the demographic and social needs of the community. These could include consulting and engaging with the community and investing in programs, which tackle the social determinants of health, and the funding and resources (Wakerman et al., 2008). Inter-professional practice Multidisciplinary approaches are appropriate for management of diabetes. In Armidale, the core diabetes healthcare team would comprise the GP, diabetes specialist, registered nurse and registered dietician. As the GP, by increasing involvement of allied healthcare professionals in the management plan and collaboration with other health professionals, would ensure a cost-effective alternative for diabetes management (Azzopardi et al. 2012). Computer based technology Several evidence-based programs can be used to improve self-care for Type 2 Diabetes, among them includes the use of computer-based technology that takes input from the patient to offer tailored response, so as to enable behaviour change and emotional management of action-planning (Pal et a. 2013). For this to happen in a rural setting, the patients should be helped to improve their knowledge, as well as understand their patterns of physical activity, eating and compliance with the treatment regimens. The theory underlying education component intervention is anchored in the principles of adult education and learning (Pal et a. 2013). Conclusion Armidale is faced with the rising demand for healthcare, amid limited resources and increased inequalities in health. Armidale, however, has a high level of socio-economic advantage since most residents earn high income, have higher educational level, and are in gainful employment. Of particular concern are two special populations: the elderly and the culturally diverse and linguistically diverse (CALD) population. The ‘hub and spoke’ model is generally applied in Armidale as the biomedical health service delivery model. In the case of primary health, the multipurpose centres (MPC) healthcare service model is used in delivering various local services to small Armidale rural and remote communities to ensure the limited health resources are co-ordinated and shared effectively. The GP leaving Armidale without any replacement would have greater adverse effects than the impact of one leaving their practice in metropolitan areas. Recruitment of a GP with a longer longevity should be based on rural pipeline, which should apply to home-grown locally trained health professionals. References Azzopardi, P., Brown, A., Zimmet,P. et al. (2012). Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention. Med J Aust 197 (1): 32-36. Bidwell, S. (2001). Successful Models of Rural Health Service Delivery and Community Involvement in Rural Health: International Literature Review. Otago: Centre for Rural Health Birks, M., Mills, J., Francis, K. & Coyle, M. (2012). Models of health service delivery in remote or isolated areas of Queensland: a multiple case study. Australian Journal of Advanced Nursing 28(1), 25-34 Department of Health Western Australia. (2009). Working with Youth – A legal resource for community-based health workers. Perth: Department of Health Western Australia Hansen V, Pit SW, Honeyman P, Barclay L. (2013). Prolonging a sustainable working life among older rural GPs: solutions from the horse’s mouth. Rural and Remote Health 13, 2369. Harris, S., Bhattacharyya, O., Dyck, R., Naqshbandi, M. (2014). Type 2 Diabetes in Aboriginal Peoples. Canadian Diabetes. Retrieved: HNE Health. (2010). Armidale Health Services Plan 2010-2014. New Lambton: Hunter New England Health Jeffery, S. (2012). Woodsmoke on the rise. Armidale Express. Retrieved: Katterl, R., Bowers, J., Hagger, C. & Bywood, P. (2011). Regionally-based needs assessment in Australian primary health care. Primary Health Care Research & Information Service Miller, S. (2011). Rural and Remote Health Workforce Innovation and Reform Strategy. Retrieved: Navarro, V. (2009). What We Mean By Social Determinants Of Health International. Journal of Health Services 39(3), 423–441 Neville, N. (1993). A Model of Allied Health Service Delivery to Country Communities in the Upper Eyre Peninsula. 2nd National Rural Health Conference Armidale, 12-14 February 1993 Proceedings Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss J. & Murray, E. (2013). Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus (Review). Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD008776. DOI: 10.1002/14651858.CD008776.pub2 SmartBurn. (2014). SmartBurn in Practice at Armidale Dumaresq Council. retrieved: Tessa, P., Foley, E. & Hutchinson, R. (2004). The Changing Face Of Nurses In Australian General Practice. Australian Journal of Advanced Nursing 23(1), 1-10 Thepwongsa I., Kirby C., Paul, C. & Piterman L. (2014). Management of type 2 diabetes: Australian rural and remote general practitioners’ knowledge, attitudes, and practices. Rural and Remote Health 14(1), 1-12 Tripp-Reimer, T. & Kelley, L. (2001). Cultural Barriers to Care: Inverting the Problem. Diabetes Spectrum 14(1), 13-22 Wakerman, J., Humphreys, J., Wells, R., Kuipers, P.. Entwistle, P. & Jones, J. (2008). Primary health care delivery models in rural and remote Australia – a systematic review. BMC Health Services Research 8,276 doi:10.1186/1472-6963-8-276 Read More