Flying doctors suggest rural health fixes

Jolyon Attwooll

14/02/2023 3:31:28 PM

RFDS report shows stark lack of rural health access, with the commonest emergency presentation being one that primary care could help prevent.

Flying Doctors air strip
Most recently, the most common reason for aeromedical retrievals was for diseases of the circulatory system.

More than 57,000 people in remote areas of Australia do not have access to a GP within a recommended distance, according to report released by the Royal Flying Doctor Service (RFDS).
The research, Best for the Bush: Remote and Rural Health baseline 2022, also reveals that the most common reason for RFDS emergency evacuations is heart disease. 
Of 34,082 retrievals conducted by the RFDS in 2021–22, more than 30% involved Aboriginal and Torres Strait Islander patients, and more than 55% of patients were male. Diseases of the circulatory system topped the reasons for the service at 21% of the total.
‘In many cases, cardiovascular disease can be prevented or carefully managed in the primary healthcare setting to avoid the need for urgent intervention, such as an aeromedical retrieval or hospitalisation,’ the authors wrote, before stating that access to primary healthcare is ‘significantly lacking’ in many rural areas.
On a similar note, the authors said their analysis suggested people from rural and remote areas are 2.5 times more likely than their city counterparts to be hospitalised for a reason that is potentially preventable.
‘All Australians should expect reasonable access to primary healthcare services no matter where they live,’ RFDS Federation Executive Director Frank Quinlan said.
‘For Australians living in rural, remote and regional Australia, access to simple services such as a nurse-led clinic, a GP, a dentist or a specialist is much, much harder.’
According to the AIHW, a one-hour drive time ‘is often considered to be the maximum time people should have to travel to access primary or emergency healthcare’.
The RFDS said that, according to its Service Planning and Operational Tool, there are 57,899 people who do not have access to GP services within that timeframe, with an estimated 44,930 people without access to any primary healthcare services at all.
The authors are calling for additional funding to address the inequities, as well as primary care plans for certain populations.
‘Focused effort should be made to establish and deliver comprehensive primary healthcare plans for high-risk individuals, based on evidence of the most effective health preventions to ensure optimum health and wellbeing that is tracked through comprehensive monitoring,’ they recommend.
With the prevalence of cardiovascular disease, they said ‘it may be appropriate that all people aged over 45 years in rural and remote Australia, and especially males and Aboriginal and Torres Strait Islander people receive additional intervention, information and prevention services addressing risk factors for heart disease’.
The RFDS also called for a clearer definition of reasonable access to healthcare which would ‘consider proximity, as well as affordability, cultural appropriateness, availability, frequency and mode of delivery’.
‘Equity of access is a major objective of the Medicare system – that being Australia’s publicly-funded universal healthcare insurance scheme,’ they stated.
Additionally, they advocated for improvements to local service planning and monitoring health outcomes, and called for national agreement between the Commonwealth, states and territories to tangibly improve health outcomes of those living outside the cities.
The RFDS report also highlighted the huge life expectancy inequities of people in the most remote areas of the country, stating that females live 19 years less than their counterparts in major cities, while males died 13.9 years earlier on average (in 2020).
These figures are supported by the Australian Institute of Health and Welfare (AIHW). In its rural and remote statistics, the AIHW data for rural and remote healthcare shows the median age of death for males who died in major cities in 2020 was 79.6, with the equivalent group in very remote areas standing at 65.7 years.
While the median age of death for females in very remote areas was older at 66.2 years compared to men, the gap was even more pronounced with the median age of death sitting at 85.2 years for women in major cities.
In a foreword to the report, the National Rural Health Commissioner Adjunct Professor Ruth Stewart said the RFDS research ‘demonstrates how these challenges can be addressed by systematic service planning’.
Improving access to care in rural communities is among the RACGP’s stated advocacy priorities.
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