Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia.

INTRODUCTION: Development of sustainable multidisciplinary services in north-west Queensland, Australia, is challenged by large distances, culturally diverse communities, a prolonged wet season, a history of poor retention of allied health professionals (AHPs), and high prevalence of chronic disease. In 2001, the Northern Queensland Rural Division of General Practice drew on wide community consultation and recent research into the recruitment and retention of AHPs to develop a Model for delivery of outreach allied health services operating within a primary healthcare framework. AIM: to develop a Model of allied health service delivery using the principles of primary healthcare, to meet the needs of 11 culturally diverse (indigenous, non-indigenous and mixed) remote communities, in an area of over 373 000 km2.
METHODS: The development of the outreach Model of allied-health service delivery occurred over four stages: (1) Formulation of a planning matrix as the outcome of a workshop to identify the core components; (2) Environmental scan including mapping of existing allied health services and identification of gaps in service delivery; community consultation to assist in the gap analysis of service delivery, identification health priorities at a local level, and provision of context as to how services should be provided; analysis of available morbidity, mortality data and screening data; (3) Desktop analysis of previous research into the recruitment and retention of allied health professionals, and determination of a 'reasonable' level of service delivery in rural and remote areas; and (4) Synthesis of information to develop options or a Model of service delivery.
RESULTS: The environmental scan indicated the need for a raft of AHPs to address chronic disease and injury in the target communities, including the disciplines of physiotherapy, podiatry, dietetics, occupational therapy, speech pathology and psychology. The Model of service delivery sought to provide services in a form appropriate to communities (ie regular and reliable), with duration of visit providing opportunities for case conferencing and inservice education with resident health professionals and workers. A range of strategies were developed to support the recruitment and retention of allied health professionals, including working and travelling in functional teams; orientation to remote practice; schedules that recognize the need for time back at base, and utilisation of aircraft to minimise travel time; employment packages recognizing isolated and remote practice, professional development, postgraduate study, professional and clinical mentoring; financial subsidies for housing and childcare. A hub-and-spoke model of service delivery was developed with functional teams visiting each community on a 6-weekly rotation for 2-3 days/community per rotation, dependent on population. The duration of visit would promote opportunities for community development, training therapy assistants to promote continuity of care, and health promotion activities within the primary healthcare framework under which the service would operate. Integration and coordination with existing resident health and community services, and visiting services, was considered through the development of a 6 month calendar of service delivery, and Memoranda of Understanding with state health services to allow access to clinics and client records.
CONCLUSION: The planning matrix informed and underpinned the final form of the outreach Model of service delivery. The process described enabled the development of a Model for delivering allied health services in a remote rural area that considered the burden of disease, context for service delivery addressing community concerns with visiting services, recruitment and retention of health professionals and integration with resident and visiting health and community services. The strategies employed provide a template for allied health service development in rural and remote areas internationally.