Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1941-1947, October 2008

Issues and Challenges for Development of a Sustainable Service Model for People With Spinal Cord Injury Living in Rural Regions

Presented in part to the Australian and New Zealand Spinal Cord Society Conference, November 1–3, 2007, Sydney, Australia.

  • James W. Middleton, MBBS, PhD

      Affiliations

    • Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, Sydney, Australia
    • New South Wales Spinal Outreach Service, Sydney, Australia
    • New South Wales State Spinal Cord Injury Service, Sydney, Australia
    • Corresponding Author InformationCorrespondence to James W. Middleton, MBBS, PhD, Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, PO Box 6, Ryde NSW 1680, Australia
    • ,
  • Melissa McCormick, RN, BaHSc, MPH

      Affiliations

    • New South Wales Spinal Outreach Service, Sydney, Australia
    • ,
  • Stella Engel, MBBS

      Affiliations

    • Spinal and Rehabilitation Medicine Department, Prince of Wales Hospital, Sydney, Australia
    • ,
  • Susan B. Rutkowski, MBBS, MHA

      Affiliations

    • Spinal Cord Injury Outpatient Services and Research, Royal North Shore Hospital, Sydney, Australia
    • ,
  • Ian D. Cameron, MBBS, PhD

      Affiliations

    • Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, Sydney, Australia
    • ,
  • Peter Harradine, MBBS

      Affiliations

    • Rehabilitation Unit, Tamworth Base Hospital, Tamworth, NSW, Australia
    • ,
  • Jennifer L. Johnson, BAppSci, MHA

      Affiliations

    • New South Wales Spinal Outreach Service, Sydney, Australia
    • New South Wales State Spinal Cord Injury Service, Sydney, Australia
    • ,
  • David Andrews, RN, GradCertHSM

      Affiliations

    • New South Wales State Spinal Cord Injury Service, Sydney, Australia

Abstract 

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.

Objective

To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.

Design

Service development, pilot evaluation study.

Setting

Regional and remote areas of the state of New South Wales, Australia.

Participants

Persons with SCI, caregivers, and health professionals.

Intervention

Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.

Main Outcome Measures

Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.

Results

Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.

Conclusion

Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.

Key Words: Community networks, Community outreach, Education, Rehabilitation, Rural health services, Spinal cord injuries

List of Abbreviations: NSW, New South Wales, SCI, spinal cord injury

 

 Supported by the Motor Accidents Authority of New South Wales, the Commonwealth Government through the Medical Specialist Outreach Assistance Program (travel support), the Paraplegic and Quadriplegic Association of New South Wales (travel and accommodation costs), the Australian Quadriplegic Association (now Spinal Cord Injuries Australia), and the New South Wales Spinal Outreach Service.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Reprints are not available from the author.

PII: S0003-9993(08)00500-5

doi:10.1016/j.apmr.2008.04.011

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 10 , Pages 1941-1947, October 2008

Article Tools

* Image Usage & Resolution