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.
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.
aRehabilitation Studies Unit, Faculty of Medicine, University of Sydney, Sydney, Australia
bNew South Wales Spinal Outreach Service, Sydney, Australia
cNew South Wales State Spinal Cord Injury Service, Sydney, Australia
dSpinal and Rehabilitation Medicine Department, Prince of Wales Hospital, Sydney, Australia
eSpinal Cord Injury Outpatient Services and Research, Royal North Shore Hospital, Sydney, Australia
fRehabilitation Unit, Tamworth Base Hospital, Tamworth, NSW, Australia
Correspondence to James W. Middleton, MBBS, PhD, Rehabilitation Studies Unit, Faculty of Medicine, University of Sydney, PO Box 6, Ryde NSW 1680, Australia
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.
ABSTRACT