Case study Assessment
The following is an essay on a case study assessment. It is about the health needs of Bourke NSW, Australia and looks into the health services available in that community, the cultural groups and communities in the area as well as different health needs. It discusses the Social determinants of health and how it affects the health needs of Bourke NSW, Australia community’s population groups.
The second part of this essay looks into the models of service delivery used to address the particular health needs of the community through a biomedical approach. It includes research and description of the medical workforce in Bourke community and discussion of the impact of removal of the general practitioner.
There is a discussion on the impact of one GP leaving the practice in a town classified as ASGC-RA 2. The third part of the essay is about how real life practice might look at a particular scenario of health professional and patient, covering cultural safety, inter-professional practice, and use of computer based technology.
Range of health services available in Bourke
There are services that are available for the Bourke community. Though it is a remote part in Australia the area has a multipurpose service hospital that offers variety of services such as the general medical services, minor surgeries, obstetrics, and care services for the aged (Department of Health and Ageing 2004).
The hospital staffs are general practitioners from the local community and other visiting staff. There is the Bourke community primary service, which has the community health service and mental health service (Barnes et al. 2003). This community service has two outposts that offer health services to remote places in Bourke. The health services centres are Wanaaring and Enngonnia (Rose 2006).
Cultural groups or special populations and their different health needs
New South Wales Bourke is a sparsely populated area with two dominant groups. The aboriginal community comprises of thirty per cent of the population while the other people are immigrants (Department of Health and Ageing 2004). Their health needs are not different from each other and require general medical services as well as specialised medical services (Vinson 2004).
However, the aboriginal population has people who suffer from drug dependence or alcoholism and they may need specialised attention in a rehabilitation centre to help them overcome addiction (Barnes et al. 2003). The Bourke Aboriginal community is special because they live in remote villages that are far from the mainstream health facilities and walk for long distances to access health services (Department of Health and Ageing 2004). This makes it hard for the local community to access health services immediately.
Social determinants of health and their effect local community
These factors affect the health condition of an individual directly or indirectly. The social determinants are those factors that affect the individual’s health. They are not contributed by the individuals but through social factors surrounding the individual such as the education, health policies, health support systems as well as the education of the local community (Hagan et al. 2001).
In the case of the Bourke community, the main social determinant in the community is a rural community. This may have effect on them in matters of accessing health facilities. The other issue is education as many people may not be educated meaning that there are few local doctors or medical practitioners who live in the community. The other social determinant of health is the poverty level.
The employment level in Bourke is at 7.3 per cent lower than in the rest of the areas in Australia (Barnes et al. 2003). This means that most people in the area are economically stable and can afford basic health services. The Aboriginal populations may be poor than other groups in the area mainly because they live in remote areas and may not be employed in urban areas. Most of them work in the farms and informal sectors (Asthana & Halliday 2004).
The other social determinant is the availability of social support networks to work with the local community, which help to access the basic health services. The social support networks such as the Aboriginal Health network has been of help to the local community by bringing the health services where people can access (Barnes et al. 2003).
It has also helped in establishment of mental and drug health service programs among the aboriginal communities in the villages (Hagan et al. 2001). The other determinant relates to the physical environment. In the case of the Bourke NSW community, the physical environment affects the health of the individual in accessing the health care services (Rose 2006).
The models of service delivery used to address the particular health needs of Bourke NSW Australia community, taking a biomedical approach
The first mode of approach by the Bourke community is the discrete primary care services model. This is where the health care services are offered from a central point (Vinson 2004). This approach takes into consideration the health needs of the community and the availability of the general practitioner. In this model, the health care workers operate from one central point where the patients go and find them (Booth 1996).
This approach allows the practitioners to settle as they serve the local community. This model is applicable to the Bourke community that lives in the urban part of Bourke. It is however not fully effective in the case of rural and remote communities that are far from accessing the health facility (Asthana & Halliday 2004). The facility is suitable for specialised treatments such as minor surgeries (Harvey 2001).
The other health service model that may apply in the Bourke community is the integrated health services model. This model usually emerges from other community based health programs that seek to offer alternative health services to the local community (Vinson 2004).
The integrated health service offers variety of healthcare services such as care for the aged as well as rehabilitation services. This model incorporates the general practitioner and the allied practitioners such as the dentists, who usually visit the community (Booth 1996). This model is already in place in the Bourke community (Down, Jeffries & Seward 2000).
The comprehensive primary healthcare services model is appropriate for the Bourke community especially for the aboriginal community, as most of them do not have the mainstream health facilities (Down, Jeffries & Seward 2000).
These primary healthcare services models are at low cost and provide primary services to the clients such as the general practitioner and nurses to assist the patients with medication (Harvey 2001). These primary care services may have only one or two staffs. Their purpose is to meet the primary healthcare needs of the patients.
The outreach model of providing healthcare services use the biomedical approach where the general practitioners provide services to a remote community by visiting the community occasionally or on a routine of once a week or twice (Asthana & Halliday 2004).
This model is applicable in the Bourke community as most of the community members live in remote places where general practitioners or health specialists may not manage to live together with the community. The outreach program enables the doctors to reach out to the community by bringing in their services closer (Smith & Wilkin 1996).
The other model of health care service delivery is the telemedicine. This is where the communities living in rural or remote areas may access health services through communication lines such as telephone, where the patient can call the doctor, explain the symptoms of the disease and the doctor may prescribe the medicines (Asthana & Halliday 2004).
The patient can use the prescription to buy medicine from the local pharmacy. This usually applies to the migrant populations who have come from the cities and they are not used to remote areas. They may not access the personal doctors as quickly as they want. They therefore use telemedicine methods to receive treatment (Vinson 2004).
The medical workforce in Bourke NSW, Australia community
The medical workforce in Bourke falls under various categories. There is one radiotherapist in the Bourke Hospital and one physiotherapist (Department of Health and Ageing 2004). Five workers in the catering department cater for the patients’ accommodation in the health facility (Vinson 2004).
There are six nurses in the wards, five mental health practitioners, one sexual health practitioner, one community health midwife and one Aboriginal health liaison (Rose 2006). This shows that the area has few medical health practitioners (Department of Health and Ageing 2000).
Impact of one general practitioner leaving their practice without any replacement
There would be a negative effect in case any of the general practitioners left the area without any replacement. When considering that the area has many patients, this would strain the existing practitioners making the accessibility of healthcare services more difficult. It will affect the community’s biomedical health negatively and leave many of the community members under the risk of ill health due to inadequate personnel in the healthcare facilities (Down, Jeffries & Seward 2000).
The impact would be different in case of towns classified as ASGC-RA 2. These towns are densely populated such as Sydney, Melbourne with proliferation of medical doctors and health care services (Vinson 2004).
The effect of the doctor moving out without replacement will rarely affect the patients because there are many general practitioners in the area (Hagan et al 2001). There are many private healthcare centres where the patients can seek help unlike in the rural and remote places such as Bourke (Vinson 2004).
There are strategies that may help in retaining medical practitioners in the remote areas. The first one is giving them additional remuneration similar to practitioners in other cities (Rose 2006). The other strategy is to offer the practitioners in Bourke opportunities of advancing their careers through scholarships after their stay in the area for a given period (Smith & Wilkin 1996).
Rural and remote practice
For answering this question, I have chosen to be the doctor. As a doctor in the remote area, there are challenges in relating with the patients as well as ensuring that they get proper treatment. To discuss this issue of rural and remote practice, let me take an example of a child who has recurrent infection. The child lives together with the parents in a rural area in Bourke.
It takes them two hours to come to the medical facility. The child has tried other nearby health centres but the infection has not healed. To deal with such a patient I have to diagnose the child and determine whether the disease is infectious or not. If it is not I will prescribe the necessary dosage to the patient (Vinson 2004).
As a doctor, I must address the issue of intercultural safety. This relates to providing healthcare services without intruding or degrading the cultural beliefs of the community that may put one at loggerheads with the community. To do this I must consult the local community on their cultural practices.
In this case of the child with recurrent infections I will inform the parents of the need to admit the child in hospital so that he is aware where the child and the mother are during treatment. In case of the Aboriginal child, whose culture does not allow the woman to sleep away from home, alternative transport like driving the patient home may apply (Hagan et al 2001).
As a practitioner, I shall keep the clients information confidential (Asthana & Halliday 2004). Keeping the patients records in rural area where there are no electronic health records implies that the records must be stored manually. They must be kept in a safe place where unauthorized person cannot access them. I will do these by ensuring that the facility has secure safes to store patient’s medical history and it is only the doctor who will have access to the records (Hagan et al 2001).
The other factor of consideration when working in rural areas is provision of primary healthcare services to the patients when they are away from the hospital. I may have to visit the patient at home to check the condition of the child. In case there is a remote health centre near the child’s home such as a primary healthcare centre, I may recommend the child’s parent to frequently take the child for health assessments (Asthana & Halliday 2004).
To address the issue of inter professional practice in rural and remote areas I will communicate with other medical practitioners and contact them for assistance in case there is a patient who needs specialised treatment. In case of the child with recurrent infection and it is beyond the available treatment procedures, I may use the allied professionals who come to visit the health care facility occasionally to recommend treatment (Asthana & Halliday 2004).
The other factor of consideration is the use of computer-based technology while in the remote area. This will help to network with other doctors in other parts of the country. The technology helps in accessing information such as prescriptions for the patients. In addition, the medical practitioner will use online communication and social networks making the work more enjoyable compared to instances where the technology is not available (Rose 2006).
References
Asthana, S & Halliday J 2004, ‘What can rural agencies do to address the additional costs of rural services? A typology of rural service innovation,’ Health and Social Care in the Community, vol. 12, pp. 457-465.
Barnes, T, Griew, R, Hill, P, Shannon, C, & Wakerman, J. 2003. Achievements in aboriginal and Torres Strait islander health, Cooperative Research Centre for Aboriginal and Tropical Health, Darwin.
Booth, A 1996, ‘Health service delivery to outback South Australia: A story of organizational change,’ International Journal of Health Care Quality Assurance, vol. 9, pp. 15-19.
Department of Health and Ageing 2004, Health fact sheet 4; A continuing commitment to rural, regional, and remote Australians, Australian Government Department of Health and Ageing, Canberra.
Department of Health and Ageing 2000, Regional health strategy fact sheet 3, Australian Government Department of Health and Ageing, Canberra.
Down, G, Jeffries, F & Seward, M 2000, Towards Northern wheat belt GP sustainability, Western Australian Centre for Rural and Remote Medicine, Perth.
Hagan, P, Kelman, C, Liu, C, & Sadkowsky, K. 2001. Health services in the city and the bush: Measures of access and use derived from linked administrative data, Commonwealth Department of Health and Aged Care, Canberra.
Harvey, P 2001, ‘The impact of coordinated care: Eyre region, South Australia 1997-1999,’ Australian Journal of Rural Health, vol. 9, pp. 69-73.
Rose, G 2006, Primary health care services university led practice made perfect? The sequel NSW Rural Doctors Network, Sydney.
Smith D & Wilkin C 1996, A round peg in a square hole: Changes in a rural health service, Australian Journal of Primary Health Interchange, vol. 2, pp. 63-71.
Vinson, T 2004, Community adversity, and resilience: The distribution of social disadvantage in Victoria and New South Wales and the mediating role of social cohesion, The Ignatius Centre for Social Policy and Research, Richmond.