Individual perceptions of existing rural primary health care providers

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1 Individual perceptions of existing rural primary health care providers Informing the development of new and sustainable rural primary health care services Lisa Crossland PhD Student School of Medicine, James Cook University

sustainable rural primary health care services Lisa

2 INTRODUCTION Background Aims and objectives Methodology Analysis Anticipated outcomes References

3 WHY INNOVATIVE SERVICES? International & National Context System review & restructure Primary care workforce shortages 1,2,3,4,6,8,9,10 Changes in community demographics & expectations 5,6,7,15 Chronic & complex care disease 11,12 Refocus on broad principles of primary health care 13,14

care workforce shortages 1,2,3,4,6,8,9,10 Changes in community

4 WHAT ENABLES INNOVATION? Health care system changes 3,5,16,17 Skills-sets vs. health professional shortages 14,18,19 Team work in primary care 20,21,22 Community readiness - inclusion of community perceptions & expectations 23,24, 25,26,30

5 How communities understand their current models of care their perceptions and expectations of current health care professionals and how this may impact on the design and delivery of new approaches to PHC 26 What we know Exposure & usage Geography Age / Gender Role (patient/carer)

how this may impact on the design and delivery of new approaches to

6 AIM & OBJECTIVES To identify individual perceptions of health care providers in a range of existing rural primary care services identify individual perceptions of existing primary health care providers in 4+ communities with range service types; identify & investigate broad differences/similarities between perceptions of primary health care providers; identify & investigate how these perceptions match services (staff skill-mix & service use) within each community setting

service types; identify & investigate broad differences/similarities between perceptions of primary health care

7 METHODOLOGY Phase 1: Focus groups broad archetypes (characterisations) of primary health care providers & in-depth interviews - perceptions of local primary care service types Phase 2: In-depth interviews service provider roles; development of service profiles Phase 3: Development of community profiles (socio-economic; population profiles; broad patterns of morbidity/mortality)

In-depth interviews service provider roles; development of service profiles Phase 3:

8 FOCUS GROUPS & INTERVIEWS Information Attributes associated with the roles of existing primary care service providers within each service type Perceptions of existing primary care services; perceived gaps in service provision Perceptions of the role and function (both professional & broad community-related roles of local primary care services) Sources Focus groups using attributes identified in literature In-depth interviews individuals In-depth interviews individuals Community profiles (population profile; socioeconomic status; morbidity/mortality; previous/planned community health care action) AIHW; ABS; Qld Health; existing service data

local primary care services) Sources Focus groups using attributes identified in literature In-depth interviews individuals In-depth interviews individuals

9 SERVICE PROFILES & STAFF INTERVIEWS Data/Information Background/Service History information Service evolution; policies, guidelines; history of community involvement/action Sources Archived information & interviews Service operation range of clinical services; referral patterns; skills-sets; broad staff roles; service reach; provider perceptions of service gaps Access patterns Staff interviews & service records Service records Other local services Local & regional service links; local services (primary, secondary & tertiary; outreach/visiting) Network mapping; interviews; observation

skills-sets; broad staff roles; service reach; provider perceptions of service gaps Access patterns Staff interviews & service records Service

10 PROPOSED ANALYSIS Community & service profiles Individual perceptions (Service type 1 ) National Individual perceptions (Service type 2 ) Actual Actual National & International Experience

11 ANTICIPATED OUTCOME Conceptual Framework attributes associated with health professionals within different health service types within context of community profiles identified epidemiological needs & actual service use international experience

service types within context of community profiles

12 REFERENCES (1) 1. Farmer J, Lauder W, Richards H and Sharkey S (2003) Dr John has gone: assessing health professionals contribution to remote rural community sustainability in the UK, Social Science and Medicine, Vol 57, pp Berman, P (1995) Health sector reform: Making health development sustainable, Health Policy, Vol 32, pp Building a Health Service fit for the Future. A National Framework for Service Change in the NHS Scotland, The Scottish Executive, National Health Service,National Parliament of Scotland, Brooks, P and Ellis N (2006) Health Workforce Innovations Conference, Medical Journal of Australia, Vol 184 (3): pp Duckett, S (2005) Interventions to facilitate workforce restructure, Australian and New Zealand Health Policy, Vol 2 (14) Accessed online: 22/06/06 6. Sinking Deeper into the Abyss: A concise overview of current and future trends in the Australian urban, rural and remote general practice workforce, Health Workforce Queensland, Australian Health Workforce Productivity Commission, Australian Productivity Commission, Australian Government, Veitch C, (2005) Rural health: Past, Present and Future, Inaugural Lecture, James Cook University, Townsville, Queensland, Australia 9. Jenkins-Clark, S and Car-Hill, R (2001) Changes, challenges and choices for primary health care workforce: Looking at the future, Journal of Advanced Nursing, Vol 34 (6) pp Richards, H; Farmer, J; Selvarig S (2005) Sustaining the rural primary care workforce: Survey of health care professionals in the Scottish Highlands, Rural and Remote Health Online (365) accessed online 24/02/06, Bailey, P; Jones, L et al. (2006) Family Physician/Nurse Practitioner: Stories of collaboration, Journal of Advanced Nursing, Vol 53 (4): pp Richards A; Carley, J et al. (2000) Skill mix between doctors and nurses working in primary care: delegation or allocation. A review of the literature, International Journal of Nursing Studies, Vol 37: pp Tovey, P (ed) Contemporary primary care: The challenge of change, Open University Press, Buckinghamshire (2000) 14. Taylor, J; Blue I, Misan, G (2001) Approach to sustainable primary health care service delivery for rural and remote South Australia, Australian Journal of Rural Health, Vol 9: pp Strasser, R; Hays, R et al (2000) Is Australian rural general practice changing? Findings from the National Rural General Practice Study, Australian Journal of Rural Health, Vol 8 (4): pp

57, pp 673-686. 2. Berman, P (1995) Health sector reform: Making health development sustainable, Health Policy, Vol 32, pp 13-28 3. Building a Health Service fit for the Future.

13 REFERENCES (2) 16. Feldstein, P Health policy issues: An economic perspective on health reform, Health Administration Press, Chicago, USA, Wells, R (2005) The future health workforce options we do and do not have, Outback.doc, Vol 2 (2): pp Sibbald, B; Shen, J; McBride, A (2004) Changing the skill mix of the health care workforce, Journal of Health Services Research and Policy, Vol 9, Suppl 1: pp S O Connor, T (2005) Physician Assistants for Queensland Health: Discussion Paper, James Cook University 20. Opie, A (1997) Thinking teams, thinking clients: issues of health discourse and representation in the work of health care teams, Sociology of Health and Illness, Vol 19 (3): pp Saltman, D; O Dea, N; et al. (2006) IN PRESS Groups or teams in health care: Finding the best fit 22. Farmer J, West C et al (2005) Primary health care teams as adaptive organisations: exploring and explaining work variation using case studies in rural and urban Scotland, Health Services Management Research, Vol 18: pp Humphreys, J; Wakerman, J and Wells, R (2006) What do we mean by sustainable rural health services? Implications for rural health research, Australian Journal of Rural Health, Vol 14: pp Veitch, PC An investigation of the influence of distance on rural and remote area residents' health care behaviour, Thesis: For degree of Doctor of Philosophy, Social and Preventive Medicine, University of Queensland, October, Brown, I (2001) Organisational values in general practice and public involvement: Case studies in an urban district, Health and Social Care in the Community, Vol 9 (3): pp Black, N; Rafferty, A; et al. (2004) Health care workforce research: Identifying the agenda, Journal of Health Services Research and Policy, Vol 9, Suppl 1: S Bridger, J and Luloff, A (1999) Toward an interactional approach to sustainable community development, Journal of Rural Studies, Vol 15: pp Palmer, J; Cooper, I and Van der Vorst R (1997) Mapping out fuzzy buzzwords who sits where on sustainability and sustainable development, Sustainable Development Vol 5, pp Ekins, P (2000) Costs, benefits and sustainability in decision-making, with special reference to global warming, International Journal of Sustainable Development, Vol 3 (4) accessed online 28/06/ Wakerman, J; Humpreys J et al. A Systematic Review of Primary Health Care Delivery Models in rural and remote Australia ; APHCRI September, Cheek, J; Price K et al. Consumer perceptions of nursing and nurses in general practice, Centre for Research into Nursing and Health Care, University of Sotuh Australia, Novmeber 29, 2002

Sibbald, B; Shen, J; McBride, A (2004) Changing the skill mix of the health care workforce, Journal of Health Services Research and Policy, Vol 9, Suppl 1: pp S22-38 19.

Position Statement on Physician Assistants

Position Statement on Physician Assistants Team-based models of medical care that are characterised by responsiveness to local needs, mutual reliance and flexibility have always been a part of rural and