Rural and Remote General Practice
Healthcare is important. It’s important that good health is promoted, that early intervention is provided, that patients and families have access to healthcare services they can afford, when they need them. It’s important that this access is smooth and easy – across all areas, from seeing the GP or specialist, from attending a hospital, or using the services for aged care, for disability and for community care.
There are differences in health services and health outcomes between major cities and rural & remote areas.
Rural & Remote areas generally have higher rates of chronic disease, higher levels of health risks and greater levels of need. However they have less access to health services, less health-related infrastructure and the costs of delivering healthcare are higher.
Cardiovascular Disease in Rural & Remote Australia:
25% of people living in rural & remote areas suffer from cardiovascular disease. That’s one in four people. This compares with one in five in metropolitan areas. People in rural & remote areas have more cardiovascular risk factors and are more likely to die from cardiovascular disease than people in metropolitan areas.
Many cardiovascular medications and treatments are under-prescribed and under-utilised. People in rural areas are dispensed medicines (eg beta blockers, ACE inhibitors, statins and warfarin) at half the rate as those in major cities; and people in remote areas at 1/30th. These medicines are all critical for the treatment of cardiovascular disease.
With increasing remoteness there are fewer allied health professionals (eg diabetes educators, dieticians), fewer GPs and fewer nurses. These healthcare workers play an important role in the prevention, treatment, rehabilitation and management of patients with cardiovascular disease.
Cancer in Rural & Remote Australia:
People in rural & remote areas have poorer survival rates than those living in metropolitan areas.
There are a number of reasons for this: fewer diagnostic services; later diagnosis; less availability of treatment services; higher rates of smoking; higher rates of high risk alcohol consumption; increased sun exposure; lower socioeconomic status.
Cancer patients in rural & remote areas have poorer access to cancer treatments and support. A study highlighted that 38% of rural hospitals had neither a resident nor visiting medical oncology service administering chemotherapy; and that as remoteness increased, chemotherapy was increasingly administered by people other than a chemotherapy-trained nurse; that only 58% of rural hospitals had chemotherapy orders written by a medical oncologist; only 7% of non-metropolitan hospitals had access to a radiation unit; and that many rural hospitals reported long waiting times for allied health and inpatient services.
The further a patient with cancer lives from a major city the more likely they are to die. A study found that people with cancer in remote areas of NSW were 35% more likely to die within ﬁve years of diagnosis than patients in metropolitan areas. For prostate and cervical cancers, patients
in remote NSW were up to three times more likely to die within ﬁve years of diagnosis than those living in more accessible areas.
Diabetes in Rural & Remote Australia:
Mortality rates due to diabetes are twice as high in remote areas, than in major cities, and four times higher in very remote areas.
There is a higher risk of developing high blood pressure, heart disease, stroke, kidney failure, nerve damage and impaired vision in patients with type 2 diabetes. These complications can be prevented through diabetes management. Shortages in dieticians, optometrists, podiatrists, GPs and diabetes specialists mean that rural and remote patients have poorer access to acute and preventative health services, and therefore have a higher prevalence of diabetic complications.
Aboriginal and Torres Strait Islander people are three times more likely to have diabetes compared to nonindigenous people; with 6% of Aboriginal and Torres Strait Islander people having diabetes, and those living in remote areas having higher rates at 9%.
Kidney Disease in Rural & Remote Australia:
The rate of end-stage kidney disease is 4 times higher in rural & remote areas than metropolitan areas.
With end-stage kidney disease patients may need dialysis for up to 5 hours 3 times each week. To attend dialysis sessions, rural patients can face long travel times and this can influence compliance, with associated increased mortality. It has been demonstrated that survival of patients on dialysis is worse in rural and remote areas compared to major cities.
Similarly, rural and remote patients undertaking home peritoneal dialysis have a greater risk of peritonitis-related complications
and mortality compared to patients in major cities.
Arthritis in Rural & Remote Australia:
Arthritis is a common health condition among rural and remote residents.
Rural and remote area industries, such as agriculture, mining, forestry and fishing have higher incidences of injury, which can then lead to arthritis. Farmers also have a higher risk of developing osteoarthritis. Lifestyle factors also contribute to development of arthritis eg having joint injuries, being overweight or being physically inactive.
Indigenous Australians, of whom 70% live outside major cities, are 1.92 times more likely to have rheumatoid arthritis and 1.45 times more likely to have osteoarthritis than non-Indigenous people.
People in rural and remote communities have limited access to diagnostic services and treatments, and specialised care services, including GPs, allied health professionals and specialists, thus exacerbating their condition, resulting in a diminished quality of life.
Mental Health in Rural & Remote Australia:
Mental health issues are more prevalent in rural and remote areas than metropolitan areas. There are a number of reasons for this: a higher incidence of chronic disease and disability; unemployment; homelessness; alcohol and drug abuse; social isolation and a greater susceptibility to natural disasters.
There are also a number of barriers to accessing mental health services in rural and remote areas including availability of healthcare professionals; affordability due to lower incomes; limited or non-existent public transport; and apprehension around help-seeking for mental illness.
People residing in rural and remote areas have less access to mental health services. The number of psychiatrists, psychologists and mental health nurses in rural and remote areas is 33%, 54% and 82% less than numbers in major cities.
The result is that people who require a timely diagnosis of a mental health condition, or ongoing treatment and management, are not receiving the help they need, when they most need it, with tragic consequences - in rural and remote areas the suicide rate is 66% higher than in major cities.
Through our recruitment efforts there are healthcare workers in rural & remote areas directly treating patients. Because of what we do, patients are seeing a GPs and other health professionals when they need to.
Together, let’s make a difference to individual people’s health and to the rural & remote communities in which they live.