bs_bs_banner
Aust. J. Rural Health (2013) 21, 325–328
Original Research Outreach surgical consulting services in North East Victoria Timothy John Chittleborough, MBBS, PGDipSurgAnat,1 Kaleb Lourensz, MBBS, PGDipSurgAnat,1 Matthew Elliott, Medical Student,2 Peter Thomas, MBBS, FRCSEd, FRACS,1 and Stephen Franzi, MBBS, MD, FRACS1 1
Department of Surgery, Northeast Health Wangaratta, and 2Rural Clinical School, University of Melbourne, Wangaratta, Victoria, Australia
Abstract Objective: There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. Design: Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. Setting: Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. Participants: All patients seen in consultations over a 3-month period. Main outcome measures: Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. Results: Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. Conclusions: Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach
Correspondence: Mr Peter Thomas, Department of Surgery, Northeast Health Wangaratta, PO Box 386, Wangaratta, Victoria 3676, Australia. Email: [email protected] The corresponding author is not a recipient of a research scholarship. This paper is not based on a previous communication to a society or meeting. All authors contributed to production of the manuscript. Authors received no support or grants, and we declare no conflict of interest. This manuscript has not been previously published or submitted elsewhere. Accepted for publication 1 July 2013.
practice should be encouraged for surgeons in regional centres. KEY WORDS: outreach surgery, rural surgery.
Introduction Outreach surgical services involve a surgeon travelling from a base hospital to smaller peripheral towns for the purpose of consulting and operating. There is little published data regarding the model of outreach specialist surgical services to rural areas.1 Furthermore, there is no detailed analysis of the types of consultations in large rural towns compared with outreach clinics in peripheral towns. This study aims to analyse consultative surgical outreach practice and demonstrate outreach practice as a practical model for specialist health care delivery in rural areas.
Methods Data was prospectively collected by two surgeons based in Wangaratta, North East Victoria for a 3-month period from 1 June to 31 August 2012. Both surgeons have well-established practices in Wangaratta while also undertaking rural outreach surgical consulting at smaller peripheral centres: Beechworth, Benalla, Bright and Mansfield. These outreach centres are between 36 and 103 km from Wangaratta (see Table 1). Consultations were undertaken at either local general practitioner rooms or hospital-provided consulting rooms. The two surgeons provided a total of seven half-day outreach consulting sessions and seven outreach operating sessions per month. Surgery at outreach centres was limited to minor procedures in patients who were a low-anaesthetic risk.3 By comparison, consultations in Wangaratta accounted for 18 half-day sessions per month and 32 half-day operating sessions per month. Over this 3-month study period, data regarding patient demographics, consultation type and
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
doi: 10.1111/ajr.12065
326
T. J. CHITTLEBOROUGH ET AL.
What is already known on this subject: • There is a paucity of data regarding the provision of outreach specialist surgical services to rural areas. • Australia’s low population density results in significant numbers of rurally based patients having to travel great distances to access specialist surgical care.
TABLE 1:
What this study adds: • This study demonstrates that outreach surgical consultative practice is beneficial to both the patient by providing local access to specialist services and to the clinician by providing a valuable referral base and high proportion of new consultations and high proportion requiring a surgical procedure.
Discussion
Outreach populations2
Outreach Town (Region)
Distance from Wangaratta (km) Population
Beechworth (Indigo Region) 36 Benalla 41 Bright (Alpine S East Region) 77 Mansfield 103 (Wangaratta) –
12 004 14 293 7 988 7 972 (28938)
consultation outcome was recorded for consultations in Wangaratta and the outreach centres.
Results A total of 1227 consultations took place within the 3-month study period. Table 2 outlines consultations of the two surgeons in Wangaratta and outlier towns. Consultations in outreach locations accounted for 26% (315) of all consultations. New appointments/referrals represented a higher proportion of consulting workload in outreach areas when compared with the base rural centre (56% versus 45%, P < 0.05). New referrals in outreach centres were marginally more likely to result in a surgical procedure than those in surgeons’ base rural centre (76% versus 70%, P = 0.19). The majority (92%) of patients seen initially in Wangaratta had their procedure in Wangaratta. Conversely, 67% of patients initially seen in outreach centres had their surgery in that centre, with the remainder having their procedure in Wangaratta because of procedure complexity, equipment provision, or the need for specialist anaesthetic or intensive care support. As demonstrated in Table 3, patients in the outreach service presented with a range of general surgical problems that were comparable with that seen in the rural base centre, Wangaratta.
Australia’s relatively low population density,4 compared with much of the rest of the developed world, results in significant cost and difficulty for rural patients to access specialist services.5 Surgical services are in high demand, and need is projected to increase by 36% from 2003 to 2021.6 Outreach surgical practice has been demonstrated to be beneficial in improving access to specialist consultation in remote, disadvantaged Australian communities7,8 and overseas.9 There has been an identified need to compare outreach practice in rural and disadvantaged settings.1 Although there is limited data on outreach specialist practice in the Australian setting, benefits from outreach models have included improved access, reduced costs, early detection of chronic disease and skin cancer, and more effective management of chronic diseases.8 The published experience of outreach practice in Australia pertains mostly to remote, disadvantaged and indigenous communities in northern territory.7,10 This paper demonstrates that the benefits of outreach practice extend to the less remote rural areas. Outreach surgical practice provides the regional surgeon with the opportunity to provide service to patients residing in smaller rural centres and minimise the inconvenience to the patient. This is of particular importance to the aging rural population, for whom transport can be difficult to arrange. An outreach model of specialist care has advantages over a fly-in/-out model as care for emergency or complicated cases can be provided at the regional hub and the specialist can more easily foster links with local general practitioners.11 Although it is difficult to quantify the cost–benefit that outreach practice affords rural patients, this study demonstrates the travel distance saved by patients. The two surgeons conducting outreach consultations travelled a total of 2958 km in the 3-month study period. Should the patients seen in outreach locations have needed to travel to the regional centre for their consultations, the 315 patients would have travelled a total of 38,634km to achieve the same patient–specialist contact.
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
327
OUTREACH SURGICAL CONSULTING SERVICES
TABLE 2:
Consultations by location and nature of appointment
New consultations Proceeding to surgery Location of Procedure:
Wangaratta Outreach
Review appointments Post operative review appointments Total consultations
Wangaratta
Outreach
411 289 (70%) 267 (92%) 22 (8%) 184 317 912
176 133 (76%) 44 (33%) 89 (67%) 76 63 315
Total Consultations (Wangaratta and outreach): 1227.
TABLE 3:
Consultation casemix by location
Upper GI/HPB Anal Major abdominal/colorectal Urological Breast Endocrine Skin, other minor procedures Hernias Total
Wangaratta
Outreach
62 13 167 30 61 33 538 97 1001
16 4 20 21 41 12 141 55 310
Total casemix: 1311. Note casemix is greater than total consultation number as some patients present with more than one complaint.
Recruitment of surgeons to rural and regional areas can be difficult with surgeons preferring metropolitan practice, citing family ties and lifestyle factors as the major factors in declining rural practice. Most surgeons would decline opportunities for rural practice irrespective of monetary, lifestyle or professional incentives.12 Consulting casemix in this series comprises a very broad range of conditions in both outreach and regional centre practice in line with previously published rural general surgical casemix.11,13 This study suggests that outreach practice can be professionally rewarding, with a similar casemix and relatively high rates of surgery booked. This affords practitioners the benefits of residing in a larger regional centre, while still servicing smaller rural towns, which may assist in the recruitment and retention of specialist staff to rural practice. There are, however, limitations to the provision of surgical procedures in outreach communities. These can include the facilities at rural hospitals and the skills of local staff. In the outreach centres included in this study, anaesthetic services in the outreach centres are provided by
general practitioner anaesthetists. Peripheral hospitals have specific clinical practice guidelines to maximise the safety of anaesthetic practice. In one such peripheral hospital exclusion criteria included age less than four, body mass index greater than 40 and an American Society of Anesthesiologists grade of 4 or above.3 The surgeons and referring general practitioners are responsible for being judicious in deciding which operations are suitable to be undertaken at peripheral hospitals. As there are no dedicated surgical teams, the local general practitioners coordinate the postoperative care. Careful consideration must be taken of the likelihood of the need to return to theatre for complication management. Given the limitations, laparoscopic cholecystectomies are the most complex operation undertaken routinely at the peripheral hospitals by the surgeons in this study. Common procedures performed in peripheral hospitals include endoscopy, skin/plastic/ minor excisions, hernia/abdominal wall procedures, hand surgery, anal/minor colorectal surgery, laparoscopic cholecystectomy, varicose vein surgery, vasectomy and breast surgery.11 Patients seen in peripheral centres requiring major abdominal or oncological procedures had their procedures at the regional centre to facilitate surgeon led postoperative care. Surgical emergencies that present to the peripheral centres are assessed by the local general practitioners who liaise with the regional surgeon to expedite transfer and definitive surgical management. Only occasionally are emergency procedures performed at the peripheral centres in the case of stable patients presenting with minor problems on the day a surgeon is consulting or operating at the peripheral centre. Many smaller rural hospitals are equipped with adequate theatre facilities. Performing operations at these centres enables theatre staff and general practitioner anaesthetists to maintain their skill base.11 This becomes particularly important when those same staff are faced with emergency patients of high acuity at the local hospital. Outreach surgery develops and supports
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
328
T. J. CHITTLEBOROUGH ET AL.
the provision of service delivery at the local hospital and spreads elective surgical workload among facilities in the region, thus easing the caseload on the larger regional hospital. The involvement of local general practitioners in providing an anaesthetic service and postoperative care promotes an ongoing involvement in individual patient care and fosters a close working relationship with the visiting surgeons. The surgeons participating in such programs have access to a larger patient base and the professional satisfaction of being involved in a program designed to facilitate specialist care in the rural setting.
Conclusion Outreach surgical services in North East Victoria provide a valuable service to patients in the local region and afford the consulting surgeon a high proportion of new consultations and high yield of patients proceeding to undergo a surgical procedure. While outreach services will inevitably face some restrictions because of limited resources, the benefits of providing such a service are substantial. In the provision of convenience and comfort to the patient, professional satisfaction and a larger patient base to the surgeon, and in the ongoing development and maintenance of a rural health service for the community, surgical outreach programs have an important role in regional Australia. Surgeons and other specialists in regional areas should consider outreach practice to foster ties with local general practitioners and facilitate the provision of specialist services to patients residing in outlying areas.
References 1 Gruen RL, Weeramanthri TS, Knight SE, Bailie RS. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database of Systematic Reviews [Internet] 2003. [Cited 20 Dec 2012]. Available from URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858 .CD003798.pub2/abstract 2 Australian Bureau of Statistics. National regional profile. [Internet] 2011. [Cited 20 Dec 2012]. Available from URL: http://www.ausstats.abs.gov.au/ausstats/nrpmaps.nsf/ NEW+GmapPages/national+regional+profile
3 Scope of Practice for General Practitioner Anaesthetics, Benalla & District Memorial Hospital Clinical Practice Guidelines manual, Version date: Jan 2011. 4 Australian Bureau of Statistics. Regional Population Growth, Australia, 2010–2011. [Internet] 2012. [Cited 20 Dec 2012]. Available from URL: http://www.abs.gov.au/ ausstats/[email protected]/Previousproducts/3218.0Main%20 Features32010-11?opendocument&tabname=Summary &prodno=3218.0&issue=2010-11&num=&view =#PARALINK2 5 Rankin SL, Hughes-Anderson W, House AK, Heath DJ, Aitken RJ, House J. Costs of accessing surgical specialists by rural and remote residents. ANZ Journal of Surgery 2001; 71: 544–547. 6 Birrell B, Hawthorne L, Rapson V. The Outlook for Surgical Services in Australasia. Melbourne: Centre for Population and Urban Research, Monash University, [Internet] 2003. [Cited 20 Dec 2012]. Available from URL: http:// www.surgeons.org/media/294115/Outlook_for_Surgical _Services_in_Australasia_(Birrell_report).pdf. 7 Gruen RL, Bailie RS, Wang Z, Heard S, O’Rourke IC. Specialist outreach to isolated and disadvantaged Communities: a population-based study. Lancet 2006; 368: 130– 138. 8 Australian Government Department of Health and Ageing. Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme. [Internet] 2012. [Cited 20 Dec 2012]. Available from URL: http:// www.health.gov.au/internet/publications/publishing.nsf/ Content/MSOAP-VOS-evaulation 9 Bernstein M. Surgical outreach clinics in Canada: one neurosurgeon’s experience. Canadian Journal of Surgery 2004; 47: 25–28. 10 Gruen RL, Bailie RS, d’Abbs PH, O’Rourke IC, O’Brien MM, Verma N. Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service. The Medical Journal of Australia 2001; 174: 507–511. 11 Campbell NA, Franzi S, Thomas P. Caseload of general surgeons working in a rural hospital with outreach practice. ANZ Journal of Surgery 2012. [Epub ahead of print]. [Cited 20 Dec 2012]. Available from URL: http:// dx.doi.org/10.1111/j.1445-2197.2012.06207.x 12 Royal Australasian College of Surgeons. Surgical Workforce 2011 Census Report [Internet] 2011. [Cited 20 Dec 2012]. Available from URL: http://www.surgeons.org/ media/18789488/rpt_2012-09-10_2011_surgical _workforce_census_report.pdf. 13 Tulloh B, Clifforth S, Miller I. Caseload in rural general surgical practice and implications for training. ANZ Journal of Surgery 2001; 71: 215–217.
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
Aust. J. Rural Health (2013) 21, 325–328
Original Research Outreach surgical consulting services in North East Victoria Timothy John Chittleborough, MBBS, PGDipSurgAnat,1 Kaleb Lourensz, MBBS, PGDipSurgAnat,1 Matthew Elliott, Medical Student,2 Peter Thomas, MBBS, FRCSEd, FRACS,1 and Stephen Franzi, MBBS, MD, FRACS1 1
Department of Surgery, Northeast Health Wangaratta, and 2Rural Clinical School, University of Melbourne, Wangaratta, Victoria, Australia
Abstract Objective: There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. Design: Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. Setting: Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. Participants: All patients seen in consultations over a 3-month period. Main outcome measures: Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. Results: Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. Conclusions: Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach
Correspondence: Mr Peter Thomas, Department of Surgery, Northeast Health Wangaratta, PO Box 386, Wangaratta, Victoria 3676, Australia. Email: [email protected] The corresponding author is not a recipient of a research scholarship. This paper is not based on a previous communication to a society or meeting. All authors contributed to production of the manuscript. Authors received no support or grants, and we declare no conflict of interest. This manuscript has not been previously published or submitted elsewhere. Accepted for publication 1 July 2013.
practice should be encouraged for surgeons in regional centres. KEY WORDS: outreach surgery, rural surgery.
Introduction Outreach surgical services involve a surgeon travelling from a base hospital to smaller peripheral towns for the purpose of consulting and operating. There is little published data regarding the model of outreach specialist surgical services to rural areas.1 Furthermore, there is no detailed analysis of the types of consultations in large rural towns compared with outreach clinics in peripheral towns. This study aims to analyse consultative surgical outreach practice and demonstrate outreach practice as a practical model for specialist health care delivery in rural areas.
Methods Data was prospectively collected by two surgeons based in Wangaratta, North East Victoria for a 3-month period from 1 June to 31 August 2012. Both surgeons have well-established practices in Wangaratta while also undertaking rural outreach surgical consulting at smaller peripheral centres: Beechworth, Benalla, Bright and Mansfield. These outreach centres are between 36 and 103 km from Wangaratta (see Table 1). Consultations were undertaken at either local general practitioner rooms or hospital-provided consulting rooms. The two surgeons provided a total of seven half-day outreach consulting sessions and seven outreach operating sessions per month. Surgery at outreach centres was limited to minor procedures in patients who were a low-anaesthetic risk.3 By comparison, consultations in Wangaratta accounted for 18 half-day sessions per month and 32 half-day operating sessions per month. Over this 3-month study period, data regarding patient demographics, consultation type and
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
doi: 10.1111/ajr.12065
326
T. J. CHITTLEBOROUGH ET AL.
What is already known on this subject: • There is a paucity of data regarding the provision of outreach specialist surgical services to rural areas. • Australia’s low population density results in significant numbers of rurally based patients having to travel great distances to access specialist surgical care.
TABLE 1:
What this study adds: • This study demonstrates that outreach surgical consultative practice is beneficial to both the patient by providing local access to specialist services and to the clinician by providing a valuable referral base and high proportion of new consultations and high proportion requiring a surgical procedure.
Discussion
Outreach populations2
Outreach Town (Region)
Distance from Wangaratta (km) Population
Beechworth (Indigo Region) 36 Benalla 41 Bright (Alpine S East Region) 77 Mansfield 103 (Wangaratta) –
12 004 14 293 7 988 7 972 (28938)
consultation outcome was recorded for consultations in Wangaratta and the outreach centres.
Results A total of 1227 consultations took place within the 3-month study period. Table 2 outlines consultations of the two surgeons in Wangaratta and outlier towns. Consultations in outreach locations accounted for 26% (315) of all consultations. New appointments/referrals represented a higher proportion of consulting workload in outreach areas when compared with the base rural centre (56% versus 45%, P < 0.05). New referrals in outreach centres were marginally more likely to result in a surgical procedure than those in surgeons’ base rural centre (76% versus 70%, P = 0.19). The majority (92%) of patients seen initially in Wangaratta had their procedure in Wangaratta. Conversely, 67% of patients initially seen in outreach centres had their surgery in that centre, with the remainder having their procedure in Wangaratta because of procedure complexity, equipment provision, or the need for specialist anaesthetic or intensive care support. As demonstrated in Table 3, patients in the outreach service presented with a range of general surgical problems that were comparable with that seen in the rural base centre, Wangaratta.
Australia’s relatively low population density,4 compared with much of the rest of the developed world, results in significant cost and difficulty for rural patients to access specialist services.5 Surgical services are in high demand, and need is projected to increase by 36% from 2003 to 2021.6 Outreach surgical practice has been demonstrated to be beneficial in improving access to specialist consultation in remote, disadvantaged Australian communities7,8 and overseas.9 There has been an identified need to compare outreach practice in rural and disadvantaged settings.1 Although there is limited data on outreach specialist practice in the Australian setting, benefits from outreach models have included improved access, reduced costs, early detection of chronic disease and skin cancer, and more effective management of chronic diseases.8 The published experience of outreach practice in Australia pertains mostly to remote, disadvantaged and indigenous communities in northern territory.7,10 This paper demonstrates that the benefits of outreach practice extend to the less remote rural areas. Outreach surgical practice provides the regional surgeon with the opportunity to provide service to patients residing in smaller rural centres and minimise the inconvenience to the patient. This is of particular importance to the aging rural population, for whom transport can be difficult to arrange. An outreach model of specialist care has advantages over a fly-in/-out model as care for emergency or complicated cases can be provided at the regional hub and the specialist can more easily foster links with local general practitioners.11 Although it is difficult to quantify the cost–benefit that outreach practice affords rural patients, this study demonstrates the travel distance saved by patients. The two surgeons conducting outreach consultations travelled a total of 2958 km in the 3-month study period. Should the patients seen in outreach locations have needed to travel to the regional centre for their consultations, the 315 patients would have travelled a total of 38,634km to achieve the same patient–specialist contact.
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
327
OUTREACH SURGICAL CONSULTING SERVICES
TABLE 2:
Consultations by location and nature of appointment
New consultations Proceeding to surgery Location of Procedure:
Wangaratta Outreach
Review appointments Post operative review appointments Total consultations
Wangaratta
Outreach
411 289 (70%) 267 (92%) 22 (8%) 184 317 912
176 133 (76%) 44 (33%) 89 (67%) 76 63 315
Total Consultations (Wangaratta and outreach): 1227.
TABLE 3:
Consultation casemix by location
Upper GI/HPB Anal Major abdominal/colorectal Urological Breast Endocrine Skin, other minor procedures Hernias Total
Wangaratta
Outreach
62 13 167 30 61 33 538 97 1001
16 4 20 21 41 12 141 55 310
Total casemix: 1311. Note casemix is greater than total consultation number as some patients present with more than one complaint.
Recruitment of surgeons to rural and regional areas can be difficult with surgeons preferring metropolitan practice, citing family ties and lifestyle factors as the major factors in declining rural practice. Most surgeons would decline opportunities for rural practice irrespective of monetary, lifestyle or professional incentives.12 Consulting casemix in this series comprises a very broad range of conditions in both outreach and regional centre practice in line with previously published rural general surgical casemix.11,13 This study suggests that outreach practice can be professionally rewarding, with a similar casemix and relatively high rates of surgery booked. This affords practitioners the benefits of residing in a larger regional centre, while still servicing smaller rural towns, which may assist in the recruitment and retention of specialist staff to rural practice. There are, however, limitations to the provision of surgical procedures in outreach communities. These can include the facilities at rural hospitals and the skills of local staff. In the outreach centres included in this study, anaesthetic services in the outreach centres are provided by
general practitioner anaesthetists. Peripheral hospitals have specific clinical practice guidelines to maximise the safety of anaesthetic practice. In one such peripheral hospital exclusion criteria included age less than four, body mass index greater than 40 and an American Society of Anesthesiologists grade of 4 or above.3 The surgeons and referring general practitioners are responsible for being judicious in deciding which operations are suitable to be undertaken at peripheral hospitals. As there are no dedicated surgical teams, the local general practitioners coordinate the postoperative care. Careful consideration must be taken of the likelihood of the need to return to theatre for complication management. Given the limitations, laparoscopic cholecystectomies are the most complex operation undertaken routinely at the peripheral hospitals by the surgeons in this study. Common procedures performed in peripheral hospitals include endoscopy, skin/plastic/ minor excisions, hernia/abdominal wall procedures, hand surgery, anal/minor colorectal surgery, laparoscopic cholecystectomy, varicose vein surgery, vasectomy and breast surgery.11 Patients seen in peripheral centres requiring major abdominal or oncological procedures had their procedures at the regional centre to facilitate surgeon led postoperative care. Surgical emergencies that present to the peripheral centres are assessed by the local general practitioners who liaise with the regional surgeon to expedite transfer and definitive surgical management. Only occasionally are emergency procedures performed at the peripheral centres in the case of stable patients presenting with minor problems on the day a surgeon is consulting or operating at the peripheral centre. Many smaller rural hospitals are equipped with adequate theatre facilities. Performing operations at these centres enables theatre staff and general practitioner anaesthetists to maintain their skill base.11 This becomes particularly important when those same staff are faced with emergency patients of high acuity at the local hospital. Outreach surgery develops and supports
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
328
T. J. CHITTLEBOROUGH ET AL.
the provision of service delivery at the local hospital and spreads elective surgical workload among facilities in the region, thus easing the caseload on the larger regional hospital. The involvement of local general practitioners in providing an anaesthetic service and postoperative care promotes an ongoing involvement in individual patient care and fosters a close working relationship with the visiting surgeons. The surgeons participating in such programs have access to a larger patient base and the professional satisfaction of being involved in a program designed to facilitate specialist care in the rural setting.
Conclusion Outreach surgical services in North East Victoria provide a valuable service to patients in the local region and afford the consulting surgeon a high proportion of new consultations and high yield of patients proceeding to undergo a surgical procedure. While outreach services will inevitably face some restrictions because of limited resources, the benefits of providing such a service are substantial. In the provision of convenience and comfort to the patient, professional satisfaction and a larger patient base to the surgeon, and in the ongoing development and maintenance of a rural health service for the community, surgical outreach programs have an important role in regional Australia. Surgeons and other specialists in regional areas should consider outreach practice to foster ties with local general practitioners and facilitate the provision of specialist services to patients residing in outlying areas.
References 1 Gruen RL, Weeramanthri TS, Knight SE, Bailie RS. Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database of Systematic Reviews [Internet] 2003. [Cited 20 Dec 2012]. Available from URL: http://onlinelibrary.wiley.com/doi/10.1002/14651858 .CD003798.pub2/abstract 2 Australian Bureau of Statistics. National regional profile. [Internet] 2011. [Cited 20 Dec 2012]. Available from URL: http://www.ausstats.abs.gov.au/ausstats/nrpmaps.nsf/ NEW+GmapPages/national+regional+profile
3 Scope of Practice for General Practitioner Anaesthetics, Benalla & District Memorial Hospital Clinical Practice Guidelines manual, Version date: Jan 2011. 4 Australian Bureau of Statistics. Regional Population Growth, Australia, 2010–2011. [Internet] 2012. [Cited 20 Dec 2012]. Available from URL: http://www.abs.gov.au/ ausstats/[email protected]/Previousproducts/3218.0Main%20 Features32010-11?opendocument&tabname=Summary &prodno=3218.0&issue=2010-11&num=&view =#PARALINK2 5 Rankin SL, Hughes-Anderson W, House AK, Heath DJ, Aitken RJ, House J. Costs of accessing surgical specialists by rural and remote residents. ANZ Journal of Surgery 2001; 71: 544–547. 6 Birrell B, Hawthorne L, Rapson V. The Outlook for Surgical Services in Australasia. Melbourne: Centre for Population and Urban Research, Monash University, [Internet] 2003. [Cited 20 Dec 2012]. Available from URL: http:// www.surgeons.org/media/294115/Outlook_for_Surgical _Services_in_Australasia_(Birrell_report).pdf. 7 Gruen RL, Bailie RS, Wang Z, Heard S, O’Rourke IC. Specialist outreach to isolated and disadvantaged Communities: a population-based study. Lancet 2006; 368: 130– 138. 8 Australian Government Department of Health and Ageing. Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme. [Internet] 2012. [Cited 20 Dec 2012]. Available from URL: http:// www.health.gov.au/internet/publications/publishing.nsf/ Content/MSOAP-VOS-evaulation 9 Bernstein M. Surgical outreach clinics in Canada: one neurosurgeon’s experience. Canadian Journal of Surgery 2004; 47: 25–28. 10 Gruen RL, Bailie RS, d’Abbs PH, O’Rourke IC, O’Brien MM, Verma N. Improving access to specialist care for remote Aboriginal communities: evaluation of a specialist outreach service. The Medical Journal of Australia 2001; 174: 507–511. 11 Campbell NA, Franzi S, Thomas P. Caseload of general surgeons working in a rural hospital with outreach practice. ANZ Journal of Surgery 2012. [Epub ahead of print]. [Cited 20 Dec 2012]. Available from URL: http:// dx.doi.org/10.1111/j.1445-2197.2012.06207.x 12 Royal Australasian College of Surgeons. Surgical Workforce 2011 Census Report [Internet] 2011. [Cited 20 Dec 2012]. Available from URL: http://www.surgeons.org/ media/18789488/rpt_2012-09-10_2011_surgical _workforce_census_report.pdf. 13 Tulloh B, Clifforth S, Miller I. Caseload in rural general surgical practice and implications for training. ANZ Journal of Surgery 2001; 71: 215–217.
© 2013 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
