Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health

Nicole E. Ranson A , Daniel R. Terry B , Kristen Glenister C , Bill R. Adam B and Julian Wright B D
+ Author Affiliations
- Author Affiliations

A Melbourne Medical School, Level 2 West, Medical Building (181), University of Melbourne, Vic. 3010, Australia.

B Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia.

C Department of Rural Health, University of Melbourne, PO Box 386 Wangaratta, Vic. 3676, Australia.

D Corresponding author. Email: julian.wright@unimelb.edu.au

Australian Journal of Primary Health 22(3) 176-180 https://doi.org/10.1071/PY15056
Submitted: 2 April 2015  Accepted: 5 November 2015   Published: 9 May 2016

Abstract

Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.

Additional keywords: chronic disease, integrated care, quality of health care, rural health.


References

Abegunde DO, Mathers CD, Adam T, Ortegon M, Strong K (2007) The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 370, 1929–1938.
The burden and costs of chronic diseases in low-income and middle-income countries.Crossref | GoogleScholarGoogle Scholar | 18063029PubMed |

Astley CM, Tonkin AM Astley CM, Tonkin AM (2011) Clinical effectiveness in everyday practice: improving outcomes for all patients through a national acute coronary syndrome data collaborative. Internal Medicine Journal 41, 206–210.
Clinical effectiveness in everyday practice: improving outcomes for all patients through a national acute coronary syndrome data collaborative.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38bitlGguw%3D%3D&md5=5b40e49f8a1569d2a101e37bd59475f0CAS | 22747557PubMed |

Befort CA, Nazir N, Engelman K, Choi W (2013) Fatalistic cancer beliefs and information sources among rural and urban adults in the USA. Journal of Cancer Education 28, 521–526.
Fatalistic cancer beliefs and information sources among rural and urban adults in the USA.Crossref | GoogleScholarGoogle Scholar | 23813489PubMed |

Bloom DE, Cafiero E, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, Feigl AB, Gaziano T, Mowafi M, Pandya A, Prettner K, Rosenberg L, Seligman B, Stein AZ, Weinstein C (2012). The global economic burden of noncommunicable diseases. Program on the Global Demography of Aging Working Paper No. 87. Available at http://www.hsph.harvard.edu/program-on-the-global-demography-of-aging/Working Papers/2012/PGDA_WP_87.pdf [Verified 7 December 2015]

Bourke L, Humphreys JS, Wakerman J, Taylor J (2012) Understanding rural and remote health: a framework for analysis in Australia. Health & Place 18, 496–503.
Understanding rural and remote health: a framework for analysis in Australia.Crossref | GoogleScholarGoogle Scholar |

Britt HC, Miller GC (2013) The Bettering the Evaluation and Care of Health (BEACH) program: where to from here? The Medical Journal of Australia 199, 240
The Bettering the Evaluation and Care of Health (BEACH) program: where to from here?Crossref | GoogleScholarGoogle Scholar | 23984774PubMed |

Buykx P, Humphreys J, Tham R, et al (2012) How do small rural primary health care services sustain themselves in a constantly changing health system environment? BMC Health Services Research 12, 81
How do small rural primary health care services sustain themselves in a constantly changing health system environment?Crossref | GoogleScholarGoogle Scholar | 22448876PubMed |

Clark RA, Driscoll A, Nottage J, et al (2007) Inequitable provision of optimal services for patients with chronic heart failure: a national geo-mapping study. The Medical Journal of Australia 186, 169–173.

Crouch R, Wilson A, Newbury J (2011) A systematic review of the effectiveness of primary health education or intervention programs in improving rural women’s knowledge of heart disease risk factors and changing lifestyle behaviours. International Journal of Evidence-Based Healthcare 9, 236–245.

Cummins J, Francis R, Coffey R (2007) ‘Local solutions or postcode lotteries? The acceptability of difference in public services.’ (Office for Public Management Ltd.: London)

Ford E, Ford U, Ajani J, et al (2007) Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. The New England Journal of Medicine 356, 2388–2398.
Explaining the decrease in U.S. deaths from coronary disease, 1980–2000.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXmt1Wnsbs%3D&md5=e3911f55d48303db7cf2574eff536e75CAS | 17554120PubMed |

Fortin M, Chouinard M-C, Bouhali T, Dubois M-F, Gagnon C, Belanger M (2013) Evaluating the integration of chronic disease prevention and management services into primary health care. BMC Health Services Research 13, 132–145.
Evaluating the integration of chronic disease prevention and management services into primary health care.Crossref | GoogleScholarGoogle Scholar | 23565674PubMed |

Gore FM, Bloem PJ, Patton GC, et al (2011) Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet 377, 2093–2102.
Global burden of disease in young people aged 10–24 years: a systematic analysis.Crossref | GoogleScholarGoogle Scholar | 21652063PubMed |

Gregory A, Armstrong R, Van Der Weyden MB (2006) Rural and remote health in Australia: how to avert the deepening health care drought. The Medical Journal of Australia 185, 654–660.

Harris M, Lloyd J, Litt J, et al (2013) Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial. Implementation Science; IS 8, 8–18.
Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 23327664PubMed |

Heeley EL, Peiris DP, Patel AA, et al (2010) Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). The Medical Journal of Australia 192, 254–259.

Herbert-Cheshire L (2000) Contemporary strategies for rural community development in Australia: a governmentality perspective. Journal of Rural Studies 16, 203–215.
Contemporary strategies for rural community development in Australia: a governmentality perspective.Crossref | GoogleScholarGoogle Scholar |

Howat A, Veitch C, Cairns W (2006) A descriptive study comparing health attitudes of urban and rural oncology patients. Rural and Remote Health 6, 563

Humphreys JS (2008) ‘Beyond workforce’: a systemic solution for health service provision in small rural and remote communities. The Medical Journal of Australia 188, S77

Kodner D (2003) Consumer-directed services: lessons and implications for integrated systems of care. International Journal of Integrated Care 3, e12

Kodner D, Spreeuwenberg C (2002) Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care 2, e12

Lê Q, Terry DR, Woodroffe J (2013) Current programs and future needs in health literacy for older people: a literature review. Journal of Consumer Health on the Internet 17, 369–388.
Current programs and future needs in health literacy for older people: a literature review.Crossref | GoogleScholarGoogle Scholar |

Liaw S-T, Chen H-Y, Maneze D, et al (2012) Health reform: is routinely collected electronic information fit for purpose? Emergency Medicine Australasia 24, 57–63.
Health reform: is routinely collected electronic information fit for purpose?Crossref | GoogleScholarGoogle Scholar | 22313561PubMed |

Mahoney M, Townsend M, Hallebone E, Nesbitt P (2001) An ‘upside-down’ view of rural health care. International Journal of Consumer Studies 25, 102–113.
An ‘upside-down’ view of rural health care.Crossref | GoogleScholarGoogle Scholar |

Moffatt J, Eley D (2010) The reported benefits of telehealth for rural Australians. Australian Health Review 34, 276
The reported benefits of telehealth for rural Australians.Crossref | GoogleScholarGoogle Scholar | 20797357PubMed |

Montgomery AA, Fahey T, MacKintosh C, Sharp DJ, Peters TJ (2000) Estimation of cardiovascular risk in hypertensive patients in primary care. The British Journal of General Practice 50, 127–128.

National Heart Foundation of Australia (2013) ‘A systematic approach to chronic heart failure care: a consensus statement.’ (National Heart Foundation of Australia: Melbourne)

Nelson M, Doust J (2013) Primary prevention of cardiovascular disease: new guidelines, technologies and therapies. The Medical Journal of Australia 198, 606–610.
Primary prevention of cardiovascular disease: new guidelines, technologies and therapies.Crossref | GoogleScholarGoogle Scholar | 23919708PubMed |

Nolte E, McKee M (2008) Integration and chronic care: a review. In ‘Caring for people with chronic conditions: a health system perspective’. (Eds E Nolte, M McKee) pp. 64–91. (McGraw-Hill Education: Berkshire, UK)

Philippon DJ, Braithwaite J (2008) Health system organization and governance in Canada and Australia: a comparison of historical developments, recent policy changes and future implications. Healthcare Policy 4, e168–e186.

Russell DJ, Humphreys JS, Ward B, et al (2013) Helping policy-makers address rural health access problems. The Australian Journal of Rural Health 21, 61–71.
Helping policy-makers address rural health access problems.Crossref | GoogleScholarGoogle Scholar | 23586567PubMed |

Teng TH, Katzenellenbogen JM, Hung J, et al (2014) Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage. BMJ Open 4, e004724
Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage.Crossref | GoogleScholarGoogle Scholar | 24793254PubMed |

The World Bank (2013) World development indicators. Available at http://data.worldbank.org/data-catalog/GDP-ranking-table [Verified 7 December 2015]

Webster RJ, Heeley EL, Peiris DP, Bayram C, Cass A, Patel AA (2009) Gaps in cardiovascular disease risk management in Australian general practice. The Medical Journal of Australia 191, 324