Extending Health Services to Rural Communities: Telepediatrics in Queensland

Background

Geographic isolation and restricted access to specialist health services are main contributing factors to the inequality of health care around the world. Remote communities often have limited health facilities and access to health care, particularly specialist care, compared to their urban counterparts. Consequently health status of rural and remote populations is generally inferior. This is evident in both developed and developing counties. Rural communities are generally characterized with high rates of poverty, mortality, and limited access to primary health care services.

Recruitment and retention of health workers in rural areas is a problem characteristic of both developed and developing countries. For example, a US report indicated that there were only 55 primary care physicians per 100,000 residents in rural areas compared to 72 per 100,000 in urban areas. This number was significantly lower (36 per 100,000) in isolated and smaller rural areas (Fordyce, Chen, Doescher, & Hart, 2007). According to the same study, the number of specialists per 100,000 residents in rural areas was less than half that compared to urban areas, while the number of psychiatrists was three times less (Fordyce et al., 2007). Various studies have shown the disparity of specialist care in rural and urban communities. For example, studies have revealed that 25% of Americans living in rural areas receive suboptimal stroke care due to lack of facilities, specialists, and funding (Callison & Leira, 2008; Leira, Hess, Torner, & Adams, 2008). Another study has shown that people living in medically underserved areas have higher rates of cardiovascular morbidity and mortality (Colleran, Richards, & Shafer, 2007). Reports on rural America show that the level of care for patients with diseases such as diabetes is noticeably lower compared to their urban counterparts (Health Care in Urban and Rural Areas, Combined Years 2004-2006).

The situation in the developing world is even more daunting. The majority of the population in developing countries lives in rural areas where health facilities are significantly scarce. Lack of funding and low socio-economic development, coupled with difficult geography and topography, can be identified as some of the reasons for the poor health care in developing countries (Chou & Wang, 2009; Joshipura, 2008).

Thus, providing services to rural communities remains a serious challenge for health systems around the world. The conventional method is patient transfer from rural areas to urban centers. In some countries, systems are in place to refer patients from rural areas to urban tertiary centers and in some cases, governments provide subsidies to cover transport and other expenses of patients. The Royal Flying Doctor Service in Australia is an example of governments making special arrangements to transfer patients from rural locations (http://www.flyingdoctor.org.au/). Typically in developing countries patients voluntarily travel to urban hospitals to seek specialist care. Outreach services are another way to provide specialist care to rural areas; occasional visits of specialist health professionals to rural areas are arranged to meet the needs of local communities. Many of these methods involve long distance travel for patients, families, and/or health professionals. These methods are also costly, time consuming, and usually a major inconvenience.