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The determinants of quality in procedural rural medical care.
Rural Remote Health 2005 Oct-Dec; 5(4):473RR

Abstract

INTRODUCTION

A substantial proportion of health services for rural Australians is provided in rural health facilities by rurally based generalist health professionals. These services include procedural care within smaller rural hospitals, where teams of health professionals--medical practitioners, nurses and other support staff--work in teams to deliver a range of procedural services, both elective and urgent, that reduce the need for rural people to travel to major centres. Recent debate over the training of rural medical practitioners has focused on whether or not they need to provide procedural services, because current health service management policy appears to support the rationalisation and centralisation of service delivery in larger centres to contain costs and ensure high quality. Hence there is an assumption, without much evidence, that the quality of care in rural hospitals is lower than that provided in larger urban hospitals, although there is little agreement on just what aspects of care should be measured to indicate its quality. This article reports an exploration of multiple perspectives on what constitutes quality of care in rural procedural medical practice, as part of a broader study of the quality of care of a series of real clinical cases.

METHODS

During the collection of a series of 91 individual patient cases involving anaesthetic, obstetric or surgical procedures conducted in small rural hospitals, interviews were conducted with several participants in each case: the rural doctors; rural nurses; the rural patients; and family members of those patients. In addition to issues pertaining to each case, interviews explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative thematic analysis using Atlas.ti software (Muhr T, ATLAS.ti Scientific Software Development; Berlin, Germany). In order to consider how to measure rural health care, the thematic comments were then applied to a Donabedian structure/process/outcome model.

RESULTS

The different groups produced different views on what might determine the quality of health care in rural hospitals. The health professionals tended to focus on technical aspects of care, although the doctors and nurses had some different emphases, while the patients and their families were more concerned with access, interpersonal communication, convenience and cost. These themes appeared to be consistent with previous literature from general healthcare settings. A list of indicators is suggested for measuring the quality of rural health care.

CONCLUSION

This study has improved understanding of the differing views held by rural health professionals and rural patients in thinking about the quality of care provided in rural hospitals. Consideration of the quality of procedural rural medical care should include the needs and expectations of those living and working in a smaller, more familiar environment. This has implications for health planners, and suggests that there is a continuing need for rural health professionals to be trained to provide procedural medical services in rural hospitals, and for rural hospitals to be maintained at a standard necessary to support quality service provision.

Authors+Show Affiliations

School of Medicine, James Cook University, Queensland, Australia. richard.hays@jcu.edu.auNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16288583

Citation

Hays, Richard B., et al. "The Determinants of Quality in Procedural Rural Medical Care." Rural and Remote Health, vol. 5, no. 4, 2005, p. 473.
Hays RB, Veitch C, Evans RJ. The determinants of quality in procedural rural medical care. Rural Remote Health. 2005;5(4):473.
Hays, R. B., Veitch, C., & Evans, R. J. (2005). The determinants of quality in procedural rural medical care. Rural and Remote Health, 5(4), p. 473.
Hays RB, Veitch C, Evans RJ. The Determinants of Quality in Procedural Rural Medical Care. Rural Remote Health. 2005;5(4):473. PubMed PMID: 16288583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The determinants of quality in procedural rural medical care. AU - Hays,Richard B, AU - Veitch,Craig, AU - Evans,Rebecca J, Y1 - 2005/11/17/ PY - 2005/11/18/pubmed PY - 2006/3/21/medline PY - 2005/11/18/entrez SP - 473 EP - 473 JF - Rural and remote health JO - Rural Remote Health VL - 5 IS - 4 N2 - INTRODUCTION: A substantial proportion of health services for rural Australians is provided in rural health facilities by rurally based generalist health professionals. These services include procedural care within smaller rural hospitals, where teams of health professionals--medical practitioners, nurses and other support staff--work in teams to deliver a range of procedural services, both elective and urgent, that reduce the need for rural people to travel to major centres. Recent debate over the training of rural medical practitioners has focused on whether or not they need to provide procedural services, because current health service management policy appears to support the rationalisation and centralisation of service delivery in larger centres to contain costs and ensure high quality. Hence there is an assumption, without much evidence, that the quality of care in rural hospitals is lower than that provided in larger urban hospitals, although there is little agreement on just what aspects of care should be measured to indicate its quality. This article reports an exploration of multiple perspectives on what constitutes quality of care in rural procedural medical practice, as part of a broader study of the quality of care of a series of real clinical cases. METHODS: During the collection of a series of 91 individual patient cases involving anaesthetic, obstetric or surgical procedures conducted in small rural hospitals, interviews were conducted with several participants in each case: the rural doctors; rural nurses; the rural patients; and family members of those patients. In addition to issues pertaining to each case, interviews explored the perspectives of individuals in each group on the broader question of what constitutes quality of care in a general sense. Their comments were subjected to qualitative thematic analysis using Atlas.ti software (Muhr T, ATLAS.ti Scientific Software Development; Berlin, Germany). In order to consider how to measure rural health care, the thematic comments were then applied to a Donabedian structure/process/outcome model. RESULTS: The different groups produced different views on what might determine the quality of health care in rural hospitals. The health professionals tended to focus on technical aspects of care, although the doctors and nurses had some different emphases, while the patients and their families were more concerned with access, interpersonal communication, convenience and cost. These themes appeared to be consistent with previous literature from general healthcare settings. A list of indicators is suggested for measuring the quality of rural health care. CONCLUSION: This study has improved understanding of the differing views held by rural health professionals and rural patients in thinking about the quality of care provided in rural hospitals. Consideration of the quality of procedural rural medical care should include the needs and expectations of those living and working in a smaller, more familiar environment. This has implications for health planners, and suggests that there is a continuing need for rural health professionals to be trained to provide procedural medical services in rural hospitals, and for rural hospitals to be maintained at a standard necessary to support quality service provision. SN - 1445-6354 UR - https://www.unboundmedicine.com/medline/citation/16288583/The_determinants_of_quality_in_procedural_rural_medical_care_ L2 - http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=473 DB - PRIME DP - Unbound Medicine ER -