Enhancing Palliative Care Delivery in a Regional Community in Australia

Article excerpt

Abstract

Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales.

Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalised integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

Aust Health Rev 2006: 30(3): 370-379

ACCESS TO PALLIATIVE CARE is a fundamental right for people in Australia and is endorsed by government policy.1,2 Access, a key component of all palliative care service delivery models, implies fairness not determined by geographical location.1-5 Despite this ideal, the increasing demand for palliative care in regional, rural and remote areas, combined with the limited number of palliative care specialists, presents considerable challenges for health service planners.6,7

This discussion document reviews the evidence pertaining to model-of-care development, the policy environment and existing rural palliative care models in operation in rural Australia. This review was conducted to inform the development of a sustainable model of palliative care delivery for the mid-north coast of New South Wales.

Mid-north coast New South Wales

The mid-north coast consists of the Coffs Harbour, Bellingen and Nambucca local government areas (LGA) which now reside within the central network of the recently created North Coast Area Health Service. Although the reorganisation of the area health service boundaries in NSW occurred subsequent to the completion of this need assessment, this does not alter the significance of these findings.8

This area has a population of 97 774 people, with the largest concentrated population residing in the Coffs Harbour LGA and the remaining population in smaller coastal townships, which are popular holiday destinations, or in inland farming communities.9 Over the past 20 years the area has had the highest population growth in NSW with an annual rate of 2.3%, primarily due to the internal migration of people over 65 years of age.10-11 Many of these people have left behind their family, support and kinship networks with the expectation that services to which they are accustomed will be readily available in their new regional community.12 A significant number of residents are of lower socio-economic status and are welfare recipients.9,13-14 There is a poor transport infrastructure in the area and limited access to community-based aged care-related services.13,15 A workforce shortage of general practitioners, specialists and nurses has been noted.9,15 Significantly, the area has a large Indigenous population, representing about 3.2% of the local population, compared with 1.9% for NSW. An additional feature of this area is also the presence of a well established Punjabi community.16

The Coffs Harbour palliative care service commenced operation in 1984(13) and is essentially a seven day per week community-based specialist palliative care nursing service that provides direct care with minimal community nursing input. The service has a designated part-time counsellor; trained volunteers; a visiting palliative care physician service; access to hospital-based allied health staff; a large loan equipment pool; and a bereavement support program. …