Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

7.2 Integration and coordination

Page last updated: 28 February 2012

Stakeholder views

In the survey of service providers, coordination was assessed as good in 55% of locations, adequate in 38% of locations and poor in 7% of locations (Table 67). Coordination problems were more common for remote and very remote locations, where it was assessed as adequate for 49% of locations and poor for 14% of locations.

Table 67 - MSOAP provider views on coordination, selected locations
How well coordinated are the outreach services provided in this location? Inner and Outer Regional Remote and Very Remote Total
1. Good coordination, problem are rare 64% 37% 55%
2. Adequate coordination, there are some problems, but these do not greatly affect the services provided 32% 49% 38%
3. Poor coordination, there are regular problems, which have a detrimental effect on the services provided 4% 14% 7%


Source: HPA survey of MSOAP service providers, 2011. See also Table 3.24 in Volume 3.



Table 68 - MSOAP specialist follow up communications with local health care providers, selected communities
In this location/town how do you communicate with a patient's GP/health service medical officer following a consultation with a patient? Inner and Outer Regional Remote and Very Remote Total
1.1 Letter 56% 46% 53%
2.1 Face to face or telephone discussion with the GP where required 34% 31% 33%
3.1 Notes are entered directly onto the electronic health system of the GP/health service 8% 19% 11%
4.1 Other 2% 5% 3%


Source: HPA survey of MSOAP service providers, 2011. See also Table 3.26 in Volume 3.


Coordination of visiting services emerged as a significant issue for stakeholders consulted. Coordination issues exist at a several different level in relation to outreach services. One level is the coordination of travel and accommodation for visiting specialists and teams. Arrangements for this level of coordination vary from:
  • no specific assistance
  • coordination by the fundholder
  • coordination by a local staff member located in a GP division
  • coordination by a local staff member located in a state health service.
Another level relates to coordinating issues in a local community. This is particularly an issue for remote communities with significant Aboriginal and Torres Strait Islander populations. The issues here include ensuring there is a physical location at which consultations can take place, ensuring patients (or families/carers) are informed that the specialist will be conducting an outreach clinic, arranging for medical records to be available for the specialist, finding and transporting patients to and from the clinic, and interpreting and conducting clinical procedures (e.g. taking a blood sample). Following the specialist visit there may be a range of other coordination issues, particularly if the patient is referred for further treatment.

In some situations eye health coordinators play this local role for outreach eye health services (including visiting optometry services).

Several stakeholders argued that good local coordination is a critical but often overlooked ingredient for successful outreach services. They believed that there needed to be more investment in this side of outreach services.

Evaluation findings

There is insufficient sharing of information on timing of visits of specialists, associated teams and optometrists to localities. Furthermore, there is insufficient communication with local primary care providers to ensure visits are coordinated, and a limited capacity for the local staff to manage the level of visiting at any one time. We conclude there is a good case for changing the eligibility criteria for the Rural Health Outreach Fund and MSOAP-ICD to allow funding to be provided for regional outreach coordinator positions, focussed on outreach services into remote and very remote communities and local coordination, as recommended above.

Recommendations

See recommendations 2c and 2d.Top of page