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

Appendix 2.c - Crystal Brook, South Australia

Page last updated: 28 February 2012

Overview


Crystal Brook is a small town of 1,185 people (according to the 2006 census) located in a region with a well-developed agricultural industry.  Including people living in the township and the immediate vicinity, there were 1,549 people resident in 2006.  The population in the local SLA (Port Pirie Balance) was estimated as 3,532 in 2006.

Crystal Brook is located 199 kilometres north of Adelaide. There are several towns in the region around Crystal Brook.  Port Pirie is a small city with a resident population of 13,610 people, which is located 29 kilometres from Crystal Brook.  Other towns include Gladstone (population 764), Georgetown (population 119), Spalding (population 303), Jamestown (population 1,407) which are all within 50 kilometres.  Clare (population 3,063) is 77 kilometres away.

Of the estimated population of Crystal Brook in the 2006 census, 25 identified as being of Aboriginal or Torres Strait Islander origin (Table 24). 

Map of Crystal Brook, SA.
Figure 5 – Location of Crystal Brook within South Australia

Table 8 – Regional population statistics (2006)
Township/ location ARIA+ (GISCA 2010) Remoteness Area SEIFA (ABS 2008) Resident Population (ABS 2011a) ATSI Population (ABS 2011a) % ATSI
Crystal Brook (state suburb) 2.70 RA3 Outer regional 957 1,549 25 1.6%
Port Pirie C Districts (M) Balance SLA   RA3 Outer regional 970 3,532 46 1.3%
Port Pirie C Districts (M) - City   RA3 Outer regional 884 13,610 351 2.6%
Port Pirie C Districts (M) - City and Port Pirie C Districts (M) Bal 2.72 RA3 Outer regional 902 17,142 396 2.3%

Health service organisation

Top of pageCrystal Brook falls within the Country Health South Australia Local Health Network (LHN), which covers all areas outside of Adelaide.  The LHN services a very large geographic area, operating through a network of 65 country hospitals and health centres.  Crystal Brook is in the mid north of country South Australia, for which the main health hub for the area is the Port Pirie Regional Hospital and Health Service. In additional to Port Pirie, there are several small hospitals/health services in towns in the near vicinity including:
      • Burra Hospital and Health Services
      • Clare Hospital and Health Services
      • Gladstone Health Centre
      • Jamestown Campus
      • Laura Campus
      • Port Broughton District Hospital and Health Service.
Geographically Port Augusta is the largest hospital near Crystal Brook (111 kilometres), all referrals out of Crystal Brook are either to Port Pirie or Adelaide hospitals (principally Royal Adelaide Hospital).  Patients may be referred to Port Pirie to access visiting specialists that do not visit locally, such as ENT.

The division of general practice in which Crystal Brook is located is the Mid North Division of Rural Medicine. The Division’s geographical coverage extends from just north of Adelaide through to the north east covering an area of approximately 62,000 square kilometres.  It does not include Port Augusta. There are two major population centres in the Division’s boundaries Port Pirie and Clare.  The region has a population of approximately 46,000, mainly distributed sparsely across many small towns and 17 medical practices. GP coverage within the Division is reported to be close to the average for Australia.

Crystal Brook will be part of the Country North Medicare Local, which include most of country South Australia north and west of Adelaide.

Health services in Crystal Brook

While the hospital in Crystal Brook generally services people from Crystal Brook and Red Hill, the outpatient specialist services have a wider catchment area that includes Hawker, Orroroo and Wallaroo.

Crystal Brook has one GP practice (Crystal Brook Medical Practice) with three FTE GPs.

Crystal Brook has a hospital with a small number of beds.  Medical coverage for the hospital is by the GP practice which is co-located with the hospital. There are about 500 separations per year.  It offers aged care, GP-type emergency services, obstetrics and outpatient services. The hospital provided both day and overnight admissions, with about 20% of admissions being same day. There is no surgery done at the hospital, except for simple procedures generally performed by the local GPs.   There is no mental health care available within the hospital. Most procedures are performed at the hospital, and some, such as echocardiogram and electrocardiogram (ECG), are also done in the medical practice.

A diabetes educator is employed in the hospital for two days a week (and works in other surrounding areas for the remainder of the week).  The hospital also has access to a physiotherapist, a dietitian and a podiatrist, who all visit from Port Pirie.
Photo of the Crystal Brook Medical Practice
Figure 6 – Crystal Brook Medical PracticeTop of page
 

Visiting medical specialist services

Visiting medical specialist services to Crystal Brook supported under MSOAP in 2009-10 are shown in Table 9 below.
Table 9 – Visiting health services – Crystal Brook, 2009-10
Town Specialty Visits per year Patients ATSI Patients
Crystal Brook Physician - Rheumatology 11 170 <10
Physician - Cardiology 11 393 <10
Physician - Endocrinology 16 324 <10
Psychiatry - Child and Adolescent 11 111 <10
Psychiatry - Adult/Child and Adolescent 6 37 <10
Physician - Gastroenterology 11 341 <10
Physician - Rheumatology 3 <10 0
Port Pirie Dermatology 11 404 <10
Physician - Palliative 1 29 0
Jamestown Physician - Palliative 0.4 0 0
Ophthalmology - General 11 360 0
Riverton Physician - Palliative 0.4 <10 0
Spalding Physician - Palliative 0.4 0 0
Auburn Physician - Palliative 0.4 0 0
Clare Physician - Palliative 0.4 0 0
Physician - Endocrinology 11 93 0
Psychiatry - Child and Adolescent 11 96 0
Psychiatry - Adult 11 101 <10

Note:  This table represents information collected through MSOAP national data and may not capture all visiting services

Services which are not offered within the region for which patients travel to Adelaide include:
      • neurosurgery
      • spinal injury
      • general physician (for patients with multiple complex problems)
      • general surgery.
GPs in surrounding areas are informed about specialists visiting Crystal Brook either through word of mouth, or through continuing professional development.  The medical practice at Crystal Brook is informed about visiting services in Port Pirie in particular in a similar way.

Some specialists require the medical practice to take their bookings, while others do this themselves.  In all instances, the medical practice provides reception services for patients turning up for appointments.

Upskilling, in an informal sense, is a key feature of the way in which specialists operate when they visit.  However, the environment in the hospital (which is more ‘detached’) does not allow this as easily when compared with the medical practice. An example is the GP asking the endocrinologist about advice for their patients with endocrine disorders.   The environment facilitates ‘picking the brain’ of the specialists. Also, this informal approach was preferred to calling someone over the phone for advice, and is facilitated by building good relationships between the visiting specialists and the local primary care providers.

Other ways in which upskilling occurs informally is through activities such as the visiting cardiologist assisting with a stress test, or advice from the rheumatologist on joint inspections, thereby building the skills of the GP to undertake this at other times.

There is also collaboration and follow up between specialists and primary care providers outside of specialists’ visits.  This is often in the form of a telephone call and/or email.
Formal upskilling occurs in the form of education sessions run by specialists at lunch time or in the evenings.  These are usually organised through the local division of general practice, and are available to the wider region; not just to local practitioners.

The national Tele-Derm service is accessed by the GPs in Crystal Brook.  They regard this is an invaluable service, as there is no visiting dermatologist to Crystal Brook (only Port Pirie).  It was commented that apart from receiving the actual service, it is also educational for them.

There was also a trial of telehealth with dermatology.  Funding for the trial was through MSOAP, and it is now covered by Medicare.

There are no optometrists in Crystal Brook. However, the ‘Eyebus’[9] visits and coverage is generally good.

Organisational factors impacting on visiting specialist services

A major issue for Crystal Brook is space for visiting specialists. Although some specialist have been able to increase the frequency of their visits in recent years, the room available does not allow for any further expansion.
Another major issue is for patients needing to be seen in Adelaide.  In most instances, people are able to travel, but in other instances, people cannot easily make these appointments (e.g. elderly and/or frail).  Finance is also an issue for people, and the Patient Assistance Travel Scheme (PATS) is accessed in these instances, and works well.  However, another issue is appointment times for people travelling from Crystal Brook.  Often appointments are made early (e.g. 9 am), not realising that it takes up to three hours for people to drive to Adelaide.

Effectiveness of visiting services

The overall views on MSOAP in Crystal Brook are that it works well.  Integration and collaboration between primary care and specialists was cited as the main reason for this, including enthusiasm from the individuals involved and networking between them.  The alternative model, which does not work well, is the sense that specialists are ‘plonked’ into a region.

Therefore, outreach in the region is highly valued, and local practitioners are looking for ways in which collaboration could be enhanced, as well as other opportunities to enhance services, such as telehealth.

Assessment of need and gaps in specialist services

Local staff pointed out that there was not a strong sense of using need to shape health services from a regional perspective. Need tended to be measured using waiting times for different specialities.

It was also perceived that there needs to be a ‘marrying’ of what GPs regard as priorities for health services for the region and what the community regards as priorities, because both groups will have different perspectives.

No major gaps in visiting specialists were identified.  Ophthalmology usually has a waiting time, but there are two ophthalmologists in Port Pirie which patients can access.
The more significant issues are with increasing the frequency of some of the current visiting specialists, but not having the room to do so.  This is required for endocrinology in particular.  Telehealth was identified as a potential means to overcome this problem.Top of page