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

Appendix 3.b - Results MSOAP service provider survey

Page last updated: 28 February 2012

Table 3.1 – Estimate of response rate by state/territory and other summary statistics, Medical specialty, MSOAP Provider Survey, Provider level and location level responses

  NSW / ACT Vic. Qld WA SA Tas. NT Other Total
Number of survey respondents 64 83 42 19 23 10 8 3 252
Surveys distributed:   192 97       50    
Response rate   43% 43%       16%   39%
                   
Average locations visited by respondents 2.5 1.6 5.5 3.1 3.0 3.1 7.6 9.0 3.1
Total location/service provider combinations for respondents 161 135 233 58 68 31 61 27 774
MSOAP services 2009-10 395 504 609 313 337 79 329   2,566
Estimated proportion of MSOAP services 41% 27% 38% 19% 20% 39% 19%   30%
                   
Detailed location/service provider responses                  
Locations/services provider combinations with detailed responses 95 111 72 31 27 23 15 3 377
Detailed location responses as % of total MSOAP services 24% 22% 12% 10% 8% 29% 5%   15%
Outreach visits undertake to these locations in 2010-11 1,250 1,404 487 143 198 119 77 15 3,693
Average visits per location per specialist 13.2 12.6 6.8 4.6 7.3 5.2 5.1 5.0 9.8


Table 3.2 –Location of principal practice medical specialty, MSOAP provider survey, provider level responses
  NSW / ACT Vic. Qld WA SA Tas. NT Other Total
Location of principal practice:                  
1. Capital City 30 44 12 6 19 4 7   122
2. Other 33 39 29 13 4 6 1 2 127
9. No response 1   1         1 3
% capital city based 48% 53% 29% 32% 83% 40% 88%   49%


Table 3.3 –Location of principal practice medical specialty, MSOAP provider survey, location level responses
  Inner Regional Outer regional Remote Very Remote Missing Total
Individual locations reported on in survey            
Individual locations for which respondents provided information 26 72 17 56 NA 171
Individual locations receiving MSOAP outreach services 2009-10 35 144 53 184   416
Sample and proportion of individual locations visited 74% 50% 32% 30%   41%
             
Detailed location/service provider responses            
Locations/services provider combinations with detailed responses 81 176 23 92 5 377
Approved MSOAP services 2009-10 535 840 367 813 11 2,566
Detailed location responses as % of total MSOAP services 15% 21% 6% 11%   15%
             
Outreach visits undertake to these locations in 2010-11 by respondents 1,116 1,953 154 431 39 3,693
Average visits per location per respondent 13.8 11.1 6.7 4.7 7.8 9.8
Average visits per individual location 42.9 27.1 9.1 7.7 NA 21.6


Table 3.4 – Medical specialty, MSOAP provider survey, provider level responses Top of page
  Response category Number %
What is your medical specialty? 1. Medical 150 60%
1.01 General Medicine 8 3%
1.02 Paediatrics 23 9%
1.03 Geriatrics 5 2%
1.04 Cardiology 7 3%
1.05 Clinical Genetics 6 2%
1.06 Dermatology 25 10%
1.07 Endocrinology 9 4%
1.08 Gastroenterology 7 3%
1.09 Haematology 1 0%
1.10 Infectious disease 4 2%
1.11 Nephrology 8 3%
1.12 Neurology 14 6%
1.13 Oncology 2 1%
1.14 Palliative Care 6 2%
1.15 Public health 1 0%
1.16 Rehabilitation Medicine 5 2%
1.17 Respiratory 7 3%
1.18 Rheumatology 7 3%
1.19 Thoracic Medicine 1 0%
1.20 Other 4 2%
2. Surgical 41 16%
1.06 Dermatology 2 1%
2.01 General Surgery 12 5%
2.03 Ear Nose & Throat 4 2%
2.04 Neurosurgery 1 0%
2.05 Ophthalmology 8 3%
2.06 Orthopaedic surgery 6 2%
2.07 Paediatric surgery 2 1%
2.08 Urology 5 2%
2.09 Vascular Surgery 1 0%
3. Anaesthesia 2 1%
3.01 Anaesthesia 2 1%
4. Obstetrics & gynaecology 14 6%
4.01 Obstetrics & gynaecology 10 4%
4.02 Gynaecology 4 2%
5. Psychiatry 28 11%
5.01 Psychiatry - Child & Adolescent 5 2%
5.02 Psychiatry - Adult 19 8%
5.03 Psychiatry - Old age 3 1%
5.04 Psychiatry - Other 1 0%
6. Allied health 16 6%
6.01 Diabetes Educator 1 0%
6.02 Dietitian 3 1%
6.03 Exercise physiology 2 1%
6.04 Physiotherapy 2 1%
6.05 Podiatry 5 2%
6.06 Prosthetics and orthotics 1 0%
6.07 Diabetes Team 2 1%
9. No response 1  
9. No response 1  
Total 252  
Total excluding no response 251 100%


Table 3.5 – Practice arrangements, MSOAP provider survey, provider level responses
  Response category Number %
Which of the following categories would best describe your main practice arrangements? 1. Private practice specialist with no or limited involvement 35 14%
2. Private practice specialist with some or significant 97 39%
3. Staff specialist working in a public hospital with rights of private practice 66 26%
4. Other staff specialist working in a public hospital 26 10%
5. Clinical academic working in a public hospital 3 1%
6. Staff specialist working in community health or NGO 6 2%
7. Allied health provider working in a public hospital 5 2%
8. Allied health provider working in private practice 8 3%
9. Allied health provider with other arrangements 3 1%
9. No response 1  
Other 2 1%
Total 252  
Total excluding no response 251 100%


Table 3.6 – Number of locations visited, MSOAP provider survey, provider level responses
  Response category Number %
In 2010-11 financial year, in how many discrete towns/ communities did you provide MSOAP supported outreach services? 1. One location 107 43%
2. Two to four locations 93 38%
3. Five to nine locations 32 13%
4. Ten or more locations 15 6%
9. No response 5  
Total 252  
Total excluding no response 247 100%


Table 3.7 – Organisation of travel arrangements, MSOAP provider survey, provider level responsesTop of page
  Response category Number %
Who helps you organise travel and accommodation for your MSOAP visits? 1.1 You/your own practice staff 167 67%
1.2 You/your own practice staff PLUS: Local staff in health practice visited 1 0%
1.2 You/your own practice staff PLUS: MSOAP fundholder for travel ATSI staff for accommodation 1 0%
1.3 You/your own practice staff PLUS: Staff employed by the division of general practice 2 1%
2.1 The fundholder organisation for MSOAP 16 6%
3.1 Staff employed by the public hospital/health service in the region which you visit 52 21%
3.2 Staff employed by the public hospital/health service of your main practice 1 0%
4.1 Staff employed by the Division of General Practice in the region which you visit 8 3%
5.1 Staff employed by the Aboriginal or Torres Strait Islander Health service based in the region which you visit 1 0%
6.1 Other 2 1%
9. No response 1  
Total 252  
Total excluding no response 251 100%


Table 3.8 – Previous outreach experience, MSOAP provider survey, provider level responses
  Response category Number %
Were you involved in providing outreach programs to rural and remote communities prior to receiving support under the MSOAP programs? If yes, since receiving support under MSOAP, have you expanded your provision of outreach services? 1. Involved in providing outreach prior to receiving MSOAP support - Have not expanded outreach since receiving MSOAP support 43 17%
2. Involved in providing outreach prior to receiving MSOAP support - Have expanded outreach since receiving MSOAP support 108 44%
3. Involved in providing outreach prior to receiving MSOAP support - Other 2 1%
4. Not involved in providing outreach prior to receiving MSOAP support 95 38%
5. Other 4  
Total 252  
Total excluding no response 248 100%


Table 3.9 – Assessment of effectiveness of program, MSOAP provider survey, provider level responses
  Response category Number %
From your perspective how effective is the MSOAP program in improving access for non-Indigenous patients to specialist services for people living in rural and remote Australia? 1. Very effective 142 59%
2. Reasonably effective 91 38%
3. Not effective - the current arrangements are not a good way of addressing access problems and a new approach is required 8 3%
9. No response 11  
Total 252  
Total excluding no response 241 100%
 
From your perspective how effective is the MSOAP program in improving access for Aboriginal and Torres Strait Islander patients to specialist services for people living in rural and remote Australia? 1. Very effective 79 34%
2. Reasonably effective 124 53%
3. Not effective - the current arrangements are not a good way of addressing access problems and a new approach is required 32 14%
9. No response 17  
Total 252  
Total excluding no response 235 100%


Table 3.10 – Ideas on improving the effectiveness of program, MSOAP provider survey, provider level responses Top of page
In what ways could MSOAP supported visits be more effective? Responses mentioning these issues
Level of support  
Increase funding and number of visits funded under MSOAP 30
Support for a complementary nurse/allied health service provider 14
Improved/Expanded upskilling role 13
Increase funding for equipment 7
Increase integration with telehealth initiatives 7
Increased reimbursement rates 6
Ensure continuity in funding of outreach services (e.g. from year to year) 3
Pay for registrars to attend 2
Change eligibility criteria to include communities < 100 from metropolitan centres 1
Coordination and communication  
Improved administrative support/coordination at site/community visited 22
Improved coordination of visiting specialist services 5
Increase awareness of visiting service amongst GPs 5
Improved administrative support/coordination for travel arrangements 3
Reduce number of 'did not attend' patients 3
Improved cooperation between outreach and regional services 2
Electronic sharing of information 2
Awareness of other visiting specialists is lacking 2
Local issues  
Improved Primary Care services 11
Increase availability of regional allied health staff 6
Improved continuity/linking of specialists to communities visited 4
Improved facilities in outreach settings 2
Improved access to public hospital procedures 2
Improve ATSI referral rate 1
Less dependence on key individuals 1
Administration  
More efficient MSOAP administration 4
More flexibility in scheduling outreach visits 3
Allow two consultants to visit together 1
Better governance of program by people experienced in outreach 1
Better screening of MSOAP specialists 1
Improved long term service planning 1


Table 3.11 – Assessment of quality of clinical services, communication on clinical care issues and referral pathways, MSOAP provider survey, provider level responses
  Response category Number %
Compared with what occurs in metropolitan/ regional practice settings how would you assess the quality of clinical services supported through MSOAP? 1. Superior 34 14%
2. Similar 165 68%
3. Not as good 45 18%
9. No response 8  
Total 252  
Total excluding no response 244 100%
 
Compared with you base practice, how would you assess the quality of communication on clinical care matters between you and your patient's GP/health service medical officer in the outreach 1. Better quality 37 16%
2. Similar quality 179 76%
3. Poorer quality 18 8%
9. No response 18 8%
Total 252  
Total excluding no response 234 100%
 
In the outreach locations you visit, how would you assess the effectiveness of the referral pathways for patients who require further treatment or services (e.g. surgery or a diagnostic procedure)? 1. Patients requiring further treatment typically are able to access these services in a reasonable time period. 89 38%
2. In most instances patients eventually receive treatment/services, although this might be delayed. 114 49%
3. Many patients do not receive the additional treatment/services they require. 29 13%
9. No response 20  
Total 252  
Total excluding no response 232 100%


Table 3.12 – Comments on the quality of clinical services, MSOAP provider survey, provider level responses
Compared with what occurs in metropolitan/regional practice settings how would you assess the quality of clinical services supported through MSOAP? Responses mentioning these issues
Availability of local resources  
The availability of diagnostic testing affects the quality of services 6
A reduced range of procedures can be provided in MSOAP locations 3
The availability of equipment was an issue in providing services 3
Services were affected by the availability of local allied health/ancillary staff 3
Facilities were inadequate to provide the same level of service 1
Lack of availability of GP services reduces quality of care 1
Lack of support from other specialists in outreach location 1
High local staff turnover 1
Access issues  
Insufficient number of clinics supported under MSOAP 9
Waiting times longer in rural remote areas 4
Issues with after care / Continuing support/Continuity between visits 4
Difficulty in knowing about/accessing local resources 2
MSOAP leads to shorter waiting times 1
Access to medications is reduced 1
Difficult to access metropolitan hospitals 1
Getting patients to appointments 1
Referral from local doctors is insufficient 1
Improved services  
Level of interaction between GP/Specialist is superior 2
Better continuity of care 1
Superior facilities available 1
Patients better known to specialists 1
Inefficiencies in services  
Support from the local GP/AMS is critical to success 1
Limited time for consultations 1
Local health system politics interfere with service 1
Inefficiencies in number of patients able to be seen 1


Table 3.13 – Satisfaction with MSOAP program, MSOAP provider survey, provider level responsesTop of page
  Response category Number %
Overall how satisfied are you with the MSOAP program? 1. Very satisfied 94 38%
2. Satisfied 120 49%
3. Neither satisfied or dissatisfied 23 9%
4. Dissatisfied 10 4%
9. No response 5  
Total 252  
Total excluding no response 247 100%


Table 3.14 – Comments on dissatisfaction with MSOAP program, MSOAP provider survey, provider level responses
Overall how satisfied are you with the MSOAP program? - If you are dissatisfied, what are the principal factors that have lead to this assessment? Responses mentioning these issues
General  
Excess of transport time to get to communities 2
Wants more awareness of program amongst specialists 2
Too much cost shifting occurring 1
Lack of public awareness of program 1
MSOAP needs geographic expansion 1
Administration  
Funding not sufficient/increase number of visits 11
Issues with billing/invoicing process 4
Poor administrative support/coordination for travel arrangements 2
Poor administrative support/coordination at site/community visited 2
Lack of continuity in funding of outreach services(e.g. from year to year) 2
Administration too rigid in scheduling outreach visits 2
Challenges in reporting/paperwork 2
Poor fundholder administration/understanding 1
Decisions based more on cost than clinical need 1


Table 3.15 – Medical equipment at outreach location, MSOAP provider survey, provider level responses
  Response category Number %
Is the medical equipment available in locations you visit adequate for the services you deliver? 1. Yes 182 78%
2. No 50 22%
9. No response 20  
Total 252  
Total excluding no response 232 100%


Table 3.16 – Patient payments at outreach locations, MSOAP provider survey, provider level responses
  Response category Number %
In providing outreach services under MSOAP what approach do you take to patient co-payments (gap payments)? 1. All patients are charged a gap payment 12 5%
2. A proportion of patients are charged a gap payment in the same way as applies in your principal practice, and others bulk billed 47 21%
3. A proportion of patients are charged a gap payment, but more patients are likely to be bulk billed compared with your principal practice 28 12%
4. Patients seen are bulk billed under Medicare 88 38%
5. No Medicare claim is made for patients seen and no patient charges are applied 54 24%
9. No response 23  
Total 252  
Total excluding no response 229 100%


Table 3.17 – Assessment of administrative processes, MSOAP provider survey, provider level responses Top of page
  Response category Number %
What is your assessment of the administrative processes for the original and subsequent approval under MSOAP of the outreach services you provide? 1. Reasonable relative to funding involved 137 58%
2. Onerous relative to funding involved 26 11%
3. I am not directly involved with this admin process 73 31%
9. No response 16  
Total 252  
Total excluding no response 236 100%
 
What is your assessment of the administrative processes for the development and renewal of the contract with the MSOAP fundholder? 1. Reasonable relative to funding involved 125 53%
2. Onerous relative to funding involved 32 14%
3. I am not directly involved with this administrative process 77 33%
9. No response 18  
Total 252  
Total excluding no response 234 100%
 
What is your assessment of the administrative processes for submitting an invoice and associated reports once services have been delivered? 1. Reasonable relative to funding involved 151 65%
2. Onerous relative to funding involved 29 12%
3. I am not directly involved with this administrative process 53 23%
9. No response 19  
Total 252  
Total excluding no response 233 100%


Table 3.18 – Intention to continuing providing outreach and age, MSOAP provider survey, provider level responses
  Response category Number %
How long do you intend to continue providing outreach services under the MSOAP program? 1. Less than 12 months 7 3%
2. One to two years 32 13%
3. Three to four years 56 23%
4. Five years or more 148 61%
9. No response 9  
Total 252  
Total excluding no response 243 100%
 
How old are you? 20-29 years 2 1%
30-39 years 31 13%
40-49 years 74 30%
50-59 years 94 38%
60 years and over 47 19%
9. No response 4  
Total 252  
Total excluding no response 248 100%


Table 3.19 – Factors that would affect decision to continue providing MSOAP services, MSOAP provider survey, provider level responses
How long do you intend to continue providing outreach services under the MSOAP program? What factors would affect your decision to continue? Responses mentioning these issues
Personal/professional issues  
Health problems 18
Age/retirement 17
Family commitments 11
Fatigue 5
Professional issues  
Professional demands 17
Use of telehealth 1
Loss of VMO funding 1
Local issues  
Too much time spent on transport/ transport issues 5
Lack of coordination/ logistical support 5
Lack of local support for service/specialist 13
Inadequate facilities/ equipment 2
Isolation/loss of engagement with local practitioners 2
Lack if reimbursement from patients 2
Service is not functioning up to personal standards 2
Receiving alternative funding 1
Administration  
Decrease in funding 37
Remuneration/high expenditure on outreach service 12
Transfer of service to a new specialist 4
Poor billing/invoicing process 2
Fundholder issues 2
Lack of input to service planning 1


Table 3.20 – Intention to continuing providing outreach and age, MSOAP
  20-49 years 50-59 years 60 years and over 9. No response Total
1. Less than 12 months 3 2 2   7
2. One to two years 14 6 12   32
3. Three to four years 17 18 21   56
4. Five years or more 70 66 12   148
9. No response 3 2   4 9
Total excluding no response 107 94 47 4 252
Proportions:          
1. Less than 12 months 3% 2% 4%   3%
2. One to two years 13% 6% 26%   13%
3. Three to four years 16% 19% 45%   22%
4. Five years or more 65% 70% 26%   59%
Total excluding no response 100% 100% 100%   100%
Proportion in age group 43% 38% 19%    


Table 3.21 – Capacity and willingness to expand services with additional funding, MSOAP provider survey, provider level responses
  Response category Number %
If funds were available under MSOAP to expand outreach specialist services, would you have the capacity and the willingness to expand the level of outreach services you provide? 1. No 76 31%
2. Yes, number of visits could be expanded by up to 10% 78 32%
3. Yes, number of visits could be expanded by over 10% 92 37%
9. No response 6  
Total 252  
Total excluding no response 246 100%


Table 3.22 – Capacity and willingness to expand services with additional funding, MSOAP provider survey, provider level responsesTop of page
If funds were availably under MSOAP to expand outreach specialist services, would you have the capacity and the willingness to expand the level of outreach services you provide? Responses mentioning these issues
Personal issues  
Retiring soon 4
Too much time spent on transport 4
Family limitations 3
Professional issues  
Not enough time/availability to expand 22
More staff needed 4
Need more backfill cover/problems finding backfill 4
Too much additional admin work for practice staff 1
Administration  
Insufficient funding to support more visits / current visits not fully supported 15
Through more support for telehealth 3
Having local services would be better 2
More flexibility needed in scheduling visits 1
Ensure continuity in funding of outreach services (e.g. from year to year) 1
MSOAP approval needed 1
Expand to more rural services 1
Service issues  
Too much fluctuation in population of outreach site 2
Improved effectiveness of services needed 1
More equipment/tests needed 1
Difficulty recruiting specialists 1
Insufficient clinic space at outreach location 1
Need better coordination on ground - too many no shows 1


Table 3.23 –Help with local coordination, MSOAP provider survey, location specific responses
When you visit this location who helps with local coordination (e.g. ensuring patients know you are coming, ensuring patients can get to the location in which you provide you service, ensuring there is space available for you to conduct your consultations and that required equipment is Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
1.1 Local hospital 99 40 2 141 31% 24% 29%
2.1 AMS 22 39 1 62 7% 23% 13%
3.1 Local General Practice staff 68 19 1 88 22% 11% 18%

4.1 Local community health

59 55 1 115 19% 33% 23%
5.1 Division of GP 4     4 1% 0% 1%
5.2 Local specialist 16     16 5% 0% 3%
6.1 Own staff 40 7   47 13% 4% 10%
7.1 Other 4 6   10 1% 4% 2%
8.1 None 4 2 2 8 1% 1% 2%
9. No response 8 3   11      
Total 324 171 7 502      
Total excluding no response 316 168 7 491 100% 100% 100%


Table 3.24 – Coordination at outreach locations, MSOAP provider survey, location specific responses
How well coordinated are the outreach services provided in this location? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
1. Good coordination, problems are rare 160 41   201 64% 37% 55%
2. Adequate coordination, there are some problems, but these do not greatly affect the services provided 80 54 5 139 32% 49% 38%
3. Poor coordination, there are regular problems, which have a detrimental effect on the services provided 9 15   24 4% 14% 7%
9. No response 8 5   13      
Total 257 115 5 377      
Total excluding no response 249 110 5 364 100% 100% 100%


Table 3.25 – Consultation locations of outreach services, multiple responses per location, MSOAP provider survey, location specific responses
Where do your consultations take place in this location? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
1.1 General community facility 8 2   10 3% 2% 2%
2.1 Home visit 14 5 1 20 5% 4% 5%
3.1 AMS 21 25 1 47 7% 19% 11%
4.1 Local Community Health Service 31 35 2 68 10% 27% 15%
5.1 Local public hospital 121 48 2 171 40% 37% 39%
6.1 Local multipurpose service 4     4 1% 0% 1%
7.1 Local private hospital 7 1   8 2% 1% 2%
8.1 General community facility 20     20 7% 0% 5%
9.1 Local GP practice 62 12   74 20% 9% 17%
10.1 other 17 2   19 6% 2% 4%
11. No response 8 3   11      
Total 313 133 6 452      
Total excluding no response 305 130 6 441 100% 100% 100%


Table 3.26 – Post-consultation follow up, multiple responses per location, MSOAP provider survey, location specific responses
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
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
1.1 Letter 231 90 4 325 56% 46% 53%
2.1 Face to face or telephone discussion with the GP where required 139 61 4 204 34% 31% 33%
3.1 Notes are entered directly onto the electronic health system of the GP/health service 31 37 2 70 8% 19% 11%
4.1 Other 9 9   18 2% 5% 3%
9. No response 9 5   14      
Total 419 202 10 631      
Total excluding no response 410 197 10 617 100% 100% 100%


Table 3.27 – Upskilling/education during visit, multiple responses per location, MSOAP provider survey, location specific responsesTop of page
What other functions do you undertake during the visit? Inner and
Outer
Regional
Remote
and Very
Remote
Missing Total Inner and
Outer
Remote
Remote
and Very
Remote
Total
1.1 Upskilling of Aboriginal Health Workers 23 46 1 70 5% 21% 11%
2.1 Upskilling of local GP 131 41 2 174 30% 18% 26%
3.1 Upskilling of local medical officer 60 39 1 100 14% 17% 15%
4.1 Upskilling of nursing staff 94 53 3 150 22% 24% 23%
5.1 Upskilling of other health staff 69 34   103 16% 15% 16%
6.1 Teaching(i.e. medical students, trainees, etc.) 50 9   59 12% 4% 9%
education 3 2   5 1% 1% 1%
9. No response 65 15 2 82      
Total 495 239 9 743      
Total excluding no response 430 224 7 661 100% 100% 100%