Undergraduate student experience in dental service delivery in rural South Australia: an analysis of costs and benefits.

BACKGROUND: Rural experience for dental students can provide valuable clinical education, change attitudes to rural practice, and make a valuable contribution to clinical service provision. The aim of this paper is to assess the costs and benefits of service delivery by students through rural training programmes. METHODS: Groups of two students worked in the public dental clinics in adjacent rural centres where there had been long-term difficulties in recruiting staff. The costs and benefits of the programme were assessed by the impact on waiting lists, the total cost per patient of a course of care and by the marginal cost of adding service provision by students to existing arrangements. RESULTS: The total costs of emergency and complete treatment provided by students were greater than the costs of treatment provided by public-sector dentists but less than the costs of private providers treating public patients. However, the value of services were greater when care was provided by students or private providers and the marginal cost of students providing services was 50-70 per cent of the cost of care provided by public dentists. CONCLUSION: This assessment suggests that the service benefits achieved compliment the primary objective of influencing the attitude of students to rural practice.

Positive impact of rural academic family practices on rural medical recruitment and retention in South Australia.

Difficulty recruiting and retaining doctors in rural and remote Australia is well recognised. Here, we describe the positive impact on recruitment and retention of general practitioners of a network of university-linked rural family practices in South Australia. Between August 1995 and October 1999, 17 doctors were recruited; eight (47%) were female and six (35%) worked part time. Four doctors left the practices after an average of 20 months service (annual turnover of 6%). Of the two general practice registrars placed in the single accredited practice, one has since joined the practice and the other will do so in 2000. Five doctors are overseas-trained (24%) and four are expected to stay permanently. Rural academic family practices have successfully recruited and retained medical staff in this setting over the past few years. This model of practice may be a useful recruitment and retention strategy for other parts of Australia.

Establishing a practice based primary care research network. The University Family Practice Network in South Australia.

BACKGROUND: Practice based research networks enable the study of primary care problems in a primary care setting. To be successful, our experience indicates that a network will need to incorporate a number of key components. In South Australia, a University Family Practice Network has been established to undertake primary health care research and teaching and to contribute to the general practice workforce. The University Family Practice Network is composed of five practices and is managed jointly by the Department of General Practice, Adelaide University and the South Australian Centre for Rural and Remote Health, Adelaide University and the University of South Australia. OBJECTIVE: This article details the successful establishment of the University Family Practice Network in the hope of providing a model for other universities who may be interested in setting up a practice based research network. DISCUSSION: The characteristics of this network include fractional academic positions for general practitioners, computerised medical records, location in rural and urban sites, regular meetings and the appointment of a research fellow. A number of benefits have arisen since the network's establishment that will assist its future development and sustainability. These include collocation with allied health services, development of local expertise and workforce support.

Amalgamation and collaboration in rural general practices: early experience with the GP links program in rural South Australia.

The GP Links program aims to promote the amalgamation of smaller general practices into larger group practices and is one of several strategies being used to modernise Australian family practice. GP Links provides financial incentives to practices willing to amalgamate. The focus of the program has been on urban practices to date and indeed some of the requirements of the program mean that rural practices are less likely to access the scheme. We report our positive and negative experiences of practice amalgamation through the GP Links program in a regional setting of South Australia. From our experience we suggest that for rural practices, a staged approach of increasing collaboration that may lead to amalgamation, which focuses on rural practices developing a supportive network and alliances with others such as Divisions and University Departments of Rural Health might be a positive way ahead.

Inequitable distribution of general practitioners in Australia: estimating need through the Robin Hood Index.

OBJECTIVE: From Census data, to document the distribution of general practitioners in Australia and to estimate the number of general practitioners needed to achieve an equitable distribution accounting for community health need. METHODS: Data on location of general practitioners, population size and crude mortality by statistical division (SD) were obtained from the Australian Bureau of Statistics. The number of patients per general practitioner by SD was calculated and plotted. Using crude mortality to estimate community health need, a ratio of the number of general practitioners per person: mortality was calculated for all Australia and for each SD (the Robin Hood Index). From this, the number of general practitioners needed to achieve equity was calculated. RESULTS: In all, 26,290 general practitioners were identified in 57 SDs. The mean number of people per general practitioner is 707, ranging from 551 to 1887. Capital city SDs have most favourable ratios. The Robin Hood Index for Australia is 1, and ranges from 0.32 (relatively under-served) to 2.46 (relatively over-served). Twelve SDs (21%) including all capital cities and 65% of all Australians, have a Robin Hood Index > 1. To achieve equity per capita 2489 more general practitioners (10% of the current workforce) are needed. To achieve equity by the Robin Hood Index 3351 (13% of the current workforce) are needed. CONCLUSIONS: The distribution of general practitioners in Australia is skewed. Nonmetropolitan areas are relatively underserved. Census data and the Robin Hood Index could provide a simple means of identifying areas of need in Australia.

Accessibility to general practitioners in rural South Australia. A case study using geographic information system technology.

OBJECTIVE: To demonstrate the potential of GIS (geographic information system) technology and ARIA (Accessibility/Remoteness Index for Australia) as tools for medical workforce and health service planning in Australia. DESIGN: ARIA is an index of remoteness derived by measuring road distance between populated localities and service centres. A continuous variable of remoteness from 0 to 12 is generated for any location in Australia. We created a GIS, with data on location of general practitioner services in non-metropolitan South Australia derived from the database of RUMPS (Rural Undergraduate Medical Placement System), and estimated, for the 1170 populated localities in South Australia, the accessibility/inaccessibility of the 109 identified GP services. MAIN OUTCOME MEASURES: Distance from populated locality to GP services. RESULTS: Distance from populated locality to GP service ranged from 0 to 677 km (mean, 58 km). In all, 513 localities (43%) had a GP service within 20 km (for the majority this meant located within the town). However, for 173 populated localities (15%), the nearest GP service was more than 80 km away. There was a strong correlation between distance to GP service and ARIA value for each locality (0.69; P < 0.05). CONCLUSIONS: GP services are relatively inaccessible to many rural South Australian communities. There is potential for GIS and for ARIA to contribute to rational medical workforce and health service planning. Adding measures of health need and more detailed data on types and extent of GP services provided will allow more sophisticated planning.

Establishing a new university department of rural health: the first 2 years of the South Australian Centre for Rural and Remote Health.

This study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on.