Co-designing innovative rural primary care models

Aim

This Pilot aims to improve the health and wellbeing for people living with complex conditions in Charleville, Quilpie, Cunnamulla and Thargomindah. This is achieved by enhancing collaboration and coordination among local services and health providers, building on strengths and addressing identified gaps.

Outcomes

The overarching objective is to improve the health and wellbeing for those living with complex health conditions in the Pilot region. The Interim Evaluation (April 2024) identified overall, stakeholders indicated that the co-design process to date was successful in designing an overall and site-specific model that balanced overall program objectives, with tailoring to address local context & requirements. The Insights Evaluation report (due June 2025) will provide preliminary outcomes, experience, and insights for implementation improvement.

Anticipated benefits for community:

• person-centred, culturally safe care for consumers, closer to home
• improved communication between providers and services
• better coordinated access to health, community & support services
• health literacy.

Background

A literature search identified rural and remote populations, such as the SWHHS catchment, can face multiple challenges due to their geographic isolation, including accessing necessary medical services, and often experience poorer health outcomes than people living in cities. Enhancing primary care could be a key strategy for improving the health outcomes of rural and remote communities. In particular, care coordination for complex chronic conditions is a major challenge. In the SWHHS catchment, individuals are confronted with a distinct set of obstacles when it comes to accessing quality healthcare due to long travel distances, inadequate regional transportation, limited patient and family housing, telecommunication limitations, and extreme weather events. In addition, health and community services in remote locations have difficulty recruiting and retaining healthcare professionals to meet population needs. Therefore, the SWHHS catchment, being one of the most remote catchments in Queensland, faces exceptional difficulties in fulfilling the health needs of its residents. It’s also noted health outcomes for First Nations people across the South West are poorer than for non-Indigenous residents, and for Queenslanders statewide.

The four rural and remote pilot communities experience poorer health outcomes than the Queensland average, and the geographic isolation of the communities creates challenges in access to health care due to large distances, limited service capacity and service and workforce gaps. These include:

• a lower average life expectancy
• higher rates of potentially preventable hospitalisations
• a higher number of Emergency Department (ED) presentations per capita. Residents across all four sites also experience high rates of chronic disease compared to broader South West region and Queensland populations, with nearly half the population living with one or  more chronic conditions. People living with chronic disease often access health services from multiple, fragmented providers and have difficulties coordinating their care.

Available evidence suggests:

1. Primary care services are fragmented across many service providers, are often transient and information sharing is limited between providers.
2. Models of care that work for metropolitan areas do not necessarily work in rural or remote areas.
3. Whilst there is a small population, there are indications there are unmet primary healthcare needs that the pilot could address. Partnerships are essential to addressing barriers in the delivery of equitable and sustainable healthcare in the South West and the opportunity to leverage off the existing South West Primary Health Care Alliance provides a valuable platform to determine the healthcare needs of the community and co-design with stakeholders how to deliver healthcare more effectively through a sustained and shared approach to care.

Discussion

Whilst the pilot implementation is still underway, the interim evaluation focused on the scoping and co-design phases and progress to date has provided many key findings, lessons learnt and opportunities to inform future rollout across sites or similar programs in Queensland. A key factor in innovation is leadership that is willing to do things differently and there is an environment in South West to do this. The pilot concept pilot offers a new way of integrating care for people living with chronic conditions and improving access to coordinated care across the community. It’s also unique in promoting shared ownership and works collaboratively across a number of organisations and providers in the community and primary care setting. Positions are hosted by local Shire Councils, SWHHS, Royal Flying Doctor Service and local Aboriginal and Torres Strait Islander Community Controlled Organisations.

Learnings include:

• investment in building trust and demonstrating commitment is critical to success.
• extensive consultation, engagement and true co-design takes time and dedicated resources.
• working in collaboration with numerous partners and stakeholders requires clear and consistent communication to build a shared understanding of vision and direction, desired outcomes and measures of success.
• building on established successful partnerships, where possible, is beneficial to address barriers to the delivery of equitable and sustainable healthcare in rural and remote regions.
• identifying, acknowledging and supporting the in-kind resourcing commitments required is critical to success.
• clarity of program scope, roles and responsibilities is critical to ensure understanding and maximise benefit of the program. A continuous improvement approach is being taken to implement learnings from the co-design phase to enhance successful implementation. Undertaking scoping and place-based co-design with local stakeholders led to designing an overall and site-specific model that balances program objectives with tailoring to address local needs and requirements.

The interim evaluation (April 2024) reported strengths of this approach:

• enabled the Pilot to be established on strong foundations, with local stakeholders feeling ownership of the model for their communities.
• an inclusive and tailored approach maximised purposeful stakeholder engagement and ensured the right people, with appropriate decision-making
  authority and influence, were invited to participate.
• data-driven approach allowing decision-making to be guided by data and provided a strong understanding of local needs. Other key strengths include effective program management, communication, and information sharing. Pilots often bring about concerns around the pressure on programs, the ability to achieve desired outcomes within pilot period and sustainability.

The pilot approach creates risks related to breaking trust with stakeholders, which can create barriers to future collaboration, integration and service delivery; raising community expectations; and exacerbating workforce challenges and competition within the region. Continuing to build trust and demonstrate commitment are critical to the pilot’s success to overcome challenges e.g. siloes, historical relationships, and perceived and actual competition for resources and funding. Emphasising and demonstrating collaboration, rather than competition, will be essential. This place-based approach is a transferable method to empowering rural and remote health service providers to design and develop sustainable, collaborative health services with local communities that meet their unique needs.

References

Available on request