Limits...
Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

Adams R, Jones A, Lefmann S, Sheppard L - BMC Health Serv Res (2015)

Bottom Line: Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres.Where demand exceeds available resources, decisions about resource allocation are required.Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, 1 James Cook Dr, Douglas QLD 4811, Townsville, Australia. Robyn.Adams@jcu.edu.au.

ABSTRACT

Background: Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required.

Methods: A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities.

Results: Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision.

Conclusions: The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

No MeSH data available.


Related in: MedlinePlus

Technical and distributive criteria.
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Fig1: Technical and distributive criteria.

Mentions: Criteria reflecting prevalent society values can assist to establish priorities or make choices at all organisational levels. Criteria are used to inform health policy and planning at macro and meso levels and are reflected in micro level decision-making of clinical health professionals. Criteria have been classified as technical or distributive [14]. Technical criteria refer to qualities that services must possess and have been suggested to be a prerequisite in any selection of priorities [14] [p67]. Whilst they can exclude interventions, they are not sufficient in themselves to establish how many, or which intervention to provide and to whom. Distributive criteria are a set of principles that establish an order of priority in the allocation of healthcare resources. They do not address the question of what must be guaranteed to individuals and society at large, but do help establish order of priorities in the choice between different patients or patient groups (FigureĀ 1) [14].Figure 1


Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

Adams R, Jones A, Lefmann S, Sheppard L - BMC Health Serv Res (2015)

Technical and distributive criteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4383192&req=5

Fig1: Technical and distributive criteria.
Mentions: Criteria reflecting prevalent society values can assist to establish priorities or make choices at all organisational levels. Criteria are used to inform health policy and planning at macro and meso levels and are reflected in micro level decision-making of clinical health professionals. Criteria have been classified as technical or distributive [14]. Technical criteria refer to qualities that services must possess and have been suggested to be a prerequisite in any selection of priorities [14] [p67]. Whilst they can exclude interventions, they are not sufficient in themselves to establish how many, or which intervention to provide and to whom. Distributive criteria are a set of principles that establish an order of priority in the allocation of healthcare resources. They do not address the question of what must be guaranteed to individuals and society at large, but do help establish order of priorities in the choice between different patients or patient groups (FigureĀ 1) [14].Figure 1

Bottom Line: Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres.Where demand exceeds available resources, decisions about resource allocation are required.Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions.

View Article: PubMed Central - PubMed

Affiliation: Discipline of Physiotherapy, College of Healthcare Sciences, James Cook University, 1 James Cook Dr, Douglas QLD 4811, Townsville, Australia. Robyn.Adams@jcu.edu.au.

ABSTRACT

Background: Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required.

Methods: A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities.

Results: Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision.

Conclusions: The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

No MeSH data available.


Related in: MedlinePlus