Issues and Challenges for Development of a Sustainable Service Model for People With Spinal Cord Injury Living in Rural Regions

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.ObjectiveTo develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.DesignService development, pilot evaluation study.SettingRegional and remote areas of the state of New South Wales, Australia.ParticipantsPersons with SCI, caregivers, and health professionals.InterventionPhase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.Main Outcome MeasuresSelf-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.ResultsClinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.ConclusionEducation and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.