Introduction

Health disparity between urban and rural regions in Australia is well-documented.  In the Wheatbelt catchments of Western Australia there is higher prevalence and rate of avoidable hospitalisation for chronic disease.  Structured care approach to chronic illnesses is not new.  A recent ARC Discovery Project on nurse-led chronic disease (diabetes, hypertension and stable ischaemic heart disease) management in three general practices reported acceptance of such model of primary care.  In our study we extended the disease states to include all chronic respiratory and cardiovascular conditions. 

Method:

A QUAN(qual) design was utilised.  Eight pairs of rural general practices were matched.  Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic condition.  Patients were excluded if deemed medically unsuitable.  A comprehensive care plan was formulated based on individual’s readiness to change and was informed by local resource availability.  A case management approach was utilised.  Our primary outcome was reduction in avoidable hospitalisation.  Secondary outcomes were quality of life and relevant interim clinical outcomes. 

Results:

Qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice.  Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases.

Conclusion:

Despite the pragmatic nature of our care model, efficient primary-secondary care integration requires consideration of social inclusion.