I work about three-and-a-half hours away from a large metropolitan area. While the cancer services in this region are very good (four medical oncologists, two radiation oncologists, and a multitude of surgeons and allied health workers), much of the more complex cancer care is done in Melbourne.
Consider the case of a patient I worked with recently:
A male presents to a rural hospital with ongoing headaches and visual changes. This is his third presentation in six months with the same complaints, and he has always been sent home diagnosed with migraine. This time, his wife refuses to leave without a brain scan. This takes 24 hours to arrange, as he needs to be transported to a larger hospital for this. The scan shows a major brain tumor, for which he is transported to a metropolitan hospital for immediate review and surgery, which occurs two days later. While a family member is allowed to travel with him, the rest have to make their own arrangements for travel and accommodation. After surgery and a little bit of rehab (three weeks away from home in total), the patient is returned to his home for follow-up care. The family waits for word on when this will be, eventually having to chase the referrals themselves, finding out that the metropolitan doctors' electronic health system doesn’t sync with the regional doctors' system, and no referral was actually sent.
While this may sound far-fetched, it is not uncommon for patients in my area to experience this type of situation. Lack of communication between hospitals; lost scans, results, and referrals; and being left to tackle the healthcare system without guidance are common complaints. Families have even complained of feeling as if they’re being talked down to because they come from a country area. Families also feel that local services let them down due to lack of knowledge and skill in caring for rarer tumors.
Effective networking among the health facilities is probably the only way to get on top of all of this. Key positions should be used to not only help smooth the way for patients and their families but to ensure that communication and information pathways are maintained. The case described above would have gone so much more smoothly if the specialist nurse in the metropolitan hospital had contacted local health workers (such as a care coordinator like myself) prior to discharge to properly "hand over" the patient (including history, current situation, key contacts, etc.).
We could have then discussed the needs of the patient against the current services offered and arranged education or mentoring to support local health workers. We could have made sure referrals came through and were acted on, and that the patient and family were contacted once they got home to ensure a feeling of continuity of care.
Unfortunately, cancer services seem to work in isolation to other services. This limits patient choice, outcomes, and support, and these walls need to come down.
For those of you who work in rural areas, do you find this to be a common issue? How do you bridge the gap?