The challenge of generalist care in remote Australia: Beyond aeromedical retrieval.

OBJECTIVE: To examine clinical service activity amongst patients of the Royal Flying Doctor Service South Eastern Section in Far West New South Wales and to evaluate the management of chronic disease among frequent users of evacuation services.

DESIGN: A retrospective audit of the Royal Flying Doctor Service South Eastern Section patient database inclusive of patients within the geographical study area who accessed a clinical or remote consultation, or evacuation service at least once between 1 July 2008 and 30 June 2013. Frequent users of evacuation services (≥3 evacuations per year) were investigated through RFDS patient files for determinants of chronic disease management.

MAIN OUTCOME MEASURES: Category of service accessed, clinical consultation amongst frequent evacuees, determinants of chronic disease management.

RESULTS: Total number of evacuees increased by 5.4%; number of remote and clinical consultation patients increased by 5.4%. Of the 47 frequent users of evacuation services, 19 (40%) were infrequent or non-users of clinics (≤3 attendances per year) and 32 (70%) did not have a general practice management plan. Frequent evacuees averaged 2.7 chronic conditions per patient and had seen an average of 16.8 primary care physicians over the 5-year evaluation.

CONCLUSION: Most frequent evacuees had several chronic conditions, multiple primary care providers, did not have a general practice management plan and had infrequent clinic reviews. This evidence highlights the challenge of remote primary care and the need to improve systems of chronic disease management. It underlines the importance of current local efforts to improve electronic records, follow-up and team care and to explore further telehealth implementation.