Buikstra Elizabeth, Pearce Susanne, Hegney Desley, Fallon Tony
Centre for Rural and Remote Area Health, USQ, Toowoomba, Queensland, Australia.
Rural Remote Health. 2006 Jan-Mar;6(1):415. Epub 2006 Feb 22.
The proliferation of professional palliative care services in recent years has increased access for people with palliative care needs; however, gaps in services continue to exist, particularly in rural and remote areas of Australia. In order to address one gap in rural health service delivery, the Support, Education, Assessment, and Monitoring (SEAM) Service for regional and rural people in Toowoomba, Queensland, Australia, was introduced. This new model of service delivery aimed to provide palliative services to patients and their families who live in the regional city of Toowoomba and its rural catchment area. It also aimed to facilitate education, support and networking among health-care professionals, particularly general practitioners and nurses employed in general practice (practice nurses).
The evaluation involved twenty face-to-face interviews with a variety of health professionals who had contact with the SEAM service from June 2003 to June 2004. Qualitative data analysis of the transcribed interviews provided the basis for the evaluation. The emergent themes regarding the SEAM service included: satisfaction and benefit of the SEAM service; knowledge of and contact with the SEAM service; the SEAM role; and expansion of the role.
The data indicate that the majority of health professionals who had contact with the SEAM service were satisfied with the service and found it to be of benefit to them and their clients. Participants commented on the extensive networking and support work established by the SEAM nurse with other health service providers. Difficulties experienced with the SEAM service included poor utilisation by GPs and, therefore, clients in need of palliative support. This was predominately due to lack of knowledge of the service as well as limited understanding of the SEAM nurse role.
The SEAM service has resulted in increased links between health professionals providing palliative care to rural clients. The most successful strategy was the use of multidisciplinary case conferencing which not only built links among health professionals caring for individual clients, but also resulted in improved care for those clients. As a result of better integration and communication, palliative care services to rural people have been improved. However, with regard to the delivery of direct patient care, or in the support of GPs for the management of palliative care patients, it was apparent that the service did not meet its objectives. The lack of use by GPs and patients appears to be related to a lack of awareness of the existence of the service. A positive outcome of this poor utilisation is, however, that the model has allowed the identification of factors that work as barriers to GPs and client/family utilisation of rural palliative care services.
近年来，专业姑息治疗服务不断增加，使有姑息治疗需求的人更容易获得此类服务；然而，服务差距依然存在，尤其是在澳大利亚的农村和偏远地区。为解决农村医疗服务提供方面的一个差距，澳大利亚昆士兰州图文巴为该地区及农村居民引入了支持、教育、评估和监测（SEAM）服务。这种新的服务模式旨在为居住在区域城市图文巴及其农村集水区的患者及其家属提供姑息治疗服务。它还旨在促进医疗保健专业人员之间的教育、支持和交流，特别是全科医生和受雇于全科诊所的护士（诊所护士）。
该评估涉及对20名在2003年6月至2004年6月期间与SEAM服务有接触的各类医疗专业人员进行面对面访谈。对访谈记录进行定性数据分析为评估提供了依据。关于SEAM服务出现的主题包括：SEAM服务的满意度和益处；对SEAM服务的了解和接触；SEAM的作用；以及作用的扩展。
数据表明，大多数与SEAM服务有接触的医疗专业人员对该服务感到满意，并认为它对他们自己和他们的客户有益。参与者对SEAM护士与其他医疗服务提供者建立的广泛交流和支持工作进行了评价。SEAM服务遇到的困难包括全科医生利用率低，因此，需要姑息治疗支持的客户也得不到充分服务。这主要是由于对该服务缺乏了解以及对SEAM护士的作用认识有限。
SEAM服务增加了为农村客户提供姑息治疗的医疗专业人员之间的联系。最成功的策略是使用多学科病例会诊，这不仅在照顾个体客户的医疗专业人员之间建立了联系，而且还改善了对这些客户的护理。由于更好的整合和沟通，为农村居民提供的姑息治疗服务得到了改善。然而，在直接提供患者护理或支持全科医生管理姑息治疗患者方面，很明显该服务没有达到其目标。全科医生和患者对该服务的使用率低似乎与对该服务的存在缺乏认识有关。然而，这种低利用率的一个积极结果是，该模式有助于确定那些成为全科医生和客户/家庭利用农村姑息治疗服务障碍的因素。
