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

Objective: To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions. Design: Service development, pilot evaluation study. Setting: Regional and remote areas of the state of New South Wales, Australia. Participants: Persons with SCI, caregivers, and health professionals. Intervention: Phase I 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 Measures: Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision. Results: Clinician 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. Conclusion: Education 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.