University departments of rural health: Is a national network of multidisciplinary academic departments in Australia making a difference?

Abstract

Introduction: In 1996, the Australian Government established the first regionally based, multi-professional university department of rural health (UDRH). Currently, there are 12 UDRHs located across Australia. The UDRH program aims to provide education and training facilities in non-metropolitan centres, thereby helping to attract health professionals to practise in rural and remote communities. UDRHs operate as clinical academic units located within the health service sector. They have sufficient critical mass to develop and deliver academically enriched clinical education and training, and the capacity to manage and coordinate placements and undertake targeted research relevant to the region. This article evaluates the role and contribution of UDRHs to teaching, research and health service performance in rural and remote Australia, prior to expansion funding announced in 2015. Methods: Mixed methods were employed, combining administrative data from 2009 to 2013, Australian Bureau of Statistics Census data for 2011, and interviews with key UDRH staff to assess UDRH teaching and research activity, contributions to workforce and service development, and engagement with rural communities. Descriptive statistical methods were used to determine geographical coverage of UDRHs across Australia, and the pattern and trends of student education and training activity. Content analysis was used to identify clinical training programs, additional educational opportunities delivered by the UDRHs, and collaborative projects that demonstrated engagement in their region. The main outcome measures included UDRH coverage of rural and remote Australia; student activity and contributions, including research outputs, to rural workforce and service development; and engagement with rural communities. Results: All UDRHs participated in the study. In 2013, 18 years after its inception, the UDRH Network footprint covered 3.152 million km 2 - 40.9% of the landmass of Australia - with a population of 2 207 426. An estimated 18% of annual university enrolments in 10 leading health disciplines accessed UDRH clinical placements. Common features across all UDRH student programs included availability of cross-cultural, interprofessional and simulation training, orientation of students to placements, and UDRH-managed accommodation. Other features varied by context across the network. The UDRHs generated 220 peer-reviewed papers in 2013 of which 86% were applied research and 40% addressed some aspect of rural and/or remote health. UDRHs also contributed academic input to many significant regional projects that aim to develop new models of care, improve service access, support better-trained health professionals, or build capacity in organisations and communities. Conclusions: Since their inception 20 years ago, UDRHs have become well-integrated entities, effectively embedded within their regional communities. This evaluation shows that UDRHs are making a difference based on an assessment of geographical coverage and activity, relevant contribution, and engagement in rural and remote communities. The UDRH Network now operates across a substantial geographical footprint, fulfilling an essential academic and workforce development role within the health system in rural and remote Australia. The funding of the UDRHs has recently been doubled to support increased training activity and expand their regional footprint. The Australian Government recently announced funding to establish three additional UDRHs in 2017. As the UDRH Network approaches this new phase of its existence, the next stage of evaluation should focus on providing evidence on the specific workforce, health service, and population health outcomes.