Background and aims
Remote Australians have poorer health outcomes than their metropolitan compatriots, in context of prohibitive distances to health services, including specialist care. In Western NSW, patients living beyond 100km of Dubbo had a lower than expected use of face to face or telehealth Oncology services based in Dubbo Hospital, the referral hospital for the district.
Outreach Oncology clinics were established in four towns in Western NSW (Cobar, Coonabarabran, Mudgee and Walgett) in 2015, guided by a mathematical algorithm using census data for population, socioeconomic disadvantage, cancer deaths and geographic isolation. The primary aim was to assess the impact of these on referrals to the Oncology service.
A database of all Oncology referrals to Dubbo Hospital and outreach clinics from January 2013 to December 2016 was interrogated. The incidence proportion (IP) of new referrals were compared before and after outreach clinics were established for six subgroups; the four mentioned towns, as well as regions within 100km, and beyond 100km of them.
Across the four towns and regions within 100km of them, there were 43.74 referrals per year for the period before outreach clinics were established, with an incidence proportion (IP) of 0.001298 referrals per person per year. Afterwards, this figure rose to 105.17, with an IP of 0.0031210 (p-value <0.001). Living beyond 100km of an outreach clinic conferred the lower IP of 0.002279, rising from an IP of 0.001750 (p-value 0.378). IP in very remote towns including Bourke and Brewarrina remained very low (0.001476 and 0.001502 respectively).
Outreach clinics resulted in a significant increase in referrals and access to an Oncologist, though the impact was felt least by those living beyond 100km of outreach clinics. This raises the concern that telehealth alone is not as effective in providing cancer care closer to home as outreach.