Palliative care in the hinterlands: a description of existing services and doctors' attitudes.
OBJECTIVE
To describe palliative care services as they exist in the hinterlands (towns away from regional centres) of Midwest New South Wales, including an estimation of the numbers of cases treated by local doctors, and the service they provide to their patients. Generalist doctors' attitudes to palliative care are also explored, as this information is lacking in the literature but is important for service provision.


METHODS
Descriptive survey.


METHODS
Rural primary care and district hospitals.


METHODS
Generalist doctors in hinterland areas.


RESULTS
In total, 38% (19/50) of surveys were returned. "Visiting rights" to the district hospital were held by 78.9% of local doctors, and patients are admitted under the care of their own doctor for symptom control and terminal care, 94.1% and 76.5% of the time, respectively. All doctors surveyed perform home visits for terminally ill patients, and 68.4% make themselves routinely available after hours. Doctors surveyed estimated that they managed a mean of 8.4 deaths due to chronic illness in the past 12 months. Most (78.9%) said that they would continue to manage dying patients even if they had a choice, and they feel between moderately and very satisfied that they provide quality care. However, only 21.1% considered their undergraduate training in palliative medicine to be adequate, and all said that they would refer to a specialist service if it were available.


CONCLUSIONS
Generalist rural doctors not only treat many dying patients, but also provide a continuity of care that is rarely seen in other settings. Proposals of models for "rural" palliative care should, therefore, take this unique setting into account. One such suggestion is given in this article.
Pereira
Glenn J
GJ
Braeside Hospital, South Western Sydney Area Health Service, Asquith, New South Wales 2077, Australia. glennjpereira@yahoo.co.uk
D039602:After-Hours Care; D001291:Attitude of Health Personnel; D018672:Community Health Planning; D005194:Family Practice / Q000193:education / Q000458:organization & administration* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006792:House Calls; D006801:Humans; D009517:New South Wales; D010166:Palliative Care / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D011365:Professional Practice Location; D019035:Rural Health Services / Q000458:organization & administration*