title: Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health.
abstract: Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.
authors.affiliation: Melbourne Medical School, Level 2 West, Medical Building (181), University of Melbourne, Vic. 3010, Australia.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Ranson
authors.affiliation: Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Terry
authors.affiliation: Department of Rural Health, University of Melbourne, PO Box 386 Wangaratta, Vic. 3676, Australia.
authors.forename: Kristen
authors.initials: K
authors.lastname: Glenister
authors.affiliation: Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia.
authors.forename: Bill R
authors.initials: BR
authors.lastname: Adam
authors.affiliation: Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia.
authors.forename: Julian
authors.initials: J
authors.lastname: Wright
mesh_terms: D001315:Australia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D006801:Humans; D018802:Patient-Centered Care / Q000639:trends*; D011320:Primary Health Care / Q000639:trends*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000639:trends*