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 1 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.