Post-pandemic rehabilitation needs in regional, rural and remote Australia

  • Nurse checking female patients temperature
Ruth Stewart
By
National Rural Health Commissioner
Ruth Stewart
Adjunct Professor
Issue
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Twelve months into the COVID-19 pandemic we are seeing long-term health impacts not all of which are immediately apparent. What is apparent is that some people require ongoing rehabilitation to return to their pre-COVID-infection level of health and wellbeing.

International evidence suggests that approximately 10 per cent of infected people experience ‘long COVID’ – a prolonged illness occurring after the initial acute phase COVID-19, with the most common persistent symptoms relating to breathing. Other possibly persistent symptoms include fatigue, cough, congestion or shortness of breath, loss of taste or smell, headache, body aches, diarrhoea, nausea, chest or abdominal pain and confusion.

The symptoms of COVID-19 are most severe in older populations and in people with pre-existing conditions such as hypertension, diabetes and cardiovascular disease. These are also risk factors for persistence of COVID-19 illness, as are obesity and mental health conditions.

Older patients who survive the acute phase of COVID-19 are at high risk of progressive loss of muscle mass and function, malnutrition, depression and delirium. However, there is evidence that young adults and children without underlying chronic medical conditions can also experience prolonged illness after contracting the virus. 

Those patients who experience prolonged illness following COVID-19 are likely to require rehabilitation services for an extended time to fully recover. Accelerated deterioration in condition and overall health could lead to burgeoning rehabilitation demands in the near future. For this reason, patients will need affordable access to allied health professionals, general practitioners, Aboriginal health workers, nurses and specialists.

This pandemic has had marked psychological impacts, with isolation, illness and economic and social restrictions, loss and uncertainty being widely felt across the world. In Australia, more people have sought information about managing stress and anxiety; mental health and wellbeing have been adversely affected.

Recent years have brought bushfires, floods and drought to rural and remote Australia; and then came the COVID-19 pandemic. For our rural communities, face-to-face mental health support services are needed more urgently than ever before. Planning for the ongoing COVID-19 recovery must include the provision of mental health services.

Allied health will be integral in recovery and rehabilitation of people experiencing prolonged COVID-19 symptoms, but the rural allied health professional workforce is thin on the ground and needs more support.

Rural health care access

Partyline readers know that Australians living in rural and remote regions experience poorer health outcomes than their urban peers and that on average, the more remote your residence, the shorter your life span and the greater the burden of disease carried by your community.

A key for effective disease prevention is access to timely and appropriate care. Management of chronic disease and rehabilitation improves health outcomes but health outcomes deteriorate when access to the right care at the right time is compromised.  We need to minimise and remove barriers to access that still exist for rural patients. COVID-19 response measures such as the introduction of Medicare billing for telehealth has increased access to primary care including allied health.  Telehealth has been an effective stop gap measure, but it is not an appropriate replacement for comprehensive face-to-face primary care or rehabilitation services, anywhere in Australia let alone in rural and remote regions.

COVID-19 rehabilitation service provision in Australia

The pandemic will result in an increased demand for rehabilitation services. This is an important time to raise awareness of the vital role allied health professionals play in recovery. Allied health professionals will be at the forefront of delivering COVID-19 rehabilitation services. Patient care will be most effectively managed within multidisciplinary models of care which include allied health professionals, nurses, general practitioners and specialists working together.

It is, as yet, uncertain what impact vaccination will have on the incidence of long COVID. So far, the hot spots of COVID-19 infection in Australia have been concentrated in large metropolitan areas and some regional cities. Rural and remote communities have had low case numbers; thus, demand for rehabilitation out bush should be less. That is a relief because, with the current undersupply of the rural allied health professional workforce, there will be little capacity to respond to the potential need.

To start planning for increased allied health need, Commonwealth, state and territory governments need to know where rural allied health professionals are and how many we have. They must consider whether existing funding arrangements can support the services that are needed.

Rural and remote Australians need appropriately funded services as close to home as possible. Rural and remote allied health professionals and communities cannot be left out of the COVID-19 recovery plan.

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