Factors That Influence Medical Retrieval Decisions in Remote Central Australia

Introduction Medical retrieval services play a key role in the transportation of unwell patients from remote communities across Australia. Decision to retrieve a patient from a remote community is dependent on unique characteristics of remote locations and thus different to urban and rural retrievals. The study aims to explore various factors that affect medical practitioner decisions to retrieve patients from remote central Australian communities. Methods Semi-structured interviews were conducted with 36 staff involved in medical retrieval processes in central Australia. The data collection and analyses were part of a broader study evaluating a newly implemented medical retrieval model in central Australia. All interviews were recorded and transcribed. Transcripts were co-coded inductively by two researchers using NVivo software. Similar codes were grouped into themes, one of which related to the range of factors that affect decisions to retrieve a patient or request a retrieval which is the focus of this paper. Results: Decision-making about who, when and how to retrieve patients was complex and involved trade-offs. Severity of patient illness, resource availability (e.g. transport infrastructure, remote area staff workload and fatigue), the skills, experience and relationships with community of primary health care and medical retrieval staff, strength of primary health care systems in remote communities, specific primary health care and retrieval policies, and innovations in disease prevention and management influenced medical retrieval decisions. Conclusion: It is critical to understand that both general and contextual factors unique to remote communities affect medical retrieval decisions. Decisions are highly complex and necessitate trade-offs, frequently related to resource scarcity, which are somewhat different from those of urban retrieval services. Resource allocation in the context of providing retrieval services for remote populations must account for differences in burden of disease, cultural requirements, workforce characteristics and overall access to health care compared to urban populations.