Cure for tyranny of distance in country practices

BRIDGING the gap between theory and practice has been Angela Murphy's remit since 2000, when she used her doctoral thesis to see how this worked in health services in regional and rural Victoria.

BRIDGING the gap between theory and practice has been Angela Murphy's remit since 2000, when she used her doctoral thesis to see how this worked in health services in regional and rural Victoria.

Dr Murphy studied the application of a concept called evidence-based practice.

Whether a method was still state-of-the-art was judged by surveying as many documented examples of its use as possible and analysing its success.

One instance was a popular 1970s US documentary, Scared Straight, in which teenage offenders visited prisons. Not only was it not a deterrent, it proved a bad influence.

Dr Murphy, working through the University of Ballarat, looked at evidence-based practice in a regional city, a rural town and its surrounds, and a remote area of 10,000sqkm.

She surveyed doctors, nurses, physiotherapists and social and welfare workers, and concluded that keeping up with improved practices became more difficult the farther workers were from big cities, with their face-to-face training courses and easy transport.

"The practitioners are doing amazing work in what can be very difficult situations," Dr Murphy said. "This work is about supporting them."

Even the internet was difficult: at that time not all services had desktop computers and internet speeds were glacial. "Three years ago the location I looked at was the last line on the grid for the internet server," she said.

Also, some workers felt strong pressure to accede to the requests of the community.

"In a regional location people go to the doctor or the hospital, receive a service and walk away, but in the remote areas if they are not happy they knock on the door or make an approach at the supermarket."

Initially sceptical about evidence-based practice, Dr Murphy emerged a devout believer in the need to help staff implement it. She said hurdles included getting enough relevant studies of programs to provide evidence, allowing for unique environments in which health teams worked and accepting what the teams' experience told them would work.