The availability of chronic disease management and dialysis services, and the patient characteristics of aeromedical retrieval for renal disease within rural and remote, Australia

A/Prof. Fergus Gardiner1

1Royal Flying Doctor Service, Canberra, Australia


Objective: To determine the geographical coverage of chronic disease management and dialysis services available to the rural and remote Australian population; and the characteristics of Royal Flying Doctor Service (RFDS) patients that underwent an aeromedical retrieval for renal disease.

Method: To determine provision of chronic disease management and dialysis services by geographic area, data from RFDS, the Australian Bureau of Statistics, and Health Direct were used. Patient diagnostic data were recorded using ICD-10 coding from 2014 to 2018. Descriptive statistics and Chi-square analysis were used in data analysis, with significance determined at p <0.01.

Main outcome measures: Chronic disease and dialysis service coverage in rural and remote areas, and patient disease type and prevalence (by age, gender, and Indigenous status).

Results: Mapping demonstrated that there are many rural and remote areas that may be without regular chronic disease management or dialysis services. The RFDS conducted 4139 aeromedical retrievals for diseases of the genitourinary system, which represented 3.9% of all aeromedical retrievals. Males were more likely than females (53.9% vs. 46.1%, p<0.01) to be retrieved. Indigenous patients (n=1337, 32.3%), were significantly younger then the wider population (40.2 vs. 58.3, p<0.01). Detailed ICD-10 2-item diagnoses were recorded for the majority (58.2%) of patients. There were significant diagnosis differences (all p<0.01) between genders, including although not limited to, males being more likely (all p<0.01) then females to have acute renal failure, calculus of the kidney and ureter, renal colic, obstructive and reflex uropathy, and kidney failure, conversely females were more likely (all p<0.01) to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo-interstitial nephritis, and cystitis.

Conclusion: The majority of retrievals were from areas without access to regular chronic disease management services or dialysis units, with many rural and remote patients required to travel extensive distances to access services.


Fergus Gardiner has completed a PhD (medicine) specialising in chronic kidney disease management. Fergus has been the lead author on research projects, involving emergency and military medicine, rural and remote healthcare, pathology, and obstetrics and gynecology.  Prior to commencing with the Flying Doctor, Fergus served in the Australian Defense Force before employment in large teaching hospitals and the Department of Health.  Fergus is an academic at the Australian National University were he conducts epidemiology and clinical research. Furthermore, he is a consultant associated with applications to the Federal Government’s Medical Services Advisory Committee, in the field of chronic disease management.