Shea Spierings, Victor M Oguoma, Anthony Shakeshaft, Jim Walker, Maree Toombs, James S Ward
Objectives
To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations.
Study design
Web-based survey.
Setting
Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022.
Participants
Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia.
Main outcome measures
Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations.
Results
A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23–38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% v 124, 61%) and very or extremely effective (212, 76% v 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16–29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66–0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09–1.27).
Conclusion
The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.
{"title":"Knowledge about COVID-19 vaccines among Aboriginal and Torres Strait Islander people, and attitudes to and behaviours regarding COVID-19 and influenza vaccination: a survey","authors":"Shea Spierings, Victor M Oguoma, Anthony Shakeshaft, Jim Walker, Maree Toombs, James S Ward","doi":"10.5694/mja2.52551","DOIUrl":"10.5694/mja2.52551","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess Aboriginal and Torres Strait Islander people's knowledge about coronavirus disease 2019 (COVID-19) vaccines, and their attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Web-based survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia (excluding the Northern Territory), 1 October 2021 to 31 May 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Convenience sample of Aboriginal and Torres Strait Islander people aged 16 years or older living in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Proportions of respondents who reported knowledge about COVID-19 vaccines, and attitudes to and behaviours regarding COVID-19 and influenza vaccinations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 530 people provided valid survey responses; their median age was 27 years (interquartile range, 23–38 years), 255 (48%) were from urban areas, and 309 (58%) were men. Of the 480 participants (91%) who provided complete survey questions (including sex and location information), larger proportion of men than women believed COVID-19 vaccines were very or extremely trustworthy (219, 79% <i>v</i> 124, 61%) and very or extremely effective (212, 76% <i>v</i> 138, 68%). The prevalence of COVID-19 vaccination was lower among respondents aged 60 years or older than among those aged 16–29 years (adjusted prevalence ration [PR], 0.81; 95% confidence interval [CI], 0.66–0.99). After adjusting for socio-demographic factors, the association between intention to receive the influenza vaccine and receiving the COVID-19 vaccine was statistically significant (adjusted PR, 1.18; 95% CI, 1.09–1.27).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The high levels of trust in COVID-19 vaccines and their effectiveness indicate that Aboriginal and Torres Strait Islander people are confident about their safety and efficacy and understand the importance of vaccination. The findings also highlight a positive attitude to vaccination and a commitment to preventive health measures among Aboriginal and Torres Strait Islander people.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 1","pages":"30-37"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alyssa Pradhan, David Pham, Alexander Brennan, Jen Kok, Priya Garg
<p>A 39-year-old woman underwent bilateral sequential lung transplantation for fibrotic hypersensitivity pneumonitis in May 2022. Her immunosuppression treatment included prednisolone, tacrolimus and mycophenolate. She received one dose of Comirnaty (Pfizer) pre-transplant and tixagevimab–cilgavimab in June 2022.</p><p>Her first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed on 14 December 2022 and she was treated with molnupiravir for five days. On Day 11 of illness, she presented to hospital in respiratory distress with hypoxia (SpO2; 73% on room air). SARS-CoV-2 RNA was detected by polymerase chain reaction (PCR) with a cycle threshold of 21.8 (cobas SARS-CoV-2 and Influenza A/B, Roche). A chest computed tomography scan demonstrated extensive bilateral ground-glass opacification (Box 1). She required intensive care unit admission for high-flow nasal oxygen (FiO<sub>2</sub> 60%, flow rate 50 litres) and received tocilizumab, ten days of remdesivir, increased prednisolone, and piperacillin–tazobactam. Three days of pulsed methylprednisolone was prescribed for possible transplant rejection. Despite clinical improvement, SARS-CoV-2 RNA remained detectable with a cycle threshold of 16.2 (VIASURE SARS-CoV-2, flu and RSV, Certest Biotec) and SARS-CoV-2 was isolated from a cell culture.<span><sup>1</sup></span> Whole genome sequencing identified Omicron BR.2 (variant of concern B.1.1.529) lineage, with molnupiravir-associated mutational signatures,<span><sup>2</sup></span> (sequence available on GISAID [Global Initiative of Sharing All Influenza Data]; 26/12/22: hCoV-19/Australia/NSW_ICPMR_40135/2022 and 03/03/23: hCoV-19/Australia/NSW_ICPMR_43136/2023).</p><p>The patient was transferred to a high acuity respiratory ward after three weeks, but over the ensuing six weeks, became severely deconditioned and continued to require high-flow nasal oxygen (FiO<sub>2</sub> 30–35%, 35 litres). Chest imaging was stable, demonstrating fibrosis but minimal progressive inflammation. The persistent detection of SARS-CoV-2 RNA and isolation of SARS-CoV-2 by culture (Box 2) from upper respiratory tract samples prevented participation in enhanced inpatient pulmonary rehabilitation beyond her single room, as per local infection prevention guidelines and hospital policy.<span><sup>3</sup></span> The policy, based on national guidelines,<span><sup>3</sup></span> dictated that for coronavirus disease 2019 (COVID-19) de-isolation, immunocompromised hosts need to be 21 days post-infection, asymptomatic, and without detectable SARS-CoV-2 RNA. In individuals with persistent RNA detection, a cycle threshold greater than 30 with either positive spike antibody, negative rapid antigen test (RAT) or culture is sufficient for de-isolation.</p><p>The patient received a further dose of tixagevimab–cilgavimab, regular intravenous immunoglobulin and ten further days of remdesivir. Repeat whole genome sequencing did not identify infection with anothe
{"title":"Prolonged SARS-CoV-2 shedding in a lung transplant recipient: time for flexibility in infection prevention?","authors":"Alyssa Pradhan, David Pham, Alexander Brennan, Jen Kok, Priya Garg","doi":"10.5694/mja2.52556","DOIUrl":"10.5694/mja2.52556","url":null,"abstract":"<p>A 39-year-old woman underwent bilateral sequential lung transplantation for fibrotic hypersensitivity pneumonitis in May 2022. Her immunosuppression treatment included prednisolone, tacrolimus and mycophenolate. She received one dose of Comirnaty (Pfizer) pre-transplant and tixagevimab–cilgavimab in June 2022.</p><p>Her first severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed on 14 December 2022 and she was treated with molnupiravir for five days. On Day 11 of illness, she presented to hospital in respiratory distress with hypoxia (SpO2; 73% on room air). SARS-CoV-2 RNA was detected by polymerase chain reaction (PCR) with a cycle threshold of 21.8 (cobas SARS-CoV-2 and Influenza A/B, Roche). A chest computed tomography scan demonstrated extensive bilateral ground-glass opacification (Box 1). She required intensive care unit admission for high-flow nasal oxygen (FiO<sub>2</sub> 60%, flow rate 50 litres) and received tocilizumab, ten days of remdesivir, increased prednisolone, and piperacillin–tazobactam. Three days of pulsed methylprednisolone was prescribed for possible transplant rejection. Despite clinical improvement, SARS-CoV-2 RNA remained detectable with a cycle threshold of 16.2 (VIASURE SARS-CoV-2, flu and RSV, Certest Biotec) and SARS-CoV-2 was isolated from a cell culture.<span><sup>1</sup></span> Whole genome sequencing identified Omicron BR.2 (variant of concern B.1.1.529) lineage, with molnupiravir-associated mutational signatures,<span><sup>2</sup></span> (sequence available on GISAID [Global Initiative of Sharing All Influenza Data]; 26/12/22: hCoV-19/Australia/NSW_ICPMR_40135/2022 and 03/03/23: hCoV-19/Australia/NSW_ICPMR_43136/2023).</p><p>The patient was transferred to a high acuity respiratory ward after three weeks, but over the ensuing six weeks, became severely deconditioned and continued to require high-flow nasal oxygen (FiO<sub>2</sub> 30–35%, 35 litres). Chest imaging was stable, demonstrating fibrosis but minimal progressive inflammation. The persistent detection of SARS-CoV-2 RNA and isolation of SARS-CoV-2 by culture (Box 2) from upper respiratory tract samples prevented participation in enhanced inpatient pulmonary rehabilitation beyond her single room, as per local infection prevention guidelines and hospital policy.<span><sup>3</sup></span> The policy, based on national guidelines,<span><sup>3</sup></span> dictated that for coronavirus disease 2019 (COVID-19) de-isolation, immunocompromised hosts need to be 21 days post-infection, asymptomatic, and without detectable SARS-CoV-2 RNA. In individuals with persistent RNA detection, a cycle threshold greater than 30 with either positive spike antibody, negative rapid antigen test (RAT) or culture is sufficient for de-isolation.</p><p>The patient received a further dose of tixagevimab–cilgavimab, regular intravenous immunoglobulin and ten further days of remdesivir. Repeat whole genome sequencing did not identify infection with anothe","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"69-71"},"PeriodicalIF":6.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline K Dowsett, Francesca Frentiu, Gregor J Devine, Wenbiao Hu
<p>Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,<span><sup>1</sup></span> and is endemic in many countries on that continent and islands of the Pacific region. Although only a small percentage of cases are symptomatic, 20–30% are fatal and 30–50% develop significant neurological sequelae.<span><sup>2</sup></span> Australia has escaped relatively unscathed, with only a few cases detected in the late 1990s, mostly from international travellers, with local transmission limited to the Torres Strait and Cape York.<span><sup>2, 3</sup></span> The last detection of JEV in Cape York was from feral pigs and an isolate of mosquitoes in 2005. Sentinel animal surveillance in Australia was phased out in 2011 due to costs and labour-intensive maintenance, potential occupational health and safety issues, and concerns about the potential public health risk of using amplifying hosts (pigs), which may contribute to transmission when they become viremic.<span><sup>3</sup></span> Sentinel animal use was replaced by a general mosquito trap-based surveillance system.<span><sup>3</sup></span> The Box provides a timeline of JEV milestones in Australia from the 1990s to 2023, with details on animal and human cases, and corresponding changes in surveillance.</p><p>JEV emerged again in 2021 with a fatal case in the Tiwi Islands, and shortly after was detected on an unprecedented scale and geographical spread in 2022: cases in humans and piggeries were detected across four states in south-eastern Australia (New South Wales, Victoria, Queensland, South Australia). On 4 March 2022, the Australian Government declared the JEV outbreak a communicable disease incident of national significance.<span><sup>4</sup></span> Over the following months, a total of 46 cases (including 7 deaths) were identified in humans (as of 13 February 2023).<span><sup>5</sup></span> The end of the JEV emergency response was announced on 16 June 2023,<span><sup>6</sup></span> although concern remains regarding potential endemicity in Australian waterbird, pig and mosquito populations.</p><p>JEV is maintained in an enzootic cycle between wading waterbirds and <i>Culex</i> spp mosquitoes and, in some cases, pigs, with spillover to humans and horses.<span><sup>7</sup></span> Birds act as maintenance hosts and can harbour the virus without overt signs of disease. Humans and horses are dead-end hosts and may become infected through the bite of an infectious mosquito. However, dead-end hosts cannot produce virus levels high enough to infect feeding mosquitoes. In Asia, pigs commonly act as amplifying hosts, rapidly multiplying the virus to high levels that can be passed on to susceptible mosquito species, resulting in spillover to humans. There is no evidence of pigs acting as amplifying hosts during the 2021–2023 outbreak in Australia.</p><p>The dominant JEV vector in Australia and parts of the Western Pacific (such as Papua New
{"title":"Japanese encephalitis transmission in Australia: challenges and future perspectives","authors":"Caroline K Dowsett, Francesca Frentiu, Gregor J Devine, Wenbiao Hu","doi":"10.5694/mja2.52550","DOIUrl":"10.5694/mja2.52550","url":null,"abstract":"<p>Japanese encephalitis is caused by the Japanese encephalitis virus (JEV). JEV is the main cause of viral encephalitis in Asia,<span><sup>1</sup></span> and is endemic in many countries on that continent and islands of the Pacific region. Although only a small percentage of cases are symptomatic, 20–30% are fatal and 30–50% develop significant neurological sequelae.<span><sup>2</sup></span> Australia has escaped relatively unscathed, with only a few cases detected in the late 1990s, mostly from international travellers, with local transmission limited to the Torres Strait and Cape York.<span><sup>2, 3</sup></span> The last detection of JEV in Cape York was from feral pigs and an isolate of mosquitoes in 2005. Sentinel animal surveillance in Australia was phased out in 2011 due to costs and labour-intensive maintenance, potential occupational health and safety issues, and concerns about the potential public health risk of using amplifying hosts (pigs), which may contribute to transmission when they become viremic.<span><sup>3</sup></span> Sentinel animal use was replaced by a general mosquito trap-based surveillance system.<span><sup>3</sup></span> The Box provides a timeline of JEV milestones in Australia from the 1990s to 2023, with details on animal and human cases, and corresponding changes in surveillance.</p><p>JEV emerged again in 2021 with a fatal case in the Tiwi Islands, and shortly after was detected on an unprecedented scale and geographical spread in 2022: cases in humans and piggeries were detected across four states in south-eastern Australia (New South Wales, Victoria, Queensland, South Australia). On 4 March 2022, the Australian Government declared the JEV outbreak a communicable disease incident of national significance.<span><sup>4</sup></span> Over the following months, a total of 46 cases (including 7 deaths) were identified in humans (as of 13 February 2023).<span><sup>5</sup></span> The end of the JEV emergency response was announced on 16 June 2023,<span><sup>6</sup></span> although concern remains regarding potential endemicity in Australian waterbird, pig and mosquito populations.</p><p>JEV is maintained in an enzootic cycle between wading waterbirds and <i>Culex</i> spp mosquitoes and, in some cases, pigs, with spillover to humans and horses.<span><sup>7</sup></span> Birds act as maintenance hosts and can harbour the virus without overt signs of disease. Humans and horses are dead-end hosts and may become infected through the bite of an infectious mosquito. However, dead-end hosts cannot produce virus levels high enough to infect feeding mosquitoes. In Asia, pigs commonly act as amplifying hosts, rapidly multiplying the virus to high levels that can be passed on to susceptible mosquito species, resulting in spillover to humans. There is no evidence of pigs acting as amplifying hosts during the 2021–2023 outbreak in Australia.</p><p>The dominant JEV vector in Australia and parts of the Western Pacific (such as Papua New","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"222 2","pages":"58-62"},"PeriodicalIF":6.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52550","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Stroke is a devastating disease, leaving survivors with physical and cognitive impairments, and emotional and psychological instability. In 2021, the most current year available, the coronavirus disease 2019 (COVID-19) pandemic shifted the rankings of the <i>Global Burden of Disease Study</i>, bringing stroke down to the third leading cause of death worldwide,<span><sup>1</sup></span> and fourth leading cause of disability-adjusted life years.<span><sup>2</sup></span> In Australia, in 2022, cerebrovascular disease (mostly stroke) was the third leading cause of death in women compared with fifth in men.<span><sup>3</sup></span></p><p>Women have a lower age-adjusted incidence of stroke than men.<span><sup>4</sup></span> However, on age group breakdowns, authors of a recent meta-analysis of 16 studies (33 775 women and 36 018 men) found that sex difference in ischaemic stroke incidence was the greatest in adults younger than 35 years of age, with an estimated 44% more women than men.<span><sup>5</sup></span> These findings, showing that young women may be disproportionately at risk of ischaemic stroke, represent a significant shift from our current understanding, with important implications regarding causes and potential management of ischaemic strokes in young adults.</p><p>We acknowledge that the studies referenced herein use mostly sex data. However, in this perspective article, we use the term “women” in a binary manner to denote females.</p><p>There are key modifiable risk factors that are more strongly associated with stroke risk in women than in men. In the <i>UK Biobank Study</i> of 471 971 individuals (56% women),<span><sup>6</sup></span> in women, hypertension and obesity were associated with a 30% greater risk of stroke, and smoking and type 2 diabetes a 20–25% greater risk of stroke, compared with men.</p><p>In young women, non-atherosclerotic factors that increase the risk of stroke may be important. These include female-specific risk factors such as exogenous hormones and pregnancy-related exposures. Hormonal contraceptives are very effective, reliable and provide women with multiple health benefits. Combined oral contraceptives (COCs) containing oestrogen and progestogen carry an increased risk of arterial thrombosis, with a Cochrane systematic review noting a 1.7-fold increased risk of ischaemic stroke compared with non-users (relative risk [RR], 1.7; 95% confidence interval [CI], 1.5–1.9). The risk increased the higher the dose of oestrogen.<span><sup>7</sup></span> In a separate meta-analysis (six case–control studies), progestogen-only contraceptives were not associated with stroke when compared with individuals that had never used or formerly used this type of contraceptive.<span><sup>8</sup></span> Although overall COC-use ischaemic stroke risk is low for individuals, women with migraine who also use COCs have a further increased risk (RR, 7.02 [95% CI, 1.51–32.68]) while women experiencing a migraine with aura, COC use, and
{"title":"Stroke in young women: the need for targeted prevention and treatment strategies","authors":"Cheryl Carcel, Kylie Tastula, Amanda Henry","doi":"10.5694/mja2.52516","DOIUrl":"10.5694/mja2.52516","url":null,"abstract":"<p>Stroke is a devastating disease, leaving survivors with physical and cognitive impairments, and emotional and psychological instability. In 2021, the most current year available, the coronavirus disease 2019 (COVID-19) pandemic shifted the rankings of the <i>Global Burden of Disease Study</i>, bringing stroke down to the third leading cause of death worldwide,<span><sup>1</sup></span> and fourth leading cause of disability-adjusted life years.<span><sup>2</sup></span> In Australia, in 2022, cerebrovascular disease (mostly stroke) was the third leading cause of death in women compared with fifth in men.<span><sup>3</sup></span></p><p>Women have a lower age-adjusted incidence of stroke than men.<span><sup>4</sup></span> However, on age group breakdowns, authors of a recent meta-analysis of 16 studies (33 775 women and 36 018 men) found that sex difference in ischaemic stroke incidence was the greatest in adults younger than 35 years of age, with an estimated 44% more women than men.<span><sup>5</sup></span> These findings, showing that young women may be disproportionately at risk of ischaemic stroke, represent a significant shift from our current understanding, with important implications regarding causes and potential management of ischaemic strokes in young adults.</p><p>We acknowledge that the studies referenced herein use mostly sex data. However, in this perspective article, we use the term “women” in a binary manner to denote females.</p><p>There are key modifiable risk factors that are more strongly associated with stroke risk in women than in men. In the <i>UK Biobank Study</i> of 471 971 individuals (56% women),<span><sup>6</sup></span> in women, hypertension and obesity were associated with a 30% greater risk of stroke, and smoking and type 2 diabetes a 20–25% greater risk of stroke, compared with men.</p><p>In young women, non-atherosclerotic factors that increase the risk of stroke may be important. These include female-specific risk factors such as exogenous hormones and pregnancy-related exposures. Hormonal contraceptives are very effective, reliable and provide women with multiple health benefits. Combined oral contraceptives (COCs) containing oestrogen and progestogen carry an increased risk of arterial thrombosis, with a Cochrane systematic review noting a 1.7-fold increased risk of ischaemic stroke compared with non-users (relative risk [RR], 1.7; 95% confidence interval [CI], 1.5–1.9). The risk increased the higher the dose of oestrogen.<span><sup>7</sup></span> In a separate meta-analysis (six case–control studies), progestogen-only contraceptives were not associated with stroke when compared with individuals that had never used or formerly used this type of contraceptive.<span><sup>8</sup></span> Although overall COC-use ischaemic stroke risk is low for individuals, women with migraine who also use COCs have a further increased risk (RR, 7.02 [95% CI, 1.51–32.68]) while women experiencing a migraine with aura, COC use, and ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 11","pages":"571-572"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Georgina M Luscombe, Andrew Wilson, Amanda J Ampt, Amy Von Huben, Kirsten Howard, Clare Coleman, Georgia Wingfield, Shannon Nott
<div> <section> <h3> Objective</h3> <p>To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS).</p> </section> <section> <h3> Design</h3> <p>Retrospective cohort study; analysis of emergency department and administrative hospital data.</p> </section> <section> <h3> Setting</h3> <p>Twenty-nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting. The VRGS was providing predominantly virtual medical support when local doctors needed relief or were unavailable, typically for lower acuity ED presentations and scheduled inpatient ward rounds.</p> </section> <section> <h3> Patients</h3> <p>All patients who presented or were admitted to a Western NSW Local Health District hospital serviced by the VRGS between 1 July 2021 and 30 June 2022.</p> </section> <section> <h3> Main outcome measures</h3> <p>Treatment completions, transfers, ED departure within 4 hours, length of stay, and hospital mortality.</p> </section> <section> <h3> Results</h3> <p>During 2021–22, 34% of ED presentations (13 660/39 701) and 40% of admissions (2531/6328) involved VRGS care. For ED presentations, after adjusting for socio-demographic and clinical factors, patients attended by VRGS doctors had higher odds of not waiting (adjusted odds ratio [aOR], 3.69; 95% CI, 2.79–4.89), lower odds of transfer to another hospital (aOR, 0.66; 95% CI, 0.60–0.72) and slightly lower odds of ED departure within 4 hours (aOR, 0.92; 95% CI, 0.86–0.98) when compared with patients not attended by VRGS doctors (ie, those provided usual care). For admissions, after adjusting for socio-demographic and clinical factors, inpatients attended exclusively by VRGS doctors had higher odds of discharging at their own risk (3.33; 95% CI, 1.98–5.61) and lower odds of being a long stay outlier (aOR, 0.51; 95% CI, 0.35–0.74) when compared with inpatients not attended by VRGS doctors. The odds of inpatient mortality were equivalent when comparing VRGS and non-VRGS care (aOR, 0.78; 95% CI, 0.48–1.28) and when comparing combined (VRGS and non-VRGS) and non-VRGS care (aOR 1.21; 95% CI, 0.91–1.61).</p> </section> <section> <h3> Conclusions</h3>
{"title":"Health service access and quality of care provided by the Western NSW Local Health District Virtual Rural Generalist Service: a retrospective analysis of linked administrative data","authors":"Georgina M Luscombe, Andrew Wilson, Amanda J Ampt, Amy Von Huben, Kirsten Howard, Clare Coleman, Georgia Wingfield, Shannon Nott","doi":"10.5694/mja2.52528","DOIUrl":"10.5694/mja2.52528","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study; analysis of emergency department and administrative hospital data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Twenty-nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting. The VRGS was providing predominantly virtual medical support when local doctors needed relief or were unavailable, typically for lower acuity ED presentations and scheduled inpatient ward rounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>All patients who presented or were admitted to a Western NSW Local Health District hospital serviced by the VRGS between 1 July 2021 and 30 June 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Treatment completions, transfers, ED departure within 4 hours, length of stay, and hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During 2021–22, 34% of ED presentations (13 660/39 701) and 40% of admissions (2531/6328) involved VRGS care. For ED presentations, after adjusting for socio-demographic and clinical factors, patients attended by VRGS doctors had higher odds of not waiting (adjusted odds ratio [aOR], 3.69; 95% CI, 2.79–4.89), lower odds of transfer to another hospital (aOR, 0.66; 95% CI, 0.60–0.72) and slightly lower odds of ED departure within 4 hours (aOR, 0.92; 95% CI, 0.86–0.98) when compared with patients not attended by VRGS doctors (ie, those provided usual care). For admissions, after adjusting for socio-demographic and clinical factors, inpatients attended exclusively by VRGS doctors had higher odds of discharging at their own risk (3.33; 95% CI, 1.98–5.61) and lower odds of being a long stay outlier (aOR, 0.51; 95% CI, 0.35–0.74) when compared with inpatients not attended by VRGS doctors. The odds of inpatient mortality were equivalent when comparing VRGS and non-VRGS care (aOR, 0.78; 95% CI, 0.48–1.28) and when comparing combined (VRGS and non-VRGS) and non-VRGS care (aOR 1.21; 95% CI, 0.91–1.61).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 ","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S8-S15"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52528","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy Von Huben, Anna E Thompson, Andrew Wilson, Georgina M Luscombe, Amelia Haigh, Kirsten Howard, Emily Saurman, Tim Shaw, Georgia Wingfield, Amanda J Ampt, Shannon Nott
<div> <section> <h3> Objective</h3> <p>Evaluate the cost-effectiveness of the Virtual Rural Generalist Service (VRGS) model of care.</p> </section> <section> <h3> Design</h3> <p>A cost–consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non-VRGS] doctors) from the perspective of the health care funder in 2022 prices.</p> </section> <section> <h3> Setting</h3> <p>Twenty-nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites).</p> </section> <section> <h3> Patients</h3> <p>Patients of any age who presented to an emergency department (ED) or were admitted to hospital at VRGS sites over the pre-VRGS period (1 February 2019 to 31 January 2020) or the post-VRGS period (1 July 2021 to 30 June 2022).</p> </section> <section> <h3> Intervention</h3> <p>The VRGS model of care, which provides 24-hour 7-days-a-week rural generalist doctors, both virtually and in person, to small rural and remote hospitals, predominantly for lower acuity ED presentations, daily ward rounds for inpatients admitted by a VRGS medical officer, and ad hoc inpatient medical reviews when local doctors need support or are unavailable.</p> </section> <section> <h3> Main outcomes measures</h3> <p>Incremental cost per incremental quality-of-care outcome, maintenance of health service activity levels, workforce sustainability (measured by changes in locum shifts), and service acceptability (as determined by thematic analysis of interviews).</p> </section> <section> <h3> Results</h3> <p>The cost per standard unit of health care (national weighted activity unit) was lower for the VRGS ($1047) than for usual care ($1753). VRGS doctors dealt with ED presentations of similar complexity to non-VRGS doctors, and admissions of significantly lower (40%) complexity. Health service activity remained stable from the pre-VRGS period to the post-VRGS period, only declining by 4% in the post-VRGS period, which was during the coronavirus disease 2019 pandemic. Locum shifts decreased from 1456 days in the pre-VRGS period to 609 days in the post-VRGS period, improving the sustainability of the workforce. Local doctors and managers found the VRGS to be acceptable, but thought it could be enhanc
{"title":"An economic evaluation of the Virtual Rural Generalist Service versus usual care in Western NSW Local Health District","authors":"Amy Von Huben, Anna E Thompson, Andrew Wilson, Georgina M Luscombe, Amelia Haigh, Kirsten Howard, Emily Saurman, Tim Shaw, Georgia Wingfield, Amanda J Ampt, Shannon Nott","doi":"10.5694/mja2.52530","DOIUrl":"10.5694/mja2.52530","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate the cost-effectiveness of the Virtual Rural Generalist Service (VRGS) model of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cost–consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non-VRGS] doctors) from the perspective of the health care funder in 2022 prices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Twenty-nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients</h3>\u0000 \u0000 <p>Patients of any age who presented to an emergency department (ED) or were admitted to hospital at VRGS sites over the pre-VRGS period (1 February 2019 to 31 January 2020) or the post-VRGS period (1 July 2021 to 30 June 2022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Intervention</h3>\u0000 \u0000 <p>The VRGS model of care, which provides 24-hour 7-days-a-week rural generalist doctors, both virtually and in person, to small rural and remote hospitals, predominantly for lower acuity ED presentations, daily ward rounds for inpatients admitted by a VRGS medical officer, and ad hoc inpatient medical reviews when local doctors need support or are unavailable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcomes measures</h3>\u0000 \u0000 <p>Incremental cost per incremental quality-of-care outcome, maintenance of health service activity levels, workforce sustainability (measured by changes in locum shifts), and service acceptability (as determined by thematic analysis of interviews).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cost per standard unit of health care (national weighted activity unit) was lower for the VRGS ($1047) than for usual care ($1753). VRGS doctors dealt with ED presentations of similar complexity to non-VRGS doctors, and admissions of significantly lower (40%) complexity. Health service activity remained stable from the pre-VRGS period to the post-VRGS period, only declining by 4% in the post-VRGS period, which was during the coronavirus disease 2019 pandemic. Locum shifts decreased from 1456 days in the pre-VRGS period to 609 days in the post-VRGS period, improving the sustainability of the workforce. Local doctors and managers found the VRGS to be acceptable, but thought it could be enhanc","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S28-S36"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52530","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna E Thompson, Tim Shaw, Shannon Nott, Andrew Wilson, Emily Saurman
Objectives
To understand patients’ and carers’ experiences of virtual medical care delivered into rural and remote hospitals.
Study design
Qualitative study using semi-structured interviews.
Setting, participants
Interviews were conducted between 7 June 2022 and 21 February 2023. Participants were people who had received a virtual medical service from the Virtual Rural Generalist Service (VRGS), and their carers, in rural and remote hospitals within the Western NSW Local Health District.
Main outcome measures
Acceptability of, access to, quality of and appropriateness of care provided by the VRGS.
Results
We interviewed 43 patients and carers about their experiences of VRGS services received in an emergency department or inpatient setting. About half of our participants thought that virtual medical care (supported by in-person nursing staff) was highly acceptable and equivalent to in-person care. For the remaining participants, virtual care was seen as being an acceptable alternative if in-person care was not available. Patients reported that the model met their immediate needs, even if the virtual delivery mode was not their preference. VRGS doctors were generally seen as skilled and personable, and acceptability of virtual care increased with more experience of it. A key perceived benefit of virtual care was increased access to medical care without the need to travel long distances. Hospital-based virtual care was not considered less appropriate for older adults or children.
Conclusions
Virtual care in a rural hospital setting, such as that delivered by the VRGS, is broadly acceptable to patients and carers. While most would prefer to have a doctor physically present, patients and carers are accepting of the need for virtual care to supplement in-person care in rural and remote areas. Patients and carers who experience hospital-based virtual care perceive that it can provide good quality medical care and meet many of their needs.
{"title":"Patient and carer experiences of hospital-based hybrid virtual medical care: a qualitative study","authors":"Anna E Thompson, Tim Shaw, Shannon Nott, Andrew Wilson, Emily Saurman","doi":"10.5694/mja2.52520","DOIUrl":"10.5694/mja2.52520","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To understand patients’ and carers’ experiences of virtual medical care delivered into rural and remote hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>Qualitative study using semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, participants</h3>\u0000 \u0000 <p>Interviews were conducted between 7 June 2022 and 21 February 2023. Participants were people who had received a virtual medical service from the Virtual Rural Generalist Service (VRGS), and their carers, in rural and remote hospitals within the Western NSW Local Health District.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Acceptability of, access to, quality of and appropriateness of care provided by the VRGS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 43 patients and carers about their experiences of VRGS services received in an emergency department or inpatient setting. About half of our participants thought that virtual medical care (supported by in-person nursing staff) was highly acceptable and equivalent to in-person care. For the remaining participants, virtual care was seen as being an acceptable alternative if in-person care was not available. Patients reported that the model met their immediate needs, even if the virtual delivery mode was not their preference. VRGS doctors were generally seen as skilled and personable, and acceptability of virtual care increased with more experience of it. A key perceived benefit of virtual care was increased access to medical care without the need to travel long distances. Hospital-based virtual care was not considered less appropriate for older adults or children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Virtual care in a rural hospital setting, such as that delivered by the VRGS, is broadly acceptable to patients and carers. While most would prefer to have a doctor physically present, patients and carers are accepting of the need for virtual care to supplement in-person care in rural and remote areas. Patients and carers who experience hospital-based virtual care perceive that it can provide good quality medical care and meet many of their needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S22-S27"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The end of the year is a good time to reflect on why a journal like the <i>MJA</i> does what it does, who supports the Journal's work, and the headwinds that journals are navigating.</p><p>The <i>MJA</i> publishes high quality research and commentary that aims to inform health policy and influence medical practice in Australia. Our process is largely one of curation of what is submitted to us, combined with commissioning on issues we identify as important. We prioritise for publication articles that report on or discuss conditions with a high burden of disease, that are likely to have an effect on policy or practice, support Aboriginal and Torres Strait Islander health and wellbeing, and articles that report on uniquely Australian topics.</p><p>Articles go through a rigorous process that includes editorial assessment, peer review, author revision in response to peer review, and, after acceptance, expert structural editing. We hope that this process — essentially a collaboration between authors, editors and reviewers — will ensure that, by the time an article is published, it is the best representation of the authors’ work. In the 12 months to 31 October 2024, the <i>MJA</i> received 1598 articles, of which 196 were accepted; we publish around 10–12 in each issue. Each issue is a curated mix of content; some, such as the theme issues on surgery (https://www.mja.com.au/journal/2024/220/5), general practice (https://www.mja.com.au/journal/2024/220/9), women's health (https://www.mja.com.au/journal/2024/221/7), infectious diseases (https://www.mja.com.au/journal/2024/221/4), child and adolescent health (https://www.mja.com.au/journal/2024/221/10), and the special issue on Indigenous health (https://www.mja.com.au/journal/2024/221/1), have a specific focus.</p><p>This end of year issue has no specific theme; its diversity, however, collectively reflects the Journal's priorities. We hope these articles will interest you as readers and support you in your clinical practice or research as much as we were fascinated by them as editors. The research articles include an analysis of the cost of treating hypertension (https://doi.org/10.5694/mja2.52522), participation in the national bowel screening program by people with severe mental illness (https://doi.org/10.5694/mja2.52521), an analysis of out-of-hospital cardiac arrests (https://doi.org/10.5694/mja2.52532), and an analysis of the Northern Territory health workforce (https://doi.org/10.5694/mja2.52507). Perspectives include the need for targeted prevention and treatment of stroke in young women (https://doi.org/10.5694/mja2.52516), and a review of the evidence of persistently replicating SARS-CoV-2 as a driver of long COVID (https://doi.org/10.5694/mja2.52517). We are proud to also publish in this section a thoughtful article, “Decolonisation, Indigenous health research, and Indigenous authorship: sharing our teams’ principles and practices” (https://doi.org/10.5694/mja2.52509), by a collective of Ab
{"title":"Curating an evidence base for health research and policy making: more crucial than ever","authors":"Virginia Barbour","doi":"10.5694/mja2.52536","DOIUrl":"10.5694/mja2.52536","url":null,"abstract":"<p>The end of the year is a good time to reflect on why a journal like the <i>MJA</i> does what it does, who supports the Journal's work, and the headwinds that journals are navigating.</p><p>The <i>MJA</i> publishes high quality research and commentary that aims to inform health policy and influence medical practice in Australia. Our process is largely one of curation of what is submitted to us, combined with commissioning on issues we identify as important. We prioritise for publication articles that report on or discuss conditions with a high burden of disease, that are likely to have an effect on policy or practice, support Aboriginal and Torres Strait Islander health and wellbeing, and articles that report on uniquely Australian topics.</p><p>Articles go through a rigorous process that includes editorial assessment, peer review, author revision in response to peer review, and, after acceptance, expert structural editing. We hope that this process — essentially a collaboration between authors, editors and reviewers — will ensure that, by the time an article is published, it is the best representation of the authors’ work. In the 12 months to 31 October 2024, the <i>MJA</i> received 1598 articles, of which 196 were accepted; we publish around 10–12 in each issue. Each issue is a curated mix of content; some, such as the theme issues on surgery (https://www.mja.com.au/journal/2024/220/5), general practice (https://www.mja.com.au/journal/2024/220/9), women's health (https://www.mja.com.au/journal/2024/221/7), infectious diseases (https://www.mja.com.au/journal/2024/221/4), child and adolescent health (https://www.mja.com.au/journal/2024/221/10), and the special issue on Indigenous health (https://www.mja.com.au/journal/2024/221/1), have a specific focus.</p><p>This end of year issue has no specific theme; its diversity, however, collectively reflects the Journal's priorities. We hope these articles will interest you as readers and support you in your clinical practice or research as much as we were fascinated by them as editors. The research articles include an analysis of the cost of treating hypertension (https://doi.org/10.5694/mja2.52522), participation in the national bowel screening program by people with severe mental illness (https://doi.org/10.5694/mja2.52521), an analysis of out-of-hospital cardiac arrests (https://doi.org/10.5694/mja2.52532), and an analysis of the Northern Territory health workforce (https://doi.org/10.5694/mja2.52507). Perspectives include the need for targeted prevention and treatment of stroke in young women (https://doi.org/10.5694/mja2.52516), and a review of the evidence of persistently replicating SARS-CoV-2 as a driver of long COVID (https://doi.org/10.5694/mja2.52517). We are proud to also publish in this section a thoughtful article, “Decolonisation, Indigenous health research, and Indigenous authorship: sharing our teams’ principles and practices” (https://doi.org/10.5694/mja2.52509), by a collective of Ab","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 11","pages":"567-570"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52536","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna E Thompson, Emily Saurman, Shannon Nott, Andrew Wilson, Tim Shaw
Objectives
To explore the experiences of clinicians delivering, facilitating, and potentially affected by a hybrid virtual medical model servicing rural and remote hospitals in western New South Wales.
Design, setting, participants
Qualitative study using semi-structured focus groups and individual interviews, conducted between 7 April 2022 and 16 March 2023, with rural generalist doctors delivering the Virtual Rural Generalist Service (VRGS) within the Western NSW Local Health District, local site staff, and local general practitioner visiting medical officers (GP VMOs).
Main outcome measures
Key themes in clinician experience of the model and recommendations for improved experience, based on qualitative content analysis.
Results
We interviewed 12 VRGS doctors, 25 site nursing staff and nine GP VMOs. Clinicians were overwhelmingly positive about the VRGS, seeing it as providing good quality care and being an innovative and translatable solution to rural workforce challenges. In-person site visits by VRGS doctors were highly valued, especially by local site staff, for team building, skill building and increasing VRGS doctors’ understanding of the local context. The VRGS model relies on nursing availability and skill, and creates additional workload for nurses. Nurses in isolated sites valued the clinical support provided by the VRGS. Overall, most GP VMOs valued the fatigue relief offered by the VRGS; however, some viewed the VRGS as diminishing local doctors’ autonomy and the viability of their positions.
Conclusions
The hybrid VRGS model is widely accepted by clinicians as providing good quality care for patients and high job satisfaction for providers. The service supports the local health workforce and makes rural medical positions more attractive and sustainable. The in-person shift requirement is central to the model's effectiveness and acceptability. Further investment is needed to train and resource local nurses who play an integral role in providing virtual medical care.
{"title":"Clinician experiences of a hybrid virtual medical service supporting rural and remote hospitals: a qualitative study","authors":"Anna E Thompson, Emily Saurman, Shannon Nott, Andrew Wilson, Tim Shaw","doi":"10.5694/mja2.52525","DOIUrl":"10.5694/mja2.52525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To explore the experiences of clinicians delivering, facilitating, and potentially affected by a hybrid virtual medical model servicing rural and remote hospitals in western New South Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design, setting, participants</h3>\u0000 \u0000 <p>Qualitative study using semi-structured focus groups and individual interviews, conducted between 7 April 2022 and 16 March 2023, with rural generalist doctors delivering the Virtual Rural Generalist Service (VRGS) within the Western NSW Local Health District, local site staff, and local general practitioner visiting medical officers (GP VMOs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Key themes in clinician experience of the model and recommendations for improved experience, based on qualitative content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We interviewed 12 VRGS doctors, 25 site nursing staff and nine GP VMOs. Clinicians were overwhelmingly positive about the VRGS, seeing it as providing good quality care and being an innovative and translatable solution to rural workforce challenges. In-person site visits by VRGS doctors were highly valued, especially by local site staff, for team building, skill building and increasing VRGS doctors’ understanding of the local context. The VRGS model relies on nursing availability and skill, and creates additional workload for nurses. Nurses in isolated sites valued the clinical support provided by the VRGS. Overall, most GP VMOs valued the fatigue relief offered by the VRGS; however, some viewed the VRGS as diminishing local doctors’ autonomy and the viability of their positions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The hybrid VRGS model is widely accepted by clinicians as providing good quality care for patients and high job satisfaction for providers. The service supports the local health workforce and makes rural medical positions more attractive and sustainable. The in-person shift requirement is central to the model's effectiveness and acceptability. Further investment is needed to train and resource local nurses who play an integral role in providing virtual medical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S16-S21"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shannon Nott, Georgia Wingfield, Amelia Haigh, Georgina M Luscombe, Anna E Thompson, Emily Saurman, Tim Shaw, Amy Von Huben, Kirsten Howard, Andrew Wilson
<p>It is well known that rural and remote communities globally experience inequities in both health outcomes and access to health provision.<span><sup>1</sup></span> In Australia, despite a range of initiatives to address the shortfall for doctors in rural and remote areas, there remain substantial gaps in access to doctors in many rural communities.<span><sup>2, 3</sup></span> Telehealth is a means to manage this gap; however, few models have been developed to deal with workforce challenges for small rural hospitals and fewer have been evaluated through the lens of the Quadruple Aim: improved health outcomes that matter to patients, improved experiences of receiving and providing care, and improving health care costs.<span><sup>4</sup></span> This article introduces the <i>MJA</i> supplement on the Virtual Rural Generalist Service (VRGS), which is a model of care designed to provide medical support to rural hospitals where there is limited onsite medical staff or where there are no local doctors available. This perspective provides the background for four articles evaluating the VRGS.</p><p>Western NSW Local Health District (WNSWLHD) is a vast health district in the state of New South Wales, Australia. It covers some of the state's most vulnerable communities across 246 676 km<span><sup>2</sup></span> and is home to a population of about 279 000 people, of whom 14% identify as First Nations peoples.<span><sup>5</sup></span> Of the 38 health facilities within the WNSWLHD footprint, six are classified as “inner regional”, 14 are classified as “outer regional”, and the remainder are either “remote” or “very remote”, and no local government area is classified as a metropolitan area, according to the Australian Statistical Geography Standard – Remoteness Areas.<span><sup>6</sup></span> WNSWLHD is primarily responsible for the acute and emergency services across this region, operating 38 inpatient facilities, including three rural referral hospitals, four procedural hospitals, six community hospitals, and 25 multipurpose hospitals.<span><sup>5</sup></span></p><p>Like many rural and remote regions across Australia, and internationally, workforce access in western NSW remains a challenge.<span><sup>3, 7</sup></span> This is particularly true for rural general practitioners, who provide primary care and are also the main medical workforce for 35 of the region's 38 acute care services. Medical workforce has faced increasing strain over the past five to ten years, with the Western NSW Primary Health Network predicting that 41 of the region's 49 communities will be without a general practitioner by the end of the decade.<span><sup>3</sup></span> Consequently, WNSWLHD became increasingly reliant on contracted short term medical officers, with many towns reliant on a locum medical model sometimes having no consistency in visiting medical officers. Even where general practitioner visiting medical officers were available, doctors in small communities were under
{"title":"The Virtual Rural Generalist Service: a hybrid virtual model of care designed to improve health access and outcomes in rural and remote communities","authors":"Shannon Nott, Georgia Wingfield, Amelia Haigh, Georgina M Luscombe, Anna E Thompson, Emily Saurman, Tim Shaw, Amy Von Huben, Kirsten Howard, Andrew Wilson","doi":"10.5694/mja2.52529","DOIUrl":"10.5694/mja2.52529","url":null,"abstract":"<p>It is well known that rural and remote communities globally experience inequities in both health outcomes and access to health provision.<span><sup>1</sup></span> In Australia, despite a range of initiatives to address the shortfall for doctors in rural and remote areas, there remain substantial gaps in access to doctors in many rural communities.<span><sup>2, 3</sup></span> Telehealth is a means to manage this gap; however, few models have been developed to deal with workforce challenges for small rural hospitals and fewer have been evaluated through the lens of the Quadruple Aim: improved health outcomes that matter to patients, improved experiences of receiving and providing care, and improving health care costs.<span><sup>4</sup></span> This article introduces the <i>MJA</i> supplement on the Virtual Rural Generalist Service (VRGS), which is a model of care designed to provide medical support to rural hospitals where there is limited onsite medical staff or where there are no local doctors available. This perspective provides the background for four articles evaluating the VRGS.</p><p>Western NSW Local Health District (WNSWLHD) is a vast health district in the state of New South Wales, Australia. It covers some of the state's most vulnerable communities across 246 676 km<span><sup>2</sup></span> and is home to a population of about 279 000 people, of whom 14% identify as First Nations peoples.<span><sup>5</sup></span> Of the 38 health facilities within the WNSWLHD footprint, six are classified as “inner regional”, 14 are classified as “outer regional”, and the remainder are either “remote” or “very remote”, and no local government area is classified as a metropolitan area, according to the Australian Statistical Geography Standard – Remoteness Areas.<span><sup>6</sup></span> WNSWLHD is primarily responsible for the acute and emergency services across this region, operating 38 inpatient facilities, including three rural referral hospitals, four procedural hospitals, six community hospitals, and 25 multipurpose hospitals.<span><sup>5</sup></span></p><p>Like many rural and remote regions across Australia, and internationally, workforce access in western NSW remains a challenge.<span><sup>3, 7</sup></span> This is particularly true for rural general practitioners, who provide primary care and are also the main medical workforce for 35 of the region's 38 acute care services. Medical workforce has faced increasing strain over the past five to ten years, with the Western NSW Primary Health Network predicting that 41 of the region's 49 communities will be without a general practitioner by the end of the decade.<span><sup>3</sup></span> Consequently, WNSWLHD became increasingly reliant on contracted short term medical officers, with many towns reliant on a locum medical model sometimes having no consistency in visiting medical officers. Even where general practitioner visiting medical officers were available, doctors in small communities were under","PeriodicalId":18214,"journal":{"name":"Medical Journal of Australia","volume":"221 S11","pages":"S3-S7"},"PeriodicalIF":6.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.5694/mja2.52529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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