Rural and remote health最新文献

Introduction: Pharmacies and pharmacists play an integral role in primary health care. This role is particularly important in regional and rural settings where workforce is scarce. There are many challenges in recruiting and retaining a pharmacist workforce in regional and rural Australia. The literature on rural pharmacy workforce is largely based on employees' perspectives, with little emphasis on employers' experiences. This study aims to explore employers' perspectives of (1) recruitment and retention of staff pharmacists in their regional or rural practices and (2) strategies to mitigate recruitment and retention challenges of regional rural staff pharmacists.

Methods: This study was a qualitative, cross-sectional study of a randomised group of employers. A database of 151 unique employers was created using publicly available sources, and a randomised sample of 20 was identified using the Statistical Package for the Social Sciences. Semi-structured interviews were conducted individually with each selected employer. As part of a content analysis, responses pertaining to recruitment and retention were coded.

Results: A total of 473 basic responses were discovered using the inductive coding process. These codes were then condensed into 72 codes, based on their interpretive meaning and similarity. The codes were then sorted and categorised, by their logical and natural epistemology, into three separate but related topic areas: remuneration, work conditions and policy aspects (161 responses, 28 codes); workplace and role satisfaction (231 responses, 31 codes); and social factors (81 responses, 13 codes). The most significant findings included that pay and remuneration are highly inadequate, flexibility both in terms of working hours and scope of practice are perceived to be key factors for recruiting and retaining employee pharmacists, and geographical distance and social aspects persist and were reported as difficult to overcome. Various strategies to address these issues were discussed with mixed outcomes.

Discussion: Like employee pharmacists, employers emphasised that contemporary pay and remuneration, as outlined in industry awards and agreements, were inadequate. In addition, flexibility both in terms of scope and working hours, as well as a harmonious work environment, are key factors to recruiting and retaining employee pharmacists from an employers' perspective.

Conclusion: This study identified that remuneration, work conditions and policy aspects, as well as workplace and role satisfaction and social factors, are the major challenges for employers in recruiting and retaining pharmacists in regional or rural Victoria. More needs to done to attract and retain a workforce for rural Victoria.

Introduction: Indonesia comprises 16,771 islands, including 111 small islands and atolls. The Indonesian government has established community health centres, known as puskesmas in Indonesian, to provide health services to the entire populations of the country, including those in remote areas. In 2014, the Indonesian government introduced a national health insurance system with the goal of providing equitable access to health care for all citizens. However, not all health issues can be managed by these community health centres, necessitating a referral system to more advanced healthcare facilities. This study aims to evaluate the implementation of the referral system by community health centres in small island areas, with a view to addressing a research gap on this topic.

Methods: This implementation research explores the challenges associated with the referral system using the intervention mapping approach. This approach involves six stages: (1) needs assessment, (2) change matrix development, (3) devising strategies to optimise referrals based on practical theories, (4) program preparation, (5) adoption and implementation planning, and (6) evaluation planning. The target population will comprise patients, healthcare workers at community health centres and various other stakeholders. The study is to be conducted on three small islands in Sangihe Islands Regency, North Sulawesi Province: Nusa Tabukan, Marore and Kahakitang.

Results: The evaluation of the referral program addresses the gap in the implementation of referrals from community health centres on small islands, providing valuable information for the government and policymakers regarding healthcare delivery in hard-to-reach and remote areas.

Conclusion: The study's results are expected to offer valuable insights into systematic research processes and provide recommendations for interventions designed to improve the referral system from community health centres to regional hospitals.

Introduction: Recruitment and retention of the healthcare workforce are crucial to maintaining access to services and provision of care, but these are ongoing challenges for health services both in the UK National Health Service (NHS) and globally. We know from systematic reviews of the international literature that many recruitment and retention strategies are based on little definitive evidence. As part of a wider study of place-based community-led initiatives to attract healthcare staff to remote and rural areas, we decided to examine how NHS job advertisements represent the community to which they are recruiting, drawing on the concept of asset-based community development (ABCD) to focus on which social and professional community assets are given prominence and how.

Methods: In total, 270 job advertisements for posts in remote and rural areas of the UK were collected between July and December 2022, from a monthly search of three sources: the British Medical Journal job advertisement site; the NHS Scotland GP job site, and the NHS Scotland jobs site. We then contacted named recruitment contacts from all the advertisements collected where possible, to ask how many applications were received and whether an appointment had been made. Informed by the ABCD lens, job advertisements were analysed using a thematic framework analysis approach to identify the different assets that advertisements highlighted. Responses from advertisers contacted were added to the framework, including free text about their experiences of trying to recruit.

Results: Advertisements ranged from a couple of short paragraphs of text describing the post, with perhaps (although not always) a few details about the location, to lengthy and elaborate descriptions of both the post and the local community, sometimes with photographs, links to further information and videos about the community. We found that while many advertisements included plenty of detailed information about the community and the lifestyle, other places may not be realising the full potential of local assets. One simple change would be to provide more visual information, either in the advertisement itself or - if that is too costly - in a linked website or document. Emails were sent to 189 advertisers, and we received 45 responses. Of the 45 responses received, only 18 stated that an appointment had been made as a direct result of the advert. Feedback from advertisers has also suggested that those recruiting to rural and remote posts may need to proactively seek connections with potential applicants rather than hoping that the advertisement alone will be enough to find them.

Conclusion: There is evidence from our results that local place-based assets are not always featured as strongly or as visually as they could be in advertisements for remote and rural healthcare jobs. To our knowledge, there has not been a cost-effectivene

Introduction: Oral and maxillofacial (OMF) injuries encompass all forms of trauma to the tissues of the oro-facial complex, the face, jaws and mouth. In rural areas, where healthcare access is often limited, OMF injuries pose unique challenges. These challenges are compounded by environmental factors, occupational hazards and socioeconomic disparities, making rural populations particularly vulnerable to such injuries. This study explores the epidemiology and geographical variation of OMF injuries in Queensland, Australia.

Methods: Data for injury from several Queensland hospital emergency departments were obtained from state register Queensland Injury Surveillance Unit for the years 2015-2021. Data parameters included patient demographics, mechanism, intent and location of injury.

Results: The data (n=9095) revealed that OMF injuries are more prevalent in rural areas and increasing in incidence. Those in inner and outer regional areas sustained injuries 1.8-2.2 times more than the metropolitan population and the incidence was 8.7-11.7 times higher in remote and very remote locations (p<0.05). Approximately 70% of injuries occurred among males in all populations, with peak age of injuries noted as 15-24 years. Assault-related injuries were the predominant cause of injury, notably more common in regional (35.6%) and remote (45.7%) areas compared to metropolitan regions (19.8%) (p<0.05).

Conclusion: The high proportion of OMF injuries experienced in rural areas signifies a considerable health concern. This may be attributable to engagement in risk-taking behaviours, contributing as aetiology or exacerbators. These findings underscore the need for targeted interventions aimed at addressing the mental health and risky behaviour patterns in rural communities. Further research should consider wider aetiological and exacerbating factors including social determinants of health, ethnicity and cultural factors that underlie interpersonal violence in these communities.

Introduction: Attracting and retaining physicians in rural and medically underserved areas is a global challenge. In France, undergraduate medical students must do their professional training in the region where they attend school. Many students from rural underserved areas register at distant schools, thereby precluding training in their region of origin. We hypothesised that the relocation of potential future physicians to regions outside the rural and underserved Centre-Val de Loire (CVDL) region exacerbates the lack of physicians in that region.

Methods: This mixed-methods study with simultaneous quantitative and qualitative analyses focused on medical students from the rural county of Indre (in CVDL). The quantitative analysis assessed the number of Indre students at three medical faculties (one in CVDL, and two in a nearby region) during the academic years 2014-2017, and compared their passing rates with those of their peers. The qualitative analysis investigated factors that may hinder or facilitate choice of faculty, using in-person and telephone student interviews from academic year 2017-2018.

Results: From academic years 2014-2017, 296 students from Indre registered for the first-year examination, with significantly fewer enrolled at the medical faculty of Tours (in CVDL) than at the other two faculties combined (2.0% v 6.8%; p<0.01). First-year pass rates for all faculties combined were similar for Indre students compared to all students (15.5% v 16.1%; p=0.84). Most of the 22 students interviewed knew that they would have to relocate for school. Key determining factors in their choice of faculty included a nearby support network of family and friends, prior impressions of the city, and school reputation as shared with them by others.

Conclusion: Students from the rural county of Indre were as successful as their peers in their first year of medical school, yet were convinced of the opposite. For the confidence to apply and the community assistance to succeed, students need both reliable information, preferably from undergraduates to whom they feel close, and logistical and moral support. Medical schools can work to build community, in order to attract students and help them succeed in their studies.

Introduction: Rural Longitudinal Integrated Clerkships (LICs) have been shown to produce graduate doctors who are more likely to work rurally than those from other clinical training pathways. The student selection and admission process to rural LICs is a relatively unexplored area. To address this knowledge gap, rural LIC graduates' perceptions on participating in the program and the medical students most suited to an LIC were explored. Enhanced understanding of selection and admission processes could provide procedures to optimise student success and wellbeing in rural training environments. Additionally, it could ensure student selection aligns with the program goal and help build targeted strategies to select and train medical students for rural practice.

Methods: An exploratory qualitative study was undertaken. Participants were graduates of the Doctor of Medicine at Deakin University, Australia, who participated in the rural LIC and graduated between 2011 and 2020. Semi-structured qualitative interviews were undertaken, and reflexive thematic analysis was employed.

Results: A sample of 39 graduates participated. Two main themes were identified: selecting and selection. The 'why' (selecting) referred to perceptions on clinical school preferencing decisions, with associated subthemes of being at the centre, aspiration, size matters and being disrupted. The 'who' (selection) referred to the type of student most suited to thrive in the clerkship, with associated subthemes of adaptive learner, relationship builders, harnessing life experiences and familiarity with rurality.

Conclusion: The linking of the 'why' and 'who' has the capacity to ensure that the most suitable students are selecting and selected to undertake a rural LIC. This has benefits for students' personal learning, but also for medical schools with an interest in building effective training models that integrate selection policies with intended outcomes of the program, which often include to graduate doctors who work rurally.

Introduction: Limited data exist on allergic rhinitis and asthma control in rural primary care. Therefore, the aim of our study was to assess asthma and comorbid allergic rhinitis control in patients attending primary care in both urban and rural settings in Greece. Additionally, we aimed to identify potential factors associated with the control of asthma and comorbid allergic rhinitis.

Methods: In this cross-sectional study, patients with asthma and comorbid allergic rhinitis completed questionnaires assessing demographic, co-morbidities and treatment status. Symptom control was evaluated by the Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ) and Control of Allergic Rhinitis/Asthma Test (CARAT). Multivariate logistic regression analysis was applied to identify associated factors of asthma and comorbid allergic rhinitis control after adjusting for age, gender, smoking status and comorbidities.

Results: Out of 121 subjects with asthma and comorbid allergic rhinitis 75 (62%) resided in rural areas. A significant percentage of participants reported suboptimal asthma control using the ACT (54%) and ACQ (67%). Moreover, 88% of participants had not-well-controlled asthma and comorbid allergic rhinitis based on CARAT. Females (odds ratio (OR)=4.1, 95% confidence interval (CI) 0.8-19.9, p=0.043) and patients living in rural areas (OR=3.8, 95%CI 1.34-10.5, p=0.010) were more likely to report well-controlled asthma and allergic rhinitis based on CARAT score (>24). Patients reporting intranasal steroid use (OR=3.6, 95%CI 1.1-121, p=0.035) were more likely to have well-controlled asthma based on ACT score. Analysis also indicated a trend towards significance for the association between short-acting beta-agonist use and not-well-controlled asthma based on the ACT (score≤19) (OR=5, 95%CI 0.9-10, p=0.066) and partially and not-well-controlled asthma based on the ACQ (score>0.75) (OR=5, 95%CI 0.9-10, p=0.066).

Conclusion: Our results suggest that asthma and allergic rhinitis control remain suboptimal in a large proportion of patients in primary care. Area of residence, female gender and medications emerged as significant associated factors that must be taken into account in order to effectively improve asthma and comorbid allergic rhinitis outcomes.

Introduction: Agriculture is Indonesia's largest sector and largest employer, with 10.5% (40.9 million) of the population working in agriculture, forestry or fishing. However, little is known about agricultural workers' health status; risk factors for non-communicable diseases such as heart disease, stroke, cancer, respiratory diseases, diabetes; and wellbeing. This study aimed to undertake a pilot to assess health status, behavioural risk factors, wellbeing and safety among farmers in Indonesia.

Methods: Data were collected from 51 participants in a small rural area of East Java, Indonesia. Trained medical students, supervised by doctors, conducted assessments including anthropometric measurements, overall health status, lifestyle factors and wellbeing using the translated Kessler Psychological Distress Scale (K10). Data analyses were performed using SPSS statistical software and presented descriptively.

Results: The mean age of farmers was 39.5 years with the majority having normal BMI (64.7%). Most farmers reported good health status (62.7%), good hearing (98%), and good vision (88.2%). Overall health is not interfered with their farm activities (76.5%). A total of 76% were active smokers, and 96.1% had low diabetes risk based on the Finnish Diabetes Risk Score - Bahasa Indonesia as well as low psychological distress (76.5%) using the K10-Indonesian adapted scale. All participants used agrichemicals and use of appropriate personal protective equipment was lacking.

Conclusion: Farmers in this pilot study generally reported good health status, although smoking and use of and exposure to agricultural chemicals were highly prevalent. Although a pilot study, the findings highlight the need for further studies on the health, wellbeing and safety of farmers to engage the agricultural community and foster collaboration between local health services, farmers' groups and students.