Australian Journal of Rural Health最新文献

Background

Access to child development allied health services is challenging in rural and remote areas. A companion review has described the types of models of care that are used to deliver these services and their impact on the quality of healthcare.

Objective

This review aimed to identify service drivers for, and barriers and enabling strategies to the delivery of these services.

Design

A scoping review was conducted in alignment with the Joanna Briggs Institute methodology and PRISMA methodology. Data from included citations were thematically organised to describe and connect drivers, enabling strategies and barriers.

Findings

Twenty-five citations met the inclusion criteria. Six key drivers were identified, four key enabling strategies and five key barriers.

Discussion

Most models of care were driven by the need to address the inadequacy of child development allied health services. Place-based strategies were described by most citations as key to enabling the delivery of new models of care. However, understanding the community's capacity for a new model of care was a prominent barrier to implementation.

Conclusion

Findings from this review highlight the complexities of devising and delivering new models of care for children in rural and remote areas with developmental needs. While place-based approaches were the most widely adopted enabling strategy, these strategies presented their own challenges. Understanding community needs, capacity and assets from end-user (including children) perspectives is complex but should underpin designing and implementing models of care.

Objective

To explore how self-reported coastal visitation, participation, risk perception, safety knowledge, experiences and safety practices differed between regional and remote, and major city residents to inform remoteness-specific coastal drowning prevention efforts.

Methods

This study used data obtained from the annual National Coastal Safety Survey from 2018 to 2023. Data were postweighted proportionally according to age, gender and Australian Statistical Geography Standard classification using 2021 census population data. Descriptive statistics and chi-square analyses were used to identify key differences in the behaviours, knowledge, and experiences of regional and remote respondents as compared to major city respondents.

Results

A total of 14 210 respondents were included in this dataset. Regional and remote respondents were more likely to visit an unpatrolled beach, particularly when swimming/wading (n = 929, 42.3%; χ² = 502.14, p < 0.001). However, similar proportions of regional and remote and major city respondents reported following safety practices on patrolled beaches. Regional and remote respondents were more likely to consider sea and weather conditions for all coastal activities, but there was little difference between remoteness groups regarding rip current identification, perceptions and experiences.

Discussion

This study demonstrates that future coastal safety research should consider the impact of remoteness to corroborate the findings of this study: that a significant contributor to the regional and remote drowning burden is a lack of access to patrolled beaches.

Conclusions

Regional and remote residents are more likely to frequent unpatrolled beaches but, if able to visit a patrolled beach, are just as likely as major city residents to adhere to safety practices.

Objective

This study has arisen in response to a lack of studies examining how farming affects mortality patterns across areas of Northern Ireland (NI) over a 10-year period. This paper aims to investigate whether agriculturally intensive electoral Wards have higher mortality rates compared to non-agriculturally based Wards, controlling for relevant factors.

Methods

The population census and farm census information was downloaded from the Northern Ireland Neighbourhood Service (NINIS) website to construct two original mortality-based datasets. Linear regression was used for the analysis.

Design

Decennial Ward-Level Influence of Demographic, Farming, and Economic Predictors on All-Cause Mortality.

Setting

Five hundred and eighty-two Ward areas of Northern Ireland.

Main Outcome Measure

Mortality risk within Ward areas.

Results

Findings showed larger amounts of natural log of the population, 65 to 100+ year-olds, limiting long-term illnesses, Farming Intensity Scores, residents living alone and full-time workers within Wards were predictive of mortality risk within those Wards.

Conclusions

This study is the first of its kind in NI to provide evidence for Farming Intensity Scores explaining the variation of mortality rates between areas, in addition to many of the usual predictors.

Objective

Australia currently lacks a standardised paediatric diabetes care model. This study explores the model of care and outcomes of paediatric Type 1 diabetes mellitus (T1D) at a rural multidisciplinary paediatric diabetes clinic.

Methods

A retrospective cross-sectional study.

Design

A single centre quantitative study.

Setting

A rural multidisciplinary paediatric diabetes clinic.

Participants

Patients under 19 years old with a T1D diagnosis who attended the paediatric diabetes clinic for at least 12 months.

Main Outcome Measures

Baseline demographics, glycosylated haemoglobin (HbA1c) levels, time in range, clinic appointment adherence, and diabetes-related hospitalisations over a 12-month period from October 2021 to September 2022.

Results

Fifty-two patients, with a median age of 13.5 (IQR 7) years and 58% females, were included. Of the patients, 40% lived more than 50 km away from the diabetes clinic, 73% were on continuous subcutaneous insulin infusion, and 92% used continuous glucose monitoring. The median HbA1c was 8.3% (67 mmol/mol), with four patients (8%) achieving the international target HbA1c level of less than 7.0% (53 mmol/mol). The CGM users' average time in range was 54%. A total of 29 patients (56%) attended all annual clinic reviews. Six patients (12%) were hospitalised for diabetes-related complications.

Conclusion

Paediatric T1D managed in a rural multidisciplinary paediatric diabetes clinic, with experienced local clinicians and support from a tertiary centre, can attain outcomes in glycaemic control, clinic attendance, and diabetes-related hospitalisation comparable to those of large Australian metropolitan clinics. However, glycaemic outcomes remain suboptimal when compared to international standards.

Introduction

Across Australia, there is considerable variation in the quality of health care and the risk of associated complications. Hence, many patients are receiving poor-quality care. This may be exacerbated in rural and remote areas where the availability of health care is relatively limited. Addressing this requires a multipronged approach that supports the workforce. Involving medical practitioners in medical students' quality improvement (QI) scholarly projects may be one strategy to assist with bridging this gap. The aim of this review was to synthesise the evidence relating to medical students' compulsory curriculum-based quality improvement projects and associated practice outcomes.

Method

Scoping review of peer-reviewed literature (January 2000–June 2024).

Results

Of the 239 articles, six empirical studies from Australia, New Zealand, the UK and the USA were included. Half of these were based in community settings and the rest in hospitals. Only one was in a rural setting. The time allocated to projects was between 5 and 12 weeks. Five of the six studies reported that student project recommendations had been implemented. One study reported that the process enhanced doctors' adherence to best practice guidelines.

Discussion

Much of the research about the outcomes of medical student curriculum-based projects focuses on research outputs. These relatively short student QI projects are one strategy to improve evidence-based practice while upskilling clinicians. Further work is needed to examine their impact, particularly in rural areas.

Conclusion

Integrating medical students into ‘real-world’ QI health service projects can enhance the quality of health care whilst building the skills of the medical workforce.

Background

Farmers are at higher risk of developing dementia due to occupational exposures throughout their lives. People living in regional and remote areas also have increased barriers to care compared with urban populations, while farmers face additional barriers.

Aims

To explore the barriers to care and risks faced by farmers with dementia, from the perspectives of healthcare workers. This preliminary study also aims to explore the differences in barriers faced by farmers and non-farming rural populations.

Methods

Seven participants from a range of health professions were interviewed in a semi-structured style to explore their experiences. The data were coded and analysed using a constructivist grounded theory approach to search for recurring themes.

Results

Six key themes emerged from the data: (1) barriers arising from typical farmer personality traits; (2) geographic isolation; (3) late diagnoses of dementia; (4) barriers to the provision of care on the farm; (5) on-farm risks; and (6) transition to residential aged care home.

Conclusions

Farmers living with dementia on-farm may face significant barriers to care and risks to themselves and others compared to non-farm rural and urban populations. These additional barriers predominantly stem from increased geographic isolation and personality traits common to farming populations. However, there is potential for change to improve care provision through earlier diagnosis, more efficient service funding to enhance treatment availability and the use of residential aged care homes more suited to farmers.

Objective

To examine the characteristics, satisfaction levels and clinical outcomes of rural and remote Australians with chronic pain completing an internet-delivered psychological pain management program (PMP).

Design

Longitudinal routine care cohort study.

Setting

An Australian national digital psychology service.

Participants

Patients in inner regional locations (n = 401), outer regional and remote locations (n = 198), and major cities (n = 968), who used the service over a 6-year period.

Main Outcome Measures

Demographic and clinical data, patient-reported satisfaction and improvements, and meaningful clinical improvements (≥ 30% improvement).

Results

Clinical improvements were observed from pre-treatment to post-treatment in pain-related disability (32% [95% CI: 29, 34]), depression symptoms (44% [95% CI: 39, 49]), anxiety symptoms (43% [95% CI: 39, 47]), and average pain intensity (23% [95% CI: 21, 26]), which were maintained to 3-month follow-up. High levels of satisfaction and treatment completion were also observed. Minor demographic and clinical differences were observed. However, there were similar rates of clinical improvement, treatment satisfaction and treatment completion in all groups.

Conclusions

The current findings further highlight the value of internet-delivered psychological PMPs for Australians with chronic pain living in regional and remote parts of the country. Further work is needed to raise awareness about the availability of these effective programmes and to integrate their use with traditional pain management services.

Background

Lions Outback Vision provides access to specialist eye care in rural and remote Western Australia. In 2020, the Kimberley Hub was established as a new regional base in Broome for outreach services in the northwest of the state. Vitreoretinal services commenced for the first time in Broome in 2021.

This is a retrospective audit of retinal services provided by Lions Outback Vision in the year prior to, and following, establishment of the Kimberley Hub.

Methods

All ophthalmology occasions of service in the Kimberley in 2019 (1/1/19–31/12/19) were compared with those from April 2021 to March 2022.

Data are presented as number (percentage) and mean ± SD as continuous data was normally distributed. Two-way comparisons were by chi-square test.

Results

Occasions of service increased by 75% from 3307 to 5793 between the 2019 and 2021/22 periods respectively. Nonattendance significantly reduced from 28.5% to 18.7% (p < 0.001). In the 12 months following the introduction of vitreoretinal capabilities, 42 surgeries were performed on 35 people (mean ± SD age of 56.1 ± 13.1 years at first surgery), 17 (48.6%) were male, 29 (82.9%) identified as Aboriginal or Torres Strait Islander and 19 (54.3%) had diabetes. Nine (21.4%) of these cases were emergency procedures. The number of intravitreal injections given significantly increased by 87% between 2019 and 2021/22. There were 3.5 times more laser photocoagulative procedures.

Conclusion

Establishment of the Kimberley Hub saw increased appointments, reduced nonattendance and establishment of the first vitreoretinal service in remote Western Australia.

Introduction

Guideline-based care for chronic pain is variably provided. Existing data on chronic pain management in Australia come primarily from metropolitan samples. As the initial investigations for a wider needs assessment, we sought to understand how chronic pain is managed in rural Australia, focused on investigating the gap between guideline-recommended care and provided care.

Methods

We conducted semistructured interviews with rural healthcare professionals who treat patients with chronic pain and rural consumers affected by chronic pain. We asked healthcare professionals what treatments they deliver to patients with chronic pain. We asked consumers to describe the healthcare service providers they had accessed for pain care and the treatments they received from these providers. We utilised content analysis to gain an understanding of what care for chronic pain is being provided and compared these findings to guideline recommendations.

Results

We interviewed 15 healthcare professionals and 27 consumers. Both healthcare professionas and consumers reported minimal use of most first-line management strategies. We also found differences between healthcare professional and consumer reports of pain care. Healthcare professionals frequently described delivering guideline-aligned pain care and consumers frequently described receiving care that contradicted guidelines. We identified challenges with rural access to pain care services, including minimal usage of telehealth services.

Conclusions

Given the identified gaps in care, future research may consider ways of improving rural access to pain care services, including investigating ways to increase uptake of telehealth services, and how to shift consumer expectations of pain care.