Australian Journal of Rural Health最新文献

Objective(s)

To assess the impact of a regional General Practitioner Psychiatry Phone Line (GPPPL), embedded in a public Community Mental Health service (CMHS) on the wider health service's workflow and systemic outcomes.

Design

Non-controlled population-based interventional study.

Setting

Public CMHS in the Great Southern region of Western Australia (WA).

Participants

Aggregated monthly data on (i) referrals to the CMHS (July 2017–March 2022), and (ii) Emergency Department presentations (July 2017–May 2022) were obtained from the West Australian Country Health Service.

Intervention

Introduction of a regional GPPPL, for local publicly employed psychiatrists to provide specialist mental health care advice to General Practitioners working in the same region.

Main Outcome Measures

Service input: Number of calls to the GPPPL, call duration and frequency.

Service output: Rate of referrals to the CMHS, and rate of Emergency Department presentations related to mental health issues, and alcohol and other drugs.

Results

The number of weekly calls to the GPPPL decreased (slope −0.13, 95% CI −0.17, −0.08; p < 0.0001) over the course of the one-year pilot. The referral rate to CMHS was approximately 70.5 referrals per 1000 person-years in July 2017, and quite steady pre-GPPPL (p = 0.9283), then reduced significantly post-GPPPL, by 1.7 (95% CI 0.14, 3.26; p = 0.0372) referrals per 1000 person-years each month.

Conclusions

This study has demonstrated the GPPPL's effectiveness in reducing the referral rates to CMHS and its self-sustainability. The psychiatrists involved were able to continue full-time public service roles while running the phoneline, with a decreasing time demand over the one-year pilot.

Objective

The objective of this study was to understand the experience of rural undergraduate Bachelor of Nursing students engaging with a nurse tutor, enabled through a Regional University Study Hub.

Participants

Ten rural undergraduate Bachelor of Nursing students who engaged with a community-based academic nurse tutor programme.

Design

A descriptive design and data collection through an online questionnaire and telephone interviews using semi-structured questions.

Results

Engaging a support structure that is external to the university for rural, undergraduate Bachelor of Nursing students provided a safe environment for the students to explore technical academic concepts and gain clarity with topics and assessment tasks. The participants felt reticent to share their uncertainties with lecturers. This was particularly significant for mature-aged and first-in-family students.

Conclusion

The collaborative partnership between a university, community, Regional University Study Hub, and industry is a model for future initiatives aimed at ensuring the success of rural students in completing tertiary education and building the rural health workforce.

Objective

This study aimed to determine if rural community strengths identified in the literature have been causally linked to improved mental health and whether these strengths have been harnessed in interventions.

Methods

A secondary analysis of a systematic review of literature from Australia, Canada and the USA identified 28 studies that proposed a conceptual relationship to improved mental health. Studies were categorised, their distribution across a socioecological framework was assessed, and evidence of causality was evaluated.

Results

Among 28 studies, 24 were analytical and focused mainly on community strengths, with four interventional studies that addressed both personnel and community strengths. None established a causal relationship, including those that harnessed strengths in interventions.

Conclusions

Although rural strengths have been associated with improved mental health, evidence on causality, effectiveness and mechanisms for harnessing remains limited. Strengthening the evidence base is critical to justify incorporating rural strengths into mental health commissioning.

Objective

In Victoria, the onset of COVID-19 resulted in restricted entry to metropolitan areas, and lockdowns were a common occurrence. Our health services adapted and changed procedures. Surgical services were limited to urgent cases, while staff were redirected to support COVID-19 health care. This study documents the experience of surgical services in a public hospital serving a rural and regional population in south-west Victoria.

Design

Cohort study.

Methods

All patients who had operations at University Hospital Geelong, the major regional hospital in south-west Victoria, were included in this study. Operations pre-pandemic (2019), during the pandemic (2020–2022) and late pandemic (2023) were recorded. The flow of procedures within each subspecialty, cancellations and the waiting list are reported.

Results

From July 2019 until June 2023, there were 76 098 operations performed with the largest number of operations by general surgery (17 610), plastics and reconstruction (10 560), obstetrics and gynaecology (10 848) and orthopaedics (8376). Emergency procedures peaked at 41% in 2020. Urology experienced the highest percentage increase for operations in 2023 (by 40%), followed by obstetrics and gynaecology (15%), general surgery (14%), otolaryngology (14%), orthopaedics (12%), ophthalmology (11%) and vascular surgery (9%). Staff not available was a reason for cancellation of surgery and the wait list increased by 121% in 2022.

Conclusion

The wait list late pandemic far exceeds that of pre pandemic, increasing the potential to exacerbate regional/rural Victoria's limited access to care. The significant impact on various surgical specialties in regional hospitals requires refocus to ensure that the elective surgery waitlist is addressed.

Objective

To investigate rural pharmacists' perceptions of oral health services they provide in towns without dental practitioners and how to best expand their role.

Setting

Community pharmacists are well placed to provide oral health services in rural areas where oral health is poorer and access to dental care is limited. Pharmacists' views on oral health advice delivery and how to best expand their role in oral health need to be assessed.

Participants

Participants were community pharmacists practicing in small rural towns without a dental practitioner in Victoria, Australia.

Design

Eleven community pharmacists participated in semi-structured telephone interviews that were recorded and transcribed verbatim. Transcripts were thematically analysed using NVivo software.

Results

Five overarching themes were derived from the data analysis, including confidence in delivering oral hygiene instructions, barriers and facilitators to providing oral health advice, recommendations for advertising and implementing oral health promotion, undergoing oral health training and recommendations for increased collaboration with dental practitioners. Pharmacists were confident in delivering basic oral hygiene instructions upon patient request. Most pharmacists were interested in verbally delivering oral health advice. Barriers identified included time constraints and operating as a single pharmacist. Pharmacists requested enhanced training, ideally online as continued professional development and support from pharmacy educational and regulatory bodies or dental practitioners to be able to expand their scope.

Conclusion

There is a need for additional training, resources and support for rural pharmacists to deliver this expanded role in oral health to improve oral health outcomes for rural people.

Introduction

Rural areas face persistent health disparities exacerbated by workforce shortages and the geographical isolation of health professionals. Innovative approaches are needed to mitigate professional isolation and enhance access to continuous professional development. This paper explores how health professionals perceive and utilise Rural Health Pro, analysing its potential to support professional needs, enhance capability, and improve workforce retention.

Objective

To explore rural health professionals' experiences and perceptions of the Rural Health Pro focusing on its functionality, support for professional needs, enhancement of capability, and contribution to workforce retention.

Design

A qualitative study utilising thematic analysis of semi-structured interviews with 12 allied health professionals working in rural practice, examining their experiences and perceptions of the utility of the Rural Health Pro platform. They are independent of the Rural Doctors Network.

Findings

Participants reported that the Rural Health Pro platform supported their capability through professional development, peer connectivity, reducing feelings of professional isolation, and leadership development. Challenges included the need for more structured support in mentoring and professional development.

Conclusions

Rural Health Pro facilitates resource sharing, knowledge exchange, and access to professional connectivity, enabling rural health professionals to access relevant information and support. While it enhanced users' sense of capability and reduced professional isolation, further evidence is needed to evaluate its broader impact on workforce retention and quality of care in rural health.

Objective

The effects of childhood health, education and experiences can have long-term impacts on adult health and wellbeing. Access to health services and information can be complex especially in regional and rural areas of Australia. This research aimed to: (1) investigate how and where parents living in regional and rural Australia with young children search for health information and (2) explore how parents decide what is appropriate health information to enable them to meet the health needs of their families.

Setting

Regional and rural areas of Southern Queensland.

Participants

Parents with a child under the age of 5 years.

Design

A convergent mixed methods design was utilised. Parents participated in an online survey and were invited to in-depth semi-structured telephone interviews about their health information search methods. Inductive content analysis was applied to the transcripts.

Results

The 11 interviewees searched for health information when their child was unwell, using the internet, family and friends and GPs and medical services. Websites were used for health information, whereas social media sites provided support and connection. The internet helped determine when to seek medical advice, and a preference was shown for Australian, hospital and government websites and websites recommended by GPs.

Conclusion

The results may inform the development of targeted hospital and government websites to ensure all parents have easy access to evidence-based children's health information. GPs may also play a role in discussing internet-sourced health information with parents.

Aims

Artificial intelligence (AI) is having an increasing impact on many aspects of our day-to-day lives. This change is also true in healthcare, with various tools being developed to hasten burdensome administrative tasks and increase overall healthcare efficiency, particularly in metropolitan centres.

Context

AI has remained comparatively clear of rural, regional and remote Australian hospitals, where it has the potential to provide significant benefits. Like previous health technology implementations, rural workforce requirements for AI maintenance and support may hinder AI deployment in these areas. While AI has been implemented successfully in metropolitan areas, these models may have limited translatability to rural health settings with significantly different administrative and healthcare systems.

Approach

AI may assist with key issues in rural centres such as resource allocation and timely patient transfer for higher level care. While the potential benefits of AI in rural centres are clear, one must consider key factors in rural centres that may limit the success of AI in these hospitals. Smaller rural populations may limit the ability to train location-specific models, and connectivity issues may impede their effective use.

Conclusion

Specific efforts are required to realise potential benefits of medical AI for rural Australia; addressing connectivity and workforce issues in rural areas is vital to allow for AI and large language models to help benefit rural centres.

Objectives

The objective of this paper is to compare the costs of an allied health student-assisted model of care with Fly-In-Fly-Out (FIFO) and resident clinician models of care from a health system perspective.

Methods

A descriptive cost analysis was conducted to understand the costs of an allied health student-assisted model of care. Scenarios were developed for the two remaining service models to determine their costs from a health service perspective.

Design

An observed and modelled costing study.

Setting

Northern Territory, Australia.

Participants

Allied health professionals and students.

Main Outcome Measure(s)

The cost of providing a student-assisted model of care from a health service perspective.

Results

The students provided an average of 5 h of service time per client to 50 clients at a cost of $2363 per client. Three resident clinician and FIFO scenarios were modelled. The first scenario was based on time with clients across all three student cohorts. The second scenario applied the time spent with clients by the third cohort, reflecting the increase in time spent with clients as the program matured. In the third scenario, we increased the time in scenario 2 by 25% to account for the potential under-recording of client time. The resident clinician results for the three scenarios were $915, $987, and $1178, respectively. The FIFO results for the three scenarios were $1502, $1575, and $1922, respectively.

Conclusions

The student-assisted model was more expensive per client seen than the FIFO and resident clinician models, but significant intangible benefits were identified that positively impact both clients and students. These include training health professionals for remote communities in a culturally responsive model, greater cultural understanding, and increased care coordination provided by the students.