Australian Journal of Rural Health最新文献_第3页

A cross-sectional study assessing concordance with advance care directives in a rural health district 一项横断面研究评估了一个农村医疗区对预先护理指令的遵从情况。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-08-09 DOI: 10.1111/ajr.13166

Dan Curley MBBS, Leigh Kinsman PhD, Graeme Mooney MSW, Gail Whiteford PhD, Tony Lower PhD, Megan Hobbs PhD, Beverley Morris BN, Kerry Bartlett BHSc, Alycia Jacob BL

Objective

To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting.

Design

Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes.

Setting

Rural Australian coastal district.

Participants

People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project.

Main Outcome Measure(s)

Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of ‘unacceptable interventions’.

Results

Sixty-eight people met the inclusion criteria (age range of 46–92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (n = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with ‘unacceptable interventions’.

Conclusion

These results demonstrate strong compliance with rural patients' requests in ACDs, particularly ‘unacceptable interventions’. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration.

目的衡量农村地区对死者预先护理指示（ACD）的遵守情况：观察性、横断面医疗记录审计，比较 ACD 申请与实际结果：环境：澳大利亚沿海农村地区：主要结果测量：主要结果测量：通过比较 ACD 中所述要求和医疗记录中记录的结果来测量遵守情况。这包括死亡地点和 "不可接受的干预 "清单：68人符合纳入标准（年龄范围为46-92岁[平均67岁；中位数74岁]；42人[62%]为男性）。主要死因是癌症（48 人；71%）。16 份 ACD 没有说明首选死亡地点。有记录的首选死亡地点符合率为 63%（33/52）：首选死亡地点为家庭时，符合率为 48%（16/33）；首选亚急性时，符合率为 78%（7/9）；首选医院时，符合率为 100%（10/10）。对 "不可接受的干预 "的依从性为 100%：结论：这些结果表明，农村患者在 ACD 中的要求，特别是 "不可接受的干预 "得到了很好的遵守。居家是最常见的首选死亡地点，但在本研究中，符合率（48%）却是最低的。这需要进一步探讨。

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引用次数: 0

Mobile breast screening services in Australia: A qualitative exploration of perceptions and experiences among rural and remote women aged ≥75 years 澳大利亚的流动乳腺筛查服务：对年龄≥75 岁的农村和偏远地区妇女的看法和经验的定性探索。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-08-08 DOI: 10.1111/ajr.13174

Joanne Adams PhD, Virginia Dickson-Swift PhD, Evelien Spelten PhD, Irene Blackberry PhD, Carlene Wilson PhD, Eva Yuen PhD

Objective

This qualitative descriptive study draws on data collected from a sub-sample of 15 women participating in a national study (n = 60) exploring the breast cancer screening motivations and behaviours of women aged ≥75 years. The study aimed to understand why women living in rural and remote areas might continue accessing mobile breast cancer screening despite being outside the targeted age range.

Setting

Settings ranged from large towns to very remote communities (according to Monash Modified Model (MMM) classification 3–7) where BreastScreen Australia mobile screening services were available.

Participants

Interview data from 15 women aged ≥75 years living in rural and remote locations who had used mobile screening services was utilised for this study.

Design

In-depth individual interviews were conducted via telephone or online platform (Zoom). These were transcribed verbatim and imported into NVivo software to enable thematic analysis to identify key themes.

Results

Many women aged ≥75 years in rural and remote areas expressed clear intentions to continue breast cancer screening, despite no longer being invited to do so. They perceived great value in the mobile service and were highly appreciative for it yet acknowledged limited sources of information about the process of ongoing screening.

Conclusion

Few women in rural and remote areas had discussed ongoing breast cancer screening with their general practitioner (GP). More information is required to inform women about the risks and benefits of ongoing screening. Without an invitation to attend screening rural women reported difficulty in knowing when the service would be available. Ongoing notification of the availability of mobile services for women aged ≥75 years in rural areas is recommended.

研究目的这项定性描述性研究从参与一项全国性研究（n = 60）的 15 名妇女的子样本中收集数据，该研究探讨了年龄≥75 岁妇女的乳腺癌筛查动机和行为。该研究旨在了解为什么生活在农村和偏远地区的妇女尽管不在目标年龄范围内，但仍会继续接受移动乳腺癌筛查：研究地点：从大城镇到非常偏远的社区（根据莫纳什修正模型（MMM）分类 3-7），澳大利亚乳腺癌筛查中心提供移动筛查服务：本研究使用了 15 名居住在农村和偏远地区、年龄≥75 岁、使用过移动筛查服务的妇女的访谈数据：设计：通过电话或在线平台（Zoom）进行深入的个人访谈。访谈内容逐字记录并导入 NVivo 软件，以便进行专题分析，确定关键主题：结果：许多年龄≥75 岁的农村和偏远地区妇女表示，尽管不再被邀请进行乳腺癌筛查，但她们仍有继续筛查的明确意愿。她们认为流动服务很有价值，并对此表示高度赞赏，但也承认有关持续筛查过程的信息来源有限：结论：农村和偏远地区的妇女很少与其全科医生（GP）讨论过乳腺癌持续筛查的问题。需要提供更多信息，让妇女了解持续筛查的风险和益处。农村妇女表示，如果没有收到参加筛查的邀请，她们很难知道何时可以获得筛查服务。建议持续通知农村地区年龄≥75 岁的妇女可获得流动服务。

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引用次数: 0

Rural unpaid caregivers' experiences in northern Aotearoa, New Zealand during the Covid-19 pandemic: A qualitative study Covid-19 大流行期间新西兰奥特亚罗瓦北部农村无酬照护者的经历：定性研究。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-08-01 DOI: 10.1111/ajr.13173

Rosemary Frey PhD, Janine Wiles PhD, Deborah Balmer PhD, Pare Meha PhD, John Parsons PhD, Mary Simpson PhD, Vanessa Burholt PhD

Objective

Rural unpaid caregivers experience different opportunities and challenges than their urban counterparts. Our aim was to understand rural unpaid caregivers' experiences of challenges and opportunities during the Covid-19 pandemic in New Zealand.

Setting

Rural northern New Zealand during the Covid-19 pandemic.

Participants

A convenience sample of 10 unpaid rural caregivers, most supporting an older person living with dementia.

Design

A qualitative descriptive design. Data included interviews and online workshops, and a thematic analysis.

Results

Rural unpaid caregivers observed that some aspects of living in a rural context were helpful during the Covid-19 pandemic. However, tasks such as shopping and long-distance travel and communication (both telephonic and digital) became more complex. Abrupt changes to routine and closure of resources and support groups created challenges. Unpaid caregivers worried about what would happen if they were hospitalised themselves. There was a diversity of experience both across caregivers, of familiar routines and rural context as resources, increased challenges requiring resourcefulness to adapt, and experiences of crisis. Many experienced all three states at different times.

Conclusion

This research provides valuable insights into challenges and opportunities experienced by rural unpaid caregivers during the Covid-19 pandemic and may help policy-makers and healthcare professionals develop improved emergency preparedness. Multilevel, multisector responses are needed to ensure effective health and social support and access to resources including health care, access to groceries and medication, transport, and communications (telephone and digital). Enhancing rural access to effective and inexpensive online services is particularly important, as is recognition of the value of rural sites or hubs of connection and social interaction.

目的农村无酬照护者与城市无酬照护者经历着不同的机遇和挑战。我们的目的是了解新西兰农村无酬照护者在 Covid-19 大流行期间所经历的挑战和机遇：环境：Covid-19 大流行期间的新西兰北部农村地区：10名农村无偿照顾者的便利样本，他们中的大多数人都在为患有痴呆症的老年人提供支持：设计：定性描述设计。数据包括访谈、在线研讨会和主题分析：结果：农村无酬照护者认为，在 Covid-19 大流行期间，在农村生活的某些方面很有帮助。然而，购物、长途旅行和通信（电话和数字）等任务变得更加复杂。日常生活的突然改变以及资源和支持团体的关闭带来了挑战。无酬照护者担心如果自己住院会发生什么。不同的照顾者有不同的经历：熟悉的日常事务和乡村环境是资源，挑战的增加需要机智的适应，以及危机的经历。许多人在不同时期经历了这三种状态：这项研究为了解农村无酬照护者在 Covid-19 大流行期间所经历的挑战和机遇提供了宝贵的见解，并可帮助政策制定者和医疗保健专业人员制定更好的应急准备措施。需要采取多层次、多部门的应对措施，以确保有效的健康和社会支持，并确保获得资源，包括医疗保健、日用品和药物、交通和通信（电话和数字）。加强农村地区获取有效且廉价的在线服务尤为重要，同时也要认识到农村地区连接和社会互动中心的价值。

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引用次数: 0

‘Profound personal and professional impacts’: A qualitative study of clinician experiences of a mental health disaster response to Australia's black summer bushfires 深刻的个人和职业影响"：针对澳大利亚夏季黑色丛林大火的心理健康灾难应对措施的临床医生经验定性研究。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-24 DOI: 10.1111/ajr.13163

Margaret Thomas MMHN, Elizabeth Martin MPH, Sophie Isobel PhD

Objective

To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019–2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia.

Setting

A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW.

Participants

Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019–2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia.

Design

An interpretive qualitative study design using semi-structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis.

Results

Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response.

Conclusion

Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire-affected community and those responding from outside a bushfire-affected community, which may inform ongoing planning of responses to disaster in Australia.

目的探索参与澳大利亚新南威尔士州南部雪谷地区 2019-2020 年黑色夏季丛林大火农村/大都市合作精神卫生灾难应对措施的临床医生和管理利益相关者的经验：新南威尔士州农村雪谷地区的心理健康和药物健康服务机构与新南威尔士州悉尼大都市的心理健康服务机构合作：来自一个农村卫生保健区（n = 6）和一个大都会卫生保健区（n = 8）的心理健康临床医生和管理人员，他们参与了澳大利亚新南威尔士州南部雪谷地区 2019-2020 年黑夏丛林火灾灾难的合作应对：设计：采用半结构式个人访谈的解释性定性研究设计，使用反思性主题分析法对记录誊本进行分析：结果：在心理健康灾难应对之前（挺身而出、立即投入）、期间（找到合作的节奏）和之后（深刻的个人和专业影响）三个组织结构下，对参与者的经历进行了专题研究：参与者的经历在心理健康灾难应对之前、期间和之后既有共同的组成部分，也有不同的组成部分，最终对个人和专业产生了深远的影响。研究结果凸显了临床医生在参与农村/大都市合作精神卫生灾难应对行动时所面临的积极方面和挑战。本研究的发现从受丛林火灾影响的社区成员和从受丛林火灾影响的社区外参与救灾的人员的双重视角，对心理健康临床医生参与丛林火灾后救灾工作的经验提供了新的知识，可为澳大利亚正在进行的救灾规划提供参考。

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引用次数: 0

Farmer wants a skin check: Improving skin cancer surveillance in rural Australia 农民要做皮肤检查：改善澳大利亚农村地区的皮肤癌监测。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-24 DOI: 10.1111/ajr.13172

Andjela Arandjelovic MD

引用次数: 0

Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit 澳大利亚地区医疗服务机构对急性夏科神经关节病患者的评估、诊断和管理特点：为期三年的回顾性审计。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-23 DOI: 10.1111/ajr.13168

Dimitri Diacogiorgis MApplSc, Byron Matthew Perrin PhD, Michael Ian Charles Kingsley PhD

Objective

Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service.

Design

Three-year retrospective medical record audit.

Setting

Large regional health service with catchment area of >250 000 people in regional Australia.

Participants

People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC).

Main Outcome Measures

Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale.

Results

Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14–47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases.

Conclusions

Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

目的：急性夏科神经骨关节病（CN）具有高度破坏性，会造成骨和关节损伤，从而导致足部结构发生破坏性变化。本研究旨在确定在澳大利亚大型地区医疗服务机构就诊的急性夏科氏神经关节病患者在评估、诊断和管理方面的特点：设计：三年回顾性病历审计：环境：澳大利亚地区的大型区域医疗服务机构，服务范围超过 25 万人：主要结果测量指标：主要结果测量：参与者特征以及急性 CN 评估、诊断和管理特征。根据 "修正莫纳什模型"（MMM）量表测量的农村地区特征对特征趋势进行了调查：共发现 17 名急性 CN 患者（20 例病例）。平均年龄为 57.1 ± 10.8 岁，其中 11 人为女性。求助时间中位数为 31 天（IQR 14-47 天）。居住在较小区域和农村社区的人更有可能延迟获得急性 CN 的金标准治疗。急性氯化萘的区域治疗模式应包括开展各种活动，提高急性氯化萘高危人群对该病的认识，并提高区域卫生专业人员的技能，以便及时在当地进行TCC治疗。

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引用次数: 0

Building research capacity at a rural place-based community service organisation in southwest Victoria, Australia 澳大利亚维多利亚州西南部一个以地方为基础的农村社区服务组织的研究能力建设。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-23 DOI: 10.1111/ajr.13170

Bianca E. Kavanagh PhD, Kevin P. Mc Namara PhD, Penny Bolton MPH, Carly Dennis BPH, Vincent L. Versace PhD

<p>Due to their unique ability to appreciate the local context, rural place-based health and community services are central to the prevention and management of health and social issues.<span><sup>1</sup></span> Place-based approaches allow relevant evidence to be generated locally; however, at present, there is a lack of evidence generated from rurally based health services<span><sup>1</sup></span> and arguably less evidence produced from the community services sector.<span><sup>2</sup></span> This lack of evidence limits the ability for policy-makers to make evidence-informed decisions about how to improve outcomes for rural populations.<span><sup>3</sup></span> There is an increasing need to provide evidence of outcomes within the community services sector, and the need to have mechanisms in place to capture, analyse and report data has been identified.<span><sup>4</sup></span> However, the complexities of this sector—including that services are delivered within complex, dynamic and multifaceted social contexts, with multiple funding sources—have led to challenges for community services to conduct research. This impedes the opportunity to enhance service performance and outcomes.<span><sup>4</sup></span> The experiences of rural health services might inform a framework for generating evidence in the community services sector. Rural health services are reported to be motivated to build research capacity to attract and retain the rural workforce,<span><sup>5</sup></span> and parallels with the community services sector may exist.</p><p>Research capacity building is an effective approach to generating and applying new knowledge to improve outcomes.<span><sup>6</sup></span> Cooke et al.<span><sup>6</sup></span> suggested that if research questions are developed through consultation with users (i.e. service providers and policy-makers), then the research generated is relevant to fundamental health issues and concerns; this may be particularly relevant to regional, rural and remote (RRR) areas. The embedded research (ER) model may support evidence acumen by bridging the disparity between research and service delivery.<span><sup>7</sup></span> Embedded researchers (i.e. when a researcher is embedded into a ‘host’ organisation) may assist in building research capacity through their function of conducting collaborative and ‘on the ground’ research.<span><sup>7</sup></span> This model differs from the bench-to-bedside model and may be a sustainable approach to research capacity building in RRR contexts.<span><sup>1</sup></span> The ER model may circumvent the need for lower-resourced health and community services from consulting with external researchers to generate evidence. Despite being a relatively new approach to building research capacity in RRR contexts, the ER model has gained traction and demonstrated success in recent years.<span><sup>8</sup></span></p><p>An ER model was recently implemented at Brophy Family and Youth Services (Brophy) in south

星光基金会是澳大利亚规模较大的非营利性组织，在多边环境协定和研究方面拥有较为成熟的文化。这次咨询为当前的工作和方法提供了宝贵的见解。因此，主要的 MEL 和研究活动是分阶段进行的，最初的重点是了解准备情况，并促成能力、决策和合作方面的变革。迄今为止，嵌入式研究员的活动主要集中在建立全机构范围的 MEL 和研究方法、为选定的计划提供支持以及对特定计划的成果进行试点监测（表 S2）。这些活动为提高研究素养提供了一个途径--这一点很重要，因为一般而言，社区服务部门可被视为一个研究新兴行业，而提高循证实践的举措应有助于提高研究素养。11 尽管这些活动还处于初步阶段，但员工的认同和兴趣以及领导团队的支持都很高（正如应急专家在与员工访谈时就 Brophy 的初步研究和评估需求所报告的那样）。这表明，社区服务人员参与和开展研究的积极性很高，尽管在这样做的过程中会遇到各种挑战。该急诊室职位的初步成功得益于布罗菲与迪肯农村医疗机构之间的紧密合作，包括通过各组织之间现有的地方关系。此外，迪肯农村医疗机构也是一个以地方为基础的组织，拥有联合医疗能力建设的授权和资源。这些因素支持了基于相互信任、共同目标和长期合作承诺的共同愿景，并促成了共同出资的 ER 角色。这项工作的成果将使证据得以公布，并有助于改善西南部人口的健康和社会成果：构思；调查；项目管理；资源；写作--原稿；写作--审阅和编辑。Kevin P. Mc Namara：项目管理；资源；监督；写作--原稿；写作--审阅和编辑。彭妮-博尔顿项目管理；资源；监督；写作--审阅和编辑。Carly Dennis：项目管理；写作--审阅和编辑；监督；资源。文森特-L-范思哲BEK 由 Brophy 家庭与青少年服务机构和澳大利亚政府的农村卫生多学科培训计划 (RHMT) 资助。VLV 也得到了 RHMT 的资助。

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引用次数: 0

Who carries the extra load? The added responsibility of end-of-life care for rural families 谁来承担额外的负担？农村家庭临终关怀的额外责任

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-23 DOI: 10.1111/ajr.13171

Kristina Thomas BA (Hons); DPsych (Health), Margaret Deerain BBus (Mgmt); MLitt; MLS

<p>There are over 7 million Australians (28%) living outside of major cities,<span><sup>1</sup></span> and these people have poorer health outcomes and poorer access to and use of primary health care services.<span><sup>2</sup></span> Just like most areas of health, there are common barriers to accessing end-of-life health care for rural Australians including geographical distance to services, lack of stable workforce and difficulty accessing culturally appropriate care.<span><sup>3-5</sup></span> While it is more difficult to access end-of-life health care for rural Australians, we know that the proportion of older Australians is higher in rural Australia so there a is significant need for end-of-life care.<span><sup>1</sup></span></p><p>When access to end-of-life health services is more challenging, who picks up the increased load? Like many areas of social and health care, family, friends and community networks end up playing an increased role in end-of-life care in rural areas.<span><sup>3</sup></span> The family ‘carer’, the person who is most involved in the person's day-to-day care, is even more vital in a rural area. Compared to carers from urban areas, rural carers are more likely to be friends or distant relatives.<span><sup>6</sup></span></p><p>Rural carers report exhaustion, lack of self-care and a need for respite.<span><sup>7</sup></span> This may be due to the fact that rural carers are likely to do more of the care tasks themselves (rather than using services).<span><sup>8</sup></span> A quarter of rural carers want more physical support with caring.<span><sup>6</sup></span> They report unmet needs such as treatment near home (37%), help with economic burden (32%) and concerns about the person being cared for (32%).<span><sup>9</sup></span></p><p>A review of studies<span><sup>3</sup></span> showed that rural end-of-life patients receive fewer home visits from doctors, less home care services, less palliative care, less respite and less allied health; however, there was increased reliance on general practitioners, pharmacy and emergency hospital. Rural carers report that local services have longer wait times, high turnover of staff, and families received late referral to palliative care.<span><sup>4</sup></span></p><p>Rural carers of cancer patients (60% of whom required end-of-life care)<span><sup>4</sup></span> report that one of the biggest stressors is travelling for health services highlighting dealing with the stress of going to the city, organising the actual travel and time away from work, family or the farm. Rural carers also find metropolitan health services difficult to navigate.<span><sup>10</sup></span> Health professionals do not always consider the effort involved in travel which may cause additional inconveniences and stress for rural carers.<span><sup>4</sup></span> Rural carers also report a strong connection to their community and miss being away from their community when travelling for health services.<span><sup

墨尔本圣文森特医院与全国农村健康联盟（National Rural Health Alliance）、澳大利亚悲伤协会（Grief Australia）和 CareSearch（弗林德斯大学）合作，目前正通过 CarerHelp Rural Connect 项目扩大对农村的关注。CarerHelp 正向农村照护者和社区伸出援手，提供新的资源和与医疗专业人员的在线会议，帮助他们为照护生命末期的人做好准备，并为他们作为农村或偏远地区的照护者可能遇到的挑战做好准备。欲了解更多信息，请访问： www.carerhelp.com.au.The 全国农村健康联盟很荣幸能参与该项目，该项目将为我们的农村照护者和他们在农村社区照护的亲人提供实用而重要的支持：构思；写作--原稿；写作--审阅和编辑。Margaret Deerain：写作--审阅和编辑。

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引用次数: 0

Towards a home-grown rural health workforce: Evidence from Tasmania, Australia 建立一支本土化的农村医疗卫生队伍：来自澳大利亚塔斯马尼亚州的证据。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-23 DOI: 10.1111/ajr.13169

B. Jessup PhD, N. Tran PhD, T. Stevens, P. Allen PhD, T. Barnett PhD

Objective

To examine the association between place of origin and principal place of practice (PPP) of domestic Tasmanian health graduates who received end-to-end training with the University of Tasmania (UTAS).

Methods

The 2022 PPP for all UTAS domestic Tasmanian graduates from medicine, nursing, pharmacy, psychology, medical radiation science and paramedicine between 2011 and 2020 was identified using the online Australian Health Practitioner Regulation Agency (Ahpra) registration database. The graduate's place of origin (home address at the time of course application), together with their 2022 PPP, was described using the Modified Monash Model (MM) classification system of remoteness. Data were analysed using STATA.

Results

Over the 10-year period, 4079 domestic Tasmanians graduated from health courses at UTAS, of which 3850 (94.4%) were matched to an Australian PPP. In all, 78.3% of graduates were working in Tasmania, while the remainder (21.7%) were employed interstate. Of those with a Tasmanian PPP, 81.4% were working in a regional setting (MM2), while 77.6% of interstate employed graduates recorded a metropolitan (MM1) PPP. Rural place of origin (MM3-7) was associated with rural employment (MM3-7) in both Tasmania (OR, 37.08; 95% CI 29.01–47.39, p < 0.001), and on the Australian mainland (OR, 21.4; 95% CI 17.4–26.3, p < 0.001).

Conclusions

Most domestic Tasmanian origin UTAS health graduates contribute to the state's health workforce after qualifying. Further research is needed to explore PPP over time and to understand why some graduates are motivated to seek employment on the Australian mainland and in particular, metropolitan cities.

目的研究在塔斯马尼亚大学（UTAS）接受端到端培训的塔斯马尼亚国内健康专业毕业生的原籍地与主要执业地点（PPP）之间的关联：通过澳大利亚卫生从业者监管局（Ahpra）在线注册数据库，确定了 2011 年至 2020 年间塔斯马尼亚州国内所有UTAS 医学、护理、药学、心理学、医学放射科学和辅助医疗毕业生的 2022 年主要执业地点。毕业生的原籍地（申请课程时的家庭住址）及其 2022 年的 PPP 采用修改后的莫纳什模型（MM）偏远地区分类系统进行描述。数据使用 STATA 进行分析：10 年间，共有 4079 名塔斯马尼亚州本地人从UTAS 的健康课程毕业，其中 3850 人（94.4%）与澳大利亚 PPP 匹配。总共有 78.3% 的毕业生在塔斯马尼亚州工作，其余的毕业生（21.7%）在州际就业。在塔斯马尼亚州 PPP 的毕业生中，81.4% 在地区环境（MM2）工作，而 77.6% 跨州就业的毕业生的 PPP 记录为大都市（MM1）。在塔斯马尼亚州，农村原籍（MM3-7）与农村就业（MM3-7）相关（OR，37.08；95% CI 29.01-47.39，p 结论）：大多数来自塔斯马尼亚州国内的UTAS卫生专业毕业生在取得资格后都为该州的卫生事业做出了贡献。我们需要进一步开展研究，探讨随着时间推移的 "PPP"，并了解为什么一些毕业生会选择到澳大利亚本土，尤其是大都市就业。

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引用次数: 0

'I am more than my diagnosis': Amplifying the voice of consumers in the design and delivery of mental health services. 我不只是我的诊断"：在心理健康服务的设计和提供过程中放大消费者的声音。

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2024-07-19 DOI: 10.1111/ajr.13150

Joy Paton, Amie Carrington, Emma Gentle, Debbie Horsefall

Objective: In line with the Australian Government's Vision 2030, this research foregrounds consumer experiences of recovery to inform the (co)design and delivery of mental health services for people living with complex needs and/or a severe and persistent mental health condition.

Setting: The research takes a specialist focus on the regional setting, with data collected from client experiences within Western NSW, Australia, in the context of the National Disability Insurance Scheme (NDIS) implementation and inclusion of psycho-social disability within the NDIS service environment.

Participants: Thirty-seven people aged 19-70 years living with complex needs and/or a diagnosis of a severe and persistent mental health condition were recruited from services where they had a care plan or where they were members of a consumer reference group for recovery-oriented services.

Design: A tripartite framework integrating recovery oriented, trauma-informed and collective impact approaches for a qualitative, arts-based (photovoice) study.

Results: In areas of the mental health service system that had not yet applied a personalised understanding of recovery or embraced trauma-informed practice there were a range of issues and gaps in service delivery relating to authentic relationships, belonging and connection, service cultures, trauma-informed care, and workforce investment.

Conclusion: Clinical and non-clinical services need to ensure consistent person-centred and trauma-informed practice is implemented throughout the mental health service system to meet the needs of the consumer. An eight-point checklist serves as the basis for services to reflect on how they are working with consumers and to support the review of systems and clinical governance frameworks.

目标：根据澳大利亚政府的 "2030 年愿景"，本研究将消费者的康复体验作为研究重点，以便为有复杂需求和/或严重且持续的精神健康状况的人设计和提供精神健康服务：本研究以地区环境为专业重点，在国家残疾保险计划（NDIS）实施以及将社会心理残疾纳入 NDIS 服务环境的背景下，从澳大利亚新南威尔士州西部的客户体验中收集数据：37 名年龄在 19-70 岁之间、有复杂需求和/或被诊断出患有严重和持续性精神疾病的人被招募到他们有护理计划的服务机构，或者他们是以康复为导向的服务消费者参考小组的成员：设计：一个三方框架，整合了以康复为导向、创伤知情和集体影响的方法，用于一项定性的、以艺术为基础的（摄影选言）研究：结果：在心理健康服务体系中，尚未对康复进行个性化理解或尚未接受创伤知情实践的领域，在提供服务时存在一系列问题和差距，这些问题和差距与真实关系、归属感和联系、服务文化、创伤知情护理以及劳动力投资有关：临床和非临床服务需要确保在整个心理健康服务体系中实施一致的以人为本和创伤知情实践，以满足消费者的需求。八点核对表可作为服务机构反思如何与消费者合作的基础，并为系统和临床治理框架的审查提供支持。

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引用次数: 0