Australian Journal of Rural Health最新文献

Introduction

A third of community-dwelling adults over the age of 65 years fall each year, making falls a significant concern for the elderly. Older people living in community-dwellings account for 73% of fall-related hospitalisations in older populations. Little is known about identifying, reaching at-risk people, and delivering these interventions in rural communities.

Objective

Setting

Rural and remote community settings in Queensland, Australia.

Participants

Forty community-dwelling older adults from the MMM 4 and 6 regions.

Design

This pilot study utilised a cross-sectional design and convenience sampling approach. A validated falls risk self-reported checklist and a screening checklist for general practitioners were used to identify older adults at risk of falling. During the home visit, participants were assessed for their cognition, balance and home safety. A client satisfaction survey was completed via telephone 3 months following the home visits.

Results

Several risk factors for falls were identified, including unsafe use of equipment, absence of Medi alerts, insufficient supervision, lack of support, inappropriate footwear, behavioural concerns and environmental hazards. Most participants reported that the home assessment was valuable and made their homes safer.

Conclusion

An innovative student-led placement model has the potential to provide much-needed access to falls prevention services and minimise falls among community-dwelling older adults in rural and remote locations.

Objective

To evaluate the alignment of undergraduate paramedicine curricula in Australia with the RESPIGHT model, focusing on diverse aspects such as emergency response, community engagement and governance.

Design

Deductive thematic analysis was conducted to assess the alignment of curricula from 16 Australian universities with the RESPIGHT framework.

Setting

The study reviewed undergraduate pre-registration paramedicine programmes across Australian universities.

Participants

The study included a comprehensive analysis of curricula from 16 universities offering undergraduate paramedicine programmes.

Main Outcome Measure

The degree of alignment of paramedicine curricula with the RESPIGHT categories: emergency response, community engagement, situated practice, primary healthcare, integration with health services, governance, leadership and treatment and transport.

Results

The analysis revealed varying degrees of alignment across the RESPIGHT categories, with notable discrepancies in areas such as community engagement and governance. Some universities demonstrated strong alignment in emergency response and treatment, while others showed weaker integration with primary healthcare and community engagement.

Conclusion

The study highlights significant disparities in the preparedness of paramedicine students for the broad scope of practice required in modern healthcare. The findings underscore the need for curriculum reform to better prepare students for community care models and the evolving healthcare landscape, ensuring a more comprehensive and integrated approach to paramedicine education in Australia.

Objective

New Zealand and international guidelines recommend surveillance mammography in breast cancer survivors. Ethnic breast cancer-specific diagnosis, treatment and survival inequities exist in Aotearoa New Zealand. Surveillance mammography uptake remains poorly studied internationally and has never been studied in AoNZ. We aim to study surveillance mammography uptake in our region and to probe for unrecognised ethnic and rural inequities.

Design

Retrospective cohort study.

Setting

Taranaki, Aotearoa New Zealand.

Participants

Surveillance mammogram candidates who received potentially curative surgery for breast cancer between January 2008 and December 2010.

Main Outcome Measure

Patients' surveillance mammogram opportunity fulfilment rates in the first 10 post-operative years were analysed using a multivariable logistic regression analysis.

Results

Only two thirds of all surveillance mammogram opportunities in our patient's first ten post-operative years were fulfilled. Fulfilment rates decrease significantly with time. Māori and those living rurally are significantly less likely to reach fulfilment rates of ≥ 70% even when accounting for covariates such as age, deprivation, healthcare system and oncology follow up.

Conclusion

Healthcare providers have a responsibility to distribute the benefits of health care equitably. This study reports previously unrecognised inequities affecting Māori and rural patients and calls for further research and policy to improve engagement of breast cancer survivors with surveillance mammography and healthcare equity in AoNZ.

Aim

Irregularities with sleep patterns and behaviours are commonly observed in Australia, but there is lack of information regarding sleep patterns among Aboriginal or Torres Strait Islander adults. This study explores sleep patterns in Aboriginal or Torres Strait Islander adults, comparing it with non-Indigenous Australian adults in addition to investigating any potential effects on daytime behaviour.

Methods

A total of 730 Aboriginal and Torres Strait Islander Peoples aged 18 years and above were included in the study. The participants completed a self-reported questionnaire on various aspects of sleep, such as difficulty falling asleep, waking up during the night, feeling well-rested upon waking, snoring loudly, gasping/choking during sleep, use of prescription medication and experiencing fatigue or sleepiness during the day. Additionally, the participants were interviewed using the ‘Top End Sleepiness Scale’ to report increased sleepiness during daily activities. The responses were compared with those of non-Indigenous Australians in the 2016 Sleep Health Foundation national survey, using questions that measures similar variables.

Results

Aboriginal and Torres Strait Islander Peoples experienced higher rates of sleep disturbances, including difficulty in falling asleep and waking in the night. Snoring and breathing pauses during sleep were more common in middle-aged men, and sleeping difficulties and daytime symptoms related to insufficient or unrefreshing sleep were more common in women. Sleep issues increased with age among adult Australians but were more common in the age group of 25–34 years for Aboriginal and Torres Strait Islander Peoples.

Conclusion

The data suggest that Aboriginal and Torres Strait Islander adults report irregularities in sleep patterns. Early interventions and management of sleep habits could potentially have benefits for overall physical and mental health.

Objective

Against the backdrop of alarming obesity rates and growing concerns about access to specialist care across Australia, this study aims to assess the utility of the nation's largest digital weight-loss service (DWLS) in regional Australia.

Setting

This study focuses on patients of the Eucalyptus DWLS who live in regional Australia (Monash Modified Model classification 3–6).

Participants

Thirty-two adults living with overweight or obesity who have been subscribed to the Eucalyptus DWLS for at least 3 weeks were invited to participate in phone-based interviews.

Design

Interviewers prompted discussion around 6 questions, pertaining to reasons for Eucalyptus subscription, previous attempts at weight loss, views on the service's comprehensiveness, access to face-to-face alternatives, areas for program improvement and general program satisfaction. Investigators conducted a Braun and Clarke thematic analysis of all interview transcripts.

Results

Six key themes were identified in the analysis, including unmanageable travel times to face-to-face obesity services; inadequate Eucalyptus app functionality; satisfaction with Eucalyptus care continuity; frustration with previously attempted standalone lifestyle interventions; aversion to or dissatisfaction with surgical interventions; and early weight loss increases confidence and exercise motivation.

Conclusion

Comprehensive DWLSs such as Eucalyptus have the potential to significantly increase access and adherence to continuous obesity care for regional Australians. However, platforms need to contain special provisions for users with lower literacy and integrate advanced lifestyle trackers to ensure patients are not simply using the DWLS to access weight-loss medications.

Objective

To explore changes to rural nursing and allied health placements during the latter stage of the COVID-19 public health emergency.

Setting

Regional, rural and remote Australia.

Participants

Nursing and allied health students with a scheduled University Department of Rural Health (UDRH) facilitated rural placement between 1 January 2022 and 31 October 2022.

Design

Cross-sectional online survey (n = 333), followed by semi-structured interviews (n = 21).

Results

Almost all students surveyed (98.5%) were able to undertake their placement, although 13.1% reported changes to the setting, timing or delivery of training. Placement tasks (47.3%), experience of the local community (39.0%) and connection with other students (39.6%) were the placement aspects most commonly reported to have changed. However, most students were satisfied with their placement (86.0%), agreed their placement provided quality clinical training (79.3%) and wanted to work rurally after their experience (73.2%). Nursing students had lower odds of reporting satisfaction with placement (OR, 0.49 [95% CI 0.24–0.99, p = 0.03]), while placements longer than 4 weeks had almost twice the odds of promoting rural intention (OR, 1.84 [95% CI 1.09–3.15, p = 0.02]). Placement changes were associated with: fear of contracting COVID-19; circulating illness; health workforce shortages; and health and safety compliance.

Conclusions

Despite changes, most students found rural placements undertaken during 2022 to be quality learning experiences which left them satisfied and wanting to work rurally. UDRHs should advocate for longer placements, improve remote supervision and accommodation infrastructure, and help prepare and support students for challenging learning environments to promote positive rural training experiences during public health emergencies.

Objective

To evaluate the effectiveness of Royal Far West allied health telehealth services to support the health and well-being of children affected by the bushfires.

Setting

In response to the 2019/2020 Black Summer bushfires, Royal Far West (RFW) implemented the Community Recovery Services (CRS) targeting the health and well-being of affected children. One component of the CRS was the delivery of allied health telehealth services to children.

Participants

One hundred and thirty-five children participated in occupational therapy, psychology and/or speech pathology telehealth. Forty-eight parents/carers completed a telehealth satisfaction survey.

Design

Measures used to determine effectiveness included child and parent/carer satisfaction surveys, the Canadian Occupational Performance Measure (COPM), the Goal Attainment Scale (GAS) and the Strengths and Difficulties Questionnaire (SDQ).

Results

The children overwhelmingly stated that they felt listened to (89%), enjoyed telehealth sessions (84%) and learned new ways to cope with their feelings (87%). Parents/carers reported that children had developed effective emotional regulation and coping strategies. COPM outcomes indicated the children demonstrated statistically significant large improvements in their self-perceived performance of and satisfaction with their identified goals, p < 0.001. The GAS outcomes indicated that 86% of children attained or exceeded their set goals. A statistically significant improvement in children's mental health outcomes post-telehealth was found, as measured by the SDQ (p < 0.05).

Conclusion

Occupational therapy, psychology and speech pathology telehealth sessions contributed to positive health and well-being outcomes for children affected by the bushfires. The findings support the implementation of RFW's five key principles for telehealth services: (1) Access to a multidisciplinary team; (2) Practical resources; (3) Flexible delivery; (4) Providing in-person session to support telehealth and (5) Take a ‘whole of child’ approach. Innovative telehealth offered children in geographically remote areas access to effective allied health support post-disaster that was not readily available in their local communities.

Objective

There are significant difficulties associated with the management of dementia patients in hospitals, leading to adverse patient outcomes, prolonged length of stay (LOS), strain on resources and high readmission rates. This study aimed to investigate these factors in the context of a regional hospital.

Design

This study retrospectively reviewed all dementia admissions in a publicly funded Australian regional hospital from January 2022 to December 2022.

Methods

All admissions including an ICD-10 coded dementia diagnosis were assessed, and data extracted using the integrated electronic medical record.

Setting

Overall, 257 bed Australian regional hospital in an area with a Modified Monash Model rating of 2.

Participants

There were 105 dementia patients admitted within the study period.

Main Outcomes Measures

Dementia severity, LOS, consultation liaison (CL) psychiatry involvement, readmission rates, and discharge destinations.

Results

The LOS in patients with dementia was 23.3 (± 35.2) days compared to age-matched patients without dementia admitted in the same period with a LOS of 8.2 (± 4.7) days. Dementia patients who died in hospital had the longest acute LOS at 14.4 (± 8.8) days. Dementia patients who were admitted from their usual residential aged care facility had the longest maintenance LOS at 69 (± 83.3) days.

Conclusions

This research contributes information to the current knowledge gap of dementia care in regional hospitals. Data from this study may help to inform the development of strategies for effective hospital-based dementia care and interventions.

Objective

To describe the co-design process and understand consumer perspectives of a virtual health services (VHS) model of primary healthcare delivery, for Indigenous Australians with chronic disease and living in regional, rural, and remote Queensland.

Design

Using decolonising methodologies, the study used an Indigenous consensus method to undertake the co-design process and generate findings. For analysis, a qualitative interpretive-description framework was applied. Thematic analysis generated themes, describing consumer perspectives of virtual healthcare models.

Setting

The Goondir Health Services (Aboriginal Community Controlled Health Organisation) operating clinics in rural and remote Queensland.

Participants

Fourteen Indigenous VHS consumers who resided in Modified Monash Model 3–7 communities across Queensland, met the eligibility criteria and provided informed consent.

Results

Two themes emerged: (1) personalised approaches to autonomous care using digital technologies, with two sub-themes of the benefits and challenges of technology, and the integration of culturally inclusive healthcare elements; (2) person-centred, culturally appropriate healthcare elements within a VHS model, with three sub-themes on the vital role of health coaches, the importance of community connections, and enabling holistic personalised healthcare access.

Conclusion

This study provides important consumer perspectives on the potential of VHS models of health care to empower Indigenous healthcare service consumers. VHS holds promise on multiple fronts: improved access, timeliness, continuity of care, and culturally sensitive health care, enabling improved self-management of chronic conditions, and provide crucial support from local Indigenous healthcare providers within the community. Future research on the sustainability and impact of personalised, consumer-centric digital health services in Indigenous populations is essential.

Objective

To explore the experiences and perceptions of rural and metropolitan applicants preparing for and completing all admission components for a provisional entry regional medical pathway.

Setting

Provisional entry regional medical pathway.

Participants

Provisional entry (school-leaver) applicants (N = 18) who completed a Multiple Mini-Interview (MMI).

Design

Applicants were invited to participate in a semi-structured interview regarding their experiences of the admissions process relative to their background (rural/metropolitan origin). A constructivist approach with a social accountability lens was taken for these semi-structured interviews.

Results

Themes were related to whether the applicants were classified as rural or metropolitan origin and the impact of the applicant's geographical location and connections to the local community, differences in local school and social support, and challenges in allocating medical school preferences.

Conclusion

Overall, applicant perceptions and experiences of the admissions process were influenced both positively and negatively by whether they were of rural or metropolitan origin. Strategies are required to ensure applicants with genuine rural interest, whether they are of rural or metropolitan origin, have access to sufficient support and resources while applying to regional medical pathways to ensure they are not disadvantaged, thus meeting admissions goals of the program.