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

Digital Health Interventions for Cardiometabolic Health Outcomes in Rural and Remote Australia: A Systematic Review 澳大利亚农村和偏远地区心脏代谢健康结果的数字健康干预：系统综述。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-26 DOI: 10.1111/ajr.70130

Cheru Tesema Leshargie, Meless Gebrie Bore, Hazel Dalton, Subash Thapa, Fentaw Tadese Berhe, Zemenu Yohannes Kassa, Zekariyas Sahile Nezenega, Setognal B. Aychiluhm, Feleke Hailemichael Astawesegn, Birhanu Wondimeneh Demissie, Tebikew Yeneabat Mengist, Kedir Y. Ahmed

Introduction

Cardiometabolic disease contributes to increased morbidity and mortality in rural and remote Australia. Digital health technologies offer a promising solution to enhance healthcare access and support self-management.

Objective

This systematic review examined the effectiveness, feasibility and acceptability of implementing digital health interventions to improve cardiometabolic health outcomes in rural and remote Australia.

Design

PubMed, MEDLINE, Embase, Scopus and CINAHL were searched from inception to end of July 2025. Eligible studies included interventional, observational and qualitative studies focused on digital interventions for cardiometabolic conditions. Due to heterogeneity among studies, a meta-analysis was not conducted; instead, a narrative synthesis was used to summarise outcomes.

Findings

Seventeen studies (7 RCTs, 1 quasi-experimental, 7 observational and 2 qualitative) evaluated digital health interventions including video consultations, telephone coaching, apps, wearables and web platforms. Telemonitoring significantly reduced HbA1c (MD = −5.5%), with modest reduction via telephone support (RR = 0.96). Telestroke programs were associated with lower stroke mortality at 6 months (HR = 0.53) and 12 months (HR = 0.58). The review also demonstrated the feasibility and acceptability of digital health interventions, particularly when culturally tailored and delivered by local providers, with successful remote adaptation and high initial engagement. Interventions such as tele-endocrinology and the “Healthy Weight” program were cost-effective, contributing to improved HbA1c and quality of life. However, challenges included limited physical assessments, technical barriers and declining patient engagement over time.

Conclusions

Digital health technologies, ranging from telehealth to mobile and web-based tools, can enhance cardiometabolic outcomes in rural and remote settings, though barriers such as technology access and sustained engagement remain.

心脏代谢疾病增加了澳大利亚农村和偏远地区的发病率和死亡率。数字医疗技术提供了一种很有前途的解决方案，可以提高医疗保健的可及性并支持自我管理。目的：本系统综述探讨了在澳大利亚农村和偏远地区实施数字健康干预措施以改善心脏代谢健康结果的有效性、可行性和可接受性。设计：PubMed， MEDLINE, Embase， Scopus和CINAHL从成立到2025年7月底进行检索。符合条件的研究包括介入性、观察性和定性研究，重点关注心脏代谢疾病的数字干预。由于研究间存在异质性，未进行meta分析；相反，他们使用叙事综合来总结结果。研究结果：17项研究（7项随机对照试验、1项准实验、7项观察性研究和2项定性研究）评估了数字健康干预措施，包括视频咨询、电话指导、应用程序、可穿戴设备和网络平台。远程监护可显著降低HbA1c (MD = -5.5%)，通过电话支持可适度降低HbA1c （RR = 0.96）。在6个月（HR = 0.53）和12个月（HR = 0.58）时，中风项目与较低的中风死亡率相关。审查还证明了数字卫生干预措施的可行性和可接受性，特别是在根据文化进行调整并由当地提供者提供、远程适应成功且初始参与度高的情况下。远程内分泌学和“健康体重”计划等干预措施具有成本效益，有助于改善糖化血红蛋白和生活质量。然而，挑战包括有限的身体评估，技术障碍和随着时间的推移患者参与度下降。结论：数字卫生技术，从远程医疗到移动和基于网络的工具，可以改善农村和偏远地区的心脏代谢结果，尽管技术获取和持续参与等障碍仍然存在。

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引用次数: 0

Singing out: The Experience of Being Involved in an Inclusive Choir for People Living With Dementia in Regional Australia 歌唱：参与澳大利亚地区痴呆症患者包容性合唱团的经历。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-22 DOI: 10.1111/ajr.70134

Belinda Cash, Elsie de Klerk, Adrienne Matthys, Anne Gemmell, Suzanne McLaren

Objective

This research explored the experience of facilitating and participating in an inclusive choir for people living with dementia in a regional Australian setting.

Setting

Sing Out Choir, a dementia-inclusive community-based choir in regional New South Wales.

Design

Two focus group discussions were held to explore the experience of choir stakeholders. Audio transcripts were analysed using inductive thematic analysis.

Participants

Twenty-five current members of the Sing Out Choir, including people living with dementia (n = 8), informal carers (n = 8), volunteers (n = 6), and choir staff (n = 3).

Results

Four themes were identified following analysis of the discussions: active encouragement promotes engagement with the choir; the choir as a place of inclusiveness and belonging; the positive benefits of choir participation; and the complexities of establishing and sustaining a dementia-inclusive choir in a regional setting.

Conclusion

The Sing Out choir provides an important opportunity for meaningful social connection for people living with dementia and their carers in this regional area. Establishing and sustaining dementia-inclusive choirs in rural and regional settings require significant time and commitment to secure initial and ongoing funding, appropriately experienced staff, an appropriate venue, and volunteer support.

目的：本研究探讨了在澳大利亚地区为痴呆症患者提供便利和参与包容性合唱团的经验。环境：唱诗班，在新南威尔士州地区的痴呆症包容性社区合唱团。设计：举行了两次焦点小组讨论，探讨合唱团利益相关者的经验。使用归纳主题分析对音频文本进行分析。参与者：歌唱合唱团的25名现任成员，包括痴呆症患者（n = 8），非正式护理人员（n = 8），志愿者（n = 6）和合唱团工作人员（n = 3）。结果：分析讨论后确定了四个主题：积极鼓励促进与合唱团的参与；唱诗班是一个包容和归属感的地方；参与合唱团的积极效益；以及在一个地区建立和维持一个包容痴呆症的合唱团的复杂性。结论：唱诗班为该地区的痴呆症患者及其护理人员提供了一个有意义的社会联系的重要机会。在农村和地区环境中建立和维持包容痴呆症的合唱团需要大量的时间和承诺，以确保初始和持续的资金、适当经验丰富的工作人员、适当的场所和志愿者支持。

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引用次数: 0

GP Obstetricians in Rural Australia: Factors Influencing the Provision of Intrapartum Care 澳大利亚农村的全科医生产科：影响产时护理的因素。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-21 DOI: 10.1111/ajr.70117

Wai Yee Yum, Louise Ann Clark, Getahun Kebede Beyera

Objective

To provide a snapshot of the GP obstetric workforce and understand why GP obstetricians chose to provide or not to provide intrapartum care to women in rural Australia.

Methods

Online survey collecting quantitative and qualitative data to characterise the current GP obstetrics workforce.

Design

Descriptive, cross-sectional study.

Setting

Australia.

Participants

All RANZCOG diploma and advanced diploma members were invited to participate via the Facebook groups ‘Rural Obstetrics Down Under (RODU)’ and ‘GPObsDU’. The survey could also be shared with eligible colleagues.

Main Outcome Measures

Social and geographical demographic details of doctors, work locations and scope of practice and self-reported factors leading to their decision to provide or not provide intrapartum care to women in rural Australia.

Results

A total of 95 eligible responses were received. A large proportion of respondents were females aged 35–44 who were balancing work with caregiving responsibilities and living in rural or remote areas with a local birth service. Seventy percent of respondents provided intrapartum care. Factors influencing the decision to provide intrapartum care included professional satisfaction, continuity of care and community service, while barriers included lack of support, safety concerns and work-life balance.

Conclusions

Intrapartum care is professionally rewarding and a highly regarded part of many diplomates' work. However, increased support for skill maintenance and upskilling, flexible work arrangements that can accommodate the modern diplomate and their family needs, and strengthened partnerships between midwifery, GPO and FRANZCOG teams are needed to empower all diplomates to practice and continue practicing to their full scope.

目的：提供全科医生产科劳动力的快照，并了解为什么全科医生产科医生选择提供或不提供分娩时护理的妇女在澳大利亚农村。方法：在线调查收集定量和定性数据，以了解当前全科医生产科工作人员的特点。设计：描述性横断面研究。设置:澳大利亚。参与者：所有RANZCOG文凭和高级文凭会员都被邀请通过Facebook小组“澳大利亚农村产科（RODU）”和“GPObsDU”参加。这项调查也可以与符合条件的同事分享。主要结果测量：医生的社会和地理人口统计细节、工作地点和实践范围以及导致他们决定向澳大利亚农村妇女提供或不提供分娩时护理的自我报告因素。结果：共收到95份符合条件的问卷。很大一部分受访者是年龄在35-44岁之间的女性，她们在工作和照顾孩子之间取得平衡，生活在农村或偏远地区，有当地的生育服务。70%的应答者提供产时护理。影响决定是否提供产内护理的因素包括专业满意度、护理的连续性和社区服务，而障碍包括缺乏支持、安全问题和工作与生活的平衡。结论：产中护理在专业上是有益的，是许多外交官工作中受到高度重视的一部分。但是，需要增加对技能维护和技能提升的支持，灵活的工作安排，以适应现代外交官及其家庭的需求，并加强助产士、GPO和FRANZCOG团队之间的伙伴关系，以使所有外交官能够执业并继续充分执业。

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引用次数: 0

Mapping Stroke in Regional and Remote Australia: A Scoping Review of Characteristics, Interventions and Outcomes 绘制中风在区域和偏远澳大利亚：特征，干预措施和结果的范围审查。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-18 DOI: 10.1111/ajr.70132

Stephanie Caldwell, Elizabeth Forster, Ramon Navarro Balbuena, Bronwyn Griffin

Background

Stroke is one of the most common causes of disability and timely treatment is crucial to reduce morbidity and mortality. Regional and remote communities in Australia face a higher incidence of stroke and encounter significant challenges in accessing timely treatment and effective management.

Objective

The scoping review aimed to analyse existing literature regarding stroke in regional and remote Australia, focusing on patient characteristics, stroke type, interventions, and outcomes. Identifying gaps could trigger future research and highlight what strategies need to be implemented to support this Australian population.

Methods

Arksey and O'Malley's methodological framework and the PRISMA-ScR checklist were used to guide this scoping review. Search dates included 2013 to August 2023, using the Medline (EBSCO), Embase, Scopus, and CINAHL databases.

Results

A total of 22 studies were included. The majority of stroke patients were male; participant ages varied, with means ranging from 64 to 74 years and medians from 64 to 78 years, in studies reporting mixed First Nations and non-Indigenous populations. Stroke risk factors were more common in First Nations people, except for atrial fibrillation, which was more prevalent in non-Indigenous people. Reported door-to-needle times for thrombolysis ranged from 77.5 to 100 min. Haemorrhagic strokes were associated with higher mortality. Patients frequently required multiple transfers to access imaging and treatment. Telestroke services were shown to improve care in several regions. However, outer regional and remote patients were less likely to receive thrombolysis, be prescribed stroke prevention medications, or receive care in a stroke unit.

Conclusions

Regional and remote Australians experience significant delays in accessing stroke treatment at a comprehensive stroke centre. Stroke is occurring at much younger ages among First Nations people. Addressing modifiable risk factors and implementing equity-focused strategies, supported by targeted research into regional and remote populations, is essential to reduce the stroke burden in these communities.

背景：脑卒中是最常见的致残原因之一，及时治疗对降低发病率和死亡率至关重要。澳大利亚的地区和偏远社区中风发病率较高，在获得及时治疗和有效管理方面面临重大挑战。目的：本综述旨在分析澳大利亚地区和偏远地区卒中的现有文献，重点关注患者特征、卒中类型、干预措施和结局。确定差距可以引发未来的研究，并强调需要实施哪些战略来支持这一澳大利亚人口。方法：采用Arksey和O'Malley的方法学框架和PRISMA-ScR检查表来指导本范围审查。检索日期包括2013年至2023年8月，使用Medline （EBSCO）、Embase、Scopus和CINAHL数据库。结果：共纳入22项研究。卒中患者以男性居多；在报告第一民族和非土著混合人口的研究中，参与者的年龄各不相同，平均年龄为64至74岁，中位数为64至78岁。中风的危险因素在原住民中更常见，除了房颤，它在非原住民中更普遍。据报道，从门到针的溶栓时间从77.5到100分钟不等。出血性中风与较高的死亡率相关。患者经常需要多次转移才能获得成像和治疗。在一些地区，远程中风服务已被证明改善了护理。然而，外围地区和偏远地区的患者接受溶栓治疗、服用预防中风药物或在中风病房接受治疗的可能性较小。结论：地区和偏远的澳大利亚人在获得综合中风中心的中风治疗方面经历了重大延误。在原住民中，中风发生的年龄要小得多。解决可改变的风险因素并实施以公平为重点的战略，在对区域和偏远人群进行有针对性的研究的支持下，对于减轻这些社区的中风负担至关重要。

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引用次数: 0

Development of a Rural and Remote Dementia Training Framework 农村和偏远地区痴呆症培训框架的发展。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-18 DOI: 10.1111/ajr.70133

Kathryn W. Fitzgerald, Katrina Fyfe, Sandra C. Thompson

Objective

Develop a framework to guide the design and delivery of dementia training for the rural and remote health and aged care workforce.

Methods

Phase 1 was a scoping review of barriers and enablers to dementia training in rural and remote settings. Phase 2 comprised semi-structured focus groups and a national health and aged care workforce survey. Findings from these phases were integrated to develop the framework.

Design

A two-phase mixed-method study and integration of the results to develop the framework.

Setting

Rural and remote areas across Australia.

Participants

There were six hundred and twenty-five rural and remote participants.

Main Outcome Measures

Representation from all seven Australian states and territories.

Results

Synthesis of the results identified three overarching key principles and seven actionable practices for consideration when designing or delivering dementia education to the rural and remote health and aged care workforce.

Conclusions

The first Rural and Remote Dementia Training Framework offers a practical guide for employers, training providers and professional organisations to design, deliver and evaluate dementia training programs, ensuring they meet the needs of the rural and remote health and aged care workforce in Australia.

目标：制定一个框架，指导为农村和偏远地区的保健和老年护理工作人员设计和提供痴呆症培训。方法：第一阶段是对农村和偏远地区痴呆症培训的障碍和促进因素进行范围审查。第二阶段包括半结构化焦点小组和全国卫生和老年护理工作人员调查。这些阶段的研究结果被整合到框架中。设计：一个两阶段的混合方法研究和整合的结果，以制定框架。环境：澳大利亚的农村和偏远地区。参与者：625名来自农村和偏远地区的参与者。主要衡量指标：来自澳大利亚所有七个州和地区的代表。结果：综合结果确定了三个总体关键原则和七个可操作的做法，供在设计或向农村和偏远地区的卫生和老年护理工作人员提供痴呆症教育时考虑。结论：第一个农村和偏远地区痴呆症培训框架为雇主、培训提供者和专业组织设计、实施和评估痴呆症培训计划提供了实用指南，确保它们满足澳大利亚农村和偏远地区健康和老年护理工作人员的需求。

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引用次数: 0

Investigating Postcode Lottery: Do Regional Outreach Clinics Improve Waiting Times to Elective General Surgical Care for Rural and Māori Populations? 调查邮编彩票：区域外展诊所是否改善了农村和Māori人口的选择性普通外科护理的等待时间？

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-17 DOI: 10.1111/ajr.70127

Sarah Cowan, Helen Waaka, Cameron Wells, Mania Campbell-Seymour, Turuki Tahuri, Jevon Puckett, Andrew Ing, Jamie-Lee Rahiri

Introduction

Health inequities, particularly for rural and Māori populations, persist in Aotearoa New Zealand (NZ) due to geographical and structural barriers to accessing healthcare. Te Whatu Ora—Health NZ aims to reduce these inequities, including through rural outreach clinics. This study evaluates the impact of rural outreach general surgical clinics in the Hawkes Bay region on access to benign elective surgeries for rural and Māori populations.

Methods

A retrospective cohort study was conducted on all adult patients who underwent elective general surgery in Hawkes Bay from August 2015 to December 2023. Data on patient demographics, ethnicity, rural status, clinic type and surgery type were collected. Primary outcomes were time from referral to first specialist assessment (FSA), waitlist to surgery and total time from referral to surgery. Data were analysed using chi-square and Mann–Whitney U-tests, with statistical significance set at p < 0.05.

Results

One thousand three hundred and ninety-seven patients met the criteria, of whom 19.4% (N = 271) resided rurally, and 24.1% (N = 337) identified as Māori. Rural patients had a longer median waitlist-to-surgery time (95.0 vs. 83.0 days, p = 0.006) and overall referral-to-surgery time (143.0 vs. 129.0 days, p = 0.04) compared with urban patients. Māori patients waited longer for surgery than non-Māori patients (p = 0.088). Outreach clinics had longer overall wait times than central clinics (p = 0.003).

Conclusions

Despite outreach clinics in our district, rural and Māori patients experience longer delays in receiving elective surgery. Additional investment in rural outreach clinics and equity-focused prioritisation could improve access and reduce healthcare disparities for these populations. Further qualitative research is needed to explore patient perspectives.

导言：由于获得医疗保健的地理和结构障碍，卫生不平等现象，特别是农村和Māori人口，在新西兰（新西兰）持续存在。新西兰Whatu Ora-Health旨在减少这些不平等现象，包括通过农村外展诊所。本研究评估霍克斯湾地区农村外展普通外科诊所对农村和Māori人口获得良性选择性手术的影响。方法：回顾性队列研究2015年8月至2023年12月霍克斯湾所有接受择期普外科手术的成年患者。收集患者人口统计学、种族、农村状况、诊所类型和手术类型等数据。主要结果是从转诊到第一次专家评估（FSA）的时间，从转诊到手术的等待名单和从转诊到手术的总时间。采用卡方检验和Mann-Whitney u检验对数据进行分析，统计学显著性设置为p。结果：符合标准的患者有1397例，其中19.4% （N = 271）居住在农村，24.1% （N = 337）确定为Māori。与城市患者相比，农村患者的中位等待手术时间（95.0天比83.0天，p = 0.006）和总转诊手术时间（143.0天比129.0天，p = 0.04）更长。Māori患者比non-Māori患者等待手术时间更长（p = 0.088）。外展诊所的总等待时间比中心诊所长（p = 0.003）。结论：尽管我们地区有外联诊所，农村和Māori患者在接受择期手术方面的延误时间更长。对农村外展诊所的额外投资和以公平为重点的优先事项可以改善这些人口的获取机会并减少保健差距。需要进一步的定性研究来探索患者的观点。

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引用次数: 0

Sustaining Nursing Programs in Rural and Remote Australia Through UDRHs 通过UDRHs在澳大利亚农村和偏远地区维持护理项目。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-17 DOI: 10.1111/ajr.70129

Sabina Knight, Geoff Argus, Isabelle Skinner, James Debenham, Catrina Felton-Busch, Jessica Elliott, Kehinde Obamiro

引用次数: 0

Strengthening National Rural Disability Research Capacity Through a Community of Practice 通过实践社区加强国家农村残疾研究能力。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-17 DOI: 10.1111/ajr.70131

Luke Wakely, Claire Quilliam, Kerryn Bagley, Casey Stubbs, Jodie Bailie, Jo Spong, Clare McHugh, Natalie Ellis, Tony Fallon, Robyn Doney, Louise French, Josie Clarke, Carol McKinstry

Aims

This commentary highlights the development and impact of a rural disability research Community of Practice (CoP) within the University Department of Rural Health (UDRH) framework. It aims to demonstrate how privileging rural lived experience as a core qualification for research participation fosters inclusive, place-based inquiry that addresses the intersectional challenges faced by people with disabilities in rural Australia.

Context

People with disabilities in rural areas face compounded inequities due to geographic isolation, limited access to services and policy frameworks that remain metrocentric. Despite national and international efforts to promote inclusive disability policy, societal acceptance of the social model of disability has been slow. The UDRH programme, which embeds academic staff within rural communities, provides a unique platform for authentic engagement and research that reflects local realities.

Approach

In response to the need for coordinated, rural-led disability research, the ARHEN Rural Disability Research CoP was established in 2024. With 27 members across nine UDRHs and four states, the CoP operates through a flattened hierarchy and task-focused collaboration. It promotes co-designed research, peer support and advocacy, ensuring rural perspectives are embedded in national and international disability discourse.

Conclusion

The CoP exemplifies effective rural leadership in disability research, challenging metrocentric norms and amplifying rural voices. By prioritising lived experience and inclusive collaboration, it informs more responsive policy and strengthens rural research capacity. This model offers a pathway for equitable, community-driven inquiry and policy reform.

目的：本评论强调了在大学农村卫生系框架内农村残疾研究实践社区（CoP）的发展和影响。它旨在展示如何将农村生活经验作为研究参与的核心资格，促进包容性，基于地点的调查，解决澳大利亚农村残疾人面临的交叉挑战。背景：由于地理位置孤立、获得服务的机会有限以及政策框架仍然以大都市为中心，农村地区的残疾人面临着复杂的不平等。尽管国家和国际努力促进包容性残疾政策，但社会对残疾的社会模式的接受速度很慢。该项目将学术人员派往农村社区，为真实参与和研究提供了一个独特的平台，反映了当地的实际情况。方法：为响应协调、农村主导的残疾研究的需求，ARHEN农村残疾研究CoP于2024年成立。CoP在9个udrh和4个州拥有27名成员，通过扁平的层次结构和以任务为中心的协作来运作。它促进共同设计的研究、同伴支持和宣传，确保农村观点融入国家和国际残疾话语。结论：缔约方会议体现了农村在残疾研究方面的有效领导，挑战了以城市为中心的规范，放大了农村的声音。通过优先考虑亲身体验和包容性合作，它为更具响应性的政策提供信息，并加强农村研究能力。这一模式为公平、社区驱动的调查和政策改革提供了一条途径。

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引用次数: 0

What are the Facilitators and Barriers to Improving the Delivery of Survivorship Care Information to Rural Cancer Survivors? A Qualitative Study Using an Implementation Science Framework 改善向农村癌症幸存者提供生存护理信息的促进因素和障碍是什么？使用实施科学框架的定性研究。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-15 DOI: 10.1111/ajr.70125

Elizabeth A. Johnston, Xanthia E. Bourdaniotis, Susannah K. Ayre, Hayley Fung, Nicole Craig, Fiona Crawford-Williams, Rebecca J. Bergin, Jon D. Emery, Raymond J. Chan, Belinda C. Goodwin

Objective

To identify facilitators and barriers to improving communication of survivorship care information to rural cancer survivors from the perspective of healthcare professionals.

Setting

Metropolitan and rural health services provide care to rural cancer survivors.

Participants

Healthcare professionals (n = 31), including cancer specialists, general practitioners, nurses, care coordinators and allied health practitioners.

Design

Qualitative descriptive study using semi-structured interviews to assess current practices for communicating survivorship care information, perspectives on how this information should be delivered and factors that may affect the implementation of a new method for delivering this information. Responses were categorised as a facilitator or barrier to improving information delivery. Barriers and facilitators were mapped to constructs of the Consolidated Framework for Implementation Research to identify the settings and contexts in which they occur.

Results

Facilitators included the evidence base and relative advantage of improving survivorship care information delivery to rural cancer survivors, indicating that healthcare professionals perceive this initiative as important and valuable. Participants also reported a tension for change (i.e., current practices for information delivery are not sustainable) and mission alignment, meaning improving survivorship information to rural cancer survivors is within participants' organisations' goals. Barriers included local conditions, policies and laws and financing, including challenges accessing support services in rural settings and limited funding for post-treatment care.

Conclusions

Guiding principles and suggested actions for improving survivorship care information delivery to rural cancer survivors are proposed, including strategies for minimising burden on healthcare teams, formalising transitional practices, streamlining referral pathways, partnering with community services and including family carers.

目的：从医疗保健专业人员的角度探讨改善农村癌症幸存者生存护理信息沟通的促进因素和障碍。环境：都市和农村卫生服务机构为农村癌症幸存者提供护理。参与者：医疗保健专业人员（n = 31），包括癌症专家、全科医生、护士、护理协调员和联合医疗从业人员。设计：采用半结构化访谈的定性描述性研究来评估当前幸存者护理信息交流的实践，对如何传递这些信息的观点，以及可能影响传递这些信息的新方法实施的因素。答复被分类为促进或阻碍改善信息传递。将障碍和促进因素映射到实施研究综合框架的构建中，以确定发生障碍和促进因素的环境和背景。结果：促进因素包括改善向农村癌症幸存者提供生存护理信息的证据基础和相对优势，表明医疗保健专业人员认为这一举措是重要和有价值的。参与者还报告了变革的压力（即，当前信息传递的做法是不可持续的）和任务一致性，这意味着改善农村癌症幸存者的生存信息是参与者组织的目标。障碍包括当地条件、政策和法律以及融资，包括在农村环境中获得支持服务的挑战以及治疗后护理的资金有限。结论：提出了改善向农村癌症幸存者提供生存护理信息的指导原则和建议行动，包括减少医疗团队负担的战略、使过渡做法正规化、简化转诊途径、与社区服务机构合作以及包括家庭照顾者在内的战略。

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引用次数: 0

‘I Am Not Going, So You're Doing It’: Management of Pregnant People With High BMI at Rural Hospitals in British Columbia: A Mixed Methods Analysis “我不去，所以你去”：不列颠哥伦比亚省农村医院对高BMI孕妇的管理：一种混合方法分析。

IF 2.1 4区医学 Q2 NURSING

Australian Journal of Rural Health

Pub Date : 2025-12-15 DOI: 10.1111/ajr.70126

Kathrin Stoll, Jude Kornelsen, Stephanie Lin, Christy Trafananko, Cecilia Jevitt

Objective

To summarise administrative and interview data relevant to the care of pregnant people with high BMI in rural British Columbia.

Methods

In this mixed methods analysis, we report administrative health data linked to maternal postal codes, to determine variations in rates of local births across BMI groups (n = 3247) and to examine associations between BMI and adverse maternal–newborn outcomes (n = 2527). Qualitative data from 169 healthcare providers and administrators at rural hospitals in BC were analyzed to understand rural providers’ experiences when caring for pregnant women with high BMI. Two clinical guidelines that were developed to improve care for women with obesity are presented, as examples of rural CQI initiatives.

Results

The proportion of local births decreased as BMI increased: 72.7% of those with normal BMI gave birth at rural hospitals compared to 34.9% with a BMI ≥ 40. For underweight, overweight, and obese women who gave birth at rural hospitals, the incidence of adverse perinatal outcomes was higher (IRR 1.85; 95% CI: 0.49–3.76, IRR = 1.19; 95% CI: 0.74–1.80; IRR = 1.81; 95% CI: 0.87–3.35), compared to those in the normal BMI range, but the associations were not significant. Healthcare providers also described challenges with maintaining quality and safety when caring for patients with high BMI in a low-volume rural setting and noted that a specialist ‘cookie cutter’ approach to managing and transferring people with high BMI was not practical in rural communities.

Discussion and Conclusion

Strategies that improve the care of pregnant women with high BMI must take into account the social risks incurred by birthers and families who leave the community alongside the clinical risks of remaining, with attention also given to the impact of adverse outcomes on health care providers. These processes must be underscored by engagement from regional referral specialists to ensure local providers are clinically supported and that there are efficient transfer pathways to higher levels of care should this be needed.

目的：总结与不列颠哥伦比亚省农村地区高BMI孕妇护理相关的行政管理和访谈资料。方法：在这一混合方法分析中，我们报告了与孕产妇邮政编码相关的行政卫生数据，以确定不同BMI组（n = 3247）当地出生率的变化，并检查BMI与不良母婴结局之间的关联（n = 2527）。本研究分析了不列颠哥伦比亚省农村医院169名医疗保健提供者和管理人员的定性数据，以了解农村提供者在照顾高BMI孕妇时的经验。作为农村CQI倡议的例子，提出了两项临床指南，以改善对肥胖妇女的护理。结果：随着BMI的升高，在当地分娩的比例下降，BMI正常的产妇在农村医院分娩的比例为72.7%，而BMI≥40的产妇在农村医院分娩的比例为34.9%。对于在农村医院分娩的体重不足、超重和肥胖妇女，与BMI正常范围内的妇女相比，不良围产期结局的发生率更高（IRR 1.85; 95% CI: 0.49-3.76, IRR = 1.19; 95% CI: 0.74-1.80; IRR = 1.81; 95% CI: 0.87-3.35），但相关性不显著。医疗保健提供者还描述了在低容量农村环境中照顾高BMI患者时保持质量和安全的挑战，并指出，在农村社区中，管理和转移高BMI患者的专家“千篇式”方法是不切实际的。讨论和结论：改善对高体重指数孕妇的护理的战略必须考虑到离开社区的新生儿和家庭所带来的社会风险以及留在社区的临床风险，还应注意不良后果对卫生保健提供者的影响。这些过程必须由区域转诊专家的参与来强调，以确保当地提供者得到临床支持，并在需要时有有效的转移途径到更高水平的护理。

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引用次数: 0