Brendan O'Driscoll, Kazi Mizanur Rahman, Richard Seamark
Objective
To analyse the changes in psychiatric inpatient admissions following the 2022 Lismore floods, focusing on admission frequency, length and reason.
Methods
We separated our dataset into two groups of equal time frame, representing the 12 months directly preceding (N = 407) and directly following (N = 500) the floods, and analysed the differences between them.
Design
A retrospective cohort study.
Setting
The adult inpatient mental health service of Lismore Base Hospital.
Participants
907 patients admitted to the Lismore Base Hospital adult inpatient mental health unit between 1 March 2021 and 28 February 2023.
Main Outcome Measures
Patient characteristics, number of admissions, admission length and admission reason were compared between the pre-flood and post-flood groups.
Results
We found a 22.9% (p = 0.002) increase in the number of admissions and an 18.2% (p = 0.001) reduction in the median admission length following the floods, culminating in no change in the total time spent in hospital when summed across all admissions. Additionally, there was a reduction in the length of Suicidality, Homicidality or Deliberate Self-Harm (DSH) admissions (p < 0.001) and Bipolar Affective Disorder admissions (p = 0.026).
Conclusion
The increase in admission frequency and decrease in admission length following the floods demonstrate the increase in demand for hospitalisation, which strained the inpatient capacity of the hospital. Further investigation is needed involving longer-term data and individual-level exposure information, along with connecting to the community-level occurrence of mental health conditions post-flood.
{"title":"Changes in Admissions to the Adult Inpatient Mental Health Service of Lismore Base Hospital, Northern New South Wales, Following the 2022 Floods","authors":"Brendan O'Driscoll, Kazi Mizanur Rahman, Richard Seamark","doi":"10.1111/ajr.70114","DOIUrl":"10.1111/ajr.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To analyse the changes in psychiatric inpatient admissions following the 2022 Lismore floods, focusing on admission frequency, length and reason.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We separated our dataset into two groups of equal time frame, representing the 12 months directly preceding (<i>N</i> = 407) and directly following (<i>N</i> = 500) the floods, and analysed the differences between them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The adult inpatient mental health service of Lismore Base Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>907 patients admitted to the Lismore Base Hospital adult inpatient mental health unit between 1 March 2021 and 28 February 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Patient characteristics, number of admissions, admission length and admission reason were compared between the pre-flood and post-flood groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found a 22.9% (<i>p</i> = 0.002) increase in the number of admissions and an 18.2% (<i>p</i> = 0.001) reduction in the median admission length following the floods, culminating in no change in the total time spent in hospital when summed across all admissions. Additionally, there was a reduction in the length of Suicidality, Homicidality or Deliberate Self-Harm (DSH) admissions (<i>p</i> < 0.001) and Bipolar Affective Disorder admissions (<i>p</i> = 0.026).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The increase in admission frequency and decrease in admission length following the floods demonstrate the increase in demand for hospitalisation, which strained the inpatient capacity of the hospital. Further investigation is needed involving longer-term data and individual-level exposure information, along with connecting to the community-level occurrence of mental health conditions post-flood.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oliver Leslie, Alasdair Leslie, Brandon Stretton, Stephen Bacchi, Darran Foo
{"title":"“A Rising Tide Lifts All Boats”: The Systemic Benefits of Artificial Intelligence on the Practice of Medicine in Regional Hospitals","authors":"Oliver Leslie, Alasdair Leslie, Brandon Stretton, Stephen Bacchi, Darran Foo","doi":"10.1111/ajr.70113","DOIUrl":"10.1111/ajr.70113","url":null,"abstract":"","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strengthening the Rural and Remote Allied Health Workforce in Australia: Issues and Solutions","authors":"Gregory S. Kolt","doi":"10.1111/ajr.70108","DOIUrl":"https://doi.org/10.1111/ajr.70108","url":null,"abstract":"","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Armstrong, Tapan Rai, Judith M. Katzenellenbogen, Sandra J. Thompson, Meaghan McAllister, Natalie Ciccone, Deborah Hersh, Leon Flicker, Dominique A. Cadilhac, Erin Godecke, Graeme J. Hankey, Neil Drew, Colleen Hayward, Deborah Woods, Mel Robinson, Ivan Lin, Sanita Kratina, Jane White, Juli Coffin
Objective
To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI).
Design
A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised.
Setting
Four urban and four rural hospitals in Western Australia, 2018–2022.
Participants
Aboriginal adults ≥ 18 years hospitalised with stroke or TBI.
Main Outcome Measures
Primary outcome was quality of life (Euro QOL–5D-3L Visual Analogue Scale (EQ-VAS)) score at 26 weeks post-injury. Secondary outcomes were modified Rankin Scale, Functional Independence Measure, Hospital Anxiety and Depression Scale, Modified Caregiver Strain Index at 12 and 26 weeks, rehabilitation occasions of service, hospital compliance with minimum processes of care (MPC), acceptability of interventions, feasibility of ABIC role and costs.
Results
In total, 108 participants recruited (target 312), 75% rural residents; 26-week outcomes assessment completed for 78% of participants. The adjusted mean QoL showed no significant difference (p = 0.83). The MPC outcome favored the intervention group, adjusted difference in means 6.8% at 26 weeks, 95% CI (0.40%, 13.26%). There were no significant differences between control and intervention groups for other secondary outcomes.
Conclusions
CST and implementation of an ABIC were feasible, acceptable and improved care processes for a predominantly rural population. Health outcomes did not differ. The effects of the COVID-19 context are discussed.
{"title":"Healing Right Way: A Stepped Wedge Cluster Randomised Controlled Trial Aiming to Enhance Quality of Life for Aboriginal Australian Survivors of Stroke and Traumatic Brain Injury","authors":"Elizabeth Armstrong, Tapan Rai, Judith M. Katzenellenbogen, Sandra J. Thompson, Meaghan McAllister, Natalie Ciccone, Deborah Hersh, Leon Flicker, Dominique A. Cadilhac, Erin Godecke, Graeme J. Hankey, Neil Drew, Colleen Hayward, Deborah Woods, Mel Robinson, Ivan Lin, Sanita Kratina, Jane White, Juli Coffin","doi":"10.1111/ajr.70106","DOIUrl":"10.1111/ajr.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the effect of cultural security training (CST) for health professionals and access to an Aboriginal Brain Injury Coordinator (ABIC) for Aboriginal Australians with stroke or traumatic brain injury (TBI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A stepped wedge cluster randomised controlled trial; the intervention package consisted of CST for hospital professionals and 6-month access to ABICs providing education, support, liaison and advocacy; the commencement order of the intervention phase was randomised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Four urban and four rural hospitals in Western Australia, 2018–2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Aboriginal adults ≥ 18 years hospitalised with stroke or TBI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Primary outcome was quality of life (Euro QOL–5D-3L Visual Analogue Scale (EQ-VAS)) score at 26 weeks post-injury. Secondary outcomes were modified Rankin Scale, Functional Independence Measure, Hospital Anxiety and Depression Scale, Modified Caregiver Strain Index at 12 and 26 weeks, rehabilitation occasions of service, hospital compliance with minimum processes of care (MPC), acceptability of interventions, feasibility of ABIC role and costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 108 participants recruited (target 312), 75% rural residents; 26-week outcomes assessment completed for 78% of participants. The adjusted mean QoL showed no significant difference (<i>p</i> = 0.83). The MPC outcome favored the intervention group, adjusted difference in means 6.8% at 26 weeks, 95% CI (0.40%, 13.26%). There were no significant differences between control and intervention groups for other secondary outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CST and implementation of an ABIC were feasible, acceptable and improved care processes for a predominantly rural population. Health outcomes did not differ. The effects of the COVID-19 context are discussed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ACTRN12618000139279</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70106","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rural hospitals in Aotearoa New Zealand (NZ) struggle to recruit and retain their senior medical workforce. This study focuses on one rural hospital (Dunstan) with a stable senior medical workforce to explore factors influencing its success.
Methods
NZ Rural Hospital Medicine Fellows participated in virtual semi-structured interviews exploring their experiences and perceptions of why the hospital under study has a stable senior medical workforce. Thematic analysis using a positive deviance approach was undertaken.
Results
Seventeen participants were recruited. Four themes were identified: (1) ‘A great place to live’ relates to Dunstan's rural hospital location and regional amenities; (2) ‘A scope of clinical practice that Fellows enjoy’ reflects on the model of care at Dunstan Hospital; (3) ‘Strong collaborative relationships’ describe successful internal (within the rural hospital) and external (professional and academic) relationships; (4) ‘Purposeful investment’ conveys the time and leadership required to build relationships, establish the professional environment, and continue to look forward.
Discussion
Successfully building and maintaining a stable senior medical workforce in NZ rural hospitals requires investment. Findings show what can be achieved through sustained longstanding partnerships, both locally and nationally, and the critical role of supportive management. Building and maintaining a desirable professional environment for the senior medical workforce and other clinicians could enhance recruitment and retention, as does a robust connection with professional training and academia.
{"title":"What Makes for a Stable Senior Rural Hospital Medical Workforce? A Qualitative Case Study","authors":"Lynne Clay, Tim Stokes, Katharina Blattner","doi":"10.1111/ajr.70107","DOIUrl":"10.1111/ajr.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background & Aim</h3>\u0000 \u0000 <p>Rural hospitals in Aotearoa New Zealand (NZ) struggle to recruit and retain their senior medical workforce. This study focuses on one rural hospital (Dunstan) with a stable senior medical workforce to explore factors influencing its success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NZ Rural Hospital Medicine Fellows participated in virtual semi-structured interviews exploring their experiences and perceptions of why the hospital under study has a stable senior medical workforce. Thematic analysis using a positive deviance approach was undertaken.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen participants were recruited. Four themes were identified: (1) ‘A great place to live’ relates to Dunstan's rural hospital location and regional amenities; (2) ‘A scope of clinical practice that Fellows enjoy’ reflects on the model of care at Dunstan Hospital; (3) ‘Strong collaborative relationships’ describe successful internal (within the rural hospital) and external (professional and academic) relationships; (4) ‘Purposeful investment’ conveys the time and leadership required to build relationships, establish the professional environment, and continue to look forward.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Successfully building and maintaining a stable senior medical workforce in NZ rural hospitals requires investment. Findings show what can be achieved through sustained longstanding partnerships, both locally and nationally, and the critical role of supportive management. Building and maintaining a desirable professional environment for the senior medical workforce and other clinicians could enhance recruitment and retention, as does a robust connection with professional training and academia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Catherine Leahy, Michelle Barakat-Johnson, Linda Deravin, Erik Biros, Rachel Kornhaber
Introduction
This study assessed the Virtual Wound Consultancy Service (VWCS) in reducing travel burden and lowering travel costs for rural patients requiring wound care. With one-third of Australians in regional or remote areas facing limited healthcare access, this study examined how virtual care could overcome geographical barriers, focusing on travel time and cost.
Methods
A retrospective analysis compared service utilisation and travel savings between patients using the VWCS and those receiving traditional in-person care. Data from chronic wound patients across inpatient, outpatient and residential aged-care settings in a large rural health district (July 2018 to March 2024) were reviewed. Key outcomes included travel time, travel costs and travel distance.
Results
The VWCS significantly reduced travel burdens. Patients living more than 201 km from specialist centres saved an average of 444 min per round trip. Financially, patients saved up to AU$507.49 per trip, with the highest savings for those farthest away. The VWCS also provided timely access to wound care, with an average wait time of 3.7 days from referral to consultation. Most services involved audio/visual assessments (40%), case management (27.5%) and email consultations (18%). Over the study period, the VWCS serviced 384 patients, averaging 2.6 consultations per patient.
Conclusion
The VWCS significantly improves access to wound care for rural populations by reducing the time burden. These results support expanding virtual care models in rural areas. Future research should assess long-term clinical outcomes and refine virtual care delivery for greater quality and cost-effectiveness.
{"title":"Bridging Distances: A Retrospective Study of Virtual Wound Care to Reduce Travel Burden in Rural Healthcare","authors":"Catherine Leahy, Michelle Barakat-Johnson, Linda Deravin, Erik Biros, Rachel Kornhaber","doi":"10.1111/ajr.70095","DOIUrl":"10.1111/ajr.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>This study assessed the Virtual Wound Consultancy Service (VWCS) in reducing travel burden and lowering travel costs for rural patients requiring wound care. With one-third of Australians in regional or remote areas facing limited healthcare access, this study examined how virtual care could overcome geographical barriers, focusing on travel time and cost.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis compared service utilisation and travel savings between patients using the VWCS and those receiving traditional in-person care. Data from chronic wound patients across inpatient, outpatient and residential aged-care settings in a large rural health district (July 2018 to March 2024) were reviewed. Key outcomes included travel time, travel costs and travel distance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The VWCS significantly reduced travel burdens. Patients living more than 201 km from specialist centres saved an average of 444 min per round trip. Financially, patients saved up to AU$507.49 per trip, with the highest savings for those farthest away. The VWCS also provided timely access to wound care, with an average wait time of 3.7 days from referral to consultation. Most services involved audio/visual assessments (40%), case management (27.5%) and email consultations (18%). Over the study period, the VWCS serviced 384 patients, averaging 2.6 consultations per patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The VWCS significantly improves access to wound care for rural populations by reducing the time burden. These results support expanding virtual care models in rural areas. Future research should assess long-term clinical outcomes and refine virtual care delivery for greater quality and cost-effectiveness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To exponentially amplify the impact of health research in regional, rural, remote, and very remote (RRRvR) communities for improved health outcomes and reduced health inequities.
Context
RRRvR health inequities are severe, enduring, and largely impervious to our best efforts to address them. It is unjust that, simply because of where they live, some people do not have the health they need to live the life they want. Although research has been one of our greatest inventions for solving problems, it has had little impact on the problems with which RRRvR communities grapple. Improving the beneficial impact of RRRvR research was the focus of a recent Research Australia University Roundtable.
Approach
As someone with an abiding interest in research methodologies and the research process more generally, I read widely on research matters, am research active, review research funding applications, and train others in research processes. This commentary is a synthesis of my insights from the Roundtable as well as the published literature, including my own published work.
Conclusion
For people in RRRvR communities to reap the benefits that research has the potential to offer, far more substantive changes are required than adjusting assessment criteria or funding streams. It is the context within which research is conceived and conducted that must be reimagined. Without changing the context, other alterations are likely to be ineffective. When research becomes a genuine partnership between researchers and RRRvR communities to answer locally prioritised problems, we might finally achieve the impact that is required.
{"title":"How Can Research Have Greater Beneficial Impact in Rural Australia?","authors":"Timothy A. Carey","doi":"10.1111/ajr.70104","DOIUrl":"10.1111/ajr.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To exponentially amplify the impact of health research in regional, rural, remote, and very remote (RRRvR) communities for improved health outcomes and reduced health inequities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>RRRvR health inequities are severe, enduring, and largely impervious to our best efforts to address them. It is unjust that, simply because of where they live, some people do not have the health they need to live the life they want. Although research has been one of our greatest inventions for solving problems, it has had little impact on the problems with which RRRvR communities grapple. Improving the beneficial impact of RRRvR research was the focus of a recent Research Australia University Roundtable.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>As someone with an abiding interest in research methodologies and the research process more generally, I read widely on research matters, am research active, review research funding applications, and train others in research processes. This commentary is a synthesis of my insights from the Roundtable as well as the published literature, including my own published work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For people in RRRvR communities to reap the benefits that research has the potential to offer, far more substantive changes are required than adjusting assessment criteria or funding streams. It is the context within which research is conceived and conducted that must be reimagined. Without changing the context, other alterations are likely to be ineffective. When research becomes a genuine partnership between researchers and RRRvR communities to answer locally prioritised problems, we might finally achieve the impact that is required.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>I learned it was ‘Women's Health Week’ in Australia the first week of September, almost a week after the occasion. It came and went without the recognition it deserved. Women are just over half of the Australian population, including across regional to very remote areas of Australia [<span>1</span>], yet Women's Health remains a problem drawing patchy attention.</p><p>Women (and girls) from regional to very remote (or rural) areas are internationally recognised as a priority population, and women in rural areas play a crucial role in strengthening their communities [<span>2, 3</span>]. Women are the stalwart backbone of their communities, often also holding responsibility and care for everyone around them. I was asked to write about ‘Women and Rural Health’, but the topic is enormous. Where do we set our focus?</p><p>Women's rights and women's health rights are once again being challenged, diminished and removed in nations around the world. In Australia, there are numerous policies, strategies and initiatives in place to address gaps in healthcare for women and for those living in rural communities, from the federal government to the local health systems and even the non-government agencies within the states and territories. The Australian Government's Minister for Women has identified Health as one of five priority areas. Priority area 4 of the Strategy for Gender Equality states that, ‘Over many decades in Australia and around the world, women's control over their health has been challenged. … A lack of support for women's health not only affects their everyday wellbeing, it also impacts how they participate and thrive at work. …and (women) in regional, remote and rural communities also face additional barriers due to religious or cultural values and beliefs, language and communication challenges or a lack of access [<span>4</span>].’</p><p>The federal Minister for Health has produced a Women's Health Strategy that recognises ‘that women's experiences of mental and physical illness are different from men's [and this] is essential for developing services that are effective in addressing the health needs of women and girls in Australia’ [<span>5</span>]. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has also responded with a strategy to address the ‘barriers that create a financial, logistical and emotional burden on women and their families’ and it will continue to ‘advocate for, and support initiatives that help support the equitable delivery of services’ [<span>6</span>].</p><p>The rules of play are being laid out, but there remains a clear gap in access to healthcare and a shortage of appropriate health providers to meet the unique health needs of women, especially in rural Australia.</p><p>In Australia, women significantly outnumber men in the health workforce—no matter the discipline, classification, or location (78% Australia-wide, 80% in rural areas) [<span>7</span>]. Women also outnumber men in the t
{"title":"I Am (Rural) Woman","authors":"Emily Saurman","doi":"10.1111/ajr.70103","DOIUrl":"10.1111/ajr.70103","url":null,"abstract":"<p>I learned it was ‘Women's Health Week’ in Australia the first week of September, almost a week after the occasion. It came and went without the recognition it deserved. Women are just over half of the Australian population, including across regional to very remote areas of Australia [<span>1</span>], yet Women's Health remains a problem drawing patchy attention.</p><p>Women (and girls) from regional to very remote (or rural) areas are internationally recognised as a priority population, and women in rural areas play a crucial role in strengthening their communities [<span>2, 3</span>]. Women are the stalwart backbone of their communities, often also holding responsibility and care for everyone around them. I was asked to write about ‘Women and Rural Health’, but the topic is enormous. Where do we set our focus?</p><p>Women's rights and women's health rights are once again being challenged, diminished and removed in nations around the world. In Australia, there are numerous policies, strategies and initiatives in place to address gaps in healthcare for women and for those living in rural communities, from the federal government to the local health systems and even the non-government agencies within the states and territories. The Australian Government's Minister for Women has identified Health as one of five priority areas. Priority area 4 of the Strategy for Gender Equality states that, ‘Over many decades in Australia and around the world, women's control over their health has been challenged. … A lack of support for women's health not only affects their everyday wellbeing, it also impacts how they participate and thrive at work. …and (women) in regional, remote and rural communities also face additional barriers due to religious or cultural values and beliefs, language and communication challenges or a lack of access [<span>4</span>].’</p><p>The federal Minister for Health has produced a Women's Health Strategy that recognises ‘that women's experiences of mental and physical illness are different from men's [and this] is essential for developing services that are effective in addressing the health needs of women and girls in Australia’ [<span>5</span>]. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has also responded with a strategy to address the ‘barriers that create a financial, logistical and emotional burden on women and their families’ and it will continue to ‘advocate for, and support initiatives that help support the equitable delivery of services’ [<span>6</span>].</p><p>The rules of play are being laid out, but there remains a clear gap in access to healthcare and a shortage of appropriate health providers to meet the unique health needs of women, especially in rural Australia.</p><p>In Australia, women significantly outnumber men in the health workforce—no matter the discipline, classification, or location (78% Australia-wide, 80% in rural areas) [<span>7</span>]. Women also outnumber men in the t","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Australia prides itself on the principle of a universal health system. But that promise rings hollow when access to essential services and health outcomes are largely determined by your postcode.</p><p>The National Rural Health Alliance (NRHA) engaged the Nous Group to deliver an updated, more comprehensive analysis of rural health investment in Australia. The overall findings confirmed what regional, rural and remote (hereafter rural) Australians have long known: the health funding gap between the city and country continues to grow, placing lives, communities and the economy at risk.</p><p>In 2023–24, the health spend shortfall for people living in rural communities, compared to metropolitan areas, reached a staggering <b>$8.35 billion</b> or <b>$1090.47 per person per year</b>. Even when using like-for-like comparison with the scope of the initial 2023 report, and adjusting for inflation, the per capita gap has still <b>grown by $110</b>. This widening chasm reveals not only deep inequity in healthcare access but systemic underinvestment in the very people who drive our national economy.</p><p>This new report provides a more comprehensive picture than ever before. It includes public and private spending across the full spectrum of healthcare services: hospitals, the Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), Department of Veteran Affairs (DVA), National Disability Insurance Scheme (NDIS), aged care, private allied health, dentistry, Primary Health Networks (PHNs), Aboriginal and Torres Strait Islander primary healthcare, Royal Flying Doctor Service (RFDS), ambulance services and Commonwealth workforce programmes. The health expenditure data has also been broken down by Modified Monash Model (MMM) and, where available, by state and territory, revealing a more accurate and granular representation to date of healthcare investment (and underinvestment) in rural Australia.</p><p>The shortfall is driven largely by lower investment in public hospitals, private hospitals, MBS services, private allied healthcare and dentistry in rural and remote regions. In <i>Very Remote</i> communities, targeted programmes, such as RFDS and Aboriginal and Torres Strait Islander primary healthcare are helping fill the gaps, but this highlights just how much mainstream systems are failing rural populations and require supplementation from special-purpose programmes.</p><p>Simply put, rural Australians need more care yet receive less per capita than urban populations.</p><p>There's currently no national definition of what constitutes ‘reasonable access to care’ across different regions of Australia, a glaring gap in health policy. Stakeholders agree that this lack of definition, along with disjointed policy responsibilities across federal, state and private systems, including inflexible funding models and policies, is contributing to persistent and growing inequity. Without a shared standard for access, the system defaults to urban-centric s
{"title":"The Forgotten Health Spend: Time to Prioritise Rural Health Equity","authors":"Leanne Kelly","doi":"10.1111/ajr.70102","DOIUrl":"https://doi.org/10.1111/ajr.70102","url":null,"abstract":"<p>Australia prides itself on the principle of a universal health system. But that promise rings hollow when access to essential services and health outcomes are largely determined by your postcode.</p><p>The National Rural Health Alliance (NRHA) engaged the Nous Group to deliver an updated, more comprehensive analysis of rural health investment in Australia. The overall findings confirmed what regional, rural and remote (hereafter rural) Australians have long known: the health funding gap between the city and country continues to grow, placing lives, communities and the economy at risk.</p><p>In 2023–24, the health spend shortfall for people living in rural communities, compared to metropolitan areas, reached a staggering <b>$8.35 billion</b> or <b>$1090.47 per person per year</b>. Even when using like-for-like comparison with the scope of the initial 2023 report, and adjusting for inflation, the per capita gap has still <b>grown by $110</b>. This widening chasm reveals not only deep inequity in healthcare access but systemic underinvestment in the very people who drive our national economy.</p><p>This new report provides a more comprehensive picture than ever before. It includes public and private spending across the full spectrum of healthcare services: hospitals, the Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), Department of Veteran Affairs (DVA), National Disability Insurance Scheme (NDIS), aged care, private allied health, dentistry, Primary Health Networks (PHNs), Aboriginal and Torres Strait Islander primary healthcare, Royal Flying Doctor Service (RFDS), ambulance services and Commonwealth workforce programmes. The health expenditure data has also been broken down by Modified Monash Model (MMM) and, where available, by state and territory, revealing a more accurate and granular representation to date of healthcare investment (and underinvestment) in rural Australia.</p><p>The shortfall is driven largely by lower investment in public hospitals, private hospitals, MBS services, private allied healthcare and dentistry in rural and remote regions. In <i>Very Remote</i> communities, targeted programmes, such as RFDS and Aboriginal and Torres Strait Islander primary healthcare are helping fill the gaps, but this highlights just how much mainstream systems are failing rural populations and require supplementation from special-purpose programmes.</p><p>Simply put, rural Australians need more care yet receive less per capita than urban populations.</p><p>There's currently no national definition of what constitutes ‘reasonable access to care’ across different regions of Australia, a glaring gap in health policy. Stakeholders agree that this lack of definition, along with disjointed policy responsibilities across federal, state and private systems, including inflexible funding models and policies, is contributing to persistent and growing inequity. Without a shared standard for access, the system defaults to urban-centric s","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen Hayes, Rosalind Bye, Liz Thyer, Simon McDonald, Kristy Coxon
<div> <section> <h3> Objective</h3> <p>Describe Australian occupational therapy (OT) workforce distribution trends by total numbers, demographics, work type, and job roles across remoteness levels.</p> </section> <section> <h3> Design</h3> <p>Exploratory spatial analysis of workforce distribution compared to total populations between 2013 and 2021.</p> </section> <section> <h3> Setting</h3> <p>Australia.</p> </section> <section> <h3> Participants</h3> <p>OTs participating in registration surveys (2013–2021) and Australians from the 2011, 2016, and 2021 National censuses.</p> </section> <section> <h3> Main Outcome Measures</h3> <p>Proportion of occupational therapists, hours worked, First Nations inclusion, leadership roles, and practice areas across Modified Monash Model (MMM) levels of remoteness compared to populations.</p> </section> <section> <h3> Results</h3> <p>Despite a 72% national workforce increase (over 10 000 OTs) over nine-years, metropolitan areas consistently retained a disproportionate share of workforce, hours worked, specialised practice areas, leadership roles, and First Nations identifying therapists. Regional centres showed the highest growth but would require similar growth for 4–15 years to equal metropolitan ratios, while workforce gaps will likely widen for other remoteness levels. Private sector hours increased substantially by 100-h/10 000 population, while public sector hours increased by just 1-h. However, private sector growth did not extend equitably to rural and remote places. Metropolitan, regional, and large rural towns outpaced all other remoteness levels in leadership growth suggesting a centralising tendency. At current rates, representative First Nations proportions will not be achieved. Equity against 2021 numbers requires redistribution of at least 1717 therapists, 278 formalised leadership positions, and increased specialised services to rural and remote places. At least 598 additional First Nations identifying therapists are needed nationally, of which 406 (68%) are needed in regional, rural, and remote places.</p> </section> <section> <h3> Conclusion</h3> <p>Persistent maldistribution of the OT workforce across remoteness levels reflects structural inequities unlikely to resolve through organic growth. Current rural workforce strategies appear insufficient to address geographic and cultural disparities. Targeted investment in rural workforce developm
{"title":"Rural Workforce Drought: Spatial Analysis Reveals Persistent Maldistribution of the Australian Occupational Therapy Workforce From 2013 to 2021","authors":"Karen Hayes, Rosalind Bye, Liz Thyer, Simon McDonald, Kristy Coxon","doi":"10.1111/ajr.70101","DOIUrl":"10.1111/ajr.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Describe Australian occupational therapy (OT) workforce distribution trends by total numbers, demographics, work type, and job roles across remoteness levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Exploratory spatial analysis of workforce distribution compared to total populations between 2013 and 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>OTs participating in registration surveys (2013–2021) and Australians from the 2011, 2016, and 2021 National censuses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Proportion of occupational therapists, hours worked, First Nations inclusion, leadership roles, and practice areas across Modified Monash Model (MMM) levels of remoteness compared to populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Despite a 72% national workforce increase (over 10 000 OTs) over nine-years, metropolitan areas consistently retained a disproportionate share of workforce, hours worked, specialised practice areas, leadership roles, and First Nations identifying therapists. Regional centres showed the highest growth but would require similar growth for 4–15 years to equal metropolitan ratios, while workforce gaps will likely widen for other remoteness levels. Private sector hours increased substantially by 100-h/10 000 population, while public sector hours increased by just 1-h. However, private sector growth did not extend equitably to rural and remote places. Metropolitan, regional, and large rural towns outpaced all other remoteness levels in leadership growth suggesting a centralising tendency. At current rates, representative First Nations proportions will not be achieved. Equity against 2021 numbers requires redistribution of at least 1717 therapists, 278 formalised leadership positions, and increased specialised services to rural and remote places. At least 598 additional First Nations identifying therapists are needed nationally, of which 406 (68%) are needed in regional, rural, and remote places.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Persistent maldistribution of the OT workforce across remoteness levels reflects structural inequities unlikely to resolve through organic growth. Current rural workforce strategies appear insufficient to address geographic and cultural disparities. Targeted investment in rural workforce developm","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 5","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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