Nerve blocks confer major benefits for patients with hip fractures, but the average time to surgery exceeds the duration of a single injection. We addressed this with an initiative to credential emergency department (ED) doctors and rural generalists to place fascia iliaca block catheters (FIBC), enabling ongoing analgesia until the time of surgery.
Cairns and Hinterland Hospital and Health Service, the major referral hospital for Far North Queensland.
Proportion of hip fracture patients receiving an FIBC in ED or prior to interhospital transfer, time from arrival to block insertion, and complication rates.
Multidisciplinary initiative involving a formal training program and protocol for FIBC insertion, with ongoing follow-up by the acute pain service.
ED doctors now place the majority of FIBC for our hospital, with a median time to block of 4.5 h compared to 13.2 h by anaesthetists (p < 0.001). Over 40% of patients from rural centres receive an FIBC before transfer. Complication rates were low and similar across specialties.
FIBC insertion in ED and rural hospitals was feasible and safe after a simple training program. Multidisciplinary collaboration was essential to the success of the program.
A balance of practical experience and theoretical knowledge is key in medical education, especially in underserved communities. The James Cook University medical curriculum includes rural and remote clinical placements to help prepare graduates to better meet local community healthcare needs.
To compare medical student learning experiences between rural and remote clinical placements in Years 4 and 6.
Post-placement surveys were administered to fourth-year (MBBS4) (2016–2023) and sixth-year (MBBS6) students (2021–2023) to assess the quality of rural and remote placements. Student ratings of clinical supervision and learning experiences were collected using a 5-point Likert scale. Placement locations were categorized into “Rural” (MM4 and MM5) and “Remote” (MM6 and MM7) and responses collapsed into “Agree” and “Disagree” for analysis. Chi-square and Fisher's exact tests were used to compare ratings between locations.
A total of 558 MBBS4 and 95 MBBS6 students completed the survey, with 46.6% and 47.4% from rural placements respectively. Survey response rates were higher for the Remote group in both year levels. There were no differences in student ratings between rural and remote placements for any survey item for either year level.
There was no difference in student satisfaction between rural and remote placements suggesting both provide meaningful clinical learning experiences.
To determine the unique wound management requirements of regional healthcare professionals and to assess the effectiveness of an evidence translation model on practice and confidence in evidence-based wound management.
A pre/post implementation study, including pre/post surveys.
The project was implemented in two regional areas in Australia.
Forty-two eligible health professionals completed pre-workshop surveys. Eighteen participants attended a face-to-face workshop while between four and 14 participants attended online workshops each week. Immediately post-workshop, 17 health professionals completed surveys, with 13 able to be directly matched with pre-workshop surveys. Seven participants completed case scenarios as part of the post evaluation within their practices.
This study obtained information on current wound types and treatment strategies in regional areas in Australia. Outcomes of this study found positive trends in the confidence of evidence-based management of wounds in regional areas following the implementation of two formats of an evidence translation model (one face-to-face and one online).
Both formats of the evidence translation model benefited the community in being able to facilitate the implementation of evidence-based wound care in regional areas; therefore potentially leading to improved health outcomes. Pilot information on the prevalence and management of wounds for people in regional areas and supporting information on healthcare professionals' perceptions, knowledge and confidence of wound care in these areas will assist in guiding practice in the future. The outcomes of this project are a starting point for establishing units and/or networks specialised in wound care across regional areas in Australia. The use of innovative evidence translation models ensures sustainability of the use of evidence-based resources and information and in particular understanding that flexible versions of models can and should be used.
This pilot study evaluated the feasibility and acceptability of a student-led group falls prevention exercise program delivered to a fixed hub via telehealth to older adults in a remote community.
A convergent parallel mixed-methods design involving pre- and post-participation outcome measures, semi-structured focus groups and interviews explored the experiences and perspectives of participants completing the program and health professional students conducting the sessions.
Telehealth delivery to a very remote town (Modified Monash Model 7) in southwestern Queensland from a regional city in southeast Queensland.
Over 2022 and 2023, 17 community participants completed the program. Seven final year students, six studying exercise physiology and one studying physiotherapy, completed a clinical placement in a regional health and wellness clinic and implemented the telehealth program during their placement.
Community participants demonstrated significant improvements in mobility and function following program participation, with higher BOOMER scores (M = 13.12, 95% CI 11.94–14.29) and faster 10-m walk times (M = 8.56 s, 95% CI 7.31–9.81) compared to baseline (M = 10.94, 95% CI 9.04–12.84; and M = 10.31 s, 95% CI 8.32–12.31, respectively). Clinically meaningful gains on the 10-m walk test were achieved by 64.7% of participants. Beyond physical outcomes, the program fostered valuable social connections. Health professional students reported increased awareness of effective telehealth strategies and growth in clinical skills as additional benefits.
Telehealth delivery of a group-based exercise program to a fixed hub appears to be a feasible and well-accepted model of rural health service delivery for both older adults and health students. Wider implementation of this approach to a broader range of health services could improve access to high-value care for rural and remote communities.
To explore how mobile interviewing can be utilised to better inform rural health promotion efforts, as well as the type and breadth of data generated. Mobile methods are defined by the researcher and participant being in motion in a specific setting, collaborating in the data collection process.
A rural health service catchment in Victoria, Australia.
Members of local Progress Associations, Town Advisory Committee and service clubs within the catchment.
The study employed an exploratory qualitative design. Mobile interviewing was used in the form of unstructured guided tours, led by participants. The theme provided was ‘What in your town helps or hinders community health?’. Content and thematic qualitative analysis were applied, and a socioecological model was adopted to structure the findings.
Six guided tours involving seven participants were conducted. Local drivers of health were identified across all five levels of the applied model (intrapersonal, interpersonal, institutional, community, public policy). Institutional-level factors figured most prominently during the guided tour discussions (e.g., relating to the agricultural sector or not-for-profit community organisations). Community factors (e.g., intentional support between local organisations) were also highlighted. Public policy factors were the least discussed out of the five levels of the socioecological model. The study found that perceptions of community health drivers varied substantially, even among geographically close and demographically similar towns.
The study highlights how mobile interviewing can generate rich, contextual data. The findings suggest that guided tours can serve as a valuable tool for rural health promotion practitioners, providing a holistic understanding of local drivers of health and informing more tailored interventions.
To explore the perceptions of rural Australian clinicians towards antenatal point-of-care ultrasound (APoCUS) training and accreditation, investigating barriers and enablers to continuing professional development (CPD).
A prospective cross-sectional online survey of rural Australian clinicians (doctors, nurses, midwives) was undertaken in 2023, using non-probability sampling with self-selection/voluntary response. The survey targeted rural clinicians caring for pregnant patients. Thematic and descriptive analyses were performed with response frequencies grouped by role, work sector, APoCUS use and previous training experience. Fisher's exact test was used for association.
Fifty-seven responses were analysed (41 midwives/nurses, 16 physicians/doctors). Two-thirds were performing APoCUS, half reported formal or on-the-job training, and none were accredited. Midwives/nurses had a poorer understanding of their scope of practice (eligibility to learn/perform APoCUS) and accreditation requirements. Interest in accreditation was high, particularly for the midwife/nurse cohort. The perceived benefits of accreditation surrounded improved patient care and services, scanning capability and professional satisfaction. The main barriers to pursuing accreditation were supervision for scanning and assessments, cost, time commitment and workforce shortages. Half of the respondents had access to employer-provided CPD funds, and most reported having to self-fund to meet professional registration requirements.
Australian rural clinicians are driven to upskill and provide high-quality care to patients but face significant barriers to CPD and attaining accreditation, evidenced by low accreditation rates. Future efforts should focus on simplifying accreditation processes, improving access to qualified supervisors/mentors and raising awareness of training and accreditation opportunities while providing support and incentives for rural clinicians to facilitate access.
To explore the place of origin and placement locations as predictors of non-metropolitan practice among domestic pharmacy graduates from the University of Tasmania (UTAS).
The 2023 principal place of practice (PPP) for all domestic UTAS pharmacy graduates between 2011 and 2022 was identified using the Australian Health Practitioners Regulation Agency (Ahpra) online registration database. The graduates' place of origin (home address at the time of course application), locations where they undertook placements, and their 2023 PPP were described using the Modified Monash Model (MM) classification system of remoteness. A multivariable logistic regression model was used to identify independent predictors of regional (MM2), or rural or remote (MM3–7) PPP.
329 domestic UTAS pharmacy graduates were practicing in Australia in 2023; 58.7% were working regionally and 13.1% in a rural or remote area. Predictors of a regional PPP included regional (aRR 36.32, 95% CI 7.88, 167.33, p < 0.0001) and rural or remote origin (aRR 24.96, 95% CI 4.73, 131.81, p < 0.0001), while the number of regional placements was inversely associated (aRR 0.53, 95% CI 0.34, 0.82, p = 0.004). Rural or remote origin (aRR 26.53, 95% CI 5.50, 1.27.93, p < 0.0001) and undertaking any rural or remote placements (aRR 4.64, 95% CI 1.04, 20.79, p = 0.045) predicted a rural or remote PPP.
Place of origin is foundational in building the future non-metropolitan pharmacy workforce. Improving opportunities for rural and remote origin students to access and complete pharmacy courses across Australia should be prioritised.
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