Leanne Rodwell, Irene Schneider, Anne Bernard, Tamara Blake, Patsi Mawn, Deearne Dodd, Jeleacha Hopkins-Lincolne, Margaret S. McElrea
Objective
Evaluate the impact on spirometry quality of a culturally responsive Indigenous Health Worker Spirometry Training and Mentoring programme (IHWS).
Methods
Participation in two-day face-to-face IHWS including post-training telehealth mentoring
Design
Submission of spirometry reports before training (T1), after training (T2) and after telehealth mentoring (T3).
Setting
Urban, rural and remote primary healthcare services in Queensland Australia.
Participants
Primarily Australian First-Nations Health Workers.
Main Outcome Measures
Two raters used nine-point quality criteria to score spirometry at T1, T2 and T3. Inter-rater reliability was assessed using Cohen's original kappa. Reports submitted at a minimum of two time-points were included in the analysis. A linear mixed model analysis and post hoc analysis assessed differences in total scores across different timepoints.
Results
Between 2011 and 2018, 360 participants (75.5% Indigenous) attended 43 workshops. Of the 284 participants attending workshops #1–#34, 56.7% (161/284) hadn't performed spirometry before IHWS and were excluded from comparative analysis because spirometry reports could be submitted at only one timepoint (T2). Introduction of telehealth mentoring sessions from workshop #35, increased spirometry submission for assessment at T2 from 9.9% (28/284) to 68.4% (52/76). Thirty-six participants submitted reports at two timepoints or more. Spirometry quality improved across all timepoints (p < 0.001). Inter-rater reliability was good or very good (0.83–0.91).
Conclusion
Two-day F2F culturally responsive IHWS training increases the quality of spirometry testing. Further increases in quality occur after telehealth mentoring. This model could be adapted to teach spirometry to First-Nation's health workers of other nations.
{"title":"A Culturally Responsive Indigenous Health Worker Spirometry Training and Mentoring Programme (IHWS) Increases Quantity and Quality of Spirometry Performed in Primary Care","authors":"Leanne Rodwell, Irene Schneider, Anne Bernard, Tamara Blake, Patsi Mawn, Deearne Dodd, Jeleacha Hopkins-Lincolne, Margaret S. McElrea","doi":"10.1111/ajr.70112","DOIUrl":"10.1111/ajr.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evaluate the impact on spirometry quality of a culturally responsive Indigenous Health Worker Spirometry Training and Mentoring programme (IHWS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participation in two-day face-to-face IHWS including post-training telehealth mentoring</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Submission of spirometry reports before training (T1), after training (T2) and after telehealth mentoring (T3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Urban, rural and remote primary healthcare services in Queensland Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Primarily Australian First-Nations Health Workers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Two raters used nine-point quality criteria to score spirometry at T1, T2 and T3. Inter-rater reliability was assessed using Cohen's original kappa. Reports submitted at a minimum of two time-points were included in the analysis. A linear mixed model analysis and post hoc analysis assessed differences in total scores across different timepoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2011 and 2018, 360 participants (75.5% Indigenous) attended 43 workshops. Of the 284 participants attending workshops #1–#34, 56.7% (161/284) hadn't performed spirometry before IHWS and were excluded from comparative analysis because spirometry reports could be submitted at only one timepoint (T2). Introduction of telehealth mentoring sessions from workshop #35, increased spirometry submission for assessment at T2 from 9.9% (28/284) to 68.4% (52/76). Thirty-six participants submitted reports at two timepoints or more. Spirometry quality improved across all timepoints (<i>p</i> < 0.001). Inter-rater reliability was good or very good (0.83–0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Two-day F2F culturally responsive IHWS training increases the quality of spirometry testing. Further increases in quality occur after telehealth mentoring. This model could be adapted to teach spirometry to First-Nation's health workers of other nations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490966","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}
Philip J. Batterham, Louise M. Farrer, Leanna Woods, Mark E. Larsen, Priya Martin, Adam Hulme
<p>Rural and regional areas of Australia are underserved by health services, which has been shown to result in poorer health outcomes [<span>1</span>]. Multiple policy initiatives have not significantly shifted the accessibility gap faced by rural communities in recent decades. Alternative, effective and creative solutions to improve rural pathways for care are therefore urgently needed to fill the gap, which may include growing the rural workforce, developing community-based models of care, and delivering services through evidence-based digital interventions. The focus of this special issue is on the latter use of digital interventions, which may be an important part of the solution to increase access to evidence-based care in rural Australia. While digital solutions alone cannot fill the gap and are not always a substitute for face-to-face services, they can provide efficient and effective delivery of evidence-based care in many areas of health.</p><p>Digital interventions are delivered using, for example, internet or mobile technology and include therapeutic interventions, prevention and health promotion interventions, interventions to monitor or manage health conditions, informational and educational interventions related to health outcomes or service use, and social interventions, along with the use of big data or passive sensing to enhance the delivery of care for rural health consumers. Interventions may be self-guided or clinician-supported, and may also build on innovative features of technology such as artificial intelligence. Alongside an expansion in digital interventions, telehealth services represent a related aspect of digital health that has proliferated rapidly during the COVID-19 pandemic [<span>2</span>].</p><p>There are many challenges to the delivery of healthcare in rural areas, both for traditional face-to-face services and digital services. Tensions within the health system may limit innovation and implementation of technology-based services, based largely on the assumption that the efficiency of digital services may compromise quality care [<span>3</span>]. There also remain evidence gaps about the impacts and effectiveness of digital interventions on health outcomes specifically within rural areas. This special issue aimed to fill gaps in the evidence and implementation of digital interventions for rural and regional areas of Australia, considering a broad range of applications to diverse health conditions and settings across eight original research articles, one commentary and one narrative review.</p><p>The special issue has a core focus on the implementation of digital health in rural Australia. A meta-review by Krahe et al. [<span>4</span>] summarises the key enablers and barriers to implementation, noting benefits such as improved accessibility and patient satisfaction. They emphasise the need for locally tailored interventions and consider implementation factors that encompass inner and outer settings, individual n
澳大利亚农村和区域地区的保健服务不足，这已被证明会导致较差的健康结果[10]。近几十年来，多项政策举措并未显著改变农村社区面临的可及性差距。因此，迫切需要替代性、有效和创造性的解决方案来改善农村的护理途径，以填补这一空白，其中可能包括增加农村劳动力、开发基于社区的护理模式，以及通过基于证据的数字干预措施提供服务。本期特刊的重点是数字干预措施的后一种使用，这可能是增加澳大利亚农村获得循证护理的解决方案的重要组成部分。虽然数字解决方案本身不能填补这一空白，也并不总是替代面对面服务，但它们可以在许多卫生领域提供高效和有效的循证护理。数字干预措施是利用互联网或移动技术提供的，包括治疗干预措施、预防和健康促进干预措施、监测或管理健康状况的干预措施、与健康结果或服务使用有关的信息和教育干预措施以及社会干预措施，同时利用大数据或被动感知来加强向农村保健消费者提供护理。干预措施可以是自我指导的，也可以是临床医生支持的，也可以建立在人工智能等技术的创新特征之上。随着数字干预措施的扩大，远程医疗服务是数字卫生的一个相关方面，在2019冠状病毒病大流行期间迅速扩散。在农村地区提供保健服务面临许多挑战，无论是传统的面对面服务还是数字服务。卫生系统内部的紧张关系可能会限制以技术为基础的服务的创新和实施，这在很大程度上是基于数字服务的效率可能会损害医疗质量的假设。数字干预措施对健康结果的影响和有效性，特别是在农村地区，也存在证据差距。本期特刊旨在填补澳大利亚农村和区域地区数字干预措施的证据和实施方面的空白，考虑到在八篇原创研究文章、一篇评论和一篇叙述性评论中对不同健康状况和环境的广泛应用。该特刊的核心重点是在澳大利亚农村实施数字保健。Krahe等人的荟萃综述总结了实施的关键推动因素和障碍，并指出了诸如改善可及性和患者满意度等益处。它们强调有必要采取因地制宜的干预措施，并考虑到实施因素，包括内部和外部环境、个人需求、干预特点以及考虑到现有系统和可用资源的仔细实施规划。在澳大利亚农村公平实施数字服务的关键是将澳大利亚原住民纳入交付模式的设计中。Nasir等人，[5]报告了与患有慢性病的澳大利亚土著共同设计进程，以发展虚拟保健服务，促进初级保健的提供。特刊中的三篇文章提供了各种数字工具的实施规划示例。Le等人研究了临床医生和消费者在实施数字心理健康服务方面的观点的异同，注意到在临床医生的支持下，与使用数字干预措施的能力、机会和动机相关的一致的促成因素。Hambleton等人确定了实施的要素，这些要素可能对农村数字服务治疗神经性厌食症的成功至关重要。Talay等人确定了数字减肥服务相对于传统面对面服务的好处。本期特刊还展示了数字干预措施对各种健康状况的潜在影响。Dear等人抽取了大量参与国家数字服务的慢性疼痛患者样本，以证明农村和城市环境中疼痛和心理健康方面的患者满意度和临床改善是一致的。同样，史泰博等人发现有证据表明，在线心理健康诊所为农村地区的人们提供了有效的护理，同时也惠及了可能得不到治疗的弱势群体。数字服务在受灾害影响的社区中也可能发挥至关重要的作用，Curtin等人的研究表明，联合远程医疗服务可以为受森林大火影响的儿童提供有效的结果和高满意度。最后，Li等人。 [12]展示了一种新型数字筛查程序的实用性，该程序使用人工智能算法来检测西澳大利亚偏远地区的糖尿病视网膜病变。特刊中包括的研究强调了数字干预在不影响患者满意度的情况下改善澳大利亚农村各种健康状况的健康结果的潜力。数字工具的许多方面提供了获得护理的更好途径，并促进了现有服务的更广泛覆盖。尽管数字技术带来了诸多好处，但它并不是解决农村卫生服务领域巨大差距的灵丹妙药。确保数字干预措施周到地融入现有的护理途径，支持临床医生和消费者的护理偏好，并确保它们得到充分的资源，对于最大限度地提高卫生效益至关重要，同时承认还需要进行更广泛的系统改革，以支持农村社区的健康。这些作者热切地期待着进一步数字技术的到来，这为农村社区的健康和福祉展示了巨大的希望。菲利普J.巴特汉姆：概念化，写作-原稿；Louise M. Farrer：概念化，写作-评论和编辑；琳娜·伍兹：概念、写作、评论和编辑；Mark E. Larsen：概念化，写作-评论和编辑；Priya Martin：概念化，写作-审查和编辑；亚当·休姆：概念化，写作-原稿。作者没有什么可报告的。数据共享不适用于本文，因为在当前研究中没有生成或分析数据集。
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Jenni Suen, Rangika L. Fernando, Maria C. Inacio, Maria Crotty, Xiaoping Lin, Gillian E. Caughey
Objective
Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings.
Methods
Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised.
Findings
Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (n = 28, 54%), accessibility (n = 11, 21%), resources (n = 9, 17%), and hospital readmissions (n = 4, 8%). Most QIs were outcome (n = 25, 48%) or process (n = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas.
Conclusions
Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare.
{"title":"Identification of Quality Indicators Used to Monitor, Evaluate and Improve Rural and Remote Care for Older People: A Scoping Review","authors":"Jenni Suen, Rangika L. Fernando, Maria C. Inacio, Maria Crotty, Xiaoping Lin, Gillian E. Caughey","doi":"10.1111/ajr.70105","DOIUrl":"10.1111/ajr.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (<i>n</i> = 28, 54%), accessibility (<i>n</i> = 11, 21%), resources (<i>n</i> = 9, 17%), and hospital readmissions (<i>n</i> = 4, 8%). Most QIs were outcome (<i>n</i> = 25, 48%) or process (<i>n</i> = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12603340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490975","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}
Primary: To evaluate adherence to statewide guidelines for managing fever in infants < 90 days old presenting to rural hospital EDs in southern NSW. Comparisons were made between level 1–2 and level 4 rural hospitals. Secondary: To assess the utility of laboratory markers in differentiating bacterial from viral infections.
Design
Retrospective observational study.
Setting
Wagga Wagga Base Hospital, a regional centre in NSW, Australia.
Participants
One hundred thirty-four febrile children aged 0–90 days.
Main Outcome Measures
Adherence to guideline-recommended investigations (basic bloods, blood culture, urine culture, lumbar puncture) and management (antibiotics, time to antibiotics). Positive predictive values of CRP, white cell count (WCC) and neutrophil count for serious bacterial infections (SBIs) were calculated.
Results
Guideline adherence: blood tests 79%, blood culture 79%, urine culture 76%, lumbar puncture 56% and parenteral antibiotics 83%. Adherence to blood/urine cultures was higher in the < 1 month age group than the 30–90 day age group. Investigations and management at level 1–2 hospitals were similar to the level 4 hospital, except regarding urine cultures in the < 1 month old age group. We observed higher CRP levels in infants diagnosed with SBIs compared to those without.
Conclusion
Management of febrile infants < 90 days in southern NSW rural hospitals aligns well with guidelines, except for lumbar punctures in infants < 1 month. Level 1–2 hospitals performed investigations as thoroughly as level 4 hospitals, except regarding urine culture in the youngest age group. Future research could explore guideline adjustments to reduce over-investigation and unnecessary antibiotic use.
{"title":"Management of Febrile Infants in a Rural Hospital: Comparison to Clinical Guidelines","authors":"Nathaniel Teng, John Preddy","doi":"10.1111/ajr.70115","DOIUrl":"10.1111/ajr.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p><i>Primary</i>: To evaluate adherence to statewide guidelines for managing fever in infants < 90 days old presenting to rural hospital EDs in southern NSW. Comparisons were made between level 1–2 and level 4 rural hospitals. <i>Secondary</i>: To assess the utility of laboratory markers in differentiating bacterial from viral infections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective observational study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Wagga Wagga Base Hospital, a regional centre in NSW, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>One hundred thirty-four febrile children aged 0–90 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Adherence to guideline-recommended investigations (basic bloods, blood culture, urine culture, lumbar puncture) and management (antibiotics, time to antibiotics). Positive predictive values of CRP, white cell count (WCC) and neutrophil count for serious bacterial infections (SBIs) were calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Guideline adherence: blood tests 79%, blood culture 79%, urine culture 76%, lumbar puncture 56% and parenteral antibiotics 83%. Adherence to blood/urine cultures was higher in the < 1 month age group than the 30–90 day age group. Investigations and management at level 1–2 hospitals were similar to the level 4 hospital, except regarding urine cultures in the < 1 month old age group. We observed higher CRP levels in infants diagnosed with SBIs compared to those without.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Management of febrile infants < 90 days in southern NSW rural hospitals aligns well with guidelines, except for lumbar punctures in infants < 1 month. Level 1–2 hospitals performed investigations as thoroughly as level 4 hospitals, except regarding urine culture in the youngest age group. Future research could explore guideline adjustments to reduce over-investigation and unnecessary antibiotic use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 6","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490930","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}
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}
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