Australian Journal of Rural Health最新文献_第6页

Health equity in clinical trials for regional, rural and First nations communities: Need for networked clinical trial system, through a values and purpose-aligned system culture 地区、农村和原住民社区临床试验的健康公平性：需要通过价值观和目标一致的系统文化，建立网络化的临床试验系统。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-17 DOI: 10.1111/ajr.13122

Sabe Sabesan FRACP, Melanie Poxton B Nursing

Clinical trials are essential components of health practice and are vital to developing new therapies, advancing interventions, improving service delivery and enhancing models of care.¹ For patients, participation in clinical trials improves outcomes in many disease areas and reduces variation in practice, due to strict monitoring requirements. For health practitioners, clinical trials present an opportunity to be at the cutting edge of best practice. For services, clinical trials improve standard procedures. For health systems, industry sponsored trials are an additional source of revenue that could be reinvested to build clinical trial units. Reports suggest that there is significant return on investment in this sector.²

For these and other reasons, the new National Clinical Trial Governance Framework has called for clinical trials to be included as a routine aspect of clinical practice.³ In the cancer care sector, which serves a significant number of patients with incurable diseases, international guidelines recommend clinical trials as the first option.⁴ This means, to be aligned with international best practice, every cancer service should be offering clinical trials to all cancer patients regardless of postcode, at least for patients with incurable diseases.

Australia and many Western countries have invested significant resources to build clinical trial capabilities and enable engagement in local and international trials. However, people in regional, rural and First nations communities continue to have limited access to trials close to home.^{5, 6} As a result, they must endure substantial travel, major costs and inconvenience, and often, must relocate to metropolitan centres or pass up the opportunity to participate. This is a key challenge highlighted by the accompanying commentary (Walsh et al.)⁷ and specifically emphasised in the accompanying research paper (McPhee et al.).^{7, 8} Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs).⁹

Many of the challenges and barriers to health services in regional, rural and First nations communities are apparent (or even more pronounced) in the case of clinical trials. Workforce shortages and turn over at all levels, limited skills and awareness among staff of the potential benefit of trials, and inadequate investment in infrastructure are common. This constrains such sites from attracting sponsors and hosting clinical trials as stand-alone sites. Beyond this, system cultural issues within rural and First nations services may stifle participation, or the economic imperatives of metropolitan trial units and their sponsors may overrule.

In the light of the above, it is not unreasonable

临床试验是医疗实践的重要组成部分，对于开发新的疗法、推进干预措施、改善服务提供和加强护理模式至关重要。1 对患者而言，由于严格的监测要求，参与临床试验可改善许多疾病领域的治疗效果，并减少实践中的差异。对医疗从业人员来说，临床试验提供了一个站在最佳实践前沿的机会。对医疗服务机构来说，临床试验可以改进标准程序。对于医疗系统来说，行业赞助的试验是一个额外的收入来源，可用于再投资，建立临床试验单位。有报告显示，在这一领域的投资回报率很高。2 出于上述原因和其他原因，新的《国家临床试验管理框架》呼吁将临床试验作为临床实践的一个常规方面。3 在癌症治疗领域，有大量的不治之症患者，国际指南建议将临床试验作为首选。这意味着，为了与国际最佳实践接轨，每家癌症治疗机构都应为所有癌症患者提供临床试验服务，而不论其邮政编码如何，至少对于无法治愈的疾病患者而言是如此。澳大利亚和许多西方国家都投入了大量资源来建设临床试验能力，使患者能够参与本地和国际试验。5, 6 因此，他们必须忍受长途跋涉、高昂的费用和不便，而且往往必须搬迁到大都市中心，否则就会放弃参与试验的机会。这是随附的评论（Walsh 等人）7 中强调的一个主要挑战，随附的研究论文（McPhee 等人）也特别强调了这一点。各级人员短缺和更替、工作人员技能有限、对试验潜在益处的认识不足、基础设施投资不足，这些都是普遍存在的问题。这就限制了这些试验点吸引赞助商并作为独立试验点开展临床试验。除此之外，农村和原住民医疗服务机构内部的系统文化问题可能会阻碍试验的参与，或者大都市试验单位及其赞助商的经济要求可能会压倒一切。综上所述，我们可以得出这样的结论：大多数地区、农村、偏远地区和原住民医疗服务机构都无法作为独立的临床试验机构发挥作用。作为一种替代方案，政府审查和政府战略计划，包括国家卫生与医学研究中心等机构，都主张采用分散试验访问的网络化方法。例如，为了在系统层面建立分散的临床试验，联邦政府通过医学研究未来基金（MRFF）资助各州和地区建立了由昆士兰州卫生部门牵头的澳大利亚远程试验计划（Australian Teletrial Program），同样，新南威尔士州和澳大利亚首都领地政府也于 2019 年建立了地区、农村和偏远地区试验计划。这两项计划的总价值达 1 亿澳元，采用澳大拉西亚 Teletrial 模式（最初由澳大利亚临床肿瘤学会的农村和地区小组设计）作为机制，将较大和较小的试验点连接起来，形成试验集群。这样，全国各地的小型中心就有可能提供某些或所有方面的试验。(这种模式的操作细节可参见《全国试验简编》（National Teletrials Compendium; https://www.health.gov.au/resources/collections/the-national-teletrials-compendium）。这些计划旨在建立有利的基础设施、制定监管流程并进行能力建设，以创建一个可行的网络化分散试验系统。同样，PARTNER 计划旨在建设地区和农村初级保健实践的试验能力 (https://partnernetwork.com.au/)。此类计划利用各州/地区的地区临床试验协调中心 (RCCC) 来帮助临床医生熟悉必要的审批流程。在过去两年中，一些试验是通过远程试验模式进行的。我们现在有一项 1 亿美元的计划，旨在改善区域、农村、偏远地区和原住民社区的试验机会。

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引用次数: 0

Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia 澳大利亚维多利亚州大都市和农村试验点癌症临床试验活动和试验特征的差异。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-17 DOI: 10.1111/ajr.13102

Narelle J. McPhee MND, Michael Leach PhD, Claire E. Nightingale PhD, Samuel J. Harris MBBS, Eva Segelov PhD, Eli Ristevski PhD

Objective

Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location.

Methods

Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.

Design

A cross-sectional study design was used.

Setting

CCTs were available Victoria-wide in 2018.

Participants

There were 1669 CCTs and 5909 CCT participants.

Main Outcome Measures

Rural CCT location was assessed as a binary variable with categories of ‘yes’ (modified Monash [MM] categories 2–7) and ‘no’ (MM category 1). MM categories were determined from postcodes. The highest (‘least rural’) MM category was used for postcodes with multiple MM categories.

Results

Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (p-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (p-value <0.05) higher for non-industry than industry-sponsored trials.

Conclusions

In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.

目的癌症临床试验（CCT）为患者提供了获得新兴疗法和额外临床护理的机会。我们旨在描述澳大利亚维多利亚州的CCT数量和特点，并确定与农村试验地点相关的因素。方法对维多利亚州癌症委员会临床试验管理计划数据集的二手数据进行定性分析。主要结局测量农村CCT位置作为二元变量进行评估，分为 "是"（修改后的莫纳什[MM]类别2-7）和 "否"（MM类别1）两类。MM类别是根据邮编确定的。结果在 1669 次 CCT 中，168 次（10.1%）在农村地区进行。在 5909 名 CCT 参与者中，315 人（5.3%）参加了农村 CCT。共有 526 次 CCT（31.5%），其中有 1907 名（32.3%）新注册的参与者。在 1892 名有邮政编码数据的新注册参与者中，有 488 人（25.8%）是农村居民。其中，368 人（75.4%）参加了大都市的 CCT。在对所有1669个CCT进行的多变量逻辑回归分析中，CCT地点在农村而非大都市的几率在早期试验中显著低于晚期试验，在非实体瘤试验中显著低于实体瘤试验，但在非工业赞助的试验中显著高于工业赞助的试验（P值<0.05）。在维多利亚州，10%的CCT在农村地区进行。大多数居住在农村地区的CCT参与者前往大都市地区，因为那里有更多的晚期非实体肿瘤试验和行业赞助的试验。应考虑采取各种方法，增加农村 CCT 的数量和种类。

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引用次数: 0

Decentralised clinical trials in rural Australia: Opportunities and challenges 澳大利亚农村地区的分散临床试验：机遇与挑战。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-17 DOI: 10.1111/ajr.13109

Sandra Walsh BPsych, BA (Hons), Med, MEval, MAboriginal Studies, Pascale Dettwiller PhD, Lee Puah PhD, Hannah Beks PhD, Vincent Versace PhD, Martin Jones PhD

Aims

To present opportunities and a model to redress the under-representation of rural communities and people in Australian clinical trials.

Context

Clinical trials are essential for building and understanding the health evidence base. The lack of representation of rural people in clinical trials is evident in other countries. Examining the Australian New Zealand Clinical Trial Registry (ANZCTR) suggests this is also the case in Australia.

Approach

We propose an approach that empowers rurally based academics and clinicians to co-design clinical trials and increase rural Australians' participation in clinical trials to address this inequality of access. A case study of a decentralised, co-designed clinical trial is presented to support this approach.

Conclusion

Decentralising clinical trials could improve access to clinical trials, strengthen the social capital of rural communities and help address the health inequalities that exist between rural and metropolitan communities.

摘要临床试验对于建立和了解健康证据基础至关重要。农村人口在临床试验中代表性不足的问题在其他国家也很明显。通过对澳大利亚-新西兰临床试验登记处（ANZCTR）的研究发现，澳大利亚的情况也是如此。方法我们提出了一种方法，让农村地区的学者和临床医生能够共同设计临床试验，提高澳大利亚农村地区居民对临床试验的参与度，以解决这种参与机会不平等的问题。结论分散临床试验可提高临床试验的可及性，加强农村社区的社会资本，并有助于解决农村社区与大都市社区之间存在的健康不平等问题。

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引用次数: 0

Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice 利用塔斯马尼亚姑息治疗和临终关怀政策框架（2022 年）评估农村全科诊所的服务提供情况

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-16 DOI: 10.1111/ajr.13126

Andrew Ridge PhD, Bastian Seidel PhD

Aims

This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice.

Context

Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end-of-life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home-based palliative care services.

Approach

All Medical Benefit Scheme billings for after-hours or home-based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after-hours and home-visits delivered over a 12-month period, almost 58% (n = 150) were for palliative care. Patients receiving palliative care were generally older than non-palliative patients visited (79.9 years vs. 72.0 years respectively; p = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home-visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role-definition, and inadequate remuneration.

Conclusion

Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team-based approach. Access to and integratio

本评论使用塔斯马尼亚姑息治疗和生命末期关怀政策框架（2022 年；TPE 框架）来反思塔斯马尼亚一家农村全科诊所提供的姑息治疗服务。

{"title":"Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice","authors":"Andrew Ridge PhD, Bastian Seidel PhD","doi":"10.1111/ajr.13126","DOIUrl":"10.1111/ajr.13126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end-of-life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home-based palliative care services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>All Medical Benefit Scheme billings for after-hours or home-based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after-hours and home-visits delivered over a 12-month period, almost 58% (<i>n</i> = 150) were for palliative care. Patients receiving palliative care were generally older than non-palliative patients visited (79.9 years vs. 72.0 years respectively; <i>p</i> = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home-visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role-definition, and inadequate remuneration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team-based approach. Access to and integratio","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598461","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}

引用次数: 0

The Australian health workforce: Disproportionate shortfalls in small rural towns 澳大利亚卫生工作者队伍：农村小城镇不成比例的短缺。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-10 DOI: 10.1111/ajr.13121

Colin H. Cortie PhD, David Garne MBChB, Lyndal Parker-Newlyn MBBS, Rowena G. Ivers PhD, Judy Mullan PhD, Kylie J. Mansfield PhD, Andrew Bonney PhD

Introduction

The distribution of health care workers differs greatly across Australia, which is likely to impact health delivery.

Objective

To examine demographic and workplace setting factors of doctors, nurses and midwives, and allied health professionals across Modified Monash Model (MMM) regions and identify factors associated with shortfalls in the health care workforce.

Design

Descriptive cross-sectional analysis. The study included all health professionals who were registered with the Australian Health Practitioner Regulation Agency in 2021, and who were working in Australia in their registered profession. The study examined number of registrations and full-timed equivalent (FTE) registrations per MMM region classification, adjusted for population. Associated variables included age, gender, origin of qualification, Indigenous status and participation in the private or public (including government, non-government organisation and not-for-profit organisations) sectors.

Findings

Data were available for 31 221 general practitioners, 77 277 other doctors, 366 696 nurses and midwives, and 195 218 allied health professionals. The lowest FTE per 1000 people was seen in MM5 regions for general practitioners, other doctors, nurses and midwives, and allied health professionals. Demographic factors were mostly consistent across MM regions, although MM5 regions had a higher percentage of nurses and midwives and allied health professionals aged 55 and over. In the private sector, FTE per 1000 people was lowest in MM5-7 regions. In the public sector, FTE per 1000 people was lowest in MM5 regions.

Discussion

A disproportionate shortfall of health workers was seen in MM5 regions. This shortfall appears to be primarily due to low FTE per capita of private sector workers compared with MM1-4 regions and a low FTE per capita of public sector workers compared with MM6-7 regions.

Conclusion

In Australia, small rural towns have the lowest number of health care workers per capita which is likely to lead to poor health outcomes for those regions.

目的研究 "莫纳什模型"（MMM）地区的医生、护士、助产士和专职医疗人员的人口和工作场所环境因素，并确定与医疗保健人员短缺有关的因素。研究对象包括2021年在澳大利亚卫生从业人员监管局注册、在澳大利亚从事其注册职业的所有卫生专业人员。该研究对每个MMM地区分类的注册人数和全职当量（FTE）注册人数进行了检查，并根据人口进行了调整。相关变量包括年龄、性别、资格来源、土著身份以及在私营或公共部门（包括政府、非政府组织和非营利组织）的参与情况。研究结果提供了 31 221 名全科医生、77 277 名其他医生、366 696 名护士和助产士以及 195 218 名专职医疗人员的数据。在 MM5 地区，每千人中全科医生、其他医生、护士和助产士以及专职医疗人员的全职医生比例最低。尽管 MM5 地区 55 岁及以上的护士和助产士以及专职医疗人员的比例较高，但各 MM 地区的人口统计因素基本一致。在私营部门，MM5-7 地区的每千人全职当量最低。在公共部门，MM5 地区每千人中的全职专业人员比例最低。与 MM1-4 地区相比，私营部门的人均全职医护人员人数较少；与 MM6-7 地区相比，公共部门的人均全职医护人员人数较少。

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引用次数: 0

Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review 解决农村、地区和偏远地区儿童心理健康和行为需求的劳动力战略：范围审查。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-04 DOI: 10.1111/ajr.13119

John Hurley PhD, Paula Longbottom MSc, Bindi Bennett PhD, Jacqui Yoxall PhD, Marie Hutchinson PhD, Kitty-Rose Foley PhD, Brenda Happell PhD, Jill Parkes MSc, Kate Currey MSc

Introduction

Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population.

Objective

To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision.

Design

A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010–2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion.

Findings

Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge.

Discussion

The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors.

Conclusion

A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.

引言生活在农村、地区和偏远地区的儿童在接受精神疾病和挑战性行为服务方面面临挑战。目标对有关农村、地区和偏远地区儿童心理健康和行为工作队伍的文献进行范围界定，并确定提供心理健康服务的障碍和有利机制。使用 Medline、CINAHL、PsycINFO、ProQuest 和 Scopus 进行数据库搜索，以确定 2010-2023 年发表的论文。对报告农村、地区或偏远地区 12 岁以下儿童心理健康工作人员特征的研究文章进行了审查，以纳入研究。保留下来的研究证实，提供服务以满足儿童心理健康的需求是一项国际挑战。讨论对审查结果进行的专题分析强调了四项劳动力策略，以潜在地缓解其中的一些挑战。它们是(1) 在临床服务中使用远程医疗，提高工作人员的技能；(2) 角色转换，由非精神健康专业人员担任精神健康工作人员的角色；(3) 服务结构策略；(4) 土著和农村文化因素。通过共同设计和制作，使这些策略适应特定的社区环境，可能会增强其功效。

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引用次数: 0

This is why we are staying: Job satisfaction among Physiotherapists in the Kimberley region of Western Australia 这就是我们留下来的原因：西澳大利亚金伯利地区物理治疗师的工作满意度。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-04 DOI: 10.1111/ajr.13117

Chenae King B. Physiotherapy, Amanda Timler PhD, Janelle Gill M. Physiotherapy, Negin Loh BSc, Maria Morgan, Jessica Nolan PhD, Robyn Sturdy M. Physiotherapy, James Robert Debenham PhD

Introduction

The Kimberley region of Western Australia (WA) is classified by the Modified Monash Model as MM6 & 7 (‘Remote/Very Remote’). Many physiotherapists in the Kimberley are considered ‘rural generalists’ and require a diverse set of clinical and non-clinical skills to work successfully within this setting.

Objective

To understand physiotherapists’ perspectives regarding job satisfaction within the Kimberley region a ‘rural and remote’ areas of Australia.

Design

An exploratory case study approach examined physiotherapists' job satisfaction in the Kimberley. Each participant completed a demographic survey and a one-on-one face-to-face interview lasting for approximately 60 minutes. Transcriptions were analysed and presented thematically. Eleven physiotherapists (nine women, two men, median age = 32 [27–60] years) participated in the study. Participants' median time working in the Kimberley was 2 (1–15) years; eight participants completed a rural placement, and eight participants had a rural background.

Findings and Discussion

Two overarching themes relating to job satisfaction emerged: ‘personal factors’ and ‘workplace factors’. Furthermore, several sub-themes illustrated high levels of job satisfaction. Positive sub-themes relating to personal factors included ‘belonging to the community and a rural lifestyle’. ‘Diversity in caseloads’ and ‘workplace culture’ were examples of positive workplace sub-themes. Subthemes that challenged the participants personally were ‘family arrangements’ including schooling, ‘spousal employment and family separation’ and the ‘transiency and social issues’ within these remote communities. Workplace challenges comprised of ‘barriers to providing best practice’ and the ‘workforce and clinical experience’ found within the Kimberley physiotherapy community and the wider health care workforce. The primary challenge of job satisfaction that encompassed both personal and workplace factors was ‘accommodation’, with ‘cost’, ‘lack of availability’, and ‘perceived unsafe location’ challenging physiotherapists’ decisions to remain in the Kimberley.

Conclusion

This study describes the many factors impacting job satisfaction among physiotherapists in a rural and remote location in WA Australia. These factors warrant consideration by organisations interested in improving recruitment and retention in this context. Improving recruitment and retentio

简介西澳大利亚（WA）的金伯利地区被莫纳什修正模型（MM6 和 MM7）归类为 "偏远/非常偏远"。金伯利地区的许多物理治疗师被认为是 "乡村全科医生"，需要具备多种临床和非临床技能才能在该地区成功工作。目的了解物理治疗师对澳大利亚 "乡村和偏远 "地区金伯利地区工作满意度的看法。每位参与者都填写了一份人口调查表，并接受了约 60 分钟的一对一面对面访谈。我们对访谈记录进行了分析，并按主题进行了展示。11 名物理治疗师（9 名女性，2 名男性，年龄中位数 = 32 [27-60] 岁）参与了研究。参与者在金伯利工作的时间中位数为 2（1-15）年；8 名参与者完成了农村实习，8 名参与者具有农村背景。此外，几个次主题也显示了较高的工作满意度。与个人因素有关的积极次主题包括 "社区归属感和乡村生活方式"。个案的多样性 "和 "工作场所文化 "是工作场所积极次主题的例子。对参与者个人构成挑战的次主题有 "家庭安排"，包括就学、"配偶就业和家庭分离 "以及这些偏远社区的 "流动性和社会问题"。工作场所的挑战包括 "提供最佳实践的障碍 "以及金伯利物理治疗社区和更广泛的医疗保健队伍中的 "劳动力和临床经验"。工作满意度的主要挑战包括个人因素和工作场所因素，即 "住宿"，"成本"、"缺乏可用性 "和 "认为地点不安全 "是物理治疗师决定留在金伯利的挑战。这些因素值得有意在这种情况下改善招聘和留住人才的机构考虑。改善澳大利亚农村和偏远地区物理治疗师的招聘和留用情况有可能对医疗服务的提供产生积极影响，从而改善农村和偏远社区居民的健康状况。

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引用次数: 0

Transforming health care delivery: The role of primary health care nurses in rural and remote Australia 改革医疗保健服务：澳大利亚农村和偏远地区初级保健护士的作用。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-04 DOI: 10.1111/ajr.13120

Tracy Robinson PHD, Linda Govan MPH, Cressida Bradley BN, Rachel Rossiter HScD

Aim

This paper describes the policy context and approaches taken to improve access to primary health care in Australia by supporting nurses to deliver improved integrated care meeting community needs.

Context

In Primary Health Care (PHC), the nursing workforce are predominantly employed in the general practice sector. Despite evidence that nurse-led models of care can bridge traditional treatment silos in the provision of specialised and coordinated care, PHC nurses' scope of practice varies dramatically. Nurse-led models of care are imperative for rural and remote populations that experience workforce shortages and barriers to accessing health care. Existing barriers include policy constraints, limited organisational structures, education and financing models.

Approach

The Australian Primary Health Care Nurses Association (APNA) received funding to implement nurse-led clinics as demonstration projects. The clinics enable PHC nurses to work to their full scope of practice, improve continuity of care and increase access to health care in under serviced locations. We reviewed a range of peer-reviewed literature, policy documents, grey literature and APNA provided sources, particularly those relevant to rural and remote populations. We argue more focus is needed on how to address variations in the scope of practice of the rural and remote PHC nursing workforce.

Conclusion

Despite growing evidence for the effectiveness of nurse-led models of care, significant policy and financial barriers continue to inhibit PHC nurses working to their full scope of practice. If their potential to transform health care and increase access to health services is to be realised these barriers must be addressed.

内容提要在初级卫生保健（PHC）领域，护理人员主要受雇于全科医生。尽管有证据表明，以护士为主导的护理模式可以弥合传统的治疗孤岛，提供专业和协调的护理，但初级医疗保健护士的执业范围却大相径庭。护士主导型护理模式对于农村和偏远地区的居民来说势在必行，因为这些地区存在劳动力短缺和获得医疗保健服务的障碍。现有的障碍包括政策限制、有限的组织结构、教育和融资模式。方法澳大利亚初级卫生保健护士协会（APNA）获得资助，将护士主导的诊所作为示范项目来实施。这些诊所使初级卫生保健护士能够在其全部执业范围内开展工作，改善护理的连续性，并增加服务不足地区的卫生保健服务。我们查阅了一系列同行评议文献、政策文件、灰色文献和亚太地区护士协会提供的资料，尤其是与农村和偏远地区人口相关的资料。我们认为，需要更加关注如何解决农村和偏远地区初级卫生保健护理人员执业范围的差异。结论尽管越来越多的证据表明护士主导的护理模式非常有效，但重大的政策和财政障碍仍然阻碍着初级卫生保健护士充分发挥其执业范围。如果要实现其改变医疗保健和提高医疗服务可及性的潜力，就必须消除这些障碍。

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引用次数: 0

Implementation of a quality improvement strategy to optimise the management of community acquired pneumonia in a rural health setting 实施质量改进战略，优化农村医疗机构对社区获得性肺炎的管理。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-04-01 DOI: 10.1111/ajr.13116

Carrington Sally B.Pharm, Grad Dip Rural Generalist Practice, Chau Gabrielle B. Pharm, MClinPharm, Miller Waugh Sidony BPharm, GCPharmPrac, Symmons Christopher MBBS, FRACGP, Titmarsh Justin BN, MBBS, FRACGP, DRANCOG (Adv), AFRACMA, Minyon L. Avent B Pharm, BSc (Hons), Pharm D, FSHP, FANZCAP (InfDis, Steward), GradCertHlthSc

Problem

In Australia, inappropriate prescribing of antimicrobials is higher in rural and regional areas than in major city hospitals. Inappropriate prescribing is defined as the prescription of antimicrobial agents that do not adhere to guidelines in terms of type of antimicrobial chosen, dose and/or duration or are deemed unnecessary. A review of antimicrobial prescribing in a Queensland rural Hospital and Health Service (HHS) identified that respiratory infections were an area for potential improvement.

Setting

The study was performed in a rural HHS in Queensland.

Key Measures for Improvement

Appropriateness of antimicrobial prescribing for baseline and post-implementation phases of the study was evaluated according to Therapeutic Guidelines: antibiotic recommendations for community acquired pneumonia (CAP).

Strategies for Change

Quality improvement strategy to implement a multifaceted package of interventions for CAP.

Effects of Change

Post-implementation, overall appropriateness of antimicrobial prescribing improved and there was a decrease in duration of antimicrobial therapy.

Lessons Learnt

A quality improvement strategy to implement a multifaceted package of interventions for CAP has shown to be acceptable and effective in improving the antimicrobial prescribing in a rural setting. Our findings highlight the importance of utilising a multifaceted package of interventions which can be tailored to the prescribers and the patients at hand. It is also valuable to engage with local clinicians to promote the optimal management of common infections in the rural setting.

问题：在澳大利亚，农村和地区的抗菌药物处方不当率高于大城市医院。不适当处方的定义是，处方中的抗菌剂在所选抗菌剂的类型、剂量和/或持续时间方面不符合指南要求，或者被认为是不必要的。对昆士兰州一家农村医院和卫生服务机构（HHS）的抗菌药处方进行的审查发现，呼吸道感染是一个有可能改进的领域：研究在昆士兰州的一家农村医院和医疗服务机构进行：主要改进措施：根据《治疗指南：社区获得性肺炎（CAP）的抗生素建议》，对基线阶段和研究实施后阶段的抗菌药物处方的适当性进行评估：质量改进战略：针对 CAP 实施多方面的一揽子干预措施：实施后，抗菌药物处方的总体适当性得到改善，抗菌药物治疗的持续时间缩短：针对 CAP 实施多方面一揽子干预措施的质量改进策略在改善农村地区的抗菌药物处方方面显示出了可接受性和有效性。我们的研究结果凸显了利用多层面一揽子干预措施的重要性，这些措施可根据处方者和患者的具体情况量身定制。此外，与当地临床医生合作以促进农村地区常见感染的优化管理也很有价值。

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引用次数: 0

A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals 从医护人员的角度，对在农村地区提供居家姑息关怀服务的姑息关怀药剂师的角色进行定性探索。

IF 1.8 4区医学 Q2 Medicine

Australian Journal of Rural Health

Pub Date : 2024-03-27 DOI: 10.1111/ajr.13115

Natasha J. Downing BPharm, AACP, MPS, Gemma Skaczkowski PhD, Donna Hughes-Barton PhD, Helen Stone BPharm, BSc, MPS, GAICD, Leah Robinson, Kate M. Gunn PhD

Introduction

Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management.

Objective

This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting.

Design

Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis.

Findings

Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1—Patient, carer and family's understanding about medication management is improved, 4.2—Patient, carer and family travel is decreased, 4.3—Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1—Enhanced communication between the patient and health care team, 5.2—Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1—Understanding about medications and their management is improved, 7.2—Workload is reduced, 7.3—Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1—A need for greater pharmacist capacity to meet demand, 10.2—A need for increased and sustained funding for the pharmacist role, 10.3—Large amount of travel to get to patients.

Conclusion

Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.

简介：药剂师通常不被认为是姑息关怀团队的核心部分，尽管他们是协助减轻药物管理负担的理想人选：本研究探讨了药剂师在以家庭为基础的农村姑息关怀团队中的作用：设计：在南澳大利亚农村地区为姑息关怀患者提供服务的医护人员参加了半结构化访谈。采用主题分析法对数据进行分析：来自 20 位参与者的数据确定了 10 个主题。主题 1：这种护理模式为患者提供了选择。主题 2：药剂师是值得信赖的支持和信息来源。主题 3：减轻了患者、护理人员和家属的痛苦。主题 4：通过提高用药知识和减轻负担，使患者能够留在家中；4.1-患者、照护者和家人对药物管理的理解得到提高，4.2-患者、照护者和家人的旅行减少，4.3-与就医相关的负担减轻。主题 5：加强各方之间的沟通；5.1-加强患者与医疗团队之间的沟通，5.2-加强医疗团队内部的沟通。主题 6：减轻病人、护理人员和家属在协调处方和用药方面的负担。主题 7：通过提高药物知识、减轻工作量和压力，使医护人员受益；7.1-提高了对药物及其管理的认识，7.2-减轻了工作量，7.3-减轻了与工作有关的压力。主题 8：缩小了农村和城市病人之间的医疗差距。主题 9：有助于解决农村劳动力短缺问题。主题 10：这种医疗模式面临的挑战；10.1--需要更多的药剂师来满足需求，10.2--需要为药剂师的角色提供更多和持续的资金，10.3--前往患者处的路途遥远：农村医疗保健专业人员支持药剂师作为居家姑息关怀团队的一员，并认为这种关怀模式有很多好处。

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引用次数: 0

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