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Comparing Parkinson's Disease Medications Categorised by Location in New South Wales, Australia: Linking the 45 and Up Study and the Pharmaceutical Benefits Scheme (PBS) Data 比较澳大利亚新南威尔士州按地点分类的帕金森病药物：将45及以上研究与药物福利计划（PBS）数据联系起来。
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-23 DOI: 10.1111/ajr.70094
Patricia A. Logan, Peter S. Micalos, Shanna Fealy, Marguerite Bramble, Alfred Wong

Objective

Explore Parkinson's Disease (PD) related prescription patterns for people with PD living in metropolitan and non-metropolitan areas of New South Wales, Australia.

Methods

Exploratory, cross-sectional data linkage study. Participants were grouped according to geographic location and by age group: metropolitan or non-metropolitan; rural, regional, and remote. Prescription patterns were analysed using descriptive and inferential statistics.

Design

The Sax Institute's 45 and Up Study data was linked to the Pharmaceutical Benefits Scheme (PBS) records (2004–2017) for all participants with PD.

Setting

Retrospective data exploration and analysis.

Participants

1648 participants who self-identified as having PD and voluntarily contributed to the 45 and Up longitudinal study.

Main Outcome Measures

Statistical comparisons based on location were undertaken for the different groupings for PD-specific medications.

Results

Significant differences in the proportions of PD-related medications are observed between locations. Significant differences in the proportions of PD-related medications are observed between locations. A higher proportion of levodopa and levodopa combinations is reported for major cities (75.5%) compared with the inner region (70.3%) and outer and remote regions (74.1%). Additionally, other PD-related medications in the non-metropolitan areas are proportionally higher than those reported for major cities. Analysis by age groups suggests large effect sizes for the 75–79 and 45–49 age groups, while medium and small effect sizes are reported for the 55–59 and 70–74 age groups, respectively.

Conclusion

Inequities with best practice medication treatment for PD exist between metropolitan and non-metropolitan areas of NSW. Efforts are required to successfully bridge gaps. Upskilling GPs may provide one way to optimise therapy and quality of life.

目的：探讨澳大利亚新南威尔士州大都市和非大都市地区帕金森病患者的相关处方模式。方法：探索性、横断面数据关联研究。参与者根据地理位置和年龄分组：大都市或非大都市；农村、地区和偏远。使用描述性和推理统计分析处方模式。设计：Sax研究所的45和Up研究数据与所有PD参与者的药物福利计划（PBS）记录（2004-2017）相关联。设置：回顾性数据探索和分析。参与者：1648名自认为患有PD并自愿参与45岁及以上纵向研究的参与者。主要结果测量：对pd特异性药物的不同分组进行了基于地点的统计比较。结果：不同地区pd相关药物的使用比例有显著差异。不同地区pd相关药物的比例有显著差异。主要城市左旋多巴和左旋多巴联合使用的比例（75.5%）高于内陆地区（70.3%）和偏远地区（74.1%）。此外，其他pd相关药物在非大都市地区的比例高于主要城市。按年龄组分析表明，75-79岁和45-49岁年龄组的效应量较大，而55-59岁和70-74岁年龄组的效应量分别为中等和较小。结论：新南威尔士州大都市与非大都市之间存在PD最佳实践药物治疗的不平等。需要努力成功地弥合差距。提高全科医生的技能可能会提供一种优化治疗和生活质量的方法。
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引用次数: 0
Implementing an Online Sexually Transmitted Infection Testing Service for Young People in Regional and Rural Victoria, Australia: Insights From Local Public Health Authorities 在澳大利亚维多利亚州地区和农村为年轻人实施在线性传播感染检测服务：来自当地公共卫生当局的见解
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-22 DOI: 10.1111/ajr.70092
Lauren Ware, Mitchell McGrath, Oliva Walsh, Ethan T. Cardwell, Jane Tomnay, Dave Evans, Anne-Marie Kelly, Jason J. Ong, Jane S. Hocking, Fabian Y. S. Kong, Teralynn Ludwick

Objective

This study investigated local public health authorities' perspectives on implementing a new online STI testing service for young people in regional/rural Victoria, Australia.

Setting

Study was conducted to support the design of Test it, a free, online STI testing service being developed for Victoria. After completing an online registration and sexual health questionnaire, users receive an electronic test request form to take directly to a pathology centre without seeing a general practitioner (GP).

Participants

Ten individuals responsible for the coordination of community sexual health services within 7 Victorian Local Public Health Units (LPHUs) and the Department of Health, and a state-wide health promotion organisation.

Design

Semi-structured interview topics covered: attitudes towards online STI testing, advantages and challenges of online STI testing for regional and rural communities, and strategies to support effective implementation.

Results

Participants were enthusiastic about the potential of an online STI testing service, perceiving it to offer options in settings with limited sexual health providers, provide users with greater anonymity (bypassing GPs), improve efficiency, and support LPHUs to deliver their priorities. However, needing to attend a pathology service in-person may reduce appeal and create barriers given limited transport/opening hours and stigmatisation concerns by young people. Navigating treatment, if needed, may also be challenging.

Conclusion

Despite offering advantages, regional/rural young people are likely to encounter barriers to online STI testing that are different from and more significant than those faced by young people in urban areas. Strategies are needed to support implementation in regional/rural areas to realise the full potential of online testing to improve equitable access for underserved communities.

目的本研究调查了当地公共卫生当局对澳大利亚维多利亚州地区/农村年轻人实施新的在线性传播感染检测服务的看法。设置研究是为了支持Test it的设计，这是一项为维多利亚州开发的免费在线STI测试服务。在完成在线注册和性健康调查问卷后，用户会收到一份电子测试申请表，直接带到病理中心，而无需见全科医生（GP）。参加者10人，负责协调维多利亚州7个地方公共卫生单位（LPHUs）和卫生部以及一个全州范围的健康促进组织的社区性健康服务。设计半结构化访谈的主题包括：对在线STI测试的态度，在线STI测试对区域和农村社区的优势和挑战，以及支持有效实施的战略。结果参与者对在线性传播感染检测服务的潜力充满热情，认为它可以在性健康提供者有限的情况下提供选择，为用户提供更大的匿名性（绕过全科医生），提高效率，并支持lphu提供优先事项。然而，由于交通/开放时间有限以及年轻人对耻辱的担忧，需要亲自参加病理服务可能会降低吸引力并造成障碍。导航治疗，如果需要的话，也可能具有挑战性。尽管具有优势，但区域/农村年轻人在进行在线性传播感染检测时可能遇到的障碍与城市地区年轻人面临的障碍不同，而且比城市地区年轻人面临的障碍更严重。需要制定战略，支持在区域/农村地区实施，以充分发挥在线检测的潜力，改善服务不足社区的公平获取机会。
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引用次数: 0
Rural Food Forward: An Appetite for Change 农村食品发展：渴望改变
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-22 DOI: 10.1111/ajr.70091
Keith McNaught, Gina Sjepcevich

Aims

This paper explores the pervasive influence of Commercial Determinants of Health (CDoH), particularly the proliferation of ultra-processed foods (UPFs), on rural diets, and introduces the concept of Commercial Determinants of Rural Health (CDoRH) to highlight the unique challenges faced by rural Australian communities. In response, we propose a framework for simple, low-cost, and adaptable initiatives aimed at improving rural food environments and dietary behaviours.

Context

Rural populations experience a disproportionately high burden of non-communicable diseases (NCDs), with poor diet and the widespread availability of UPFs as major contributing factors. The impacts of CDoH, amplified by centralised supply chains and limited market competition, are particularly acute in rural settings. As poor diet remains the most significant modifiable risk factor for NCDs, the need for targeted rural interventions is urgent.

Approach

The proposed model leverages the potential of small-scale, low-cost initiatives that harness social capital and local resources. These initiatives aim to transform local rural food environments and dietary habits through place-based, collaborative, educative, and practical activities such as community gardens, food events, and local partnerships.

Conclusion

This model intervenes in the space between large-scale systemic reform and the everyday food choices of individuals and communities. By fostering quick, accessible, and contextually grounded initiatives, it offers a practical framework for improving local food environments and behaviours, enhancing food literacy, and mitigating the harms of CDoRH in ways that resonate with rural lived experience.

本文探讨了商业健康决定因素（CDoH）对农村饮食的普遍影响，特别是超加工食品（upf）的扩散，并介绍了农村健康商业决定因素（CDoRH）的概念，以突出澳大利亚农村社区面临的独特挑战。为此，我们提出了一个简单、低成本、适应性强的倡议框架，旨在改善农村粮食环境和饮食行为。农村人口承受着不成比例的高非传染性疾病负担，饮食不良和普遍提供普遍健康补贴是主要因素。集中的供应链和有限的市场竞争放大了CDoH的影响，在农村地区尤为严重。由于不良饮食仍然是非传染性疾病最重要的可改变风险因素，因此迫切需要有针对性的农村干预措施。提出的模式利用了利用社会资本和地方资源的小规模、低成本倡议的潜力。这些倡议旨在通过社区花园、食品活动和地方伙伴关系等基于地点的协作、教育和实践活动，改变当地农村的食品环境和饮食习惯。该模型介入了大规模系统性改革与个人和社区日常食物选择之间的空间。通过促进快速、可获取和基于实际情况的举措，它为改善当地食品环境和行为、提高食品素养以及以与农村生活经验产生共鸣的方式减轻CDoRH的危害提供了一个实用框架。
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引用次数: 0
Parkinson's Disease in Australia: Evaluation of Regional Differences and Health-Related Quality of Life 帕金森病在澳大利亚：区域差异和健康相关生活质量的评估。
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-19 DOI: 10.1111/ajr.70089
Alycia Messing, Megan J. Hobbs, Frances Quirk, Deborah Apthorp

Background

Parkinson's disease (PD) is a common neurodegenerative condition with no known cure. The prevalence of PD and barriers to accessing clinical care increase with distance from major cities. Understanding factors associated with health-related quality of life (HRQoL) in PD has important clinical and public health implications.

Method

In a national survey of Australian adults diagnosed with PD, we examined the influence of location on HRQoL and demographics, symptom course and diagnosis, treatment utilisation and preferences, and satisfaction with current services. Final data included 87 respondents from six states in Australia, with 55 identified as living in regional areas and 32 in major cities. Measures also included the Parkinson's Disease Questionnaire (PDQ-39) and self-reported Hoehn and Yahr scale for disease severity.

Results

Time to obtain a diagnosis was significantly longer for regional respondents than major city counterparts. There were also significant differences in prioritising 10 statements relating to PD. In an overall analysis examining the impact of all the above variables on HRQoL as determined by the PDQ-39, only the Hoehn and Yahr scores explained significant variance; there was no significant difference between regional and metropolitan respondents after accounting for the other variables.

Conclusion

Individuals living in regional areas experienced longer delays in obtaining a diagnosis of PD. Both groups highly rated better access to neurologists and the need for better diagnosis as priorities. Location, disease duration and satisfaction with services were not significantly associated with HRQoL.

背景：帕金森病（PD）是一种常见的神经退行性疾病，目前尚无治愈方法。PD患病率和获得临床护理的障碍随着距离主要城市的距离而增加。了解PD患者与健康相关的生活质量（HRQoL）相关因素具有重要的临床和公共卫生意义。方法：通过对澳大利亚成年PD患者的全国性调查，我们研究了地理位置对患者HRQoL和人口统计学、症状病程和诊断、治疗利用和偏好以及对当前服务的满意度的影响。最终数据包括来自澳大利亚六个州的87名受访者，其中55人居住在偏远地区，32人居住在大城市。测量还包括帕金森病问卷（PDQ-39）和疾病严重程度的自我报告Hoehn和Yahr量表。结果：获得诊断的时间对地区受访者明显长于主要城市同行。与PD相关的10个陈述的优先级也有显著差异。在检验上述所有变量对由PDQ-39确定的HRQoL的影响的整体分析中，只有Hoehn和Yahr分数解释了显著差异；在考虑了其他变量后，地区和大都市受访者之间没有显著差异。结论：生活在地区的个体在获得PD诊断方面有较长的延迟。两组患者都高度评价了更好地接触神经科医生和更好地诊断的必要性。地点、病程和服务满意度与HRQoL无显著相关。
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引用次数: 0
Predicting Hypotension Before It Hits the Highway in Rural Anaesthesia 在农村麻醉中预测低血压
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-12 DOI: 10.1111/ajr.70090
Josh Andrews, Alasdair Leslie, Christina Gao, D-Yin Lin, Brandon Stretton, Stephen Bacchi
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引用次数: 0
Farm Injury Deaths and Workers' Compensation Claims in Australia and Their Economic Costs 澳大利亚农场伤害死亡和工人赔偿索赔及其经济成本
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-10 DOI: 10.1111/ajr.70087
Carlos Mesa-Castrillon, Kerri-Lynn Peachey, Tony Lower

Objective

To describe the pattern and estimated direct economic burdens associated with unintentional deaths and injuries on Australian farms over the past 11 years (2013–2023).

Design

Descriptive retrospective epidemiological study of National Coronial Information System (NCIS) data for persons fatally injured on a farm and workers' compensation injuries data from the National Data Set.

Setting

Australia.

Participants

All agricultural cases involving fatal injury events and those being injured accessing workers compensation.

Main Outcome Measures

Nature of fatal and injury events, with estimates on the economic costs associated with deaths and workers' compensation injury claims costs.

Results

There were 748 farm fatalities, with 544 (73%) being work-related. From these, 513 (94%) of the cases occurred in males, with almost half (48%) in farmers aged 60 years or older. The leading agents for fatalities were tractors (n = 118), quad-bikes (n = 117) and farm utilities (n = 52). Costs for all fatalities (work and non-work), approached $1.8 billion in the 2013-2023 period (~$164 million per year). Work-related fatalities accounted for $1.24 billion of this total, with an annual cost of approximately $112 million. There were around 5000 workers' compensation injury claims processed per year during 2013–2021, costing over $1.5 billion (~$190 million per year).

Conclusion

The costs for all on-farm injury deaths and workers' compensation injury claims conjointly during the period of 2013–2023, includes a conservative annual estimate of $355 million per year. Of this sum, approximately $300 million involved work-related incidents. Although there is a modest progression in reducing farm deaths and injuries, targeted and evidence-based approaches are required to stimulate improvements in these preventable incidents.

目的描述过去11年（2013-2023）澳大利亚农场意外死亡和伤害的模式和估计的直接经济负担。设计对国家冠状信息系统（NCIS）中农场致死性受伤人员的数据和国家数据集中的工伤赔偿数据进行描述性回顾性流行病学研究。设置 澳大利亚。所有涉及致命伤害事件和获得工伤赔偿的农业案件。致命和伤害事件的性质，以及与死亡和工伤赔偿索赔费用相关的经济成本估计。结果共有748例农场死亡，其中544例（73%）与工作相关。其中，513例（94%）为男性，近一半（48%）为60岁或以上的农民。导致死亡的主要因素是拖拉机（n = 118）、四轮摩托车（n = 117）和农场公用设施（n = 52）。2013-2023年期间，所有死亡人数（工作和非工作）的成本接近18亿美元（每年约1.64亿美元）。其中与工作有关的死亡占12.4亿美元，每年的成本约为1.12亿美元。2013-2021年期间，每年处理的工伤赔偿索赔约为5000起，费用超过15亿美元（每年约1.9亿美元）。在2013-2023年期间，所有农场伤害死亡和工伤赔偿索赔的费用包括每年保守估计的3.55亿美元。其中，约有3亿美元涉及与工作有关的事故。虽然在减少农场伤亡方面取得了一定进展，但需要采取有针对性和基于证据的方法来促进这些可预防事件的改善。
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引用次数: 0
Towards a National Longitudinal Tracking Framework of Health Graduate Practice Locations 建立全国卫生毕业生实习地点纵向跟踪框架
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-08 DOI: 10.1111/ajr.70085
Vincent L. Versace, Pam Harvey, Geoff Argus, Christine Howard, Leanne Brown

Aims

Workforce maldistribution is a challenge to the equitable provision of healthcare in Australia. This Commentary details how a multi-university, large-scale, and growing data asset is positioned to contribute strategically and operationally to addressing national workforce priorities.

Context

The Nursing and Allied Health Graduate Outcome Tracking (NAHGOT) study is a prospective longitudinal research project with a commitment to nationwide geographical coverage. NAHGOT links practice location data (the outcome) from the Australian Health Practitioner Regulation Agency (Ahpra) with university administrative records, such as admission and placement data (explanatory variables). NAHGOT also links external surveys and publicly available spatial data describing socio-economic conditions and access to services. There are seven universities formally part of the collaboration, with five others in the process of joining. NAHGOT has established a framework including project governance, data linkage and management protocols, and a central repository for de-identified data.

Approach

The background of NAHGOT, the benefits to the Rural Health Multidisciplinary Training program, current limitations and challenges, and the case for scale-up and future direction are described.

Conclusion

Universities are uniquely positioned to lead graduate tracking as they have access to a suite of key explanatory variables not available elsewhere. Increasing the number of participating universities within NAHGOT is a priority, as is broadening the pool of disciplines beyond those covered by Ahpra. The geo-enrichment of placement and practice data is also a priority. This will allow a more granular understanding of local workforce dynamics that can be overlooked if analysis is limited to existing geographical classifications.

目标劳动力分配不均是对澳大利亚公平提供医疗保健的一个挑战。本评论详细介绍了多所大学、大规模和不断增长的数据资产如何定位为在战略和业务上为解决国家劳动力优先事项做出贡献。护理和相关卫生毕业生结果跟踪（NAHGOT）研究是一项前瞻性纵向研究项目，致力于全国地理覆盖。NAHGOT将来自澳大利亚卫生从业人员管理机构（Ahpra）的实践地点数据（结果）与大学行政记录（例如入学和安置数据）（解释变量）联系起来。NAHGOT还将外部调查与描述社会经济状况和服务获取情况的公开空间数据联系起来。有七所大学正式加入了该合作，另有五所大学正在加入。NAHGOT已经建立了一个框架，包括项目治理、数据链接和管理协议，以及去识别数据的中央存储库。方法介绍了NAHGOT的背景、农村卫生多学科培训计划的好处、当前的限制和挑战、扩大规模的情况和未来的方向。大学在引导毕业生跟踪方面处于独特的地位，因为他们可以获得一套其他地方无法获得的关键解释变量。增加NAHGOT内参与大学的数量是一个优先事项，扩大Ahpra涵盖的学科之外的学科池也是一个优先事项。安置和实践数据的地理富集也是一个优先事项。这将使我们能够更细致地了解当地劳动力动态，如果分析仅限于现有的地理分类，这可能会被忽视。
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引用次数: 0
Patient-Reported Cataract Outcomes After the Introduction of the Griffith Ophthalmology Project in Regional Australia 格里菲斯眼科项目在澳大利亚地区引入后患者报告的白内障结果
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-09-02 DOI: 10.1111/ajr.70088
Jason Chami, Marc P. Chami, Harrison M. Khan, Donna Glenn, Kerrie A. Legg, Dominic McCall, John R. Grigg, Geoffrey T. Painter

Objective

To evaluate the effectiveness of the Griffith Ophthalmology Project in improving visual acuity and quality of life (QoL) among cataract surgery patients in regional New South Wales (NSW), Australia.

Design

Retrospective observational study.

Setting

Griffith Base Hospital's Department of Ophthalmology in the Western Murrumbidgee Local Health District (MLHD).

Participants

The 135 patients (168 eyes) undergoing cataract surgery between March 2022 and July 2023 completed QoL surveys.

Main Outcome Measures

Changes in vision-related QoL (assessed by National Eye Institute Visual Function Questionnaire; NEI-VFQ), health-related QoL (assessed by EuroQol 5-Dimensional 5-Level survey; EQ-5D-5L), visual acuity, and surgical waiting times.

Methods

Patients completed the NEI-VFQ and EQ-5D-5L surveys before and/or after surgery. Pre- and post-operative visual acuity and waiting list data were collected and analysed.

Results

EI-VFQ data showed significant enhancements in 11 of 12 QoL subscales (including social functioning and mental health) as well as the composite QoL score. EQ-5D-5L results indicated improvements in all five dimensions, with overall health-related QoL significantly increased. Visual acuity improved significantly, the surgical waitlist was reduced from 123 to 10 patients, and waiting times decreased from 15 to 2 months.

Conclusions

The Griffith Ophthalmology Project significantly improved visual and QoL outcomes for cataract surgery patients in regional NSW and reduced surgical waiting times. This model of utilising visiting specialists and collaborative local support may serve as a template for sustainable regional healthcare services in Australia.

目的评价Griffith眼科项目在澳大利亚新南威尔士州地区白内障手术患者中提高视力和生活质量（QoL）的效果。设计回顾性观察性研究。设置格里菲斯基地医院眼科在西Murrumbidgee地方卫生区（MLHD）。在2022年3月至2023年7月期间接受白内障手术的135名患者（168只眼睛）完成了生活质量调查。视力相关生活质量（由美国国家眼科研究所视觉功能问卷评估；NEI-VFQ）、健康相关生活质量（由EuroQol 5维5级调查评估；EQ-5D-5L）、视力和手术等待时间的变化。方法术前、术后对患者进行NEI-VFQ和EQ-5D-5L调查。收集和分析手术前后的视力和等待名单数据。结果EI-VFQ数据显示，12个生活质量分量表中的11个（包括社会功能和心理健康）以及综合生活质量评分均有显著提高。EQ-5D-5L结果表明，所有五个维度都有所改善，总体健康相关生活质量显著提高。视力明显改善，手术等待名单从123例减少到10例，等待时间从15个月减少到2个月。结论Griffith眼科项目显著改善了NSW地区白内障手术患者的视力和生活质量，减少了手术等待时间。这种利用来访专家和协作的地方支持的模式可以作为澳大利亚可持续区域医疗保健服务的模板。
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引用次数: 0
Informing a Clinical Pathway for Acute Knee Injuries: Survey Insights From Rural Clinicians 告知急性膝关节损伤的临床途径：来自农村临床医生的调查见解
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-08-27 DOI: 10.1111/ajr.70086
Tom Molloy, Benjamin Gompels, Matthew Dowsett, Stephen McDonnell

Introduction

Soft tissue knee injuries (STKIs) pose a significant healthcare challenge, particularly in rural settings with limited access to imaging and specialist consultation. This study aimed to evaluate current practices and challenges in diagnosing acute knee injuries in a rural setting and presented a pathway tailored for rural healthcare settings to improve diagnostic confidence, optimise imaging use, and streamline patient management.

Methods

A survey-based study was conducted among seventeen medical officers in six rural medical centres across New South Wales and Queensland. The survey involved a structured questionnaire on current practices and challenges. A structured rural pathway for acute knee injury was presented, and feedback was reported.

Results

Most clinicians assessed knee injuries weekly, showing variable confidence in their assessments and special tests. Key barriers identified included limited access to imaging, lack of specialist consultation, and diagnostic uncertainty, which led to increased referrals. The proposed pathway was rated highly intuitive, aligned with clinical guidelines, and was expected to streamline management.

Conclusion

The proposed pathway has clinical support and the potential to enhance knee injury management in rural settings by improving diagnostic accuracy, offering pathways aligned with the risk of injury, and promoting timely specialist care. Further research is necessary to assess long-term clinical outcomes and pathway integration across allied health services and rural healthcare facilities.

膝关节软组织损伤（STKIs）构成了重大的医疗挑战，特别是在农村地区，获得成像和专家咨询的机会有限。本研究旨在评估目前在农村地区诊断急性膝关节损伤的做法和挑战，并提出了一条适合农村医疗机构的途径，以提高诊断信心，优化成像使用，并简化患者管理。方法对新南威尔士州和昆士兰州6个农村医疗中心的17名医务人员进行调查研究。该调查包括一份关于当前实践和挑战的结构化问卷。一个结构化的农村途径急性膝关节损伤提出，并反馈报告。结果大多数临床医生每周评估一次膝关节损伤，对他们的评估和特殊测试表现出不同的信心。确定的主要障碍包括获得成像的机会有限，缺乏专家咨询和诊断不确定，这导致转诊增加。建议的途径被评为高度直观，符合临床指南，并有望简化管理。结论提出的路径具有临床支持和潜力，通过提高诊断准确性，提供与损伤风险一致的路径，并促进及时的专科护理，加强农村地区膝关节损伤管理。需要进一步的研究来评估联合医疗服务和农村医疗机构之间的长期临床结果和途径整合。
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引用次数: 0
‘It's Putting All the Burden on the Patient’: A Qualitative Study of Health Literacy and Shared Decision-Making in Rural Australian Communities “它把所有的负担放在病人身上”：澳大利亚农村社区健康素养和共同决策的定性研究
IF 2.1 4区 医学 Q2 NURSING
Australian Journal of Rural Health
Pub Date : 2025-08-21 DOI: 10.1111/ajr.70084
Heidi Gray, Tiana Kittos, Danielle M. Muscat

Objectives

Rural communities in Australia face significant barriers to health. Grounded in phenomenology as a research methodology, this study aimed to explore health literacy and shared decision-making in rural areas from the perspective of community members.

Design

Semi-structured interview study, with data analysed using Framework Analysis.

Participants

Twenty-five adults living in rural communities.

Setting

Interviews were conducted remotely, spanning seven Australian states and territories.

Results

Three main themes were generated from the data (comprising 10 sub-themes): (a) service access, (b) healthcare engagement, trust and decision making, (c) ‘a different approach for us’: leveraging community strengths. Demands on health literacy in rural settings were amplified, with additional health literacy requirements related to accessing and using healthcare services, navigating the healthcare system and understanding how to take appropriate health action in a rural setting. Participants reflected on the transient nature of the healthcare workforce in rural areas and experiences of pressurised health systems as barriers to service access and shared decision-making. Our analysis also identified a complex interplay between the social determinants of health and health literacy in rural contexts; challenges in healthcare access and navigation were discussed in the context of socioeconomic status, education, literacy and language. However, we also identified rural community strengths which could be leveraged to support health literacy action and responsiveness.

Conclusion

By addressing unique health literacy challenges and leveraging the strengths of rural communities, healthcare policies and interventions can better meet the needs of these populations.

澳大利亚农村社区在健康方面面临重大障碍。本研究以现象学为研究方法，旨在从社区成员的角度探讨农村地区的健康素养和共同决策。设计半结构化访谈研究，数据分析采用框架分析法。参与者25名生活在农村社区的成年人。采访是远程进行的，横跨澳大利亚七个州和地区。结果从数据中产生了三个主要主题（包括10个子主题）：(a)服务获取，(b)医疗保健参与，信任和决策，(c)“我们的不同方法”：利用社区优势。农村地区对卫生知识普及的需求有所增加，对卫生知识普及的额外要求涉及获取和使用卫生保健服务、使用卫生保健系统以及了解如何在农村地区采取适当的卫生行动。与会者反思了农村地区卫生保健人力的短暂性，以及卫生系统压力过大对获得服务和共同决策造成的障碍。我们的分析还发现，在农村环境中，健康的社会决定因素与健康素养之间存在复杂的相互作用；在社会经济地位、教育、扫盲和语言的背景下，讨论了获得保健和导航方面的挑战。然而，我们也确定了农村社区的优势，可以用来支持卫生扫盲行动和应对能力。通过应对独特的卫生素养挑战并利用农村社区的优势，卫生保健政策和干预措施可以更好地满足这些人群的需求。
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