Margot Leeson-Smith B.HSc, Louise Geddes PhD, Heath Johnson B.Communication (Hons), Sabrina Pit PhD, Robyn Ramsden PhD
Objective
To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job.
Methods
An annual cross-sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job.
Participants
One hundred sixty-eight general practice managers from rural and remote New South Wales.
Results
The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10–0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16–0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five.
Conclusions
Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges.
{"title":"Prevalence of technology and connectivity issues in general practices in rural New South Wales and their impact on staff capability to perform their job","authors":"Margot Leeson-Smith B.HSc, Louise Geddes PhD, Heath Johnson B.Communication (Hons), Sabrina Pit PhD, Robyn Ramsden PhD","doi":"10.1111/ajr.13129","DOIUrl":"10.1111/ajr.13129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An annual cross-sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>One hundred sixty-eight general practice managers from rural and remote New South Wales.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority of respondents (87%, <i>n</i> = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, <i>n</i> = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10–0.67; <i>p</i> = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16–0.95; <i>p</i> = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"715-723"},"PeriodicalIF":1.9,"publicationDate":"2024-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861629","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}
Amanda Tutty BASc (Physio)(Hons), Sam Martin FRACS (Orth), Corey Scholes PhD, Michel Genon FRACS (Orth), Jane Linton BASc (Physio), Simon Davidson BPhys (Hons), Christopher Williams PhD
Objective
To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia.
Method
Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined.
Results
Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups.
Conclusion
The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.
{"title":"Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study","authors":"Amanda Tutty BASc (Physio)(Hons), Sam Martin FRACS (Orth), Corey Scholes PhD, Michel Genon FRACS (Orth), Jane Linton BASc (Physio), Simon Davidson BPhys (Hons), Christopher Williams PhD","doi":"10.1111/ajr.13127","DOIUrl":"10.1111/ajr.13127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"703-714"},"PeriodicalIF":1.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855643","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}
Peter S. Micalos PhD, Patricia A. Logan PhD, Marguerite Bramble PhD, Alfred Wong PhD
Introduction
Parkinson’s disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression.
Objective
The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD.
Design
This retrospective data linkage study analysed a subset of data from the Sax Institute’s 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors.
Findings
A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality.
Discussion
Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship.
Conclusion
Further research is required on the longitudinal impact of these associations on mental health in PD.
简介：帕金森病（PD）与焦虑和抑郁等一系列非运动症状有关：帕金森病（PD）与焦虑和抑郁等一系列非运动症状有关：本研究旨在调查帕金森病患者精神健康状况的患病率和相关因素：这项回顾性数据关联研究分析了澳大利亚新南威尔士州（NSW）萨克斯研究所 "45岁及以上研究"（45 and Up Study）的部分数据。研究分析了 2005-2009 年间自认为患有帕金森病的人的数据。通过萨克斯研究所的安全统一研究环境 (SURE) 对数据进行了安全访问。参与者年龄在 45 岁以上，居住在澳大利亚新南威尔士州。对心理困扰（K10）、既往焦虑和/或抑郁诊断进行了回归分析，并对地区、人口、健康、医疗和社会文化因素进行了自变量分析：在 "45岁及以上研究 "第一波基线调查中，共有1676人自我认定患有帕金森病，并与2010年社会、经济和环境因素（SEEF）调查数据集进行了关联。精神健康表现在帕金森病中很常见，分别有29%和32%的患者曾被医学诊断为焦虑症和抑郁症。与大都市相比，农村地区出现心理困扰、焦虑和抑郁的可能性更大：讨论：帕金森病患者的心理健康状况与居住在农村地区、获得医疗服务的机会、女性性别、年龄、身体活动能力、澳大利亚出生、社会交往以及夫妻关系有关：结论：需要进一步研究这些关联对帕金森病患者心理健康的纵向影响。
{"title":"Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study","authors":"Peter S. Micalos PhD, Patricia A. Logan PhD, Marguerite Bramble PhD, Alfred Wong PhD","doi":"10.1111/ajr.13125","DOIUrl":"10.1111/ajr.13125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Parkinson’s disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective data linkage study analysed a subset of data from the Sax Institute’s 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Further research is required on the longitudinal impact of these associations on mental health in PD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"693-702"},"PeriodicalIF":1.9,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868904","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}
Susi Tegen MBA, BA, DipEd, FAICD, FGIA, GCCM, GCRL
<p>Federal and state governments invest millions of dollars to support the rural health sector to address the myriad of challenges not adequately addressed by the usual funding mechanisms, tools and levers. Rural clinicians, communities, researchers and entities that deliver care in rural Australia currently do not have access to what can learned, trends that are identified and what could be adapted in other communities.</p><p>The National Rural Health Alliance (the Alliance) and the <i>Australian Journal of Rural Health</i> (AJRH), with input from the National Rural Health Commissioner, have developed a proposal to address the challenge of inadequate evidence and information sharing and to promote capacity building, adaptation and innovation in rural health care and investment in education and training. The proposal combines the expertise and reach of all three entities and will draw together key rural health stakeholders in a steering committee.</p><p>With investment, the proposal aims to address the lack of information shared and learning from government funded research and programs that addresses declining medical and health workforce shortages, models of care, health care access discrepancies and health outcomes in rural areas compared with urban centres. Many initiatives have been implemented over past decade or are currently being trialled to achieve these goals, such as Innovative Models of Care (IMOC), Primary care Rural Integrated Multidisciplinary Models (PRIMM), as well as initiatives funded through the Medical Research Futures Fund (MRFF), the National Health and Medical Research Council (NHMRC) and other bodies. These projects include rural research initiatives, multidisciplinary models of care, various workforce or distribution programs, community-led initiatives, actions by specific professions, quality improvement activities and innovative models of delivery and care.</p><p>Although funding may impact a particular community or individual, there is currently a lack of sharing information about what is being learned, what works, why and what challenges have arisen. Indeed, often individuals or communities are not aware of the array of projects that have been or are funded or where these communities or fund holders are located. This lack of communication means that other rural communities, who may be experiencing similar problems, often do not have access to the findings, lessons and emerging trends. There is insufficient cross-pollination of ideas to build capacity, increase adoption and ensure scale-up for maximum utility and impact on health outcomes.</p><p>Up to now, isolated researchers, policy-makers in government, managers, service users, service providers, not-for-profits, local governments, primary health networks (PHNs), workforce agencies, community members and entities that support communities have not been able to benefit from high-quality, multidimensional synthesise and analysis of what has been learned. This has hamp
联邦政府和州政府投入了数百万澳元支持农村卫生部门应对各种挑战，但通常的资助机制、工具和杠杆无法充分应对这些挑战。全国农村健康联盟（National Rural Health Alliance，简称联盟）和《澳大利亚农村健康杂志》（Australian Journal of Rural Health，简称 AJRH）在全国农村健康专员（National Rural Health Commissioner）的建议下，制定了一项提案，以应对证据和信息共享不足的挑战，并促进农村医疗保健的能力建设、调整和创新，以及对教育和培训的投资。通过投资，该提案旨在解决政府资助的研究和计划缺乏信息共享和学习的问题，这些研究和计划旨在解决农村地区与城市中心地区相比不断下降的医疗卫生劳动力短缺问题、医疗模式问题、医疗服务差异问题以及医疗成果问题。为实现这些目标，过去十年间已实施或正在试行许多举措，如创新护理模式（IMOC）、农村综合多学科初级护理模式（PRIMM），以及由未来医学研究基金（MRFF）、国家健康与医学研究委员会（NHMRC）和其他机构资助的举措。这些项目包括农村研究倡议、多学科护理模式、各种劳动力或分配计划、社区主导的倡议、特定专业的行动、质量改进活动以及创新的交付和护理模式。虽然资金可能会对特定社区或个人产生影响，但目前缺乏有关正在学习什么、什么有效、为什么以及出现了什么挑战的信息共享。事实上，个人或社区往往不知道有哪些项目已经或正在获得资助，也不知道这些社区或资助方位于何处。这种缺乏交流的情况意味着，可能遇到类似问题的其他农村社区往往无法获得相关的研究成果、经验教训和新趋势。迄今为止，孤立的研究人员、政府决策者、管理人员、服务使用者、服务提供者、非营利组织、地方政府、初级卫生网络（PHNs）、劳动力机构、社区成员和支持社区的实体都无法从对所学知识进行的高质量、多维度的综合与分析中获益。这阻碍了修订和制定政策和指导方针、调整模式和方法以及影响供资优先次序以反映新趋势从而产生最佳影响的努力。这一挑战限制了澳大利亚及其他地区创新型农村医疗保健和教育/培训投资的有效性和效率。社区、非营利组织、研究人员和其他利益相关者（包括公共卫生网络、劳动力机构和地方政府）并不了解许多以往项目的潜在经验教训。交流想法、做法、资源、框架和成果可以促进循证学习，对于转化工作（包括扩大项目规模）至关重要，尤其是在各项举措越来越多地由社区驱动、以地方为基础并具有参与性的情况下。然而，从服务和教育举措中汲取的宝贵经验并没有得到充分的转化，也没有在适当的时间框架内出版，或应用于特定环境之外，以改善未来的农村医疗实践和教育。当务之急是最大限度地提高政府、社区和农村医疗利益相关者在农村医疗保健方面的投资价值，分享所学到的知识，综合并确定政策和实践方面的证据，确定趋势和学习机会，同时提高各地区的能力和认识。RuralHealthConnect 旨在改善多种信息来源的访问、连接、相关性和影响，为农村医疗服务提供者、资助者、劳动力机构、政府部门、非政府组织、大学和社区成员的行动提供证据。
{"title":"RuralHealthConnect: A network for evidence, innovation and action","authors":"Susi Tegen MBA, BA, DipEd, FAICD, FGIA, GCCM, GCRL","doi":"10.1111/ajr.13118","DOIUrl":"https://doi.org/10.1111/ajr.13118","url":null,"abstract":"<p>Federal and state governments invest millions of dollars to support the rural health sector to address the myriad of challenges not adequately addressed by the usual funding mechanisms, tools and levers. Rural clinicians, communities, researchers and entities that deliver care in rural Australia currently do not have access to what can learned, trends that are identified and what could be adapted in other communities.</p><p>The National Rural Health Alliance (the Alliance) and the <i>Australian Journal of Rural Health</i> (AJRH), with input from the National Rural Health Commissioner, have developed a proposal to address the challenge of inadequate evidence and information sharing and to promote capacity building, adaptation and innovation in rural health care and investment in education and training. The proposal combines the expertise and reach of all three entities and will draw together key rural health stakeholders in a steering committee.</p><p>With investment, the proposal aims to address the lack of information shared and learning from government funded research and programs that addresses declining medical and health workforce shortages, models of care, health care access discrepancies and health outcomes in rural areas compared with urban centres. Many initiatives have been implemented over past decade or are currently being trialled to achieve these goals, such as Innovative Models of Care (IMOC), Primary care Rural Integrated Multidisciplinary Models (PRIMM), as well as initiatives funded through the Medical Research Futures Fund (MRFF), the National Health and Medical Research Council (NHMRC) and other bodies. These projects include rural research initiatives, multidisciplinary models of care, various workforce or distribution programs, community-led initiatives, actions by specific professions, quality improvement activities and innovative models of delivery and care.</p><p>Although funding may impact a particular community or individual, there is currently a lack of sharing information about what is being learned, what works, why and what challenges have arisen. Indeed, often individuals or communities are not aware of the array of projects that have been or are funded or where these communities or fund holders are located. This lack of communication means that other rural communities, who may be experiencing similar problems, often do not have access to the findings, lessons and emerging trends. There is insufficient cross-pollination of ideas to build capacity, increase adoption and ensure scale-up for maximum utility and impact on health outcomes.</p><p>Up to now, isolated researchers, policy-makers in government, managers, service users, service providers, not-for-profits, local governments, primary health networks (PHNs), workforce agencies, community members and entities that support communities have not been able to benefit from high-quality, multidimensional synthesise and analysis of what has been learned. This has hamp","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"411-413"},"PeriodicalIF":1.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632019","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}
Rae Thomas BEd, Grad Dip Couns Psych, PhD, Vinay Gangathimmaiah MBBS, MPH, FACEM, Marlow Coates FACRRM, FRACGP-RG, FRACMA, JCCA/DRGA, Michelle Guppy MBBS, FRACGP, MPH
<p>Occasions of low-value care (LVC) are those that confer little or no benefit to the patient or where harm (including lost treatment opportunity and financial cost) exceeds likely benefit.<span><sup>1</sup></span> While it is easy to conceptualise health care as either low or high value, the reality is that ‘value’ is conferred on a continuum and within a context. Some health care activities are widely acknowledged as low value (e.g., cranial CT in patients without meeting clinical decision criteria<span><sup>2</sup></span> and MRIs for low back pain<span><sup>3</sup></span>). However, much health care is conducted in the ‘grey zone’<span><sup>4, 5</sup></span> where the ‘value’ of health care is context dependent.</p><p>In regional, rural and remote Australia, the provision of health care is characterised by challenges distinct from our urban counterparts. Limited access to services, high rates of multimorbidity, and a maldistributed and inconstant workforce are some of the contextual factors in our ‘grey zone’.</p><p>From the perspectives of regional (Townsville), rural (New England) and remote (Thursday Island) health services, we describe how the contexts of our clinical environments guide our clinical decisions and challenge notions of what is, and what is not, LVC.</p><p>Townsville University Hospital is a tertiary referral centre in regional North Queensland supporting the health care needs of 700 000 people.<span><sup>6</sup></span> Amidst a national context of emergency department overcrowding<span><sup>7, 8</sup></span> the Townsville University Hospital Emergency Department (TUH-ED) cared for 99 748 people in 2024. The challenges of providing care in this time-, space-, staff- and information-constrained setting can lead to LVC.<span><sup>9</sup></span> Similar to metropolitan settings, we have identified that approximately a third of urine cultures, coagulation studies, blood cultures and cranial CT scans conducted within the TUH-ED setting, may be seen as low value.<span><sup>10, 11</sup></span> Recent semi-structured interviews with TUH-ED clinicians identified LVC is fuelled by perceptions of efficiency further compounded by clinician beliefs about consequences and capabilities of care provision (unpublished data). This array of systemic and individual factors is shaping clinician behaviour and contributing to the persistence of LVC at TUH-ED.</p><p>The New England region of NSW has a population of 160 000 spread over a wide geographic area with regional and rural towns of MM3-6 in size. Like many rural health services, there is an increasing reliance on a locum rather than a local workforce. In many locations, it is difficult to even attract a locum workforce, so emergency care is provided via telehealth support. Since telehealth specialists cannot physically examine patients, the ordering CT scans of all body parts has increased. It is likely that clinical skill variability, concern for patient outcomes and the desire for a cli
{"title":"Editorial: Navigating low-value care in regional, rural and remote Australia","authors":"Rae Thomas BEd, Grad Dip Couns Psych, PhD, Vinay Gangathimmaiah MBBS, MPH, FACEM, Marlow Coates FACRRM, FRACGP-RG, FRACMA, JCCA/DRGA, Michelle Guppy MBBS, FRACGP, MPH","doi":"10.1111/ajr.13123","DOIUrl":"https://doi.org/10.1111/ajr.13123","url":null,"abstract":"<p>Occasions of low-value care (LVC) are those that confer little or no benefit to the patient or where harm (including lost treatment opportunity and financial cost) exceeds likely benefit.<span><sup>1</sup></span> While it is easy to conceptualise health care as either low or high value, the reality is that ‘value’ is conferred on a continuum and within a context. Some health care activities are widely acknowledged as low value (e.g., cranial CT in patients without meeting clinical decision criteria<span><sup>2</sup></span> and MRIs for low back pain<span><sup>3</sup></span>). However, much health care is conducted in the ‘grey zone’<span><sup>4, 5</sup></span> where the ‘value’ of health care is context dependent.</p><p>In regional, rural and remote Australia, the provision of health care is characterised by challenges distinct from our urban counterparts. Limited access to services, high rates of multimorbidity, and a maldistributed and inconstant workforce are some of the contextual factors in our ‘grey zone’.</p><p>From the perspectives of regional (Townsville), rural (New England) and remote (Thursday Island) health services, we describe how the contexts of our clinical environments guide our clinical decisions and challenge notions of what is, and what is not, LVC.</p><p>Townsville University Hospital is a tertiary referral centre in regional North Queensland supporting the health care needs of 700 000 people.<span><sup>6</sup></span> Amidst a national context of emergency department overcrowding<span><sup>7, 8</sup></span> the Townsville University Hospital Emergency Department (TUH-ED) cared for 99 748 people in 2024. The challenges of providing care in this time-, space-, staff- and information-constrained setting can lead to LVC.<span><sup>9</sup></span> Similar to metropolitan settings, we have identified that approximately a third of urine cultures, coagulation studies, blood cultures and cranial CT scans conducted within the TUH-ED setting, may be seen as low value.<span><sup>10, 11</sup></span> Recent semi-structured interviews with TUH-ED clinicians identified LVC is fuelled by perceptions of efficiency further compounded by clinician beliefs about consequences and capabilities of care provision (unpublished data). This array of systemic and individual factors is shaping clinician behaviour and contributing to the persistence of LVC at TUH-ED.</p><p>The New England region of NSW has a population of 160 000 spread over a wide geographic area with regional and rural towns of MM3-6 in size. Like many rural health services, there is an increasing reliance on a locum rather than a local workforce. In many locations, it is difficult to even attract a locum workforce, so emergency care is provided via telehealth support. Since telehealth specialists cannot physically examine patients, the ordering CT scans of all body parts has increased. It is likely that clinical skill variability, concern for patient outcomes and the desire for a cli","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"213-215"},"PeriodicalIF":1.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632054","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}
Matthew G. Cehic MD, Casey Knight MBBS, David Morris MD, James Van Essen MD, Nitin Bither MS (Orthopaedic Surgery), Kanishka Williams FRACS (Orthopaedic Surgery)
Introduction
The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings.
Objectives
To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital.
Design
A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management.
Findings
Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre.
Discussion
Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision.
Conclusion
This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.
{"title":"The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis","authors":"Matthew G. Cehic MD, Casey Knight MBBS, David Morris MD, James Van Essen MD, Nitin Bither MS (Orthopaedic Surgery), Kanishka Williams FRACS (Orthopaedic Surgery)","doi":"10.1111/ajr.13124","DOIUrl":"10.1111/ajr.13124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"684-692"},"PeriodicalIF":1.9,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680816","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}
<p>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.<span><sup>1</sup></span> 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.<span><sup>2</sup></span></p><p>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.<span><sup>3</sup></span> In the cancer care sector, which serves a significant number of patients with incurable diseases, international guidelines recommend clinical trials as the first option.<span><sup>4</sup></span> 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.</p><p>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.<span><sup>5, 6</sup></span> 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.)<span><sup>7</sup></span> and specifically emphasised in the accompanying research paper (McPhee et al.).<span><sup>7, 8</sup></span> Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs).<span><sup>9</sup></span></p><p>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.</p><p>In the light of the above, it is not unreasonable
{"title":"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","authors":"Sabe Sabesan FRACP, Melanie Poxton B Nursing","doi":"10.1111/ajr.13122","DOIUrl":"10.1111/ajr.13122","url":null,"abstract":"<p>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.<span><sup>1</sup></span> 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.<span><sup>2</sup></span></p><p>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.<span><sup>3</sup></span> In the cancer care sector, which serves a significant number of patients with incurable diseases, international guidelines recommend clinical trials as the first option.<span><sup>4</sup></span> 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.</p><p>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.<span><sup>5, 6</sup></span> 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.)<span><sup>7</sup></span> and specifically emphasised in the accompanying research paper (McPhee et al.).<span><sup>7, 8</sup></span> Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs).<span><sup>9</sup></span></p><p>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.</p><p>In the light of the above, it is not unreasonable","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"588-591"},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693749","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}
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.
{"title":"Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia","authors":"Narelle J. McPhee MND, Michael Leach PhD, Claire E. Nightingale PhD, Samuel J. Harris MBBS, Eva Segelov PhD, Eli Ristevski PhD","doi":"10.1111/ajr.13102","DOIUrl":"10.1111/ajr.13102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cross-sectional study design was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>CCTs were available Victoria-wide in 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>There were 1669 CCTs and 5909 CCT participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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 (<i>p</i>-value <0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (<i>p</i>-value <0.05) higher for non-industry than industry-sponsored trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"569-581"},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691351","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}
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.
{"title":"Decentralised clinical trials in rural Australia: Opportunities and challenges","authors":"Sandra Walsh BPsych, BA (Hons), Med, MEval, MAboriginal Studies, Pascale Dettwiller PhD, Lee Puah PhD, Hannah Beks PhD, Vincent Versace PhD, Martin Jones PhD","doi":"10.1111/ajr.13109","DOIUrl":"10.1111/ajr.13109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To present opportunities and a model to redress the under-representation of rural communities and people in Australian clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"582-587"},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691348","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}
<div> <section> <h3> Aims</h3> <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> </section> <section> <h3> Context</h3> <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> </section> <section> <h3> Approach</h3> <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> </section> <section> <h3> Conclusion</h3> <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
{"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":"32 3","pages":"597-605"},"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}
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