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}
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.
{"title":"The Australian health workforce: Disproportionate shortfalls in small rural towns","authors":"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","doi":"10.1111/ajr.13121","DOIUrl":"10.1111/ajr.13121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The distribution of health care workers differs greatly across Australia, which is likely to impact health delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"538-546"},"PeriodicalIF":1.8,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717443","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}
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.
{"title":"Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review","authors":"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","doi":"10.1111/ajr.13119","DOIUrl":"10.1111/ajr.13119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"462-474"},"PeriodicalIF":1.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741033","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}
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
<div> <section> <h3> Introduction</h3> <p>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.</p> </section> <section> <h3> Objective</h3> <p>To understand physiotherapists’ perspectives regarding job satisfaction within the Kimberley region a ‘rural and remote’ areas of Australia.</p> </section> <section> <h3> Design</h3> <p>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.</p> </section> <section> <h3> Findings and Discussion</h3> <p>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.</p> </section> <section> <h3> Conclusion</h3> <p>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
{"title":"This is why we are staying: Job satisfaction among Physiotherapists in the Kimberley region of Western Australia","authors":"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","doi":"10.1111/ajr.13117","DOIUrl":"10.1111/ajr.13117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To understand physiotherapists’ perspectives regarding job satisfaction within the Kimberley region a ‘rural and remote’ areas of Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings and Discussion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"521-537"},"PeriodicalIF":1.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140743943","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}
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.
{"title":"Transforming health care delivery: The role of primary health care nurses in rural and remote Australia","authors":"Tracy Robinson PHD, Linda Govan MPH, Cressida Bradley BN, Rachel Rossiter HScD","doi":"10.1111/ajr.13120","DOIUrl":"10.1111/ajr.13120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"592-596"},"PeriodicalIF":1.8,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140741660","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}
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。
{"title":"Implementation of a quality improvement strategy to optimise the management of community acquired pneumonia in a rural health setting","authors":"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","doi":"10.1111/ajr.13116","DOIUrl":"10.1111/ajr.13116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Problem</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The study was performed in a rural HHS in Queensland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Measures for Improvement</h3>\u0000 \u0000 <p>Appropriateness of antimicrobial prescribing for baseline and post-implementation phases of the study was evaluated according to <i>Therapeutic Guidelines: antibiotic</i> recommendations for community acquired pneumonia (CAP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Strategies for Change</h3>\u0000 \u0000 <p>Quality improvement strategy to implement a multifaceted package of interventions for CAP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Effects of Change</h3>\u0000 \u0000 <p>Post-implementation, overall appropriateness of antimicrobial prescribing improved and there was a decrease in duration of antimicrobial therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Lessons Learnt</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"560-568"},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337762","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}
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.
{"title":"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","authors":"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","doi":"10.1111/ajr.13115","DOIUrl":"10.1111/ajr.13115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Data from 20 participants identified 10 themes. Theme 1: <i>This model of care gives patients a choice</i>. Theme 2: <i>The pharmacist is a trusted source of support and information</i>. Theme 3: <i>Patient, carer and family distress is reduced</i>. Theme 4: <i>Enables patients to stay at home by improving medication knowledge and decreasing burden;</i> 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: <i>Communication between all parties is enhanced</i>; 5.1—Enhanced communication between the patient and health care team, 5.2—Enhanced communication within the health care team. Theme 6: <i>Patient, carer and family burden of coordinating prescriptions and medications is reduced</i>. Theme 7: <i>Benefits health care professionals by improving medication knowledge, reducing workload and stress;</i> 7.1—Understanding about medications and their management is improved, 7.2—Workload is reduced, 7.3—Work-related stress is reduced. Theme 8: <i>The disparity of care between rural and urban patients is reduced</i>. Theme 9: <i>Helps to address rural workforce shortages</i>. Theme 10: <i>Challenges of this model of care</i>; 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"510-520"},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307931","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}
Jennifer Luke PhD, Cristy Bartlett PhD, Sonja March PhD, Peter McIlveen PhD
Objective
To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia.
Design
Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles.
Findings
A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies.
Discussion
Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment.
Conclusion
This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.
{"title":"A systematic review of effective local, community or peer-delivered interventions to improve well-being and employment in regional, rural and remote areas of Australia","authors":"Jennifer Luke PhD, Cristy Bartlett PhD, Sonja March PhD, Peter McIlveen PhD","doi":"10.1111/ajr.13113","DOIUrl":"10.1111/ajr.13113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To systematically review evaluated local, community or peer-delivered well-being and employment interventions delivered within regional, rural and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Searches within nine databases retrieved peer-reviewed and grey literature from an initial pool of 3186 papers published between 2012 and 2022. PRISMA guidelines were adhered to, and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the well-being or employment (or both) articles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 19 items met the inclusion criteria, which included two quantitative, 12 qualitative and five mixed-methods evaluations. Intervention cohorts included Indigenous Australians, youth, older people, workers and the general community. The average methodological rating was 83%. The overall level of evidence for the interventions was low due to mostly descriptive studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Interventions that appeared effective in improving well-being tended to focus on addressing social connectedness and self-determination. Unexpected employment outcomes were evident across many of the studies, which highlighted the reciprocity between well-being and employment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review highlights promising interventions for improving well-being by focusing on social connectedness and self-determination. Further empirical evidence is encouraged to explore the reciprocal relationship between well-being and employment, emphasising the significance of social connectedness and self-determination in this context.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"433-454"},"PeriodicalIF":1.8,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307932","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}
Kelly Trearty PhD, Brendan Bunting PhD, John Mallett PhD
Introduction and Objective
Farmers experience a specific set of unique dangers, which increases their risk of mortality compared with any other occupation. This study hypothesised that Northern Ireland's (NIs) agriculturally saturated Wards have a higher risk of mortality compared against non-agriculturally based Wards.
Design
The Population Census and Farm Census information were downloaded from the Northern Ireland Neighbourhood Service (NINIS) online depository to compile three mortality-based data sets (2001, 2011, pooled data sets). Assessing the impact of socio-demographics and farming activity on Ward-level mortality patterns using farm and population decennial censuses. This study analysed all 582 Ward areas of NI, which enclosed the entire populace of the country in 2001 and 2011.
Findings
Path analysis was utilised to examine direct and indirect paths linked with mortality within two census years (2001; 2011), alongside testing pathways for invariance between census years (pooled data set). Ward-level results provided evidence for exogenous variables to mortality operating through three/four endogenous variables via: (i) direct effects (age), (ii) summed indirect effects (age; males; living alone; farming profit; and deprivation) and (iii) total effects (age; males; living alone; and deprivation). Multi-group results cross-validated these cause-and-effect relationships relating to mortality.
Discussion and Conclusion
This study demonstrated that farming intensity scores, farming profits and socio-demographics' influence on mortality risk in a Ward were dependent on the specific social-environmental characteristics within that area. In line with earlier area level research, results support the aggregated interpretation that higher levels of farming activity within a Ward increase the risk of mortality within those Wards of NI. This was an essential study to enable future tailoring of new strategies and upgrading of current policies to bring about significant mortality risk change at local level.
{"title":"Assessing the impact of socio-demographics and farming activity on ward-level mortality patterns using farm and population decennial censuses","authors":"Kelly Trearty PhD, Brendan Bunting PhD, John Mallett PhD","doi":"10.1111/ajr.13098","DOIUrl":"10.1111/ajr.13098","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction and Objective</h3>\u0000 \u0000 <p>Farmers experience a specific set of unique dangers, which increases their risk of mortality compared with any other occupation. This study hypothesised that Northern Ireland's (NIs) agriculturally saturated Wards have a higher risk of mortality compared against non-agriculturally based Wards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>The Population Census and Farm Census information were downloaded from the Northern Ireland Neighbourhood Service (NINIS) online depository to compile three mortality-based data sets (2001, 2011, pooled data sets). Assessing the impact of socio-demographics and farming activity on Ward-level mortality patterns using farm and population decennial censuses. This study analysed all 582 Ward areas of NI, which enclosed the entire populace of the country in 2001 and 2011.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Path analysis was utilised to examine direct and indirect paths linked with mortality within two census years (2001; 2011), alongside testing pathways for invariance between census years (pooled data set). Ward-level results provided evidence for exogenous variables to mortality operating through three/four endogenous variables via: (i) <i>direct effects</i> (age), (ii) <i>summed indirect effects</i> (age; males; living alone; farming profit; and deprivation) and (iii) <i>total effects</i> (age; males; living alone; and deprivation). Multi-group results cross-validated these cause-and-effect relationships relating to mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion and Conclusion</h3>\u0000 \u0000 <p>This study demonstrated that <i>farming intensity scores, farming profits and socio-demographics'</i> influence on <i>mortality</i> risk in a Ward were dependent on the specific social-environmental characteristics within that area. In line with earlier area level research, results support the aggregated interpretation that higher levels of farming activity within a Ward increase the risk of mortality within those Wards of NI. This was an essential study to enable future tailoring of new strategies and upgrading of current policies to bring about significant mortality risk change at local level.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"365-376"},"PeriodicalIF":1.8,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289775","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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