Rural and Remote Health

Australians living in regional and remote communities face several barriers when accessing high quality health care. Voluntary assisted dying (VAD), a new and sensitive end-of-life option, presents a new challenge for residents living in these communities. Western Australia (WA) is the second Australian state to implement VAD laws and, to date, is the jurisdiction with the greatest need to address access inequities in regional and remote communities due to its vast area. This article identifies and explores initiatives introduced by the WA Government to address regional and remote access inequities in each of the two stages of the reform process: the stage of the reform process leading up to passing the law ('law-making stage'), and the stage of the reform process after the law was passed and prior to it commencing operation ('implementation stage')...

INTRODUCTION: Universal access to health services and universal health coverage are needed to achieve good health for all, yet rural communities face a variety of access barriers. As part of an effort to 'rural proof' health systems, it is therefore imperative to identify and act on the factors limiting access to health services by rural and indigenous communities. This article provides a comprehensive overview of the wide range of access barriers faced by rural and remote communities in two countries where barrier assessments were conducted...

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INTRODUCTION: While the general principles of healthcare quality are well articulated internationally, less has been written about applying these principles to rural contexts. Research exploring patient and provider views of healthcare quality in rural communities is limited. This study investigated what was important in healthcare quality particularly for hospital-level care for rural communities in Aotearoa New Zealand. METHODS: A pragmatic qualitative study was undertaken in four diverse rural communities with access to rural hospitals...

INTRODUCTION: Despite policies aiming at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas are still present in Europe. This systematic review aims to summarize and compare literature on interventions and their potential effectiveness of GP recruitment and retention in these underserved areas ('medical deserts') from 2011 onwards. METHODS: PubMed and Embase were used to identify publications, applying a two-stage selection process...

INTRODUCTION: Despite substantial investment in rural workforce support, sustaining the necessary recruitment and retention of general practitioners (GPs) in rural areas remains a challenge. Insufficient medical graduates are choosing a general/rural practice career. Medical training at postgraduate level, particularly for those 'between' undergraduate medical education and specialty training, remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice...

INTRODUCTION: Access to ultrasound imaging services is limited in rural areas and point-of-care ultrasound (POCUS) has the potential to address this gap. We aimed to examine how POCUS is utilised by doctors in contemporary Australian rural general practice. METHODS: A portable ultrasound machine and access to a training course were provided to four general practices in rural South Australia, and the type and frequency of POCUS scans were recorded, along with user information, between July 2020 and June 2021...

INTRODUCTION: The purpose of this research was to determine if there is a difference in dental visits or missing teeth among Indigenous people in the USA (American Indian/Alaska Native (AI/AN) adults) by geographic and metropolitan settings. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), 2020, limited to AI/AN adults ≥18 years, n=6640. Participants self-identified as AI/AN adults, and provided information about residence, dental status, and dental visits within the previous year...

INTRODUCTION: Rural generalist anaesthetists (RGAs) are central to the delivery of health care in much of rural and remote Australia. This article details a systematic review of the literature specifically asking the question, 'What is the current evidence of the 'safety' of anaesthesia delivered by RGAs?' METHODS: Six databases were searched using terms including 'safety', 'rural', 'anaesthetics', 'general practitioners', and associated search terms. Relevant articles were assessed for rigour, and information was summarised using qualitative grid analysis that included information on the study setting, participants, methods, limitations and key result areas...

INTRODUCTION: Island communities have a different experience of health services compared with urban dwellers. Islanders face challenges of accessing equitable health services with varied availability of local services and the added difficulty of sea and weather conditions on top of the physical distance to reach specialised services. In a 2017 review of primary care island services in Ireland, it was proposed that telemedicine solutions could potentially improve delivery of health services...

The inherent clinical risks associated with remote and rural environments are potentially mitigated by timely air ambulance transfer, yet this involves other costs, operational constraints and limitations. The development of a RAS MEDEVAC capability may present the opportunity to enhance clinical transfers and outcomes across remote and rural areas as well as more conventional civilian and military environments.Methods The authors propose a multi-phase approach to assist RAS MEDEVAC capability development.Results RAS MEDEVAC capability development could be enhanced by a step-wise approach that: (a) incorporates a clear understanding of related clinical (including aviation medicine), vehicle and interface principles; (b) understands opportunities and limitations of related technology advancements; and (c) develops a new glossary and taxonomy to describe echelons of care and phases of medical transfer...

INTRODUCTION: Over many years in Australia, public hospitals were funded on historical grounds with about 40% of running costs provided by the national government. In 2010, a national reform agreement established the Independent Hospital Pricing Authority (IHPA) to put in place activity-based funding, where the national government contribution was based on activity and National Weighted Activity Units (NWAU) and a National Efficient Price (NEP). Rural hospitals were exempted from this on the assumption that they were less efficient and activity more variable...

INTRODUCTION: Recruiting doctors in rural areas is challenging. Various educational interventions have been introduced in many countries. This study aimed to explore undergraduate medical education interventions introduced to recruit doctors to rural areas, and the results of these interventions. METHODS: We undertook a systematic search using search words 'rural', 'remote', 'workforce', 'physicians', 'recruitment' and 'retention'. We included articles meeting the following criteria: educational interventions clearly described; study population consisted of medical graduates; and outcome measures included place of work (rural/non-rural) after graduation...

INTRODUCTION: Universities have the ability to bring science and comprehensive care to remote regions. This can be done through the creation of rural clerkships during the training of health professionals. METHODS: Report of students' experiences during their rural clerkships in Brazil. RESULTS: Rural clerkships made contact possible between students from different areas of health, such as medicine, nutrition, psychology, social assistance, and nursing...

BACKGROUND: General practice is well situated to promote physical activity (PA) among middle-aged and older adults, but often those who are most likely to benefit from interventions tend to be the least likely recruited to participate in research. This study aimed to systematically review the published literature pertaining to PA interventions in general practice settings, in order to investigate approaches to recruitment and study populations profiles. METHODS: Seven databases were searched, including: PubMed, CINAHL, the Cochrane Library Register of Controlled Trials, Embase, Scopus, PsycINFO and Web of Science...

INTRODUCTION: Patients with uncontrolled diabetes living in rural communities experience many challenges, including lack of access to needed medication management services. Telepharmacy has been identified as a promising approach for addressing this gap. This presentation describes early insights into the implementation of a Comprehensive Medication Management (CMM) service in seven rural primary care clinics in North Carolina and Arkansas (USA). The CMM service involved two pharmacists meeting remotely with patients in their homes to identify and resolve Medication Therapy Problems (MTPs)...

INTRODUCTION: The COVID-19 pandemic has had a significant impact on the health and wellbeing of people worldwide. General practices were forced to adapt to constantly changing circumstances, leading to predominance of virtual consultations. The aim of this study was to examine the impact the pandemic had on the ability of patients to access general practice. Other focuses included determining the nature of changes to appointment cancellations or delays and the level of disruption to long-term medication regimes during this period...

INTRODUCTION: ScotGEM is the first graduate entry medical degree course in Scotland. Students are viewed as 'Agents of Change', embedded in clinical practice and communities and, as such, are able to facilitate change. The Quality Improvement Projects presented demonstrate the commitment of the students (and their host practices) to improving the sustainability of health care. METHODS: The selected projects illustrated use of a Quality Improvement methodology: identifying areas of need; working with key stakeholders; collecting and analysing data; testing change; modifying changes; and re-testing...

INTRODUCTION: This study addresses two main questions: 'How does having the experience of farming influence college students' intrinsic motivations towards farm health and safety (FHS)?' and 'Are there any differences between the motivations reported by students with and without having such experience?'. This study seeks to investigate the role of farming experience in students' cognitive factors and intentions to evaluate whether sharing experiences and stories positively shape students' cognitive factors to perform FHS behaviours...

INTRODUCTION: Gonçalo, a village with 1316 inhabitants of which 573 are 65 years old or older, presents itself as the 'Cradle of Fine Basketry'. Its population, rich in culture and stories to tell, has the support of a day care center for the elderly, where around 20 elderly people spend their days and find social connection. These patients make individual trips to access medical and nursing consultations. METHODS: Creation of a monthly consultation at the day care center for the elderly patients there...