Rural and remote health最新文献

{"title":"Mental health discussions among rural residents: a social network approach.","authors":"Emily Long, Abodunrin Q Aminu, Srebrenka Letina, Claire Goodfellow, Mark McCann","doi":"10.22605/RRH9450","DOIUrl":"https://doi.org/10.22605/RRH9450","url":null,"abstract":"<p><strong>Introduction: </strong>Mental health in rural areas can be affected by a lack of available services, which highlights the need for alternative support. Social relationships are known to bolster mental health, yet discussions of mental health in rural areas may be hindered by concerns over stigma and anonymity. This study applies a novel social network design to identify characteristics of mental health discussion networks among rural residents in Scotland.</p><p><strong>Methods: </strong>Data were collected on 505 social contacts of residents living in the Scottish Highlands. Study participants (n=20) completed a personal network interview, which captured information about their social relationships, including whether they would discuss their mental health with each individual. Multilevel models were used to parse characteristics of individuals (study participants and social contacts), aspects of relationships and social network structure associated with the discussion of mental health.</p><p><strong>Results: </strong>The results show that 23% of social contacts were rated as someone with whom rural residents would speak about their mental health. Social contacts who were women (odds ratio (OR) 4.06, 95% confidence interval (CI) 1.77-9.32) and younger (OR 0.71, 95%CI 0.54-0.94) were more likely to be engaged for mental health discussion. Occupying a more central position in the network increased the likelihood that a social contact would be a mental health discussion partner (ie betweenness; OR 1.03, 95%CI 1.01-1.05), but other aspects of network structure were not associated. Longer relationships (OR 2.33, 95%CI 1.40-3.87) and more frequent interactions (OR 5.05, 95%CI 3.12-8.17) increased the likelihood of mental health discussion, while higher mental health stigma (OR 0.38, 95%CI 0.17-0.85) of study participants lowered the likelihood of mental health discussion.</p><p><strong>Conclusion: </strong>Findings demonstrate that personal attributes, relational characteristics and network properties can all affect the likelihood of mental health discussions. The study uncovers multiple processes through which social networks can support rural residents, including the promotion of frequent contact, and mixed age/gender relationships, as well as reductions in mental health stigma.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 3","pages":"9450"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609250","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}

{"title":"Framing 'rural health equity' and implications for governance: thematic analysis of 51 expert narratives from a global webinar series.","authors":"Theadora Swift Koller, Alan Bruce Chater","doi":"10.22605/RRH9205","DOIUrl":"10.22605/RRH9205","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;To respond to persisting gaps in health service coverage and health outcomes impacting rural populations globally, governance for rural health equity requires enhanced focus by policymakers, researchers and practitioners. During 2021-22, 51 experts from around the world contributed (as speakers, co-chairs and discussants) to an eight-part webinar series on rural health equity convened by WHO and Rural WONCA, with inputs from partners including the OECD and agencies in the UN Inequalities Task Team subgroup on rural inequalities. The aim of the webinar series was to share technical/operational know-how and lessons learnt for addressing rural health inequities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A thematic analysis of all webinar expert narratives was completed by the authors during 2022-23, with the purpose of using the data to conceptually feed into multiple WHO technical and capacity-building products. Following transcription, this entailed familiarization with the data and reflexivity (including on the framework used to inform the series and the researchers' roles), generation of codes, combining codes in categories and themes, further analysis and reporting (alongside amendment of the original framework). The research question was 'What do the 51 expert narratives from the WHO Rural Health Equity eight-part webinar series convey about the framing of rural health equity and related governance approaches?'&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Expert narratives provided evidence suggesting that the framing of rural health equity needs to account for primary health care-oriented health systems strengthening issues in a way that highlights their indivisible, interrelated and synergistic nature, taking a system-wide approach. Expert narratives pointed to the health sector having an active role in rural development policy, as a platform to leverage action for rural health equity through working across sectors to address social and environmental determinants of health. In framing the equity dimension of rural health equity, there was a clear acknowledgement in expert narratives that the concept comprises inequitable differences both between urban and rural areas and within rural areas. Narratives underlined that a historical lens is required to understand the drivers of rural health inequities, as well as formulate or improve - through participatory approaches - the strategies to overcome them. The narratives shed light on governance issues such as inter- and intrasectorial policy and programming coherence, effective rural-proofing mechanisms, evidence-based decision-making drawing from strengthened equity-oriented information systems, ground-up participatory decision-making approaches, rights-based governance (including for self-determination), and greater accountability for redressing socio-spatial inequities and optimizing rural communities' assets. Findings suggest that unlocking rural health inequities will require the f","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 3","pages":"9205"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718283","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}

{"title":"Recruitment, retention and turnover of allied health professionals in rural and remote areas: a quantitative scoping review.","authors":"Jenny Cleland, Rachel Milte, Diana Khanna, Stacey George, Chris Brebner, Narelle Campbell, Gemma Tuxworth, Catherine Maloney, Paul Worley, Alison Dymmott","doi":"10.22605/RRH9494","DOIUrl":"10.22605/RRH9494","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Complex challenges exist in the recruitment, retention and turnover of allied health professionals (AHPs) in rural and remote areas, which negatively impacts the provision of services. The aim of this review was to synthesise evidence from studies with a quantitative component to examine the length of employment of allied health professionals, and significant factors and costs associated with the recruitment, retention and turnover of the rural and remote allied health workforce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Six databases were searched, along with grey literature, to identify studies using a quantitative approach or a mixed-methods approach with a quantitative component. The review focused on quantitative approaches due to the gap in the literature in relation to quantitative data on rural and remote AHP recruitment and retention. Included studies had to report on either recruitment, retention, turnover, length of employment or associated costs such as vacancy and recruitment costs of allied health professionals in rural or remote settings. Data for each study - including costs, employment duration and any factors affecting recruitment, retention and turnover - were extracted. The factors were identified directly from the articles and then assigned into two overarching categories of 'personal' and 'organisational'. The data were then further examined to identify if there were any significant relationships between the identified factors and recruitment, retention and turnover.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-four articles were included in the review. A variety of methods were used to measure length of employment. Overall, findings indicated that length of employment for rural and remote allied health professionals was often short with survival rates dropping substantially after 2 years of employment. Only two studies measured costs, and both indicated a relatively high cost associated with workforce turnover. A range of personal and organisational factors were identified that significantly impacted the recruitment, retention and turnover of allied health professionals in rural and remote areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This review highlighted length of employment, personal and organisational factors influencing recruitment, retention and turnover and the associated costs. Having a rural background or undertaking a rural placement, being older, being integrated into the community, good working conditions and financial incentives positively impacted upon recruitment, retention and turnover. However, there was limited evidence available on costs, which indicates a need for more research to be undertaken in this area. A variety of methods were used to measure length of employment, recruitment, retention and turnover, and currently a standardised framework does not exist to collectively synthesise data. Therefore, future research should focus on developing and then using a rigorous framework to bett","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 3","pages":"9494"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554376","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}

{"title":"Staying afloat on a realm of shifting sands: carers navigating palliative care in their rural settings.","authors":"Bonnie Zhu, Peter Lin, Heidi Bevan, Anne Croker, Karin Fisher","doi":"10.22605/RRH9343","DOIUrl":"https://doi.org/10.22605/RRH9343","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Carer roles in palliative care are complex and have many location-based issues, including for people in rural areas. Meaningful support for carers in rural areas needs to be informed by carers' actual experiences rather than relying on routine data collection. To embrace the complexity of carer experiences, we framed caregiving in palliative care as a journey that involves actions and needs to be navigated. We deliberately chose to use the verb 'navigate' as an action-based metaphor. Thus, we positioned ourselves to view carers' involvement in palliative care in rural areas as being non-linear, active and involving undetermined paths. Locating our research in the interpretive paradigm, we sought to develop a conceptual framework to inform reflections and discussions to provide meaningful support for carers involved in palliative care in rural areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our qualitative research, undertaken in the interpretive paradigm, was informed by philosophical hermeneutics. Participants were carers who had previously cared for patients requiring palliative care. Local clinicians approached potential participants known to them, inviting them to participate if interested. Our sample size of eight reflects the outcome of a deliberate balance between the sensitivity of the topic, scope for deep engagement through semi-structured interviews, recruitment requiring established carer-clinician relationships, our location with low population density and workforce shortages, and considerations for research informed by philosophical hermeneutics. Interpretations were iterative, involving cyclical phases of analysis, moving between individual and collective engagement with data, participant quotes and whole transcripts (hermeneutic circle). Through ongoing returns to the data, we moved to conceptually higher understandings (question-and-answer dialogue) that were portrayed through three dimensions (fusion of horizons).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The experiences of carers as they navigated palliative care were interpreted as three interrelated dimensions: 'realm of shifting sands', 'staying afloat' and 'doing for and with'. 'Realm of shifting sands' highlights the diversity and potential fragility of terrains carers are navigating: that is foundational sense of duty, constellations of relationships and inevitability of decline. 'Staying afloat' highlights the dynamic responses required to navigate these terrains, that is revisiting foundational sense of duty, engaging with constellations of relationships and responding to the inevitability of decline. Doing for and with highlights the multiple actions as carers hold their course and participate in palliative care, that is advocating, preparing and collaborating.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Complexities faced by caregivers can be framed in relation to individual reference points, personal capabilities, particular circumstances and locational factors","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 3","pages":"9343"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592131","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}

{"title":"Medical students' perceptions of rural clinical placement: a mixed-methods study.","authors":"Iwona Kołodziejczyk, Stephanie Maima, Sharon Tobessa, Jerzy Kuzma","doi":"10.22605/RRH9468","DOIUrl":"10.22605/RRH9468","url":null,"abstract":"<p><strong>Introduction: </strong>A severe shortage and inequitable distribution of doctors between rural and urban populations leave the rural population in Papua New Guinea deprived of medical care. Our medical school adopted strategies proven in other countries to motivate medical students to undertake rural practice effectively. This study aims to explore medical students' perceptions of rural clinical placement in Papua New Guinea.</p><p><strong>Methods: </strong>We adopted a mixed-methods parallel design. We included 41 students who undertook the rural clinical placement. For the data collection instruments, we employed the semi-structured questionnaire for the quantitative strand and focus group discussion for the qualitative strand.</p><p><strong>Results: </strong>Most students reported positive experiences of rural placement evaluating highly rural supervisors. Among the benefits of rural placement are enhanced confidence and competence level in clinical skills, an opportunity to practise several procedures, hands-on diagnosing and managing patients, a wide variety of cases and taking more responsibility for patients' care. For the students with rural upbringings, rural placement influenced them to consider future work in rural areas. For the urban students, it increased their understanding of health issues in the rural population.</p><p><strong>Conclusion: </strong>This study enhances our understanding of factors affecting medical students' opinions on rural clinical placement and how this experience will likely influence their future career choices. Further study is required to assess the association between rural placement and choosing a rural career path.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9468"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333812","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}

{"title":"Factors associated with James Cook University medical students experiencing 'high quality' clinical learning on final-year rural placement.","authors":"Brooke Mackie, Torres Woolley, Aaron Hollins, Leanne Hall","doi":"10.22605/RRH9395","DOIUrl":"https://doi.org/10.22605/RRH9395","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The James Cook University (JCU) medical school in Australia has a mission to produce graduates committed and competent to practise in local regional, rural and remote areas. As positive rural placement experiences are known to enhance interest in a rural career and generalist medicine, this study explores key factors contributing to JCU medical students having a 'high quality' rural clinical learning experience during their final-year rural placement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This sequential, explanatory mixed-methods study included four focus groups (n=17) and a one-on-one interview followed by a cross-sectional survey (n=71; response rate=45%) of final-year JCU medical students in 2023. The main outcome variable for the survey was a visual analogue scale question asking students to rate the clinical learning environment on their rural placement, while an open-ended question asked if and how clinical learning received on placement differed depending upon the background training of their supervising doctor. In the focus groups, students were asked to identify on a circle diagram all key components that impacted on having a good or bad clinical learning experience on their placement, and then to explain individually and discuss as a group the contexts around each component.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 46% of students completing the survey reported their rural placement was of high clinical learning value (&ge;85/100 on the visual analogue scale). Quantitative analysis identified 'high value' clinical learning placements were predicted by students spending &gt;50% of their placement learning in EDs (p=0.005; prevalence odds ratio (POR) 9.4), having 'very high' confidence in knowing how to manage the common presentations of North Queensland patients (p=0.006; POR 8.5) and being placed in small towns more than 100 km from the populated North Queensland coast. Student focus group participants consistently reported they received the best teaching from local doctors who were more permanently based in that community, had significant experience in rural medicine, and were familiar with their competency level as a sixth-year student and their learning objectives on rural placement. Overall, the key areas impacting students' clinical learning on rural placement can be summarized as 'quality teaching/supervision', 'appropriate levels of autonomy', 'appropriate clinical variety and workload' and 'student factors'.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study findings suggest the key to JCU medical students having 'high quality' clinical learning on rural placements is by developing supportive learning relationships with senior, permanently based rural doctors who are willing to teach and know their scope of practice and specific placement learning requirements; and experiencing a diverse roster across hospital, GP and outreach clinics but with significant placement time in the ED. Potentially, these findings ","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9395"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485763","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}

{"title":"A rural practice affinity model: recognizing the role of emergency medicine competency.","authors":"Eli Orrantia, Theresa Kline, Lindsay Nutbrown, Erin Cameron, Margaret Cousins","doi":"10.22605/RRH9355","DOIUrl":"https://doi.org/10.22605/RRH9355","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Rural Canadians have poorer health indices than their urban counterparts and struggle with worse access to care due to an undersupply of physicians. Research has identified personal factors, such as being raised in a rural environment, and traits, such as lower harm avoidance, among those drawn to rural practice. As well, the impact of aspects of medical training, such as rural rotations, have been recognized in creating rural practice intentions, but the role of specific clinical competencies here has yet to be determined. Emergency medicine is often one of the most challenging components of rural practice and thought by some to have its competencies poorly developed in family practice training. We hypothesized a model for rural practice affinity in which a strong sense of general self-efficacy would be independently mediated by the development of emergency medicine competence and rural practice self-efficacy, leading to stronger intentions to embark on a rural practice career.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This model was tested using the data from a survey of all family medicine residents nearing graduation from 14 of the 17 Canadian medical schools. Demographics and data on factors known to influence a rural career choice were collected and accounted for when determining the strength of the hypothesized relationships. Both existing and specifically designed survey tools were used to assess model components. A partial correlation matrix between the variables of interest (general self-efficacy, emergency medicine competency, rural practice self-efficacy, and rural practice intentions) - controlling for the effects of relationships, financial aspects, personal aspects, and social desirability - was created and subjected to a structural equation model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our initial rural practice affinity model resulted in a poor fit of the model to the data. However, the addition of a pathway from emergency medicine competence to rural practice self-efficacy improved the model to one showing significant paths as hypothesized as well as excellent measures of fit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The importance of general self-efficacy is recognized and is itself mediated by the more specific rural practice self-efficacy to rural practice intentions, consistent with the literature. Emergency medicine competency has a central role in both mediating general self-efficacy to rural practice intentions, while also being mediated itself by rural practice self-efficacy to rural practice intentions. This provides new understanding in the development of rural practice self-efficacy. The link of emergency medicine competency to both rural practice self-efficacy and rural practice intentions suggests that this is a curricular area that deserves greater focus and consideration of how to ensure that residents are meeting emergency medicine requirements and receiving robust training in this area. This is especi","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9355"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542101","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}

{"title":"The convergence of climate, recreation and health: La Niña, crab catching and necrotising fasciitis, a case series.","authors":"Daniel Bermingham, Bruno Sarno De Vidal Chaves, Anamika Ganju, Arifuzzaman Khan, Angela Ratsch","doi":"10.22605/RRH9705","DOIUrl":"https://doi.org/10.22605/RRH9705","url":null,"abstract":"<p><strong>Context: </strong>Necrotising fasciitis is a rapidly progressing, life-threatening soft tissue infection that carries a high morbidity and mortality, especially in susceptible populations.</p><p><strong>Issue: </strong>During the La Ni&ntilde;a spring-summer-autumn of 2021-2022, five male patients aged between 59 and 86 were admitted into the Hervey Bay Hospital (Queensland, Australia) intensive care unit (ICU) with necrotising fasciitis and multi-organ failure. All five patients had been in saltwater rivers within the local Fraser Coast area and either hunting for Scylla serrata (commonly known as green mud crabs), or descaling barnacles from their vessels. Following rapid and extensive surgical intervention and aggressive antibiotic and supportive treatment, all five patients were either discharged home or are currently in rehabilitation.</p><p><strong>Lessons learned: </strong>With a strong possibility of future floods due to climate change and the cyclic return of the La Ni&ntilde;a in the future, this article highlights a potential public health issue. This case series demonstrates the importance of increased vigilance for necrotising fasciitis by frontline healthcare staff after flooding events. Identification and escalation of a potential public health warning about the need for vigilance by people experiencing even the smallest of injury by green mud crabs or barnacles post-flood event may need to be considered.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9705"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497984","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}

{"title":"A qualitative evaluation of remote supervision guidelines for Australian general practice registrars in two practice locations.","authors":"Jill Benson, Josephine Borthwick, Tim Linton, Stacey Cotter, Karin Jodlowski-Tan, James Brown","doi":"10.22605/RRH9675","DOIUrl":"10.22605/RRH9675","url":null,"abstract":"<p><strong>Introduction: </strong>The lack of a stable general practice workforce in rural and remote Australia has been a topic of much discussion as there are fewer GPs working in many rural areas, where mortality and morbidity are higher than in urban areas. Doctors who have been trained in rural and remote areas are more likely to continue working there, but in many practices supervision is not available onsite. Good supervision ensures patient safety, an educational alliance between the supervisor and trainee, and adequate clinical and professional support by the supervisor and the onsite team. This project involved the evaluation of the pilot of the newly developed guidelines for the remote supervision of GP trainees (registrars) within the Royal Australian College of General Practitioners (RACGP) Australian General Practice Training program: Remote supervision: Guidelines for safe and effective general practice training utilising remote supervision.</p><p><strong>Methods: </strong>The aim of the evaluation was to assess the appropriateness, effectiveness and efficiency of the remote supervision guidelines and placement processes such as the selection process, risk management plan, face-to-face orientation period, development of the onsite team, communication strategies and increased payment. The guidelines were implemented as a pilot in two practice localities in 2022. The remote supervisors, remotely supervised registrars, practice managers and training organisation stakeholders were interviewed at three time points during the placement: before the placement, after the orientation period and at the conclusion of the placement. Their responses were analysed and organised into themes.</p><p><strong>Results: </strong>Overall, the results were positive, with suggestions for improvement and challenges identified. There was an identified need to ensure that guidelines are flexible and able to be tailored to the context of the registrar, the supervisor and the placement. Both registrars in the pilot continued to work in the remotely supervised practices at the end of their training and the three supervisors were keen to supervise remotely again.</p><p><strong>Discussion: </strong>The RACGP remote supervision guidelines were developed as an evidence-based practical means of supervising registrars in rural and remote locations where there is no onsite supervisor. The guidelines were updated where necessary and have now been published and implemented nationally.</p><p><strong>Conclusion: </strong>The pilot and evaluation of the RACGP remote supervision guidelines demonstrate that they are safe and fit for purpose. These guidelines form one of the training strategies to support the dwindling rural and remote general practice workforce.</p>","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9675"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369182","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}

{"title":"Exploring discrepancies in clinical coding between rural and urban hospitals in Aotearoa New Zealand in patients who underwent interhospital transfer.","authors":"Anna Donaldson, Rory Miller, Garry Nixon, Gabrielle S Davie","doi":"10.22605/RRH9309","DOIUrl":"10.22605/RRH9309","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The agreement of clinical coding between rural and urban hospitals in Aotearoa New Zealand (NZ) is unknown, and data from comparable international health systems is scarce, dated or inconclusive. There is a reliance upon administrative datasets that store clinically coded information to complete numerous rural-urban health analyses, which inform health policy and resource allocation decisions. Anecdotally, clinical coding in NZ rural hospitals is often performed by clinicians or reception staff without formal coding training; in urban NZ hospitals this would usually be completed by formally trained clinical coders. This study aimed to determine whether discrepancies existed between the primary diagnosis codes assigned in the National Minimum Dataset (hospital events) (NMDS) of hospital discharges by NZ's publicly funded hospitals, for patients who underwent an interhospital transfer from a rural to an urban hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective observational study using the NMDS. NZ's publicly funded hospitals were classified into three categories: rural hospitals, hospitals in small urban centres and hospitals in large urban centres. Interhospital transfers were identified by bundling events in the NMDS into healthcare encounters. The primary diagnosis codes assigned at discharge from the rural hospital were compared against the codes assigned at discharge from the urban hospital, and corresponding diagnosis groups based on the WHO chapter definitions were assigned to each code. The number and percentage, with 95% confidence intervals (CIs), of encounters where there was discordance between primary diagnosis codes from the rural and urban hospitals were calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 31,691 patients, from 54 publicly funded hospitals, who underwent an interhospital transfer from an NZ rural to an urban hospital between 1 January 2015 and 31 December 2019. There were discrepancies in 64.1% (95%CI 63.5-64.6%) of the primary diagnosis codes assigned between the rural and urban hospitals, and in 32.1% (95%CI 31.6-32.6%) of broader diagnosis groups. In both cases, higher discrepancies existed for transfers to hospitals in small urban centres compared to hospitals in large urban centres. The most frequently assigned diagnosis group at discharge from rural hospitals was the non-specific group 'other', constituting 24.4% of all diagnosis groups assigned by a rural hospital. For 4.8% of all healthcare encounters, a specific diagnosis group assigned on discharge from the rural hospital was subsequently changed to 'other' at the urban transfer hospital. This reassignment to 'other' following interhospital transfer occurred within every diagnosis group assigned at a rural hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Two-thirds of primary diagnosis codes and one-third of diagnosis groups were discordant after transfer from rural to urban hospitals in NZ. Further in","PeriodicalId":21460,"journal":{"name":"Rural and remote health","volume":"25 2","pages":"9309"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310342","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}