Australian Journal of Rural Health最新文献

{"title":"Implementation of a day-stay joint replacement pathway in an Australian regional public hospital: A descriptive study","authors":"Amanda Tutty BASc (Physio)(Hons),&nbsp;Sam Martin FRACS (Orth),&nbsp;Corey Scholes PhD,&nbsp;Michel Genon FRACS (Orth),&nbsp;Jane Linton BASc (Physio),&nbsp;Simon Davidson BPhys (Hons),&nbsp;Christopher Williams PhD","doi":"10.1111/ajr.13127","DOIUrl":"10.1111/ajr.13127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the implementation, feasibility and safety of a day-stay joint replacement pathway in a regional public hospital in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Over a 12-month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day-stay patients, proportion of successful same-day discharges and reasons for same-day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-one/246 (17%) patients booked for joint replacement surgery were eligible for day-stay and 21/41 (51%) achieved a successful same-day discharge. Unsuccessful same-day discharges were due to time of surgery too late in the day (7/20), no longer meeting same-day discharge criteria (11/20) and declined discharge same-day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day-stay pathway was high. Complication rates and patient-reported outcomes were equivalent across LoS groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The day-stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day-stay pathways have potential patient and system-level efficiency benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"703-714"},"PeriodicalIF":1.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study","authors":"Peter S. Micalos PhD,&nbsp;Patricia A. Logan PhD,&nbsp;Marguerite Bramble PhD,&nbsp;Alfred Wong PhD","doi":"10.1111/ajr.13125","DOIUrl":"10.1111/ajr.13125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Parkinson’s disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This retrospective data linkage study analysed a subset of data from the Sax Institute’s 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute’s Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Further research is required on the longitudinal impact of these associations on mental health in PD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"693-702"},"PeriodicalIF":1.9,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RuralHealthConnect: A network for evidence, innovation and action","authors":"Susi Tegen MBA, BA, DipEd, FAICD, FGIA, GCCM, GCRL","doi":"10.1111/ajr.13118","DOIUrl":"https://doi.org/10.1111/ajr.13118","url":null,"abstract":"&lt;p&gt;Federal and state governments invest millions of dollars to support the rural health sector to address the myriad of challenges not adequately addressed by the usual funding mechanisms, tools and levers. Rural clinicians, communities, researchers and entities that deliver care in rural Australia currently do not have access to what can learned, trends that are identified and what could be adapted in other communities.&lt;/p&gt;&lt;p&gt;The National Rural Health Alliance (the Alliance) and the &lt;i&gt;Australian Journal of Rural Health&lt;/i&gt; (AJRH), with input from the National Rural Health Commissioner, have developed a proposal to address the challenge of inadequate evidence and information sharing and to promote capacity building, adaptation and innovation in rural health care and investment in education and training. The proposal combines the expertise and reach of all three entities and will draw together key rural health stakeholders in a steering committee.&lt;/p&gt;&lt;p&gt;With investment, the proposal aims to address the lack of information shared and learning from government funded research and programs that addresses declining medical and health workforce shortages, models of care, health care access discrepancies and health outcomes in rural areas compared with urban centres. Many initiatives have been implemented over past decade or are currently being trialled to achieve these goals, such as Innovative Models of Care (IMOC), Primary care Rural Integrated Multidisciplinary Models (PRIMM), as well as initiatives funded through the Medical Research Futures Fund (MRFF), the National Health and Medical Research Council (NHMRC) and other bodies. These projects include rural research initiatives, multidisciplinary models of care, various workforce or distribution programs, community-led initiatives, actions by specific professions, quality improvement activities and innovative models of delivery and care.&lt;/p&gt;&lt;p&gt;Although funding may impact a particular community or individual, there is currently a lack of sharing information about what is being learned, what works, why and what challenges have arisen. Indeed, often individuals or communities are not aware of the array of projects that have been or are funded or where these communities or fund holders are located. This lack of communication means that other rural communities, who may be experiencing similar problems, often do not have access to the findings, lessons and emerging trends. There is insufficient cross-pollination of ideas to build capacity, increase adoption and ensure scale-up for maximum utility and impact on health outcomes.&lt;/p&gt;&lt;p&gt;Up to now, isolated researchers, policy-makers in government, managers, service users, service providers, not-for-profits, local governments, primary health networks (PHNs), workforce agencies, community members and entities that support communities have not been able to benefit from high-quality, multidimensional synthesise and analysis of what has been learned. This has hamp","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"411-413"},"PeriodicalIF":1.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Navigating low-value care in regional, rural and remote Australia","authors":"Rae Thomas BEd, Grad Dip Couns Psych, PhD,&nbsp;Vinay Gangathimmaiah MBBS, MPH, FACEM,&nbsp;Marlow Coates FACRRM, FRACGP-RG, FRACMA, JCCA/DRGA,&nbsp;Michelle Guppy MBBS, FRACGP, MPH","doi":"10.1111/ajr.13123","DOIUrl":"https://doi.org/10.1111/ajr.13123","url":null,"abstract":"&lt;p&gt;Occasions of low-value care (LVC) are those that confer little or no benefit to the patient or where harm (including lost treatment opportunity and financial cost) exceeds likely benefit.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While it is easy to conceptualise health care as either low or high value, the reality is that ‘value’ is conferred on a continuum and within a context. Some health care activities are widely acknowledged as low value (e.g., cranial CT in patients without meeting clinical decision criteria&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; and MRIs for low back pain&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;). However, much health care is conducted in the ‘grey zone’&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; where the ‘value’ of health care is context dependent.&lt;/p&gt;&lt;p&gt;In regional, rural and remote Australia, the provision of health care is characterised by challenges distinct from our urban counterparts. Limited access to services, high rates of multimorbidity, and a maldistributed and inconstant workforce are some of the contextual factors in our ‘grey zone’.&lt;/p&gt;&lt;p&gt;From the perspectives of regional (Townsville), rural (New England) and remote (Thursday Island) health services, we describe how the contexts of our clinical environments guide our clinical decisions and challenge notions of what is, and what is not, LVC.&lt;/p&gt;&lt;p&gt;Townsville University Hospital is a tertiary referral centre in regional North Queensland supporting the health care needs of 700 000 people.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; Amidst a national context of emergency department overcrowding&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; the Townsville University Hospital Emergency Department (TUH-ED) cared for 99 748 people in 2024. The challenges of providing care in this time-, space-, staff- and information-constrained setting can lead to LVC.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; Similar to metropolitan settings, we have identified that approximately a third of urine cultures, coagulation studies, blood cultures and cranial CT scans conducted within the TUH-ED setting, may be seen as low value.&lt;span&gt;&lt;sup&gt;10, 11&lt;/sup&gt;&lt;/span&gt; Recent semi-structured interviews with TUH-ED clinicians identified LVC is fuelled by perceptions of efficiency further compounded by clinician beliefs about consequences and capabilities of care provision (unpublished data). This array of systemic and individual factors is shaping clinician behaviour and contributing to the persistence of LVC at TUH-ED.&lt;/p&gt;&lt;p&gt;The New England region of NSW has a population of 160 000 spread over a wide geographic area with regional and rural towns of MM3-6 in size. Like many rural health services, there is an increasing reliance on a locum rather than a local workforce. In many locations, it is difficult to even attract a locum workforce, so emergency care is provided via telehealth support. Since telehealth specialists cannot physically examine patients, the ordering CT scans of all body parts has increased. It is likely that clinical skill variability, concern for patient outcomes and the desire for a cli","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 2","pages":"213-215"},"PeriodicalIF":1.8,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140632054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of Finke Desert race-related trauma: A 10-year retrospective descriptive analysis","authors":"Matthew G. Cehic MD,&nbsp;Casey Knight MBBS,&nbsp;David Morris MD,&nbsp;James Van Essen MD,&nbsp;Nitin Bither MS (Orthopaedic Surgery),&nbsp;Kanishka Williams FRACS (Orthopaedic Surgery)","doi":"10.1111/ajr.13124","DOIUrl":"10.1111/ajr.13124","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Finke Desert Race is an annual motorsport race (motorbikes, cars and buggies) held in Alice Springs resulting in a significant major trauma burden. This imposes unique challenges in one of the world's most remote healthcare settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To quantify the volume and characteristics of Finke Desert Race-related trauma presenting to the Alice Springs Hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A retrospective descriptive study was undertaken to review all patients presenting to the Alice Springs Hospital with Finke Desert Race-related trauma over a 10-year period. Information collected included demographic data, injury characteristics, patient disposition and required management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Over the 9 years the event was held, 325 patients were admitted to the Alice Springs Hospital. Patients were almost exclusively male (98.8%), with a mean age of 34.75 and residing outside of Alice Springs (82.2%). There were a total of 460 distinct injuries with the clavicle, spine and ribs the three most commonly injured sites. A total of 129 operations were required, of which 19 required retrieval to an interstate centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Alice Springs is one of the most remote and geographically isolated centres on Earth. This rurality poses unique challenges when trying to coordinate medical and retrieval services, exacerbated for a concentrated, yet highly resource intensive event such as Finke. It has far reaching impacts, placing additional stresses on all aspects of healthcare provision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This review has quantified the trauma burden of the event for the first time, enabling local and interstate stakeholders' ability to plan an adequate and sustainable response while also enabling the future effectiveness evaluation of recent safety reforms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"684-692"},"PeriodicalIF":1.9,"publicationDate":"2024-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140680816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health equity in clinical trials for regional, rural and First nations communities: Need for networked clinical trial system, through a values and purpose-aligned system culture","authors":"Sabe Sabesan FRACP,&nbsp;Melanie Poxton B Nursing","doi":"10.1111/ajr.13122","DOIUrl":"10.1111/ajr.13122","url":null,"abstract":"&lt;p&gt;Clinical trials are essential components of health practice and are vital to developing new therapies, advancing interventions, improving service delivery and enhancing models of care.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; For patients, participation in clinical trials improves outcomes in many disease areas and reduces variation in practice, due to strict monitoring requirements. For health practitioners, clinical trials present an opportunity to be at the cutting edge of best practice. For services, clinical trials improve standard procedures. For health systems, industry sponsored trials are an additional source of revenue that could be reinvested to build clinical trial units. Reports suggest that there is significant return on investment in this sector.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;For these and other reasons, the new National Clinical Trial Governance Framework has called for clinical trials to be included as a routine aspect of clinical practice.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; In the cancer care sector, which serves a significant number of patients with incurable diseases, international guidelines recommend clinical trials as the first option.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This means, to be aligned with international best practice, every cancer service should be offering clinical trials to all cancer patients regardless of postcode, at least for patients with incurable diseases.&lt;/p&gt;&lt;p&gt;Australia and many Western countries have invested significant resources to build clinical trial capabilities and enable engagement in local and international trials. However, people in regional, rural and First nations communities continue to have limited access to trials close to home.&lt;span&gt;&lt;sup&gt;5, 6&lt;/sup&gt;&lt;/span&gt; As a result, they must endure substantial travel, major costs and inconvenience, and often, must relocate to metropolitan centres or pass up the opportunity to participate. This is a key challenge highlighted by the accompanying commentary (Walsh et al.)&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; and specifically emphasised in the accompanying research paper (McPhee et al.).&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; Alarmingly, an MJA study recently described particularly poor representation of First nations communities in trials (exemplified in trials of parenting programs).&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Many of the challenges and barriers to health services in regional, rural and First nations communities are apparent (or even more pronounced) in the case of clinical trials. Workforce shortages and turn over at all levels, limited skills and awareness among staff of the potential benefit of trials, and inadequate investment in infrastructure are common. This constrains such sites from attracting sponsors and hosting clinical trials as stand-alone sites. Beyond this, system cultural issues within rural and First nations services may stifle participation, or the economic imperatives of metropolitan trial units and their sponsors may overrule.&lt;/p&gt;&lt;p&gt;In the light of the above, it is not unreasonable","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"588-591"},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in cancer clinical trial activity and trial characteristics at metropolitan and rural trial sites in Victoria, Australia","authors":"Narelle J. McPhee MND,&nbsp;Michael Leach PhD,&nbsp;Claire E. Nightingale PhD,&nbsp;Samuel J. Harris MBBS,&nbsp;Eva Segelov PhD,&nbsp;Eli Ristevski PhD","doi":"10.1111/ajr.13102","DOIUrl":"10.1111/ajr.13102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Cancer clinical trials (CCTs) provide access to emerging therapies and extra clinical care. We aimed to describe the volume and characteristics of CCTs available across Victoria, Australia, and identify factors associated with rural trial location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Quantitative analysis of secondary data from Cancer Council Victoria's Clinical Trials Management Scheme dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A cross-sectional study design was used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>CCTs were available Victoria-wide in 2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>There were 1669 CCTs and 5909 CCT participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Rural CCT location was assessed as a binary variable with categories of ‘yes’ (modified Monash [MM] categories 2–7) and ‘no’ (MM category 1). MM categories were determined from postcodes. The highest (‘least rural’) MM category was used for postcodes with multiple MM categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1669 CCTs, 168 (10.1%) were conducted in rural areas. Of 5909 CCT participants, 315 (5.3%) participated in rural CCTs. There were 526 CCTs (31.5%) with 1907 (32.3%) newly enrolled participants. Of 1892 newly enrolled participants with postcode data, 488 (25.8%) were rural residents. Of them, 368 (75.4%) participated in metropolitan CCTs. In a multivariable logistic regression analysis for all 1669 CCTs, odds of a rural rather than metropolitan CCT location were significantly (<i>p</i>-value &lt;0.05) lower for early-phase than late-phase trials and non-solid than solid tumour trials but significantly (<i>p</i>-value &lt;0.05) higher for non-industry than industry-sponsored trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In Victoria, 10% of CCTs are at rural sites. Most rural-residing CCT participants travel to metropolitan sites, where there are more late-phase, non-solid-tumour and industry-sponsored trials. Approaches to increase the volume and variety of rural CCTs should be considered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 3","pages":"569-581"},"PeriodicalIF":1.8,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralised clinical trials in rural Australia: Opportunities and challenges","authors":"Sandra Walsh BPsych, BA (Hons), Med, MEval, MAboriginal Studies,&nbsp;Pascale Dettwiller PhD,&nbsp;Lee Puah PhD,&nbsp;Hannah Beks PhD,&nbsp;Vincent Versace PhD,&nbsp;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}

{"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,&nbsp;Bastian Seidel PhD","doi":"10.1111/ajr.13126","DOIUrl":"10.1111/ajr.13126","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Context&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Approach&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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% (&lt;i&gt;n&lt;/i&gt; = 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; &lt;i&gt;p&lt;/i&gt; = 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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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}

{"title":"The Australian health workforce: Disproportionate shortfalls in small rural towns","authors":"Colin H. Cortie PhD,&nbsp;David Garne MBChB,&nbsp;Lyndal Parker-Newlyn MBBS,&nbsp;Rowena G. Ivers PhD,&nbsp;Judy Mullan PhD,&nbsp;Kylie J. Mansfield PhD,&nbsp;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}