Australian Journal of Rural Health最新文献

{"title":"Differences in survival of patients with multiple myeloma in rural versus metropolitan regions: Analysis of population data of an Australian local health district","authors":"Sylvia Ai MMed,&nbsp;Amarinder Thind PhD,&nbsp;Gurdeep Parmar MD","doi":"10.1111/ajr.13189","DOIUrl":"10.1111/ajr.13189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study is to determine if there are differences in outcome for patients diagnosed with multiple myeloma in a rural setting compared to a metropolitan setting and which factors influence these outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Illawarra Shoalhaven Local Health District.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participant<b>s</b></h3>\u0000 \u0000 <p>A total of 391 patients diagnosed with multiple myeloma between 2000 and 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main outcome measures</h3>\u0000 \u0000 <p>Treatment and survival outcomes of these patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients being treated in a rural cancer care centre had lower overall survival compared to those treated at a metropolitan cancer care centre (median OS = 44.4 months vs. 80.2 months, <i>p</i> = 0.002), despite access to similar treatments by the same group of haematologists. There was a significantly higher rate of upfront autologous transplantation (38% vs. 20%, <i>p</i> = 0.001) and higher rate of inclusion in clinical trials (16% vs. 7%, <i>p</i> = 0.021) in patients treated at a metropolitan cancer care centre compared to the rural cancer care centre.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multiple myeloma patients treated at a rural centre had shorter survival compared to patients treated at a metropolitan centre, and this may be related to lower rates of autologous transplantation and inclusion in clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 6","pages":"1207-1215"},"PeriodicalIF":1.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373634","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 role of the play therapist in supporting children and families following a natural disaster: A scoping review","authors":"Nicole Nilsson MCPT,&nbsp;Natalie Hadiprodjo PhD,&nbsp;Judi Parson PhD","doi":"10.1111/ajr.13186","DOIUrl":"10.1111/ajr.13186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The predicted rise in weather-related disasters indicates that many Australian children and their families will be affected by these events in the future. Play therapy, an emerging profession in Australia, may provide valuable support to children exposed to these events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review was designed to map the existing literature and the role of the play therapist in supporting children (aged 3–12 years) and families following natural disasters, and to formulate a model to guide play therapists in the future.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A systematic search of the literature was performed and a total of 25 articles were identified as relevant to the role of the play therapist in response to natural disasters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Play therapists must be mindful of the different phases of natural disaster response and how their role may vary across these phases. In the early stages post-disaster, a play therapist may be involved in psychoeducation, facilitating therapeutic play and community involvement. More formal clinical play therapy interventions that focus on the individual child or family are better suited to the latter stages of disaster response. There is a need for further research into the impact of natural disasters on children and families and interventions that aid mental health and well-being, especially for children who may be more vulnerable and potentially overlooked in the wake of such disasters. Further research is also needed into the effectiveness of play therapy as a post-disaster intervention for children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"877-889"},"PeriodicalIF":1.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301516","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":"Key success factors in implementing allied health outreach services","authors":"Julie Cullenward B.Appl.Sci(OccTher),&nbsp;Lisa Hall B.Appl.Sci(SpeechPath),&nbsp;Amanda Cook B.Appl.Sci(OccTher),&nbsp;Donna Ambler MA(OrgComm),&nbsp;Brittany Cleary MA(SocialImpact),&nbsp;Tim Smith,&nbsp;Matt Thomas PhD(ClinPsych)","doi":"10.1111/ajr.13183","DOIUrl":"10.1111/ajr.13183","url":null,"abstract":"&lt;p&gt;Clinicians who provide outreach services to remote communities often encounter barriers to engaging with local people.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Factors contributing to poor engagement include unwelcoming health settings, inflexible approaches to service delivery, a sense of alienation, poor understanding of services and referral pathways, long wait lists, inadequate care coordination and mistrust of mainstream health care.&lt;span&gt;&lt;sup&gt;1-3&lt;/sup&gt;&lt;/span&gt; However, there are effective ways of working with people in remote communities, which can build trust and authentic engagement.&lt;span&gt;&lt;sup&gt;4-6&lt;/sup&gt;&lt;/span&gt; This article provides a case study that highlights some key success factors that enabled engagement, and positive outcomes and experiences for people needing to access health and disability services in a remote community.&lt;/p&gt;&lt;p&gt;In 2023, our organisation was approached by Birrang Enterprise Development to provide Allied Health (Occupational Therapy [OT] and Speech Pathology [SP]) services in a remote rural community in NSW. Our approach to developing and delivering our clinical outreach services was drawn from the Wobbly Hub Rural and Remote Person-Centred Approach model.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; This model enables people in remote communities to access the health and disability services they want and need by first asking ‘What would make a good life?’&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; In summary, our Allied Health clinicians used this model to take a flexible person-centred approach with each person seeking a service and sought to understand what existed locally, what the outreach service brings, what we travel for and what can be accessed online.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Prior to implementing outreach services, our approach first focused on engaging at an organisational level with local service providers and leaders to clarify the local needs, budget available and agree on the scope of the outreach service to be delivered, through a codesign process.&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; This was an important first step that established the scope and expectations of the Allied Health outreach service and enabled our clinicians to maximise the effectiveness of their work within the community using the principles of the Wobbly Hub model.&lt;/p&gt;&lt;p&gt;Our Allied Health clinicians travelled to the community across two phases. In Phase 1, outreach clinicians conducted two visits to the remote community. In these first two visits, the outreach clinicians met with the clients who were referred (children and adults, hereafter referred to as person we are working with, or person/people). The clinicians had conversations in which each person identified what they wanted to talk about. The clinicians aimed to build rapport and trust by listening and respecting the person and asking what they wanted or needed to do.&lt;span&gt;&lt;sup&gt;7, 8&lt;/sup&gt;&lt;/span&gt; The outreach clinicians made a plan with each person for ‘What's next’. This was documented in a one-page easy English Assessment Sum","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"1072-1075"},"PeriodicalIF":1.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301513","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":"Building the private practice workforce in the Northern Territory: Barriers and facilitators for implementation of the allied health assistant role","authors":"Lori Roberts MPH,&nbsp;Bea Staley PhD,&nbsp;John Callanan PhD,&nbsp;Kristy Logan PhD","doi":"10.1111/ajr.13187","DOIUrl":"10.1111/ajr.13187","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To identify barriers and facilitators contributing to the successful implementation of the allied health assistant role in private disability practice to better meet population needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative case study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>This study was completed with staff working in private disability practices in a regional context in the Northern Territory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Eight participants were interviewed, including three allied health assistants, three allied health professionals, and two managers with allied health backgrounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More barriers were reported than facilitators, with four key themes identified. Financial risk was a barrier when employing allied health assistants. This risk was mediated by providing part-time employment or having allied health assistants in dual roles. Reduced confidence from allied health professionals and assistants to complete delegation work was the second barrier. A facilitator was increasing allied health assistants' task variation, which participants reported increased retention. Finally, a positive working relationship between allied health professionals and assistants facilitates delegation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This research offers private disability providers insight into the realities of employing an allied health assistant. It also suggests that formal training programs for both allied health assistants and professionals require increased focus on delegation in the private disability sector. On a government level, a review of the NDIS price guide for allied health assistant rates is needed if private providers are to better meet the requirements for NDIS participants in regional areas.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 6","pages":"1173-1184"},"PeriodicalIF":1.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11640188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301512","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":"Pandemic impacts on rural general practice: Trainees and supervision team working and learning together","authors":"Kay Brumpton MClinEd,&nbsp;Nancy Sturman PhD,&nbsp;Megan O'Shannessy MPH,&nbsp;Christy Noble PhD,&nbsp;Stephen Billett PhD","doi":"10.1111/ajr.13185","DOIUrl":"10.1111/ajr.13185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the impact of COVID-19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Twenty-three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Audio-recorded semi-structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"1054-1061"},"PeriodicalIF":1.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301514","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":"International declaration on rural mental health research: 10 guiding principles and standards","authors":"Russell Roberts PhD,&nbsp;Sarah-Anne Munoz PhD,&nbsp;Karla Thorpe MSc,&nbsp;Hazel Dalton PhD,&nbsp;Leith Deacon PhD,&nbsp;David Meredith PhD,&nbsp;Mark Gussy PhD,&nbsp;Steve F. Bain DMin,&nbsp;Christian Swann PhD,&nbsp;Maria Lindstrom MSc,&nbsp;Jordi Blanch MD, PhD,&nbsp;Annette Beautrais PhD,&nbsp;Helene Silverblatt MD,&nbsp;Luis Salvador-Carulla PhD, MD,&nbsp;Finola Colgan BA, LLB, LLM,&nbsp;Tammy D. Heinz MSc,&nbsp;David Perkins PhD,&nbsp;Sean Russell MBA,&nbsp;Laura Grattidge MPH","doi":"10.1111/ajr.13167","DOIUrl":"10.1111/ajr.13167","url":null,"abstract":"<p>Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per-capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social-service-environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well-being of rural communities.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 4","pages":"611-616"},"PeriodicalIF":1.9,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082677","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":"Efficiency considerations for acute surgical units in rural and regional Australia","authors":"Gavin J. Carmichael BSc,&nbsp;Joshua G. Kovoor MS,&nbsp;Win Le Shwe Sin Ei MPH,&nbsp;Thiep Kuany MD,&nbsp;James Stafford May MD (Dist.),&nbsp;Alexander Beath MD,&nbsp;Yasser Arafat FRACS,&nbsp;Mathew O. Jacob FRACS","doi":"10.1111/ajr.13179","DOIUrl":"10.1111/ajr.13179","url":null,"abstract":"","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"1084-1086"},"PeriodicalIF":1.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005987","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":"Who is suited to work in remote First Nations health? Perspectives of staff in remote Aboriginal Community-Controlled Health Services in northern Australia","authors":"Lisa Bourke PhD,&nbsp;Noha Merchant BSc,&nbsp;Supriya Mathew PhD,&nbsp;Michelle Fitts PhD,&nbsp;Zania Liddle MEd,&nbsp;Deb Russell PhD,&nbsp;Lorna Murakami-Gold MEd,&nbsp;Narelle Campbell PhD,&nbsp;Bronwyn Rossingh PhD,&nbsp;John Wakerman MBBS, MTH, FACRRM, FAFPHM, DSc h.c.","doi":"10.1111/ajr.13175","DOIUrl":"10.1111/ajr.13175","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is a shortage of nurses, Aboriginal Health Practitioners, GPs and other staff in remote Australian health clinics. There is also high turnover of staff, leading to questions of ‘who’ is appropriate for remote First Nations practice? The aim of this paper was to identify the characteristics of staff who are likely to work well in remote First Nations settings, from the perspectives of remote health practitioners.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This is a qualitative study involving content analysis of interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The study is conducted in and with 11 Aboriginal Community Controlled Health Services across northern and central Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Eighty-four staff working in these clinics who spoke about staff qualities suited to remote practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants identified a range of qualities desirable in remote practitioners, which were grouped into three topics: (1) professional qualifications and experience, including cultural skills; (2) ways of working, including holisitic approach, resilience, competence, and being a team player, approachable, flexible and hard-working; and (3) specific community needs, namely the need for local First Nations staff, male practitioners and returning short-term staff. The combination of experiences, ways of working, and fit to both the team and community were emphasised.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Identifying the characteristics of staff who are likely to work well in these settings can inform recruitment strategies. This study found that a combination of professional qualifications, skills and experience as well as ways of working, individual characteristics and needs of communities are desirable for working in remote, First Nations settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"1008-1017"},"PeriodicalIF":1.9,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918195","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":"A cross-sectional study assessing concordance with advance care directives in a rural health district","authors":"Dan Curley MBBS,&nbsp;Leigh Kinsman PhD,&nbsp;Graeme Mooney MSW,&nbsp;Gail Whiteford PhD,&nbsp;Tony Lower PhD,&nbsp;Megan Hobbs PhD,&nbsp;Beverley Morris BN,&nbsp;Kerry Bartlett BHSc,&nbsp;Alycia Jacob BL","doi":"10.1111/ajr.13166","DOIUrl":"10.1111/ajr.13166","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural Australian coastal district.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure(s)</h3>\u0000 \u0000 <p>Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of ‘unacceptable interventions’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-eight people met the inclusion criteria (age range of 46–92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (<i>n</i> = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with ‘unacceptable interventions’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These results demonstrate strong compliance with rural patients' requests in ACDs, particularly ‘unacceptable interventions’. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"969-975"},"PeriodicalIF":1.9,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914586","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":"Rural unpaid caregivers' experiences in northern Aotearoa, New Zealand during the Covid-19 pandemic: A qualitative study","authors":"Rosemary Frey PhD,&nbsp;Janine Wiles PhD,&nbsp;Deborah Balmer PhD,&nbsp;Pare Meha PhD,&nbsp;John Parsons PhD,&nbsp;Mary Simpson PhD,&nbsp;Vanessa Burholt PhD","doi":"10.1111/ajr.13173","DOIUrl":"10.1111/ajr.13173","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Rural unpaid caregivers experience different opportunities and challenges than their urban counterparts. Our aim was to understand rural unpaid caregivers' experiences of challenges and opportunities during the Covid-19 pandemic in New Zealand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural northern New Zealand during the Covid-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>A convenience sample of 10 unpaid rural caregivers, most supporting an older person living with dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative descriptive design. Data included interviews and online workshops, and a thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Rural unpaid caregivers observed that some aspects of living in a rural context were helpful during the Covid-19 pandemic. However, tasks such as shopping and long-distance travel and communication (both telephonic and digital) became more complex. Abrupt changes to routine and closure of resources and support groups created challenges. Unpaid caregivers worried about what would happen if they were hospitalised themselves. There was a diversity of experience both across caregivers, of familiar routines and rural context as resources, increased challenges requiring resourcefulness to adapt, and experiences of crisis. Many experienced all three states at different times.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This research provides valuable insights into challenges and opportunities experienced by rural unpaid caregivers during the Covid-19 pandemic and may help policy-makers and healthcare professionals develop improved emergency preparedness. Multilevel, multisector responses are needed to ensure effective health and social support and access to resources including health care, access to groceries and medication, transport, and communications (telephone and digital). Enhancing rural access to effective and inexpensive online services is particularly important, as is recognition of the value of rural sites or hubs of connection and social interaction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"32 5","pages":"996-1007"},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.13173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861682","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}