Australian Journal of Rural Health最新文献

{"title":"Head and Neck Cancer Care Experiences of First Nations Australians: Insights From Patients and Carers","authors":"Stephanie Ng,&nbsp;Tamara Butler,&nbsp;Rebecca Packer,&nbsp;Joanne Tesiram,&nbsp;Lynette Koina,&nbsp;Kalisha Soe,&nbsp;Elizabeth C. Ward,&nbsp;Gail Garvey,&nbsp;Bena Brown","doi":"10.1111/ajr.70238","DOIUrl":"10.1111/ajr.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>There is a paucity of evidence exploring the experiences and care needs for First Nations Australians with head and neck cancer (HNC). The aim of the study was to explore the journey of HNC diagnosis, treatment, and early recovery for patients and carers to inform service improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting, Participants and Design</h3>\u0000 \u0000 <p>First Nations HNC patient and carer (<i>n</i> = 19) experiences were explored qualitatively through Yarning. Data was analysed using reflexive thematic analysis, with First Nations researcher involvement embedded in all stages of data collection and analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Key themes identified included: Strengths and protective factors; Coordination of care; Quality and continuity of care; Cultural safety; Communication and information; Cultural connectedness in hospital; and Gaps in health system support. The Strengths and protective factors theme was noted to be interwoven throughout the other themes and supported participants as a safety net during their care. Practical recommendations to the HNC care pathway were also offered under each theme.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The seven themes identified provided insights into the HNC care experiences for First Nations Australians. These findings and participant recommendations will inform a co-design process to create an optimised care pathway.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702928","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 Geography of Guardianship: A Rural Psychiatry Perspective on Decision-Making for Older Adults With Cognitive Decline","authors":"Petula Taara Hamer,&nbsp;Georgina Haysom,&nbsp;Linda Sheahan,&nbsp;Duncan George","doi":"10.1111/ajr.70239","DOIUrl":"10.1111/ajr.70239","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This commentary examines how guardianship legislation interacts with the practical realities of providing care to older adults with cognitive decline in rural New South Wales. It aims to highlight systemic inequities arising from geographic isolation, workforce limitations and medico-legal uncertainty, and proposes reforms that align guardianship practice with the principles of autonomy, dignity and supported decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Context</h3>\u0000 \u0000 <p>In Australia, substitute decision-making for adults lacking capacity is governed by state guardianship law and Commonwealth-aged care regulation. Although these frameworks are designed to protect vulnerable individuals, their implementation in rural hospitals is often constrained by access to Consultation-Liaison (CL) Psychiatry, restricted administrative support, and delayed access to tribunal processes. These pressures contribute to inconsistent interpretation of guardianship powers, prolonged hospitalisation, and uncertainty around restrictive practice. The Royal Commission into Aged Care Quality and Safety called for nationally consistent rights-based decision-making but did not fully address the unique barriers faced in rural settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Approach</h3>\u0000 \u0000 <p>Drawing on three illustrative clinical vignettes from a rural CL Psychiatry service, this commentary explores how legislative ambiguity and resource scarcity shape substitute decision-making in everyday clinical practice. The discussion integrates medico-legal analysis, CL Psychiatry perspectives and rural health literature to identify critical gaps in knowledge, access and coordination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Improving guardianship practice in rural hospitals requires investments in clinical education, streamlined medico-legal and psychiatric support, and coherent legislative alignment between state and Commonwealth frameworks. Addressing these inequities is essential to ensuring that the protections embedded in guardianship law translate into timely, person-centred care for older adults living in rural Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681206","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 Right to Have a Family Should Not Be Determined by Your Postcode’: Rural Community Experiences With Fertility Care","authors":"Amanda Mackay,&nbsp;Selina Taylor,&nbsp;Emma Anderson,&nbsp;Beverley Glass","doi":"10.1111/ajr.70237","DOIUrl":"https://doi.org/10.1111/ajr.70237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Women in rural and remote Queensland face greater challenges in accessing fertility care than those residing in large regional or metropolitan centres of Australia. This study aims to explore the experiences of women accessing fertility care while living in a rural or remote area of Queensland and their perspectives on ways to improve fertility care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Interviews were conducted either in-person (Townsville, Emerald, Cloncurry, Mount Isa), via telephone or Microsoft Teams.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Persons currently or previously accessing fertility care, while living rurally in Queensland, identifying as female at birth, being fluent in the English language, and aged 18 years or older participated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative semi-structured interviews, with data analysed via reflexive thematic analysis, were followed by a descriptive content analysis of participants' ideas for improving rural fertility care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two main themes with 18 sub-themes emerged from the data. Theme 1: experiences of participants in accessing and receiving fertility care, whilst living in a rural or remote area, and Theme 2: participants' perspectives on how to improve the fertility care experience in rural and remote areas. Residence in a rural or remote location added to the complexity of fertility-related experiences. Rural living influenced fertility knowledge and information access, the accessibility of services, fertility care choice, privacy and social support. Participants articulated strategies from the availability of local information hubs to policy changes aimed at mitigating fertility care postcode-related disadvantage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural and remote persons accessing fertility care have highlighted not only the challenges experienced but have proposed strategies to improve rural fertility care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148616964","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":"Research Capacity and Culture Development in Remote Central Australia","authors":"Allison Gray,&nbsp;Yasmin Watts,&nbsp;Alexandra Edelman,&nbsp;Supriya Mathew,&nbsp;Richard Johnson,&nbsp;Vishnu Khanal,&nbsp;Deborah Russell","doi":"10.1111/ajr.70230","DOIUrl":"https://doi.org/10.1111/ajr.70230","url":null,"abstract":"","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467128","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":"Hidden Capacity? Uncovering the Rural Australian Health Research Workforce Using National Census Data","authors":"Michelle Kersten,&nbsp;Karen Hayes,&nbsp;Susan Heaney","doi":"10.1111/ajr.70234","DOIUrl":"https://doi.org/10.1111/ajr.70234","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide the first national analysis of the distribution and professional composition of PhD-qualified health professionals across metropolitan, regional, rural and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Cross-sectional analysis of 2021 Australian Census data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Australia, classified by Modified Monash Model (MM) remoteness categories.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Health professionals reporting a doctoral-level qualification (PhD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Counts and proportions of PhD-qualified health professionals by MM category and occupation group; association between remoteness and PhD representation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Occupations were grouped into medicine, allied health, and nursing. Residential locations were mapped to MM categories. Descriptive statistics and linear regression examined distribution patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 21 510 PhD-qualified health professionals, 85% lived in metropolitan areas (MM1), with 3027 (14%) in regional, rural and remote communities and only 12 (&lt; 1%) in very remote areas (MM7). Medical practitioners comprised 61%, allied health 36% (predominantly psychology) and nursing 3%. Increasing remoteness was associated with reduced PhD representation (<i>β</i> = −0.0041, <i>p</i> = 0.011).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Research capacity is concentrated in metropolitan areas, yet a substantial base of PhD-qualified professionals exists in RRR communities. Targeted investment in funding, infrastructure and support could leverage this workforce to build sustainable rural health research capacity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467286","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":"Reflections on the Evolving Contribution of the Rural Health Multidisciplinary Training Programme","authors":"Xiang-Yu Hou,&nbsp;Pim Kuipers","doi":"10.1111/ajr.70235","DOIUrl":"10.1111/ajr.70235","url":null,"abstract":"&lt;p&gt;This Virtual Issue of the &lt;i&gt;Australian Journal of Rural Health&lt;/i&gt; brings together a collection of studies examining different dimensions of the Rural Health Multidisciplinary Training (RHMT) Programme. While each article addresses a specific aspect of the programme, collectively they provide valuable insights into the breadth of its contribution to rural and remote Australia.&lt;/p&gt;&lt;p&gt;The RHMT programme [&lt;span&gt;1&lt;/span&gt;] is a major Australian Government rural health workforce initiative designed to improve the recruitment and retention of medical, nursing, dental and allied health professionals in rural and remote Australia. It supports a national network of Rural Clinical Schools (RCSs), University Departments of Rural Health (UDRHs), rural dental training programmes and associated rural training infrastructure. After more than two decades of investment, the programme has established a strong foundation for rural training and research and has made an important contribution to rural workforce development and local health services capacity [&lt;span&gt;2&lt;/span&gt;]. Beyond workforce training, these funded organisations have also contributed to research, service development, community partnerships and regional capacity building. One of the most consistent observations across this Virtual Issue is the range of impacts reported.&lt;/p&gt;&lt;p&gt;As expected, there is strong evidence of benefits for students. Rural placements appear to support student learning, engagement and professional development, while also strengthening students' understanding of rural health practice and underserved populations [&lt;span&gt;3, 4&lt;/span&gt;]. Several studies suggest positive impacts on students' wellbeing, social connectedness and overall placement experience [&lt;span&gt;3, 5&lt;/span&gt;], while structured supervision and interprofessional learning activities further enhance student confidence, collaboration and reflective practice [&lt;span&gt;6, 7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Importantly, emerging scholarship within this collection also highlights how place itself may influence learning. Dharmaratne et al. [&lt;span&gt;8&lt;/span&gt;] propose the ‘HARD’ framework, suggesting that distinctive characteristics of rural training environments, including hands-on patient engagement, abundant clinical exposure, responsibility in patient care and exposure to diverse practice contexts, may contribute to the development of clinical reasoning and professional identity. Such work advances understanding not only of the outcomes of rural placements but also of the educational processes. These findings align with the broader argument advanced by Harvey et al. [&lt;span&gt;9&lt;/span&gt;] that place-based education and research contribute unique value to rural communities and health systems.&lt;/p&gt;&lt;p&gt;Several papers in this Virtual Issue also highlight the ongoing commitment of RHMT-funded centres to innovation and improvement. These include studies evaluating the impact of rural placements on students' perceptions and intentions regarding future rural practice","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457848","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":"Acceptability and Utility of a Virtual Reality Diabetes-Related Foot Disease Training Program for First Nations People: A Pragmatic Quasi-Experimental Case Series Study","authors":"Neil McMillan,&nbsp;Ancret Szpak,&nbsp;Zygmunt Szpak,&nbsp;Hannah Snelling,&nbsp;Joseph Agius,&nbsp;Cathy Loughry,&nbsp;Kristin Graham,&nbsp;Sara Jones,&nbsp;Tinarra Ataata,&nbsp;Kim Morey,&nbsp;Alex Brown,&nbsp;Robert Fitridge","doi":"10.1111/ajr.70233","DOIUrl":"10.1111/ajr.70233","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To test the utility and acceptability of a novel VR training tool for community health practitioners in assessing diabetes-related foot disease in Aboriginal and Torres Strait Islander people.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The VR program featured five virtual patient models and a range of interactive assessments covering essential clinical and triage skills.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Pragmatic quasi-experimental case series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The VR training program was completed in collaboration with three Aboriginal Community-Controlled Health Organisations in regional South Australia, with recruitment directed internally at each organisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Forty-one primary healthcare staff participated, of which 34 were matched on pre- and post-VR surveys and 20 completed at least three training scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Evaluation consisted of pre-test self-efficacy scores immediately prior to participants undergoing training, submission of post-test self-efficacy scores, the System Usability Scale, and Training Evaluation Inventory scores after completing all training modules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following completion of VR training, participants reported increased self-efficacy scores (<i>n</i> = 20) for performing key assessment and triage skills. User feedback (<i>n</i> = 39) demonstrated that participants generally agreed that the training user experience was engaging, acceptable, and of value for clinical education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Community health practitioners generally found the VR training tool acceptable, useful, and increased their self-confidence in assessing and managing diabetes-related foot disease for Aboriginal and Torres Strait Islander people, highlighting the potential of VR to upskill community practitioners.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70233","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148457900","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":"Dementia and Cognitive Impairment in the Farming Community. A Preliminary Qualitative Study of Carers' Perceptions of Risks and Barriers to Care","authors":"Patrick Golemo,&nbsp;Kerri-Lynn Peachey,&nbsp;Tony Lower,&nbsp;Carlos Mesa-Castrillon","doi":"10.1111/ajr.70231","DOIUrl":"10.1111/ajr.70231","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore the risks and barriers to care of informal carers of farmers living on-farm with dementia and cognitive impairment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven individual semi-structured telephone interviews were conducted between June and July 2025. Purposive sampling included carers to discuss their perceptions of caring for people with dementia living on farms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Qualitative study, grounded theory with iterative thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Informal carers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>Risks and barriers to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six themes were noted in the interviews: (1) Geographic isolation; (2) Physical hazards and farm responsibilities; (3) Interpersonal relationship conflict; (4) Inadequate government support; (5) Lack of local healthcare resourcing; and (6) Positive aspects of the farm environment. Participants discussed strategies for care, such as enlisting additional familial support. Some of these themes were unique to the farm context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Carers of farmers with dementia highlighted a combination of risks and barriers to care that often interact synergistically with each other, leading to unmet needs for care. Carers highlighted a need for tailored solutions to care in the unique farm context. Integrating the farm environment with accessible assistance off farm appeared to be a strong desire among carers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70231","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450683","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":"Experiences and Perceptions of Patient Watch, a Rural Telehealth Case Management Model, for Frequent Presenters to the Emergency Department: A Longitudinal Mixed Methods Study","authors":"Mary Malakellis,&nbsp;Anna Wong Shee,&nbsp;Laura Alston,&nbsp;Vincent L. Versace,&nbsp;Pheona Griffith,&nbsp;Jade Odgers,&nbsp;Kevin Mc Namara","doi":"10.1111/ajr.70232","DOIUrl":"10.1111/ajr.70232","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To evaluate: (1) patient experiences and perceptions of Patient Watch; and (2) the effect on emergency department (ED) presentations, healthcare use, quality of life and chronic illness care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Design&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A prospective longitudinal cohort study using a convergent-parallel mixed methods study design combining: (1) qualitative semi-structured interviews analysed using reflexive thematic analysis and (2) quantitative assessment of Quality of Life-8D, Patient Assessment of Chronic Illness, routinely collected ED clinical data and Patient Watch programme data.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Setting&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A large public health service delivering care across the home, community, aged care and hospital, serving a regional centre and small, medium and large rural towns in Western Victoria, Australia.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Participants&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Forty-five participants were enrolled in the study. A subsample who completed all study requirements enabled baseline and 6-month follow-up analysis (&lt;i&gt;n&lt;/i&gt; = 37).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Intervention&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patient Watch, a telehealth case management model of care adapted from a metropolitan to a rural context, to manage the care of frequent presenters to the emergency department.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Before enrolment, patients reported health system, medical and situational complexity hindered effective care and contributed to high treatment burden, with acute exacerbations leading to increased healthcare use and negative care experiences. Patient Watch improved perceived care coordination, healthcare access and helped participants manage acute exacerbations. ED presentations (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), hospital admissions (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), general practitioner (&lt;i&gt;p&lt;/i&gt; = 0.02) and specialist visits (&lt;i&gt;p&lt;/i&gt; = 0.01) decreased at follow-up.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cohort heterogeneity challenged the effectiveness of a standardised care model, and the evolving nature of Patient Watch complicated impact evaluation. Frequent presenters showed diverse clinical and demographic profiles with high treatment burdens, highlighting the need for tailored care.&lt;/p&gt;\u0000 &lt;/section&gt;","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70232","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426787","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":"Physician Assistants in Australia. Function and Friction in Australian Healthcare: An Integrative Review","authors":"Shannon Widderick,&nbsp;Amy-Louise Byrne,&nbsp;Tracy Flenady","doi":"10.1111/ajr.70226","DOIUrl":"10.1111/ajr.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Australia's ongoing healthcare workforce shortages have prompted exploration of alternative models of care. One such model is the Physician Assistant (PA), a role established and trialled internationally but inconsistently implemented in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective Design</h3>\u0000 \u0000 <p>To examine the role, function and professional positioning of PAs within the Australian healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Integrative review, guided by Whittemore and Knafl's (2005) framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Limited evidence of PA use in Australia was found. Of the identified literature, findings reveal that PAs have contributed across diverse clinical settings in Australia, including emergency departments, surgical units, and primary care, particularly in underserved and rural areas. Their scope of practice has spanned diagnostic, procedural, and care coordination roles, delivered under varying levels of medical supervision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There is limited evidence on the use of PAs in Australia. Despite some positive outcomes, significant barriers, such as professional resistance and concerns about patient safety, role ambiguity, and lack of national regulation, have hindered broader adoption.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426731","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}