Australian Journal of Rural Health最新文献

{"title":"Supporting Rurally Dwelling Adults With Disabilities: The Experiences of Staff From Two Organisations in Western Australia During the COVID-19 Pandemic","authors":"Zoe Lawrence-Haughey,&nbsp;Monica Moran,&nbsp;Rohan Rasiah,&nbsp;Barbara Nattabi","doi":"10.1111/ajr.70023","DOIUrl":"https://doi.org/10.1111/ajr.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The COVID-19 pandemic had a disproportionate impact on people with disabilities and people living in rural areas, worsening pre-existing inequalities. The objective of this study was to explore the experiences of disability support staff providing support to people with disabilities in rural Western Australia during the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The two disability support organisations were located in a large rural town in Western Australia, approximately 400 km north of Perth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Eleven employees from the organisations were recruited mid-2022 using non-random purposive sampling. Most participants were over the age of 40, two-thirds of the participants were female, and over half worked part time. Approximately half of the participants were administration and management staff, and around half had started working with their organisations less than 2 years prior to the research during the COVID-19 pandemic in 2020. Two participants were recruited from one organisation, and the remaining nine participants were recruited from the other.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>This qualitative study was conducted using semi-structured in-depth interviews. Three individual interviews and two group interviews were conducted via video-call software. Reflexive thematic analysis was used in data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four major themes were identified: (1) burden of the pandemic, (2) difficulties with government pandemic response, (3) unclear work boundaries and difficult choices and (4) adapting to COVID-19. Participants reported several positive outcomes of the pandemic, including increased service innovation and an improved sense of community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Future pandemic response could be improved by early consultation with the disability sector, utilisation of appropriate communication channels and anticipation of challenges unique to rural Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530415","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":"Community Rehabilitation for Rural and Remote Australia: Measuring What Matters Based on the International Classification of Functioning, Disability and Health (ICF): A Scoping Review","authors":"Alice Cairns,&nbsp;Ruth Barker","doi":"10.1111/ajr.70017","DOIUrl":"https://doi.org/10.1111/ajr.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review the quantitative outcome measures that have been used to evaluate community rehabilitation services delivered across rural and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A scoping review was completed and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Peer-reviewed, original research published between January 2010–September 2023 was searched using MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Cochrane database, Joanna Briggs Library, PsychINFO, Web of Science and Google Scholar. Studies were selected if they involved allied health outpatient, subacute or nonacute services for Australian rural or remote dwelling populations. Participants were required to have an underlying impairment. Face-to-face or telehealth delivery <i>in</i> a rural and remote location was included. Measures were identified and then mapped to the ICF domains of activity and participation, as well as quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 27 studies were included that yielded 40 different outcome measures of activity, participation and/or quality of life. Few measures, however, were used consistently across studies, and even fewer demonstrated a significant change across more than one study. Most studies evaluated single interventions, and few studies evaluated the service model as a whole.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To ensure robust evaluation of community rehabilitation services in rural and remote Australia, a core data set and common framework for evaluation of community rehabilitation services is required. The evaluation framework must ensure consistency in measurement that reflects rural and remote service models and takes into account the environment in which services are delivered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143513777","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":"Child Development Allied Health Services in Rural and Remote Areas: A Systematic Scoping Review of Drivers, Barriers and Enabling Strategies to Delivery of Services","authors":"Georgia Gosse,&nbsp;Saravana Kumar,&nbsp;Helen Banwell,&nbsp;Anna Moran","doi":"10.1111/ajr.70010","DOIUrl":"https://doi.org/10.1111/ajr.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Access to child development allied health services is challenging in rural and remote areas. A companion review has described the types of models of care that are used to deliver these services and their impact on the quality of healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This review aimed to identify service drivers for, and barriers and enabling strategies to the delivery of these services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A scoping review was conducted in alignment with the Joanna Briggs Institute methodology and PRISMA methodology. Data from included citations were thematically organised to describe and connect drivers, enabling strategies and barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Twenty-five citations met the inclusion criteria. Six key drivers were identified, four key enabling strategies and five key barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Most models of care were driven by the need to address the inadequacy of child development allied health services. Place-based strategies were described by most citations as key to enabling the delivery of new models of care. However, understanding the community's capacity for a new model of care was a prominent barrier to implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Findings from this review highlight the complexities of devising and delivering new models of care for children in rural and remote areas with developmental needs. While place-based approaches were the most widely adopted enabling strategy, these strategies presented their own challenges. Understanding community needs, capacity and assets from end-user (including children) perspectives is complex but should underpin designing and implementing models of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475325","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":"Far From Help: Exploring the Influence of Regional and Remote Residence on Coastal Visitation and Participation, Risk Perception and Safety Knowledge and Practices","authors":"Ella G. Pratt,&nbsp;Amy E. Peden,&nbsp;Jasmin C. Lawes","doi":"10.1111/ajr.70018","DOIUrl":"https://doi.org/10.1111/ajr.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore how self-reported coastal visitation, participation, risk perception, safety knowledge, experiences and safety practices differed between regional and remote, and major city residents to inform remoteness-specific coastal drowning prevention efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used data obtained from the annual National Coastal Safety Survey from 2018 to 2023. Data were postweighted proportionally according to age, gender and Australian Statistical Geography Standard classification using 2021 census population data. Descriptive statistics and chi-square analyses were used to identify key differences in the behaviours, knowledge, and experiences of regional and remote respondents as compared to major city respondents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 14 210 respondents were included in this dataset. Regional and remote respondents were more likely to visit an unpatrolled beach, particularly when swimming/wading (<i>n</i> = 929, 42.3%; χ² = 502.14, <i>p</i> &lt; 0.001). However, similar proportions of regional and remote and major city respondents reported following safety practices on patrolled beaches. Regional and remote respondents were more likely to consider sea and weather conditions for all coastal activities, but there was little difference between remoteness groups regarding rip current identification, perceptions and experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This study demonstrates that future coastal safety research should consider the impact of remoteness to corroborate the findings of this study: that a significant contributor to the regional and remote drowning burden is a lack of access to patrolled beaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Regional and remote residents are more likely to frequent unpatrolled beaches but, if able to visit a patrolled beach, are just as likely as major city residents to adhere to safety practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481452","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":"Time to Re-Think Rural Medical Education? Challenges and Issues Raised in Planning Umeå University's ‘Rural Stream’","authors":"Dean Carson","doi":"10.1111/ajr.70021","DOIUrl":"https://doi.org/10.1111/ajr.70021","url":null,"abstract":"&lt;p&gt;The inspiration for this editorial comes from my involvement in the design of Umeå University's ‘rural stream’ in 2017/18 [&lt;span&gt;1&lt;/span&gt;]. The University had been delivering ‘non-metropolitan’ medical education in northern Sweden since 1959 [&lt;span&gt;2&lt;/span&gt;]. The medical degree program was initially offered in the city of Umeå (which has grown from 40 000 to 80 000 residents since 1959), but since 2011 students could elect to do nearly half the degree in one of three other small cities in the north. Despite this long history of ‘rural’ medical education, northern Sweden continues to experience physician shortages, most acute in the smaller centres (typically 5–10 000 residents) which have only primary care services. The rural stream allows students to do clinical rotations in one of these centres while continuing classroom education in Umeå. Implementation of the rural stream has been hindered by the Covid19 pandemic, but there are early indications that students in the stream develop greater interest in both working in general practice and working in rural areas.&lt;/p&gt;&lt;p&gt;In developing the rural stream, we consulted rural medical education experts particularly from Australia and Canada where the longitudinal integrated clerkship (LIC) model has been a common feature since the early 2000s. The LIC model seems to produce graduates who are more likely to spend the early parts of their careers in rural general practice, although the evidence varies [&lt;span&gt;3&lt;/span&gt;]. As I reflected on the development of the rural stream, there were aspects of the LIC and associated rural medical education models in Australia and elsewhere which I found challenging from a long term workforce development perspective. I present some of those challenges here in the hope that they will inspire some critical thinking and contribute to continuous improvement in what we are doing about the global challenge of rural physician shortages. These reflections will also be of interest to other health professions, which likewise experience spatial maldistribution and which have their own (sometimes very longstanding) rural education models. I acknowledge from the outset that I am not an educationalist, and that the Swedish experience, with its focus on a particular kind of rural setting may or may not be of interest or relevance to a wider Australian audience.&lt;/p&gt;&lt;p&gt;Graduates of rural medical (and other health professional) education programs gravitate towards high amenity rural areas (as do most rural migrants), and/or limit their practice to regions where they grew up or where they were trained [&lt;span&gt;4, 5&lt;/span&gt;]. This entrenches a system of ‘have and have not’ rural communities, and leads at least to the temptation for educators to focus their efforts on the ‘haves’ where successful outcomes are more likely. The focus on ‘home-grown’ workforce [&lt;span&gt;6&lt;/span&gt;] presents an immediate demographic problem for smaller rural communities (who experience workforce shortages across multi","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475326","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":"Decennial Ward-Level Influence of Demographic, Farming, and Economic Predictors on All-Cause Mortality","authors":"Kelly Trearty,&nbsp;Brendan Bunting,&nbsp;John Mallett","doi":"10.1111/ajr.70016","DOIUrl":"https://doi.org/10.1111/ajr.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study has arisen in response to a lack of studies examining how farming affects mortality patterns across areas of Northern Ireland (NI) over a 10-year period. This paper aims to investigate whether agriculturally intensive electoral Wards have higher mortality rates compared to non-agriculturally based Wards, controlling for relevant factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The population census and farm census information was downloaded from the Northern Ireland Neighbourhood Service (NINIS) website to construct two original mortality-based datasets. Linear regression was used for the analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Decennial Ward-Level Influence of Demographic, Farming, and Economic Predictors on All-Cause Mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Five hundred and eighty-two Ward areas of Northern Ireland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure</h3>\u0000 \u0000 <p>Mortality risk within Ward areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Findings showed larger amounts of natural log of the population, 65 to 100+ year-olds, limiting long-term illnesses, Farming Intensity Scores, residents living alone and full-time workers within Wards were predictive of mortality risk within those Wards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study is the first of its kind in NI to provide evidence for Farming Intensity Scores explaining the variation of mortality rates between areas, in addition to many of the usual predictors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475756","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":"Management of Type I Diabetes Mellitus at a Rural Paediatric Diabetes Clinic","authors":"Kuangjun Li,&nbsp;Ann M. Maguire,&nbsp;Jacqueline Askwith","doi":"10.1111/ajr.70013","DOIUrl":"https://doi.org/10.1111/ajr.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Australia currently lacks a standardised paediatric diabetes care model. This study explores the model of care and outcomes of paediatric Type 1 diabetes mellitus (T1D) at a rural multidisciplinary paediatric diabetes clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cross-sectional study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A single centre quantitative study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A rural multidisciplinary paediatric diabetes clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients under 19 years old with a T1D diagnosis who attended the paediatric diabetes clinic for at least 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Baseline demographics, glycosylated haemoglobin (HbA1c) levels, time in range, clinic appointment adherence, and diabetes-related hospitalisations over a 12-month period from October 2021 to September 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-two patients, with a median age of 13.5 (IQR 7) years and 58% females, were included. Of the patients, 40% lived more than 50 km away from the diabetes clinic, 73% were on continuous subcutaneous insulin infusion, and 92% used continuous glucose monitoring. The median HbA1c was 8.3% (67 mmol/mol), with four patients (8%) achieving the international target HbA1c level of less than 7.0% (53 mmol/mol). The CGM users' average time in range was 54%. A total of 29 patients (56%) attended all annual clinic reviews. Six patients (12%) were hospitalised for diabetes-related complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Paediatric T1D managed in a rural multidisciplinary paediatric diabetes clinic, with experienced local clinicians and support from a tertiary centre, can attain outcomes in glycaemic control, clinic attendance, and diabetes-related hospitalisation comparable to those of large Australian metropolitan clinics. However, glycaemic outcomes remain suboptimal when compared to international standards.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475755","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 Medical Student Quality Improvement Projects in Health Care: A Scoping Review","authors":"Casey Stubbs,&nbsp;Bernadette Ward","doi":"10.1111/ajr.70009","DOIUrl":"https://doi.org/10.1111/ajr.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Across Australia, there is considerable variation in the quality of health care and the risk of associated complications. Hence, many patients are receiving poor-quality care. This may be exacerbated in rural and remote areas where the availability of health care is relatively limited. Addressing this requires a multipronged approach that supports the workforce. Involving medical practitioners in medical students' quality improvement (QI) scholarly projects may be one strategy to assist with bridging this gap. The aim of this review was to synthesise the evidence relating to medical students' compulsory curriculum-based quality improvement projects and associated practice outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Scoping review of peer-reviewed literature (January 2000–June 2024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 239 articles, six empirical studies from Australia, New Zealand, the UK and the USA were included. Half of these were based in community settings and the rest in hospitals. Only one was in a rural setting. The time allocated to projects was between 5 and 12 weeks. Five of the six studies reported that student project recommendations had been implemented. One study reported that the process enhanced doctors' adherence to best practice guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Much of the research about the outcomes of medical student curriculum-based projects focuses on research outputs. These relatively short student QI projects are one strategy to improve evidence-based practice while upskilling clinicians. Further work is needed to examine their impact, particularly in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Integrating medical students into ‘real-world’ QI health service projects can enhance the quality of health care whilst building the skills of the medical workforce.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466303","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 Australian Farming Community. A Preliminary Qualitative Investigation of Healthcare Provider's Perceptions of Risks/Barriers to Care","authors":"James Gunning,&nbsp;Kerri-Lynn Peachey,&nbsp;Tony Lower,&nbsp;Carlos Mesa-Castrillon","doi":"10.1111/ajr.70006","DOIUrl":"https://doi.org/10.1111/ajr.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Farmers are at higher risk of developing dementia due to occupational exposures throughout their lives. People living in regional and remote areas also have increased barriers to care compared with urban populations, while farmers face additional barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To explore the barriers to care and risks faced by farmers with dementia, from the perspectives of healthcare workers. This preliminary study also aims to explore the differences in barriers faced by farmers and non-farming rural populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seven participants from a range of health professions were interviewed in a semi-structured style to explore their experiences. The data were coded and analysed using a constructivist grounded theory approach to search for recurring themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six key themes emerged from the data: (1) barriers arising from typical farmer personality traits; (2) geographic isolation; (3) late diagnoses of dementia; (4) barriers to the provision of care on the farm; (5) on-farm risks; and (6) transition to residential aged care home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Farmers living with dementia on-farm may face significant barriers to care and risks to themselves and others compared to non-farm rural and urban populations. These additional barriers predominantly stem from increased geographic isolation and personality traits common to farming populations. However, there is potential for change to improve care provision through earlier diagnosis, more efficient service funding to enhance treatment availability and the use of residential aged care homes more suited to farmers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466304","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":"Examining the Effectiveness and Acceptability of Internet-Delivered Psychological Pain Management for Regional and Rural Australians With Chronic Pain","authors":"Blake F. Dear,&nbsp;Lauren Staples,&nbsp;Olav Nielssen,&nbsp;Nickolai Titov","doi":"10.1111/ajr.70008","DOIUrl":"https://doi.org/10.1111/ajr.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the characteristics, satisfaction levels and clinical outcomes of rural and remote Australians with chronic pain completing an internet-delivered psychological pain management program (PMP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Longitudinal routine care cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>An Australian national digital psychology service.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Patients in inner regional locations (<i>n</i> = 401), outer regional and remote locations (<i>n</i> = 198), and major cities (<i>n</i> = 968), who used the service over a 6-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Demographic and clinical data, patient-reported satisfaction and improvements, and meaningful clinical improvements (≥ 30% improvement).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Clinical improvements were observed from pre-treatment to post-treatment in pain-related disability (32% [95% CI: 29, 34]), depression symptoms (44% [95% CI: 39, 49]), anxiety symptoms (43% [95% CI: 39, 47]), and average pain intensity (23% [95% CI: 21, 26]), which were maintained to 3-month follow-up. High levels of satisfaction and treatment completion were also observed. Minor demographic and clinical differences were observed. However, there were similar rates of clinical improvement, treatment satisfaction and treatment completion in all groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The current findings further highlight the value of internet-delivered psychological PMPs for Australians with chronic pain living in regional and remote parts of the country. Further work is needed to raise awareness about the availability of these effective programmes and to integrate their use with traditional pain management services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424283","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}