Australian Journal of Rural Health最新文献

{"title":"Australian Rural Surgical Workforce: A Policy Analysis.","authors":"Gavin J Carmichael, Tyler Tranquille, Vanessa Di Tano, Annas Al-Sharea, Joshua G Kovoor, Mathew O Jacob","doi":"10.1111/ajr.70208","DOIUrl":"10.1111/ajr.70208","url":null,"abstract":"<p><strong>Aims: </strong>To analyse why rural health workforce initiatives have not delivered sustainable surgical services in rural and regional Australia, and to identify system-level policy changes that could improve access.</p><p><strong>Context: </strong>Nearly one-third of Australians live in rural or remote areas, however rural hospitals face shortages of general and specialist surgeons, have dependence on locums, and frequently use inter-hospital transfers. Despite national strategies aimed at rural workforce equity, surgical services remain highly variable by location and face difficulty in sustaining them.</p><p><strong>Sources: </strong>This analysis draws on federal and state workforce strategies, national policy documents including the National Medical Workforce Strategy and Stronger Rural Health Strategy, accreditation and workforce governance reviews from the Australian Government, published statements from professional bodies including the Royal Australasian College of Surgeons and the Australian Medical Association, and peer-reviewed literature on rural surgery, training pathways, and service delivery.</p><p><strong>Approach: </strong>We applied Walt and Gilson's health policy triangle (actors, content, context and process) to map power, accountability, and implementation pathways relevant to the rural surgical workforce. Actor influence and interest were further examined using a power-interest matrix.</p><p><strong>Conclusions: </strong>Responsibility for training, accreditation, funding, and service delivery is fragmented across federal, state, and professional actors, with no mechanism to enforce or coordinate rural surgical service provision. Current reforms rely on voluntary uptake by local champions. We propose three policy shifts: reframing rural surgical access around service delivery, a national rural surgical workforce authority, and a rural surgical data and accountability framework.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70208"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13162305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147876623","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 Time to Act Is Now: Strengthening Health Systems Research Capacity, Capability and Knowledge Translation in Remote Australia.","authors":"Alexandra Edelman, Sam Moore, Karrina DeMasi, Donna-Maree Stephens, Vahab Baghbanian, Chris Perry, Deborah Russell, Kalinda Griffiths, Leisa McCarthy, John Humphreys, John Wakerman","doi":"10.1111/ajr.70205","DOIUrl":"10.1111/ajr.70205","url":null,"abstract":"<p><strong>Context: </strong>Communities in remote Australia face poorer health outcomes but are largely recipients of services, programs and policies that are disconnected from local experiences and priorities, with some notable exceptions. Local-level research capacity, capability and knowledge translation that respond to community and service provider priorities are key to strengthening remote health systems.</p><p><strong>Aim: </strong>To explore two questions: (1) What is needed to strengthen health systems research capacity and capability in remote Australia? (2) How can we, as a community of remote health systems researchers, enhance knowledge translation in remote Australia to address persistent health disparities?</p><p><strong>Approach: </strong>Sixty-five remote health systems stakeholders, including service providers, funders, researchers, and policymakers participated in a research capacity building and knowledge translation workshop in Mparntwe (Alice Springs) in 2024. They identified actions to address barriers to remote health systems research and knowledge translation. We reflect on these to highlight opportunities for policy action and learning.</p><p><strong>Conclusion: </strong>Barriers to community and service-driven research have been recognised for decades, yet feedback from remote service providers and researchers suggests that little has changed systemically despite pockets of innovation. The time to act is now. Action must include creating funding schemes that provide for cohesive and sustained investment in remote-based health systems research partnerships that involve industry partners-especially Aboriginal Community Controlled Health Services (ACCHSs) to contribute to Closing the Gap in health outcomes. Partnerships must respond directly to community and service provider priorities, create Aboriginal and Torres Strait Islander researcher career pathways, and leverage respective partners' institutional strengths to create learning health systems. Individual ACCHSs' experiences and context-responsive principles for engaging with remote Aboriginal communities provide guidance and lessons for other services and researchers nation-wide.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70205"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943764","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":"Valuing Place in Rural Health Education and Research: The Contribution of University Departments of Rural Health.","authors":"Pam Harvey, James Debenham, Joanne Hutchinson, Leanne Brown","doi":"10.1111/ajr.70209","DOIUrl":"10.1111/ajr.70209","url":null,"abstract":"<p><strong>Aims: </strong>This commentary argues that University Departments of Rural Health (UDRHs) are integral to shaping distinct, contextually grounded value for rural communities and healthcare systems through their programs of place-based education and research.</p><p><strong>Context: </strong>For over two decades, the Rural Health Multidisciplinary Training (RHMT) Program has addressed rural healthcare inequities through a place-based approach to health education and research. UDRHs, funded under the RHMT Program, deliver academic activities for nursing, midwifery and allied health students and clinicians, including placements, promoting rural health careers and conducting research relevant to their regions.</p><p><strong>Approach: </strong>This commentary draws on recent evidence of the value of place-based training and research for rural Australia. Place-based education is where the integration of concepts such as connection to and engagement with place supports the preparation of health professions students for the complexity of rural healthcare. Place-based research contributes contextually situated evidence that informs the ongoing development of healthcare education and service delivery. Together, these concepts can be understood as shaping the conditions for high quality, rurally relevant program delivery.</p><p><strong>Conclusion: </strong>The RHMT Program remains a cornerstone of rural health workforce policy. Its renewal is likely to reinforce the value of contemporary educational, clinical, and research practices for the benefit of people living in rural Australia. Extending the role of UDRHs to target retention strategies has the potential to increase connection and responsiveness to the healthcare needs of rural communities.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70209"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935699","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":"Development of an Illustrative Conceptual Model to Promote Rural Research Capacity Building Efforts by Embedded Researchers.","authors":"Carol J Reid, Kristen Glenister, William Wallace, Ruth Glanville, Jennifer Keast, Lucinda Aberdeen, Lisa Bourke","doi":"10.1111/ajr.70225","DOIUrl":"10.1111/ajr.70225","url":null,"abstract":"<p><strong>Problem: </strong>The Rural Health Academic Network aims to build research capacity through partnering with rural health services. However, describing its work and achievements is difficult. This paper presents the development of an illustrative conceptual model (the model) to promote the Network within rural healthcare.</p><p><strong>Setting: </strong>The Network was introduced by a university department of rural health in 2006. Currently, research coordinators are embedded in four rural health services in northern Victoria, Australia.</p><p><strong>Measures for improvement: </strong>The model development was informed by an established checklist for reporting Theory of Change concepts in public health interventions.</p><p><strong>Strategies for change: </strong>Commencing in 2021, collaborative, interdisciplinary group discussions initiated the model design. These involved the research coordinators and university supervisors.</p><p><strong>Effects of change: </strong>The model describes the 'what' and 'how' of the Network, conceptualised through strategies, outputs, expected outcomes (short, medium, long-term), and desired impacts. Examples from the four sites emphasise the diverse contexts, the importance of partnerships and collaboration, and the dynamic nature of the work.</p><p><strong>Lessons learnt: </strong>Sharing the development of the model highlights the benefits of applying a common understanding of building research capacity. It acknowledges the challenges of reporting impact as a rural research collective involving multiple unique sites.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70225"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280046","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":"Barriers and Challenges of Undertaking Patient Safety Reviews in Rural Health Services: A Qualitative Study.","authors":"Yinghua Yu, Mia Bierbaum, Charlotte J Molloy, Lorelle Bowditch, Alastair Newton, Kahlia Liston, Nicholas Minns, Peter D Hibbert","doi":"10.1111/ajr.70212","DOIUrl":"10.1111/ajr.70212","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the barriers and challenges that affect the efficiency and effectiveness of patient safety reviews in rural healthcare services and proposes co-designed improvement strategies.</p><p><strong>Setting: </strong>Rural health services in four Australian states and territories.</p><p><strong>Participants: </strong>Health service staff working in rural Australia.</p><p><strong>Methods and design: </strong>We used a descriptive qualitative design. Data were drawn from a broader project that explored health service staff's perspectives on patient safety reviews. Participants of the focus groups were recruited from health services across four states and territories. Findings were thematically analysed and then informed co-design workshops that developed strategies to strengthen reviews.</p><p><strong>Results: </strong>Findings show that (1) Health service staff often lack adequate oversight, monitoring and support due to the wide geographic spread of facilities, limited staffing, and resources. (2) Cross-border reviews and reliance on locum doctors and Visiting Medical Officers (VMOs) increase administrative complexity, particularly in their engagement with review interviews and the development and implementation of recommendations. (3) Rural health services frequently lack access to external subject matter experts (SMEs) and consumer representatives on review teams. When external SMEs are involved, they bring subject expertise, but they may not be familiar with rural healthcare contexts. There are limited internal SMEs to draw on due to small and close communities and potential conflict of interests risks a lack of diverse perspectives. Nurses are often the people who coordinate patient safety reviews and follow up implementation. However, their ability to influence doctors or drive broader changes was described as limited, particularly given ongoing workforce shortages and hierarchical dynamics. (4) Rural health services are further constrained by logistical challenges and resource constraints such as outdated facilities and diagnostic methods.</p><p><strong>Conclusion: </strong>This paper highlighted key barriers to patient safety reviews in rural health services including resource limitations, workforce shortages, reliance on locums and VMOs and the challenges of dispersed facilities.</p><p><strong>Patient or public contribution: </strong>Patient and public engagement was integrated into the design and delivery of the study. A panel of six consumers served as an advisory committee, assisting with framing research questions and offering their insights from working with health services staff on the review teams.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70212"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977434","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":"Implementation and Evaluation of Clinical Telepharmacy Services for Regional Hospital Inpatients: A Pilot Study in the Riverland Mallee Coorong Local Health Network in South Australia.","authors":"Anna Fletcher, Kylie Poon, Jennifer Pink, Karen Macolino, Sally Marotti","doi":"10.1111/ajr.70222","DOIUrl":"10.1111/ajr.70222","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical effectiveness, operational efficiency, and stakeholder satisfaction of telepharmacy compared to face-to-face pharmacist reviews in regional hospital sites in South Australia.</p><p><strong>Design: </strong>Quantitative observational cohort study using service activity data and structured survey feedback.</p><p><strong>Setting: </strong>Two spoke hospitals and a central hub hospital within the Riverland Mallee Coorong Local Health Network in South Australia.</p><p><strong>Participants: </strong>Hospital inpatients reviewed by a clinical pharmacist during face-to-face visits (n = 39) and via telepharmacy (n = 21), along with nursing staff and patients who provided feedback.</p><p><strong>Methods: </strong>Data were collected on cohort sizes, pharmacist travel time, review timing, number of clinical interventions, and patient risk stratification. Patient and staff feedback was gathered using structured surveys.</p><p><strong>Main outcome measures: </strong>The pilot assessed clinical activity, time efficiency, intervention rates, and patient risk profiles. Survey responses were analysed for satisfaction and perceived value.</p><p><strong>Results: </strong>More patients were seen face-to-face than via telepharmacy (5.7% vs. 3.6%), and face-to-face reviews occurred sooner after admission (median 61 h (IQR 24.1-162) vs. 72.6 h (IQR 48.1-121.9)). A significant proportion of high-risk patients were seen via telepharmacy (42.9%), and more clinical interventions were made per patient with telepharmacy than face-to-face (median 6 (IQR 2-8) vs. 1 (IQR 0-2)). Patient feedback was positive, with 92.3% reporting no dislikes. Nursing staff were mostly satisfied, though some preferred face-to-face interactions.</p><p><strong>Conclusion: </strong>Telepharmacy is a feasible model for regional medication review, enabling prioritisation of high-risk patients and clinical pharmacist interventions. Further research into barriers and enablers is required to support its continued use and broader implementation.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70222"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296817","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":"Co-Designing and Evaluating a Suicide Prevention Workshop for General Practice and Community Staff in Rural South Australia.","authors":"Megan Rattray, Elaine Leung, Adrian Waye, Tania Shelby-James","doi":"10.1111/ajr.70200","DOIUrl":"10.1111/ajr.70200","url":null,"abstract":"<p><strong>Objective: </strong>To co-design, deliver and evaluate a suicide prevention workshop aimed at improving the knowledge, skills and confidence of general practice and community staff in rural South Australia.</p><p><strong>Setting: </strong>A 2.5-h in-person workshop was delivered across three rural communities on the Eyre Peninsula, Australia.</p><p><strong>Participants: </strong>Sixty-seven individuals attended the workshop. Of these, 61 completed a pre- and post-workshop survey (91% response rate). Participants who completed the survey included practice staff (n = 27), mental health or psychosocial support workers (n = 18), community volunteers (n = 6), suicide prevention network representative (n = 4) and other (n = 6).</p><p><strong>Method: </strong>The design of the workshop was guided by Participatory Action Research principles and underpinned by the Double Diamond model. The workshop was co-designed by a multidisciplinary advisory group, including two individuals with lived experience. The objectives of the workshop were to help attendees to: (1) recognise verbal and non-verbal warning signs of suicidal ideation, (2) respond effectively to provide immediate support and (3) connect individuals with appropriate referral services. A mixed-methods pre-post survey assessed changes in participants' confidence, knowledge and skills aligned with these objectives, along with their perceptions of the workshop. Pre- and post-workshop responses were compared using the Wilcoxon Signed-Rank Test, with statistical significance set at p < 0.001. Open-ended survey responses were analysed using a combination of deductive and inductive content analysis.</p><p><strong>Results: </strong>Statistically significant improvements were observed across all evaluation items from pre- to post-workshop, with the greatest gains in recognising subtle behavioural or emotional changes (1.25 points mean difference) and feeling skilled in knowing what services to recommend (1.28 points mean difference). Participants also reported high satisfaction (4.6 ± 0.73) and found the content highly relevant to their roles (4.5 ± 0.78). Content on referral pathways, local services and strategies for responding to suicidal ideation was identified as the most impactful. Including deeper coverage of culturally safe approaches for First Nations people, greater discussion around the differences among genders in the experiences of suicidality and more detailed exploration of specific mental health conditions and self-care strategies for staff were suggested as enhancements.</p><p><strong>Conclusion: </strong>The co-designed workshop effectively enhanced suicide prevention capabilities among frontline and community staff. Its success highlights the value of locally tailored, collaborative training that integrates lived experience and responds to community-specific needs. This model offers a scalable framework for workforce development in suicide prevention.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70200"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790016","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":"Characteristics and Geographical Work Location of Early Career Nursing and Allied Health Practitioners Following a Rural Placement: Results From a Post-Graduate Survey.","authors":"Robyn McNeil, Trish Thorpe, Lisa Bourke","doi":"10.1111/ajr.70206","DOIUrl":"10.1111/ajr.70206","url":null,"abstract":"<p><strong>Objective: </strong>To describe the characteristics and geographical work locations of early career nursing and allied health practitioners who undertook a rural placement.</p><p><strong>Design: </strong>This study used quantitative data from a longitudinal survey design with students who consented to be involved in the longitudinal study after completing their rural placement. These students are followed up every 2 years after their rural placement.</p><p><strong>Participants: </strong>Nursing and allied health graduates working in their discipline of qualification (n = 706).</p><p><strong>Main outcome measure: </strong>The main outcome measure was health professionals work location: rurally based, doing some rural work (e.g., outreach) or metropolitan based.</p><p><strong>Results: </strong>Multinomial regression results indicated that rural origin, older age and nursing professionals were statistically significant predictors of being rurally based in recently graduated health professionals. Nurses were 1.7 times more likely to work rurally compared to allied health professionals. For some allied health disciplines, around one third of the respondents were rurally based up to four years after graduation, ranging from 17% for psychology to 52% for social work. Collectively, allied health professionals were more likely to be providing 'some rural work' compared to nursing professionals, and over 20% of occupational therapists, speech pathologists and psychologists responding to the survey were employed to 'do some rural work'.</p><p><strong>Conclusion: </strong>This study provided preliminary insights into work locations of early career allied health and nursing workforces following a rural placement. Findings suggest there is complexity to understanding the impact of a rural placement given the various factors involved, including rural background, age at graduation, available rural work opportunities and options for providing outreach to rural areas. This study highlighted the importance of rural origin, the need to support mature age students and the variation in allied health disciplines in the extent they practice rurally or provide some rural outreach. Continued follow-up of these professionals over time may help to identify key determinants of health professionals' workplace locations.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70206"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846665","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":"Evaluation of a Collaborative Telehealth Model for Eye Care Between Ophthalmology and Optometry in Western Australia.","authors":"Jingyi Chen, Khyber Alam, Stephen E Bartnik, Sharon A Bentley, Allison M McKendrick, Sandra C Thompson, Angus W Turner","doi":"10.1111/ajr.70203","DOIUrl":"10.1111/ajr.70203","url":null,"abstract":"<p><strong>Objective: </strong>Recent advances in technology and the impact of COVID-19 have expanded the adoption of digital health. Synchronous collaborative telehealth between optometry and ophthalmology has been used to expedite specialist eye care in Western Australia since 2011. Optometrists perform an in-person assessment and participate in videoconferencing with ophthalmology to facilitate shared decision-making. This study utilises existing implementation theory to assess factors influencing implementation success, sustainability and scalability of this telehealth model.</p><p><strong>Setting: </strong>Regional, rural, and remote Western Australia.</p><p><strong>Design: </strong>In-depth interviews were undertaken using an interview guide based on the Consolidated Framework for Implementation Research (CFIR). Deductive analysis was used to code themes to the framework, and inductive analysis was used for themes relating to sustainability and scalability.</p><p><strong>Participants: </strong>Sixteen clinical and non-clinical staff with experience in telehealth for eye care in rural Western Australia.</p><p><strong>Results: </strong>Key themes identified using the CFIR included the relative advantage of telehealth (innovation), optimising workflow and role clarification (implementation process), funding (external setting), technological infrastructure (inner setting), a champion, and ownership and adaptability (individuals). Stakeholder buy-in, resource allocation, integration into public health infrastructure, asynchronous telehealth, and artificial intelligence were themes pertaining to both sustainability and scalability.</p><p><strong>Conclusion: </strong>This study proposes key considerations in the implementation and maintenance of a collaborative telehealth model for eye care in rural areas which may be used as a basis for guideline development or to replicate the model in other contexts.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70203"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Pragmatic Co-Design Processes in a Resource-Constrained Regional Health Service: Insights From the TROPICAL-VIC Early Referral to Palliative Care Project.","authors":"Stacey Ann Rich, Jennifer Philip, Annie Williams, Anna Griffith, Kathleen Wilkins, Chi Li, Christopher Steer, Diane Davey, Michelle Hensel, Nicole Webb, Tanya Dawe, Craig Underhill","doi":"10.1111/ajr.70224","DOIUrl":"10.1111/ajr.70224","url":null,"abstract":"<p><strong>Objective: </strong>To describe an evidence-informed, experience-based co-design process used to adapt metropolitan early palliative care referral models for implementation in a regional Australian health service.</p><p><strong>Methods: </strong>A scoping review of palliative care delivery and early referral models to inform evidence-informed, experience-based co-design workshops involving consumers, clinicians, and health service staff.</p><p><strong>Design: </strong>Sequential mixed-methods development study comprising evidence synthesis to identify model components, followed by two iterative workshops to construct and refine a context-appropriate outpatient early referral model.</p><p><strong>Setting: </strong>A regional public health service in Victoria, Australia, seeking to establish an outpatient early referral palliative care clinic for people with advanced cancer.</p><p><strong>Participants: </strong>Purposefully sampled stakeholders (patients/carers, oncologists, palliative care clinicians, cancer care coordinators, Aboriginal health worker, managers, and researchers) took part in two online workshops.</p><p><strong>Main outcome measures: </strong>Co-designed model structure and components, perceived feasibility in a resource-constrained regional context, and agreed service scope and patient eligibility.</p><p><strong>Results: </strong>The process generated a regionally tailored early referral pathway incorporating needs-based screening, prioritisation to manage limited capacity, and staged roll-out initially focused on selected cancer groups. These adaptations, while pragmatic, highlight the resourcing disparities faced by rural and regional services and the equity implications of resource-driven variation in care delivery.</p><p><strong>Conclusions: </strong>Evidence-informed co-design enabled pragmatic adaptation of metropolitan palliative care models to a regional setting and offers a transferable approach for other rural and regional services.</p>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"34 3","pages":"e70224"},"PeriodicalIF":2.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284940","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}