Australian Journal of Rural Health最新文献

{"title":"Implementation of A New, Mobile Diabetic Retinopathy Screening Model Incorporating Artificial Intelligence in Remote Western Australia","authors":"Qiang Li,&nbsp;Jocelyn J. Drinkwater,&nbsp;Kerry Woods,&nbsp;Emma Douglas,&nbsp;Alex Ramirez,&nbsp;Angus W. Turner","doi":"10.1111/ajr.70031","DOIUrl":"10.1111/ajr.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Diabetic retinopathy (DR) screening rates are poor in remote Western Australia where communities rely on outdated primary care-based retinal cameras. Deep learning systems (DLS) may improve access to screening, however, require validation in real-world settings. This study describes and evaluates the implementation of a new, mobile DR screening model that incorporates artificial intelligence (AI) into routine care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Prospective, population-based study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The model was co-designed with local Aboriginal communities and implemented in the remote, Pilbara region of Western Australia. A research officer without formal healthcare qualification performed retinal screening aboard a Mercedes Sprinter Van using an automated retinal camera with integrated AI diagnostics. Patients received their diagnosis on-the-spot and completed an evaluation survey. A remote clinician provided supervision and on-the-spot telehealth consultation for referable disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>People with diabetes from the Pilbara region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measure(s)</h3>\u0000 \u0000 <p>Number of people screened, acceptability of AI to patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From February to August 2024, DR screening was provided to 9 communities across the Pilbara region. 78 patients provided research consent, of which 56.4% were Aboriginal or Torres Strait Islanders. 10.3% of retinal photos had referable DR and 8.4% of photos were ungradable. 96% of patients were ‘Happy with the use of AI’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our new model for AI-assisted DR screening was culturally safe, acceptable to patients and effective, demonstrating an 11-fold increase in screening rates compared to 2023 Pilbara data. In remote Australian settings, AI-assisted DR screening may overcome historical barriers to service provision and improve minimisation of preventable blindness.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665430","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 Treatment Outcomes for Patients of a Digital Psychology Service in Regional and Remote Parts of Australia","authors":"Lauren G. Staples,&nbsp;Blake F. Dear,&nbsp;Olav Nielssen,&nbsp;Nickolai Titov","doi":"10.1111/ajr.70032","DOIUrl":"10.1111/ajr.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The MindSpot Clinic provides psychological assessment and treatment online or via the telephone to Australian residents. This study examines patient characteristics and treatment outcomes based on geographical location.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>MindSpot Clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective analysis of patients who started an online assessment between January 2020 and December 2021 and provided a valid postcode that could be categorised as either Major City (<i>n</i> = 34 222) or Regional/Remote (<i>n</i> = 13 408).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Adults residing in Australia and reporting symptoms of depression or anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Demographic and satisfaction questionnaires, K-10, PHQ-9, GAD-7.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patient distribution was consistent with the national census, with 28% of patients residing in regional or remote locations. Comparison to patients from major cities showed that they were more likely to be residing in areas of high socioeconomic disadvantage. The regional/remote group included a higher proportion of females and a higher proportion of Indigenous patients. Despite baseline differences, online therapist-guided treatment significantly decreased symptoms of anxiety and depression. Results were comparable to the major city group. For both groups, effect sizes were large (&gt; 1.0 at post-treatment), deterioration was low (&lt; 3%) and reliable recovery rates were high (&gt; 85%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding differences and similarities based on geographic location is important for service provision. The MindSpot Clinic provides access to effective evidence-based psychological care to patients across Australia, and the current results support the continued provision of digital psychology services in regional and remote areas of Australia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Human-Centred Co-Design Framework for Developing a Web-Based Platform to Engage With Rural Australian Communities: Addressing the Complex Issue of Healthy Food Access","authors":"Cindy Needham,&nbsp;Jane Jacobs,&nbsp;Christina Zorbas,&nbsp;Laura Alston,&nbsp;Tracy Schumacher,&nbsp;Penny Fraser,&nbsp;Ana Horta,&nbsp;Michael Johnstone,&nbsp;Douglas Creighton,&nbsp;Alison Koschel,&nbsp;Leanne J. Brown,&nbsp;Annabelle Williams,&nbsp;Judy Coates,&nbsp;Gina Vereker,&nbsp;Carmen Vargas,&nbsp;Claudia Strugnell,&nbsp;Tari Forrester-Bowling,&nbsp;Kristy A Bolton,&nbsp;Steven Allender","doi":"10.1111/ajr.70028","DOIUrl":"10.1111/ajr.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This report presents the co-design framework for developing, prototyping, testing and implementing a Web-based Platform (WBP) that will use participatory approaches to engage rural communities.The WBP will be used to understand the unique factors influencing access to healthy and unhealthy foods and to generate potential solutions for promoting healthier diets.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A human-centred design (HSD) approach will be used to ideate, prototype, test and implement the WBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Participatory Action Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Two rural local government areas in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Participants will include key stakeholders from each local government's relevant public health organisations, in addition to community members.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Reach (number, cohort representation and geographic spread) of active participants in the co-design process, community members that used the WBP tool and adoption (completion of WBP activities).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A usable platform for communities to generate local solutions to drive change for diverse populations within rural communities in Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Significant advances and innovative approaches are needed to address the challenges of accessing healthy food in rural areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The resulting WBP has the potential to work at scale for communities in Australia and internationally in designing effective place-based solutions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665426","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 Differences Among Opioid Agonist Treatment Clients in Regional and Metropolitan Settings of New South Wales, Australia","authors":"Daniel T. Winter,&nbsp;Lauren A. Monds,&nbsp;Nicholas Lintzeris,&nbsp;Paul S. Haber,&nbsp;Carolyn A. Day","doi":"10.1111/ajr.70029","DOIUrl":"https://doi.org/10.1111/ajr.70029","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;Whilst prior studies have examined characteristics and barriers for opioid agonist treatment (OAT) clients in regional settings, there are limited studies examining these differences in relation to metropolitan OAT clients. This study aimed to examine key characteristics, including sedating medication and substance use, transport and driving behaviours and differences between OAT clients within regional and metropolitan areas of New South Wales, Australia.&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;Cross-sectional survey of OAT clients.&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;Fifteen public OAT clinics across New South Wales, Australia, between January 2020 and June 2021.&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;Survey was completed by 482 people currently receiving OAT.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Main Outcome Measures&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Self-reported sample characteristics, self-reported sedating medication use and substance use, transportation and driving histories.&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;Significant differences in OAT pharmacotherapies prescribed between regional and metropolitan participants were noted (aOR = 2.42, 95% CI = 1.42–4.11). Methadone was the most commonly prescribed OAT in both settings (74.1% and 54.4%, respectively). Nearly half (45.6%) of regional participants received OAT from a private dispensary compared to 4.7% in metropolitan areas. While few differences in past-month substance use were noted, reported heroin use was lower (aOR = 0.27; 95% CI = 0.09–0.78) in regional areas. Regional participants were more likely than metropolitan participants to drive a vehicle to dosing (aOR = 2.89, 95% CI = 1.12–7.46) and less likely to take public transport (aOR = 0.41, 95% CI = 0.18–0.93) or active transport (aOR = 3.75, 95% CI = 1.50–9.40). Few differences regarding driving offences, based on geography, were noted.&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;Key differences with treatment, substance use, transport and driving were noted within this study. It is evident that regional OAT clients more often rely on motor vehicles to complete daily activities. Such challenges related to OAT should be addressed by informed policy and regulatory changes that ensure","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143645850","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":"Recognising and Managing Distress Among Farming Clients: An Evaluation of Brief Training for Rural Financial Counsellors and Other Non-Clinical Rural Support Workers","authors":"Gemma Skaczkowski,&nbsp;Donna Hughes-Barton,&nbsp;Sophie Loxton,&nbsp;Kate Gunn","doi":"10.1111/ajr.70027","DOIUrl":"https://doi.org/10.1111/ajr.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the impact of a tailored, brief, 3-h training program to help Rural Financial Counsellors and other non-clinical rural support workers recognise and manage distress experienced by their farming clients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Rural, regional and remote Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Rural support workers (<i>N</i> = 75; primarily Rural Financial Counsellors and Family and Business mentors) undertaking a 2-part, online training programme for recognising and managing distress in farmers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Individual questionnaires were collected before the first workshop, after the second workshop, and 3 months post completion of both workshops.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p><b>S</b>eventy-five participants provided pre-training data. A series of mixed models for repeated measures identified significant improvements in participants' confidence in recognising and managing farmers' distress pre- to post-training. Specifically, increases in confidence in differentiating mild distress from distress requiring professional help (<i>F</i> = 11.30, <i>p &lt;</i> 0.001), skills to use time well (<i>F</i> = 14.17, <i>p</i> &lt; 0.001), recognising distress (<i>F</i> = 9.16, <i>p</i> &lt; 0.001), dealing with the needs of distressed farmers (<i>F</i> = 22.93, <i>p</i> &lt; 0.001), talking to farmers about their wellbeing (<i>F</i> = 16.47, <i>p</i> &lt; 0.001), knowing <i>when</i> to refer farmers for additional support (<i>F</i> = 19.10, <i>p &lt;</i> 0.001), knowing <i>where</i> to refer farmers for additional support (<i>F</i> = 14.00, <i>p</i> &lt; 0.001), were maintained at the 3-month follow-up. Pre- post-training, participants' behavioural intentions to refer their clients to a farmer-specific mental health intervention (www.ifarmwell.com.au) increased (<i>F</i> = 48.26, <i>p</i> &lt; 0.001), which was maintained at 3-month follow-up. The training did not significantly change participants' quality of life or work stress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Findings suggest that a brief, tailored training programme significantly increases rural support workers' confidence in recognising and managing distress in their farming clients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632907","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":"Diagnosing and Preventing Q Fever in Regional New South Wales, Australia—A Qualitative Exploration of Perspectives of General Practitioners","authors":"Sachith Maduranga,&nbsp;Lok Bahadur Shrestha,&nbsp;Braulio Mark Valencia,&nbsp;Graeme Horton,&nbsp;Michelle Guppy,&nbsp;Heather F. Gidding,&nbsp;Stephen Graves,&nbsp;John Stenos,&nbsp;William Rawlinson,&nbsp;Andrew R. Lloyd,&nbsp;Chaturaka Rodrigo","doi":"10.1111/ajr.70030","DOIUrl":"https://doi.org/10.1111/ajr.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To qualitatively explore the perceptions of general practitioners in regional New South Wales, Australia, on diagnosing, managing and preventing Q fever.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Q fever is a prevalent zoonosis in regional New South Wales, but diagnosis may be missed as patients have symptoms similar to influenza or COVID. Perspectives of general practitioners who are the primary health care providers in rural areas are important to understand the logistical difficulties in providing optimum care to Q fever patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>General practitioners practicing outside of metropolitan Sydney in regional postcodes of New South Wales, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eligible general practitioners were interviewed online using a semi-structured interview guide on their approach to diagnosis, management and prevention of Q fever. The data were transcribed, coded using NVivo software, and analysed to identify emerging overarching themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thematic saturation was achieved after 11 interviews. Diagnostic delays due to prioritising more common differential diagnoses for an influenza-like illness, difficulties in navigating the complex serological test interpretations for diagnosis, logistical difficulties in arranging immunisation, and the need for continuing medical education were the broad themes emerging from the data analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Investment in continuing medical education and expansion of the reference resources made available to general practitioners regarding the diagnosis and management of Q fever will improve health care for people suffering from and at risk of Q fever in regional New South Wales.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622538","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":"Employment Models to Attract and Sustain Rural Generalist Doctors: Barriers and Enablers","authors":"Belinda O'Sullivan,&nbsp;Shane Boyer,&nbsp;Angela Stratton,&nbsp;Jacque Philips","doi":"10.1111/ajr.70019","DOIUrl":"https://doi.org/10.1111/ajr.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Explore the barriers and enablers related to employment models to attract and sustain rural generalist (RG) doctors emerging from a state-wide RG program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Stakeholders across five rural regions in Victoria, associated with the Victorian Rural Generalist Program (VRGP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>36 stakeholders who responded from a list of 122 potential identified by a state-wide advisory group for the VRGP. Respondents included 13 program staff, nine people from related collaborative agencies, four state policy decision-makers and 10 RG employees/supervisors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>In-depth interviews were thematically coded through ongoing reflection and sense-making and verified by an independent qualitatively trained researcher.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were four barriers to employment models to attract and retain RGs and three enablers. Barriers included health service competition, variability in health service leadership and executive capabilities/competencies regarding the RG workforce, specialist competition and supply-based planning. Enablers were a state-wide vision, improving regional-level planning and RG recognition and reward.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The research offers insights about the need for state-wide, coordinated regional and local levels of strategy, planning and implementation to achieve employment models that attract and sustain RGs. Further, attracting and sustaining RGs depends on establishing and implementing clinical service models for the range of RGs needed in the community, using outpatient clinics and other networked service options across the region. It also relies on appropriate pay that recognises the additional skills that RGs have. The results might inform Australia's National Rural Generalist Pathway and the state and territory RG programs and their coordination units with progressing attractive and sustainable RG employment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622539","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":"Retrospective Cohort Study to Determine the Effect of Socioeconomic Status and Distance to Hospital on Negative Appendicectomy Rates in a Rural Setting","authors":"Roy Huynh,&nbsp;Kevin Tree,&nbsp;Matthew Smith,&nbsp;Lily Builth-Snoad,&nbsp;Faisal Syed,&nbsp;Dean Fisher","doi":"10.1111/ajr.70026","DOIUrl":"https://doi.org/10.1111/ajr.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of socioeconomic status and distance to hospital on negative appendicectomy rates is unknown. These factors have been shown to be important predictors of health in a rural setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine whether socioeconomic status and road distance to hospital were risk factors for negative appendicectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of all appendicectomies at a large rural hospital in Australia between January 2018 and December 2022 was performed. Patients' data were extracted from electronic medical records. Regression modelling was performed to determine whether socioeconomic status and road distance to hospital were risk factors for negative appendicectomy. The surgical outcomes for negative and positive appendicectomies were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 830 patients were included in our analysis, of which 106 (12.8%) had negative appendicectomy. The rate of negative appendicectomy was not significantly impacted by socioeconomic status (OR = 1.004, 95% CI 0.989–1.20, <i>p</i> = 0.583) or road distance to hospital (OR = 1, 95% CI 0.998–1.001, <i>p</i> = 0.635). There was no significant difference in complications and 30-day readmission rates between patients in the negative and positive appendicectomy groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a rural setting, the risk of negative appendicectomy does not increase with lower socioeconomic status and longer road distance to hospital. This challenges the prevailing notion that rural surgeons have a lower threshold to operate on patients with lower socioeconomic status or who live further away from hospitals due to the perception that these patients have less access to healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595265","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 Community's Role in Rural Youth Suicide Prevention: Perspectives From the Field","authors":"Laura Grattidge,&nbsp;Ha Hoang,&nbsp;Jonathan Mond,&nbsp;Denis Visentin,&nbsp;David Lees,&nbsp;Stuart Auckland","doi":"10.1111/ajr.70024","DOIUrl":"https://doi.org/10.1111/ajr.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study explored how rural communities can be involved in suicide prevention efforts for young people aged 12–25. It provides a focus on who is best placed to drive these efforts and what support these people need to implement initiatives in their communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The research was conducted across Australia, with a focus on rural areas, where suicide rates are higher due to unique challenges, including geographic isolation, stigma and limited access to health services. These areas require community-driven solutions tailored to local contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Thirty-seven participants aged 29–72 contributed insights, with diverse professional roles and lived experiences in rural youth suicide prevention, including service providers, programme leaders, researchers and policymakers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A qualitative approach was used, with semi-structured interviews and focus groups conducted between January and September 2021. Data were thematically analysed using a reflective approach to identify key factors supporting rural youth suicide prevention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two key themes emerged: (1) Program planning and implementation: highlighting the need for adaptable, stigma-sensitive and culturally responsive approaches, and (2) Breaking down silos: emphasising collaboration between schools, families, health services and community leaders. Trusted local figures such as teachers, sports coaches and peers were identified as crucial for fostering engagement and early intervention. Lived experience voices were recognised as integral to co-designing and sustaining community-led efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Rural communities are central to youth suicide prevention. By leveraging local relationships, addressing stigma and fostering collaboration, communities can create supportive environments that save lives. Policy and practice must prioritise funding and resources for community-led, culturally sensitive approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581599","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":"Connections Reduce Rheumatic Heart Disease-Related Mortality in Western Australia: A Mixed Methods Study","authors":"Virginia DeCourcy,&nbsp;Daniel Hunt,&nbsp;Ingrid Stacey,&nbsp;Emma Haynes,&nbsp;Beverley Paterson,&nbsp;Clare Huppatz,&nbsp;Marisa Gilles,&nbsp;Judith Katzenellenbogen","doi":"10.1111/ajr.70022","DOIUrl":"https://doi.org/10.1111/ajr.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Preventable rheumatic heart disease (RHD) deaths continue to occur in Australia, with Aboriginal people disproportionately affected. Despite research into structural drivers and the lived experience of people with RHD, and national guidelines focusing on RHD prevention and treatment, recent coronial inquests have highlighted that systemic failures are ongoing. Few studies describe RHD service delivery and/or mortality within the Western Australian (WA) context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to integrate quantitative information regarding RHD-related deaths in WA between 2012 and 2021 with qualitative interview data to identify system-level opportunities for the prevention of RHD-related mortality in the WA health care setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Using quantitative data from the WA RHD register, a descriptive analysis of the clinical and demographic characteristics of RHD patients aged &lt; 65 years was conducted, stratified by vital status. Thematic qualitative analysis of RHD stakeholder interviews was conducted in parallel, capturing systemic factors perceived to prevent or contribute to RHD-related mortality in WA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Findings</h3>\u0000 \u0000 <p>Limited health service contacts were documented for the 60 registered-recorded deaths among people with RHD. Interviewees emphasised that access to appropriate care was vital to prevent mortality. Passionate healthcare providers connect patients with care by fostering trusting relationships, but logistical, socio-cultural and care quality barriers continue to hamper connections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Systemic change is needed in WA to support motivated providers and ensure that efforts to reduce RHD mortality do not rely on individual initiatives. This study contributes evidence for the need to improve RHD program design by prioritising patient-provider connections, empowering, and resourcing providers to effectively engage with RHD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55421,"journal":{"name":"Australian Journal of Rural Health","volume":"33 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajr.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581679","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}