Rural Remote Health
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Rural Remote Health · Jan 2012
Qualitative needs assessment: healthcare experiences of underserved populations in Montgomery County, Virginia, USA.
Portions of Montgomery County, Virginia, are designated a Medically Underserved Area with a large portion of this population experiencing limited access to healthcare services. In September 2008, the Federal Bureau of Primary Care awarded the authors a planning grant to assess community need in Montgomery County and to develop a strategic plan to establish a Federally Qualified Health Center (FQHC) to best meet these needs. An FQHC is a federally funded clinic mandated to provide medical, dental and mental health services to underserved communities. As part of the planning process, the decision was made to include qualitative data to better understand the needs of underserved residents in the community. Descriptive studies of target populations can provide further insight into community priorities for effective health improvement and planning. The objective of the study was to investigate and describe the perceptions, beliefs and practices that impact healthcare utilization among underserved populations in Montgomery County, Virginia. This study was conducted as part of a comprehensive community assessment to determine the feasibility of developing a FQHC. ⋯ Establishing care that is culturally relevant, targets perceived barriers and incorporates and enhances coping strategies is needed to increase accessibility and utilization of preventative and comprehensive healthcare services. The findings from this study will assist in creating a strategic plan for a FQHC that capitalizes on community strengths while addressing the challenges and complex needs of the community.
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Rural Remote Health · Jan 2012
Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study.
Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. ⋯ This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice intention is recruitment of students with a rural background who also undertake an RCS placement. This research also demonstrates significant demand for post-graduate rural training places, including specialty places, as RCS graduates become junior doctors and vocational trainees.
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Rural Remote Health · Jan 2012
Comparative StudyAccess to difficult airway equipment and training for rural GP-anaesthetists in Australia: results of a 2012 survey.
In rural Australia, general practitioners (GPs) form the frontline for provision of medical services. Besides responsibilities for primary care via private practice, rural doctors often provide emergency and inpatient services for rural hospitals. The aim of this study was to determine access to difficult airway equipment and training among the GP-anaesthetist cadre in rural Australia. ⋯ Despite the existence of well-publicised algorithms for difficult airway management and the need for specific equipment to manage the difficult airway, Australian GP-anaesthetists report difficulty accessing essential equipment for these infrequent but life-threatening events. This is surprising in the light of recommendations from the Australian and New Zealand College of Anaesthetists. The consequences of difficulty in airway management can be catastrophic. Equipment needs must be balanced against important considerations including ease of use, initial and ongoing training, and cost. Suggestions for affordable equipment and ongoing training for rural GP-anaesthetists are made. The involvement of GP-anaesthetists in prehospital responses occurs in the absence of formal arrangements and with a dearth of training. There is scope to improve rural prehospital responses in Australia, utilising the advanced skills of GP-anaesthetists in resuscitation and airway management.
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Rural Remote Health · Jan 2012
Service contacts prior to death in people dying by suicide in the Scottish Highlands.
Many people who die by suicide have been in contact with health services prior to their death. This study examined service contacts in people in urban and rural areas of the Scottish Highlands. ⋯ Overall service contact rates prior to death by suicide were very similar to the results of a previous meta-analysis. Rates of contact with specialist mental health services were significantly lower in rural than urban areas, and this finding increased with greater rurality.
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Rural Remote Health · Jan 2012
A decade of Australian Rural Clinical School graduates--where are they and why?
The Australian Rural Clinical School (RCS) initiative has been addressing the rural medical workforce shortage at the medical education level for over a decade. A major expectation of this initiative is that it will improve rural medical workforce recruitment and subsequent retention through a rurally based undergraduate clinical training experience. The longitudinal nature of these workforce initiatives means that definitive evidence of its impact on the shortage of rural doctors is yet to be provided; however, to date cross-sectional studies are accumulating a measure of efficacy for these initiatives by monitoring early career factors such as internship location choice and speciality choice of RCS graduates. This article reports on a study in one RCS that is monitoring the impact of rural undergraduate clinical training on trends in workforce participation patterns of its graduates as long as 9 years in the workforce. Career location and speciality choice are reported as well as perspectives on early career intentions and the reality of making career and life decisions as a doctor in the medical workforce. ⋯ The study highlighted what is obvious but often overlooked in recruitment strategies for medical students and prevocational doctors: the significance of the inevitable life decisions that frequently take precedence over career intentions. A decade on there is strong endorsement for the positive influence that rural undergraduate clinical training has on promoting rural career intentions. However the fulfilment of these intentions is at risk when competing with concurrent personal/life choices and while based in an urban training environment. Provision of a continuum of postgraduate training opportunities in rural and regional settings that include a rural focus for specialties such as surgery, anaesthetics and obstetrics could: (1) satisfy speciality training requirements; (2) focus life decisions in a rural environment; and (3) keep rural career intentions viable and congruent with other life goals. The overriding message is: the longer the exposure to training in the rural context, the greater the impact on interest in future rural practice and, particularly, the greater the likelihood that important life decisions will also be made in the rural context.