Rural Remote Health
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Rural Remote Health · Jan 2012
Extending the paramedic role in rural Australia: a story of flexibility and innovation.
This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model. ⋯ Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model's key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics' scope of practice offers the potential to improve patient care and the general health of rural communities.
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Since the late 1980s, British Columbia (BC) Canada has been undergoing a process of regionalization of health services which includes decentralization and the demand for self-sufficiency with respect to caring for people with mental health issues. In BC, regionalization has meant the continued downsizing of its one large provincial psychiatric hospital Riverview, which has resulted in relocating patients from this hospital to cities and towns throughout BC, and the establishment and/or renovation of psychiatric tertiary-care facilities to treat local community members who experience mental ill health. In the context of the relocation of psychiatric tertiary care, communities in northern BC face the specific challenge of having to provide these specialized services in remote settings, not only for people transferred from Riverview, but also for the increasing number of people 'aging-in-place' in a region that has the fastest growth of older adults in BC. Little is known about the capacity of these remote communities to manage change, develop broader models of care, and integrate people with psychogeriatric mental health issues with residents at existing facilities. ⋯ Increased local engagement is a way to identify and address challenges related to relocating psychogeriatric care to northern and remote settings, and to enhance psychogeriatric care provision in similar locales. While provincial and regional level 'big picture' planning is a necessity, study participants highlighted the critical role of local perspective and expertise.
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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
Clinical pathways can improve the quality of pain management in home palliative care in remote locations: retrospective study on Kozu Island, Japan.
Recent studies show that a clinical pathway (CP) optimizes pain management in palliative care; however, studies on CPs in home palliative care, especially in remote locations, are scarce. Physicians performing palliative care in remote areas frequently face characteristic difficulties. The CP is an effective tool to overcome these difficulties. This study evaluates the effectiveness of the CP in home palliative care on a remote island. ⋯ Implementation of a CP for pain management in home palliative care in remote locations could improve compliance with the WHO pain management guidelines and the quality of pain management.
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Rural Remote Health · Jan 2012
Physician scarcity in underdeveloped areas of Turkey: what do new graduate physicians think?
A sufficient and balanced distribution of physicians plays a key role in access to high quality healthcare services. However, this issue presents serious problems globally. Turkey is currently experiencing physician shortages, with insufficient numbers of physicians in its rural and underdeveloped areas. The objectives of this study were to identify the views of new graduate physicians, prior to employment, on working in underdeveloped areas, in order to discover factors impacting their desire to work in these areas, and to show the actual geographic distribution of physicians in Turkey. This provides the basis for discussing future policies. ⋯ Physicians who have particular socioeconomic backgrounds such as rural origin and lower background-family income are more likely to have be motivated to work in underdeveloped areas. They are also more likely to accept work in these areas if financial and non-financial opportunities are provided. The findings of this study provide guidance for those revising health workforce policies.