Rural Remote Health
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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.
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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
Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?
Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. ⋯ Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?
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Rural Remote Health · Jan 2012
Comparative StudyCancer support services--are they appropriate and accessible for Indigenous cancer patients in Queensland, Australia?
In Queensland, Australia, the incidence of cancer (all cancers combined) is 21% lower for Indigenous people compared with non-Indigenous people but mortality is 36% higher. Support services play an important role in helping cancer patients through their cancer journey. Indigenous cancer patients are likely to face greater unmet supportive care needs and more barriers to accessing cancer care and support. Other barriers include the higher proportion of Indigenous people who live remotely and in regional areas, a known difficulty for access to health services. This study describes the availability of cancer support services in Queensland for Indigenous patients and relevant location. ⋯ Further research into the best models for providing culturally appropriate cancer support services to Indigenous people is essential to ensure Indigenous patients are well supported throughout their cancer journey. Emphasis should be placed on providing support services where a high Indigenous population percentage resides to ensure support is maintained in rural and remote settings. Further efforts should be placed on relationships with Indigenous organisations and mainstream support services and encouraging referral from Indigenous liaison officers.