Rural Remote Health
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Rural Remote Health · Oct 2009
A new model to understand the career choice and practice location decisions of medical graduates.
Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. ⋯ The PRCC is influencing graduates to choose a rural career path. The PRCC program affirms the career preferences of rural origin students while graduates with little rural exposure prior to the PRCC report being positively influenced to pursue a rural career path. The Four Qs Model is a useful model in that it demonstrates consistent themes in the characteristics of PRCC graduates and assists understanding of why they choose a rural medical career. This could be relevant to the selection of medical students into rural medical education programs and in the construction of rural curricula. The model also offers a useful framework for further research in this field.
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Rural Remote Health · Oct 2009
Developing strategies to enhance health services research capacity in a predominantly rural Canadian health authority.
This article outlines the planning, implementation and preliminary evaluation of a research capacity building (RCB) initiative within a predominantly rural Canadian health authority, Interior Health (IH), including initiative characteristics and key activities designed to initiate and enhance health services research capacity within the organization. Interior Health is one of 5 geographic health authorities in British Columbia. Over half of the population IH serves is considered to be rural/remote (approximately 3 people/km2), contributing to difficulties in sharing research information (ie geographical distance to meet in-person and a diverse set of needs and/or priority topics that warrant research support). An initial assessment of IH research capacity in 2006, using an organizational self-assessment tool and discussions with key stakeholders, revealed a need for enhanced communication of health research results, research education and networking opportunities for staff at all levels of the organization. Staff noted barriers to using and sharing research such as lack of time, resources and skills for, and value placed on, participating in research, as well as lack of awareness of linkages with local academic health researchers, including faculty located at two universities within the region. In response to this baseline assessment and stakeholder feedback, short-term funding has allowed for the initial development of RCB strategies in both urban and rural/remote areas of the region, including: IH Research Brown Bag Lunch Seminars; IH Research Skills Workshop Series; literature syntheses/summaries on priority topic areas; research collaboration/partnerships with health authorities, research networks and academic researchers; and an annual IH Research Conference. ⋯ Dedicated RCB resources and staff support, as well as enthusiasm, academic partnerships, and identification of research 'champions' within the organization, have been critical in building research capacity within the region. Video- and teleconferencing, as well as webcasts, have allowed for expansion of RCB activities to rural/remote communities. Preliminary evaluation parameters to date suggest that the information translated during the RCB activities is motivating different groups within IH to initiate their own research and/or KTE strategies. Although preliminary results indicate improvements in research capacity within the organization, barriers to research participation such as time, funding, and communication are still evident 3 years post-implementation. Additional challenges to building research capacity within a rural health authority include geographical distances, diverse 'hot'/priority topics in need of research support, lack of protected time and limited research-related human resource capacity. The translation of research evidence and enhancement of staff research skills through the IH RCB initiatives has helped to achieve new standards of excellence in the planning, management and delivery of all health services across the predominantly rural health authority.
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Evidence indicates a need to recruit more GPs to a career in rural general practice (GP). Research has indicated that placement experiences have the potential to impact on medical career decision-making. Research also suggests that rural placements can raise both professional and psychosocial concerns, but there is no existing evidence about whether pre-placement expectations translate into actual placement experiences. This study aimed to explore both the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. ⋯ Based on these results it is important for GP supervisors, regional training providers, Divisions and rural workforce agencies to work together to ensure that registrars are provided with information and support pre-placement to alleviate their unwarranted negative expectations, while confirming warranted positive expectations. Warranted negative expectations should also be discussed beforehand to plan strategies for managing them during the placement. If the findings are used in this way, an improvement in overall rural placement experience could be expected.
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Rural Remote Health · Jul 2009
Randomized Controlled Trial Multicenter StudyEvaluation of a training program for device operators in the Australian Government's Point of Care Testing in General Practice Trial: issues and implications for rural and remote practices.
From September 2005 to February 2007 the Australian Government funded the Point of Care Testing (PoCT) in General Practice Trial, a multi-centre, cluster randomised controlled trial to determine the safety, clinical effectiveness, cost-effectiveness and satisfaction of PoCT in General Practice. In total, 53 practices (23 control and 30 intervention) based in urban, rural or remote locations across three states (South Australia [SA], New South Wales [NSW] and Victoria [VIC]) participated in the Trial. Control practices had pathology testing performed by their local laboratory, while intervention practices conducted pathology testing by PoCT. In total, 4968 patients (1958 control and 3010 intervention) participated in the Trial. The point-of-care (PoC) tests performed by intervention practices were: haemoglobin A1c (HbA1c) and urine albumin:creatinine ratio (ACR) on patients with diabetes, total cholesterol, triglyceride and high density lipoprotein (HDL) cholesterol on patients with hyperlipidaemia, and international normalised ratio (INR) on patients on anticoagulant therapy. Three PoCT devices measured these tests: the Siemens DCA 2000 (Siemens HealthCare Diagnostics, Melbourne, VIC, Australia) for HbA1c and urine ACR; Point of Care Diagnostics Cholestech LDX analyser (Point of Care Diagnostics; Sydney, NSW, Australia) for lipids; and the Roche CoaguChek S (Roche Diagnostics; Sydney, NSW, Australia) for INR. Point-of-care testing in the General Practice Trial was underpinned by a quality management framework which included an on-going training and competency program for PoCT device operators. This article describes the design, implementation and results of the training and competency program. ⋯ The methods established for the implementation and delivery of training and competency assessment for the PoCT in General Practice Trial were appropriate and effective. Results of the evaluation showed rural and remote practices have a greater need for training and support compared to their urban counterparts and may require more flexible training options to cater for much higher rates of staff turnover.
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Rural Remote Health · Jul 2009
Accommodation needs for carers of and adults with intellectual disability in regional Australia: their hopes for and perceptions of the future.
This article provides an in-depth investigation of the accommodation circumstances of a population of aging adults with intellectual disability living at home with parents or in supported accommodation in an Australian regional centre. Given the ageing of both the carer and adult population with intellectual disability our research explored the accommodation needs and perceptions of future lifestyle issues from the perspective of both the carers and the adults with intellectual disability. This study aimed to describe these accommodation circumstances related to a regional/rural location and did not make direct comparisons with urban/metropolitan situations. ⋯ This study indicates that there is a lack of suitable, available, supported accommodation for people aged 18 years and older with intellectual disability in this Australian regional centre. Consequently, aging parents caring at home have little choice but to continue in their caring role. For those caring away from home, existing services are decreasingly seen as fitting the ideal life they want for the person with intellectual disability for whom they care. The told experiences, perceptions and views of older carers of and adults with intellectual disability have highlighted their increasing vulnerability to the 'disability system'. The findings suggest that government and disability services must acknowledge the changing needs of people with intellectual disability in connection with their advancing age and the urgency of increasing care needs due to the advancing age of their carer's. The overwhelming feeling is that the carer's voice will only be heard when the situation reaches crisis point. For many carers and their families this has already occurred.