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Objective This paper contributes to the literature on relocation for specialist care by providing findings on specific issues impacting on rural farmers and property owners who have to travel to the metropolitan area for specialist care for a haematological malignancy. Design and setting This paper uses descriptive qualitative research based on 45 interviews with patients with haematology in Queensland. The interviews were audio-recorded, transcribed verbatim, coded and thematically analysed. Results In addition to issues of distance, farmers and rural property owners who have to relocate for specialist care must deal with problems associated with the lack of opportunity to take absence from the property because of the inescapable pressure of daily farm and property responsibilities and the high cost of, or lack of opportunity to, outsource daily maintenance. Further concerns include the cost of relocation in the context of continuing drought, serious problems sustaining the travel and time away required, and the lack of choice for some but to deal with treatment alone. Conclusion In recent years there has been considerable progress with regard to overcoming the distance barrier for rural and remote patients with cancer through innovative clinical models using technology and telemedicine. However, there has been limited uptake of such models for patients with haematology. The present findings indicate that from the perspective of rural farmers and property owners there are important reasons why the use of innovative strategies should be fostered and expanded. [ABSTRACT FROM AUTHOR]

Objective: To explore rural residents' experiences of access to maternity care with consideration of the policy context. Design: This paper describes findings from focus groups with parents which formed part of case study data from a larger study. Setting: Four north Queensland rural towns. Participants: Thirty-three parents living in one of the four rural towns. Main outcome measures: Identifying prevalent themes in case studies regarding rural parents' expectations and experiences in accessing maternity care. Results: Parents desired a local, safe and consistent maternity service. Removing or downgrading rural services introduced new barriers to care for rural residents: (i) increased financial costs; (ii) family issues; and (iii) safety concerns. Conclusions: Although concerns about rural residents' health status and health care access have received significant policy attention for over a decade, many of the problems which prompted these policy initiatives remain today. Current policy approaches should be re-evaluated in order to improve rural Australians' access to vital health services such as maternity care. [ABSTRACT FROM AUTHOR]

Introduction: Secondary prevention is essential in reducing recurrence of diabetes‐related foot disease (DFD) but is frequently poorly implemented in clinical practice. Objective: To explore the perceptions of people with diabetes‐related foot disease (DFD) on their self‐perceived knowledge in managing DFD, facilitators and barriers influencing their DFD care, and ideas and preferences for a secondary prevention program. Design: Sixteen people with a history of DFD from Queensland and Victoria, Australia, underwent semi‐structured interviews. Interviews were audio‐recorded over telephone and transcribed and analysed following a thematic framework. Participants were asked about their experiences and perceptions relating to DFD and factors influencing the care they receive for DFD relevant to the development of a secondary prevention program for DFD. Findings and discussion: Participants had high self‐perceived knowledge in managing DFD, especially in implementing healthy lifestyle changes and conducting daily foot checks and foot care, though most received support from family members acting as carers. However, issues with access and adherence to offloading footwear, and a lack of clear education received on footwear and other aspects of DFD care were perceived as major barriers. Improved patient education, provided in a consistent manner by proactive clinicians was perceived as an essential part of secondary prevention. Telehealth was perceived positively through facilitating faster care and considered a good adjunct to standard care. Health and technological literacy were considered potentially major barriers to the effectiveness of remote care. Conclusion: People with DFD require improved access to offloading footwear and education about secondary prevention, which could be provided by telehealth with adequate support. [ABSTRACT FROM AUTHOR]

Objective: The primary aim is to explore rural clinicians' self‐reported knowledge, skills and attitudes in the decision‐making process for requesting aeromedical retrieval of patients with suspected appendicitis. A secondary aim is to understand the supports and barriers of rural clinicians experience in this clinical scenario. Setting: Clinician interviews conducted face‐to‐face in three rural hospitals in Central Queensland. Participants: Rural doctors and nurses. Design: A five‐part qualitative content analysis. Results: The majority of 44 participants identified the strong and effective teamwork. The decision to request aeromedical retrieval was a shared, joint process and identified a supportive collegial culture which supported the asking of questions and not expecting to have all the answers. Perceived barriers were lack of receiving clinicians understanding of transfer agreements, and data connectivity. Clinician pessimism was identified for perceived patient outcomes. Discussion Effective teamwork can nurture trust and collaboration across multiple health service roles. High job satisfaction may counter the physical isolation in some rural environments. Fragmentation of care is the unintended consequence of interhospital transfer and may impact rural clinicians' perception of patients' outcomes and hinder receiving clinicians' understanding of rural service limitations. Conclusion: Future work in the area of linked electronic medical records could remove a barrier for rural clinicians and improve their reflective practice by challenging their perception of definitive patient outcomes. Increased awareness by receiving clinicians of the limitation of rural services, may minimize communication barriers and thereby, improve timely patient care transfers. [ABSTRACT FROM AUTHOR]

Objective: To address access to cardiac rehabilitation (CR) for people in R&R areas, this research aimed to investigate: (1) post discharge systems and support for people returning home from hospital following treatment for heart disease (HD). (2) propose changes to improve access to CR in R&R areas of NQ. Setting: Four focus communities in R&R areas of NQ. Participants: Focus communities' health staff (resident/visiting) (57), community leaders (10) and community residents (44), discharged from hospital in past 5 years following treatment for heart disease (purposeful sampling). Design: A qualitative descriptive case study, with data collection via semi‐structured interviews. Inductive/deductive thematic analysis was used to identify primary and secondary themes. Health service audit of selected communities. Results: Health services in the focus communities included multipurpose health services, and primary health care centres staffed by resident and visiting staff that included nurses, Aboriginal and Torres Strait Islander Health Workers, medical officers, and allied health professionals. Post‐discharge health care for people with HD was predominantly clinical. Barriers to CR included low referrals to community‐based health professions by discharging hospitals; poorly defined referral pathways; lack of guidelines; inadequate understanding of holistic, multidisciplinary CR by health staff, community participants and leaders; limited centre‐based CR services; lack of awareness, or acceptance of telephone support services. Conclusion: To address barriers identified for CR in R&R areas, health care systems' revision, including development of referral pathways to local health professionals, CR guidelines and in‐service education, is required to developing a model of care that focuses on self‐management and education: Heart: Road to Health. [ABSTRACT FROM AUTHOR]

Objective: To understand the experience of rural Aboriginal and Torres Strait Islanders in engaging with oral health care services and programs in order to support the development of oral health services and prevention programs that better meet their needs. Design: The study used a qualitative research design, which aims to describe participants' lived experience of engaging with oral health services and prevention programs in a rural Aboriginal and Torres Strait Islander community. Focus group discussions and in‐depth interviews were conducted with 27 participants. The 15 transcribed discussions were analysed using a 6‐step phenomenological process. Setting: A rural community in Queensland, Australia, with a predominantly Aboriginal population. Participants: Participants were purposively recruited from established health and community groups. Main outcome: System‐level barriers to accessing and engaging with oral health services and prevention influence how communities manage oral health and seek treatment. Results: The study identified 4 main themes describing the community's experience: service location and the efforts required to access oral health services; the financial burden of accessing oral health care and practising prevention; lack of confidence in oral health services; and the avoidance or delaying of accessing care for dental problems. Results confirmed a high burden of oral disease but limited attendance at an oral health facility and difficulties engaging in preventative oral health behaviours. Treatment seeking was usually instigated by the experience of pain and typically at a tertiary health facility. Conclusion: Aboriginal and Torres Strait Islanders in rural communities experience a high burden of oral disease but have limited engagement with oral health services. This is associated with system‐level barriers to accessing and engaging with oral health services and prevention. [ABSTRACT FROM AUTHOR]

Objective: To improve the leadership capacity of existing Queensland Rural Generalists and support the emerging leaders needed to assume future leadership roles. Design: A customised leadership program for medical Rural Generalists, embedded in professional standards, was developed and delivered during 2016‐2018. Pre and post‐program and individual module evaluations from two Program cohorts were analysed. Qualitative, semi‐structured phone interviews (n = 30) discussing participant views on leadership in a rural context and their Program experience were also conducted. Setting: The Rural Generalist Leadership for Clinicians Training Program runs over twelve months and includes three residential modules as well as online learning sets. Participants: Forty‐four participants completed the Program and obtained Associate Fellowship of the Royal Australasian College of Medical Administrators. Interventions: Development and delivery of the Rural Generalist Leadership for Clinicians Training Program. Main outcome measure(s): Participant's ability to apply Program learning in a rural leadership context. Participant views on leadership in a rural context. Results: Participants indicated they benefited most from the 'understanding self' and management aspects of the Program such as finance, budgeting, and understanding and navigating broader health system governance. They greatly valued the opportunity to enhance their professional networks and relationships and have since developed a regular forum to assist in the transition from individual leadership development to the development of the broader workforce and organisation. Conclusion: The results of this study suggest that further attention and investment in medical leadership is warranted to support and enable the Rural Generalist workforce to continue to meet the complex, context‐specific needs of the communities within which they deliver vital health services. [ABSTRACT FROM AUTHOR]

The article presents short report on interprofessional education in rural health services in Queensland. It mentions that the rural clinical student placements have the potential to influence pre-entry health professional students' intentions to work in rural health settings and offer unique opportunities for students to practice and develop effective interprofessional collaborative practice and teamwork skills.

Abstract: Objective: Drug trend data can inform appropriate policies to minimise drug‐related harm, as well as assist in early detection and prevention. While Australia has a number of monitoring systems, none operate in regional areas. The aim of this study was to explore how drug trend and other data are used by the regional alcohol and other drug workforce. Method: Twenty‐one key experts from regional Queensland were interviewed between November 2014 and August 2015. Key experts worked in or had contact with the broader alcohol and other drugs field in the Darling Downs area of Queensland. Interviews were analysed thematically. Setting: Darling Downs, Queensland. Results: Two themes emerged from the analysis. There were differences in workforce needs, with those in the law and criminal justice areas believing they had access to good, current data. Those in the health sector differed, although the majority indicated that there did appear to be a knowledge gap related to their location in a regional area. Conclusions: Trends in the use of, and harms related to, substance use are well captured in urban areas, but less so in regional areas. This inhibits both our understanding of where substance use is changing, as well as how to best plan and respond. [ABSTRACT FROM AUTHOR]

Objective Improving the quality and safety of health care in Australia is imperative to ensure the right treatment is delivered to the right person at the right time. Achieving this requires appropriate clinical governance and support for health professionals, including professional supervision. This study investigates the usefulness and effectiveness of and barriers to supervision in rural and remote Queensland. Design As part of the evaluation of the Allied Health Rural and Remote Training and Support program, a qualitative descriptive study was conducted involving semi-structured interviews with 42 rural or remote allied health professionals, nine operational managers and four supervisors. The interviews explored perspectives on their supervision arrangements, including the perceived usefulness, effect on practice and barriers. Results Themes of reduced isolation; enhanced professional enthusiasm, growth and commitment to the organisation; enhanced clinical skills, knowledge and confidence; and enhanced patient safety were identified as perceived outcomes of professional supervision. Time, technology and organisational factors were identified as potential facilitators as well as potential barriers to effective supervision. Conclusions This research provides current evidence on the impact of professional supervision in rural and remote Queensland. A multidimensional model of organisational factors associated with effective supervision in rural and remote settings is proposed identifying positive supervision culture and a good supervisor-supervisee fit as key factors associated with effective arrangements. [ABSTRACT FROM AUTHOR]

Objective: This study highlights the benefits of a tailor-made course for an Indigenous high school in a remote North Queensland community. Design: Qualitative research study using a Grounded Theory approach to allow thematic analysis of participant's responses to a researcher-administered, pre-defined, semistructured questionnaire. Setting: Remote community college in Abergowrie, North Queensland. Participants: Four male high school students and eight key stakeholders were interviewed over the telephone (n = 12). Results: Thematic analyses of the feedback from students and stakeholders showed a variety of benefits from the course for Indigenous students: increased knowledge of health issues, greater awareness and interest in health career pathways, increased pride, self-esteem and self-confidence, positive role-modelling and leadership behaviour in the students, and hope for future career development. Weaknesses identified were mainly associated with a lack of resources and support for the course. Conclusions: This study demonstrates that a tailor-made primary health-care education course can create opportunities for Indigenous people to pursue health careers, promote health knowledge and leadership skills, inspire pride and self-esteem, and strengthen links within the community. [ABSTRACT FROM AUTHOR]

To explore how fly-in fly-out (FIFO) and drive-in drive-out (DIDO) mining affects the psychosocial well-being of miners resident in a rural north Queensland town as well as the sources of support miners identify and use in managing these effects. A descriptive qualitative study, using semistructured interviews. Charters Towers, a rural town in north Queensland, and a remote north-western Queensland mine. Eleven people, resident in or near Charters Towers, currently or formerly employed in FIFO or DIDO mining. Self-reported effects on psychosocial well-being and sources of support. Participants reported positive and negative psychosocial impacts across domains including family life, relationships, social life, work satisfaction, mood, sleep and financial situation. Concerns about the impact on participants' partners were described. Awareness of onsite support, such as Employee Assistance Programs, varied. Other supports included administration staff and nurses or medics. Trusted friends or colleagues at the mine site were considered a preferred means of support. Some, but not most, had experienced coworkers discussing problems with them. A reluctance to seek support was described, with a number of barriers identified. Those having problems might not recognise their own stress and thus not seek support. This study identifies numerous psychosocial impacts on FIFO/DIDO miners and their partners, and provides insights into preferences regarding support. Employee Assistance Programs cannot be relied upon as the sole means of support. Further studies exploring the impact upon and supports for FIFO/DIDO workers and their partners will assist in better understanding these issues. [ABSTRACT FROM AUTHOR]