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Objectives: The study aimed at determining the factors that contributed to older people presenting from residential aged care facilities (RACFs) to the emergency department (ED) of a regional Victorian hospital located in MM3 regional area. Methods: Appropriateness of transfer was assessed based on predefined criteria, and associated costs for each presentation were calculated. Design: The study carried out a retrospective review of records between July and December 2021. Data were extracted in a MS Excel spreadsheet and transferred to STATA 15.0 for analysis. Setting: Large regional health service in Victoria. Participants: Residential aged care facilities residents presenting to the ED. Main Outcome Measures: Was transfer appropriate or avoidable, costs associated with avoidable transfer, characteristics of the patient and circumstances relating to presentation to hospital. Results: A total of 448 presentations were recorded, and 85% of residents were >75 years of age. More than 60% of presentations occurred during weekends or after hours, with the most common reason being falls (31.9%). Over half (55.6%) of all presentations were avoidable which incurred a cost of $777 200 in 6 months. In multiple logistic regression, higher ED presentations were observed in residents with no prior GP assessment (OR: 1.47, 95% CI: 1.02–2.11). Conclusions: Necessary interventions such as preventing falls and increasing primary care access along with improving the quality of advance care directives (ACD) may reduce RACF transfers to the regional ED. To the best of our knowledge, this is the first paper of this kind that provides new data from an Australian rural and regional perspective and adds value to the growing body of knowledge in the intersection of aged care and acute emergency care. [ABSTRACT FROM AUTHOR]

Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

Objective: Farmers are prone to poor well‐being and are at higher risks of suicide than the general population. The aim of this study was to understand whether the negative impact of daily stressors on Australian farmers' well‐being could be buffered through a strong internal locus of control – a strong sense of control over what happens in life. Methods: Australian farmers self‐reported their well‐being, daily stress, and locus of control. Design: Cross‐sectional via pen‐and‐paper survey. Setting: Participants completed the surveys at the beginning of agricultural management training courses. Participants: Australian farmers (N = 129, M age = 39 ± 12 years, 54.7% male). Main Outcome Measures Internal and external locus of control, daily stress, and subjective well‐being. Results: More daily stressors were associated to poorer well‐being, regardless of external locus of control; however, farmers with a stronger internal locus of control were buffered from the negative impacts of daily stressors. That is, daily stressors were not significantly associated with well‐being for farmers with a strong internal locus of control. Conclusions: Internal locus of control may be a significant factor in supporting good well‐being for farmers. Further research should investigate how to enhance internal locus of control amongst this population. It may be that interventions to enhance internal locus of control in farmers could improve their well‐being and productivity, good outcomes for the individual farmers, and global society overall. [ABSTRACT FROM AUTHOR]

Introduction: Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. Objective: This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Design: Peer‐reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. Findings: From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Discussion: Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low‐level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Conclusions: Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas. [ABSTRACT FROM AUTHOR]

Objective: To describe participants' lived experience of co‐creating and implementing initiatives to improve children's health. Design: This manuscript reports an embedded case study design, which aims to describe participants' lived experiences of co‐creating community‐based initiatives. Information was gathered from an online survey and two focus groups. The two transcribed discussions from the focus groups were analysed using a 6‐step phenomenological process. Setting: Mansfield, Australia, population 4787, is one of ten local government areas (LGA) participating in the Reflexive Evidence and Systems Interventions to Prevent Obesity and Non‐communicable Disease (RESPOND) project. Participants: Participants were purposively selected from established community groups previously engaged by RESPOND using a co‐creation approach. The recruitment for the focus groups was a convenient sampling from participants that provided their email addresses in the online survey. Results: Eleven participants completed the online survey. A total of ten participants attended the two focus groups of 1‐h duration: five participants in each. Participants reported feeling empowered to create unique, locally relevant and readily adaptable community‐wide change. They were supported by a strong partnership that mobilised funding for a part‐time health promotion employee. Strengthened social connections were an unexpected though highly valued outcome. Conclusion: Co‐creation processes may assist stakeholders in delivering prevention strategies in ways that are empowering for them, responsive to the changing needs of the community, strengthen organisational partnerships and enhance community participation, social inclusion and engagement. [ABSTRACT FROM AUTHOR]

Introduction: Family carers play a crucial role in dementia care. As the condition progresses, people with dementia become increasingly dependent on their carers for all areas of daily living. The risk of carer burnout is significant. One of the more stressful events for family carers is when hospital admission is required for the person they care for. Living in regional Australia adds complexity to the experience. Hospital and health services in regional Australia could use a greater understanding of the issues associated with hospital care to inform patient and carer management, improve outcomes for this population and support the goal of 'ageing in place'. Objective: To explore the experience of carers of people with dementia in regional Australia when hospital care or treatment was required for the person they provide care for. Design: Six family carers living in regional Australia participated in this interpretative phenological study. Individual, semistructured interviews were held and transcribed verbatim shortly after. Data analysis occurred via three key processes: reading and highlighting, coding and grouping, which yielded the major themes and subthemes of the study. Findings: Three major themes and nine subthemes emerged from data analysis. The major themes were: (i) support and supply of specialist care; (ii) travel needs and negotiations; and (iii) empathy and experience make a difference. Discussion: Findings from this study highlight aspects of care that healthcare providers can address to improve outcomes for patients with dementia and their carers. Carers need opportunities to seek clarification and provide input on care plans. Good communication, involvement and relationship building between healthcare staff and carers are vital to achieving optimal patient outcomes. Staff training supporting understanding of appropriate dementia care is essential for improved patient and carer outcomes. Conclusion: Factors related to regional location, including lack of specialist care and support, compound carers' challenges. Healthcare provider education on dementia care and dementia‐friendly processes in hospitals will support optimal patient and carers outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess awareness, needs and use of Australian Government‐funded home aged care services among Aboriginal and Torres Strait Islander Peoples from rural and remote South Australia. Design: Mixed‐method study. Setting: Four rural and remote communities with a higher proportion of Aboriginal populations (Ceduna, Port Augusta, Port Lincoln and Whyalla). Participants: Fifty Aboriginal peoples aged 50–89 years (68% females) interviewed between August 2020 and October 2021. Main Outcome Measures: Participant awareness, needs and unmet needs. Results: 88% of the participants indicated they needed home care support with daily activities (median number of needs = 3; interquartile range 2–6 needs), especially housework (86%) and transportation (59%). However, only 41% of those reporting current needs were receiving home care services. The most prevalent unmet needs were allied health (87%), housework (79%), help with meals/meals preparation (76%), shopping (73%) and personal care (73%). Overall, 62% of the participants were unaware of the Commonwealth Home Support Programme, and 54% were unaware of the Home Care Packages program. Qualitative data showed participants felt there is insufficient information and public consultation about these services for older Aboriginal adults. Regular communication in group activities was the preferable approach to becoming aware of these services rather than websites, posted materials or phone calls. Conclusion: Further work is needed to increase home aged care service access for Aboriginal and Torres Strait Islander Peoples living in rural and remote settings. Promotion of these programmes through local group activities could facilitate access to these services and facilitate community engagement in decision‐making. [ABSTRACT FROM AUTHOR]

Objective: This study aimed at evaluating the safety of administering immune checkpoint inhibitors (ICIs) and monitoring for immune‐related adverse events (irAEs) using the Teleoncology model of care. Design: A retrospective cohort study comparing two patient groups. Setting: The North Queensland Teleoncology Network (NQTN) operated by the Townsville (THHS) and Cairns Hospital Health Services (CHHS) with the Townsville Cancer Centre (TCC) acting as the control group setting. Participants: Patients who received ICI treatment via the NQTN between January 2015 and April 2019. Patients who received ICI at the TCC over the same time period were used for comparison. Main Outcome Measures: Rates of high‐grade irAEs and irAE‐related deaths. Results: Fifty‐two patients received a total of 822 cycles of ICIs via the Teleoncology model through NQTN. Over the same time period, 142 patients received a total of 1521 cycles at the TCC. There were no significant differences in all demographic characteristics between either group, including tumour profile and Indigenous status. There were no statistically significant differences between the rates of high‐grade irAE across multiple body organ systems (p = 0.151) and rate of hospital admissions (13.5% (NQTN) vs 5.6% (TCC), p = 0.702). There were no irAE‐related deaths in either group. Conclusions: The results suggest that with adequate governance and clinical resources, ICIs can be administered safely using Teleoncology models to rural and remote towns. [ABSTRACT FROM AUTHOR]

Introduction: The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. Objective: This study assessed whether this approach would reduce the number of alcohol‐associated presentations during high‐alcohol hours (HAH) in a regional ED. Design: From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol‐related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol‐related ED presentations. Findings: ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = −0.004, p = 0.044). No other significant results were found. Discussion: Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. Conclusion: This intervention continues to have promise for reducing alcohol‐related harm. [ABSTRACT FROM AUTHOR]

Objective: To examine the principal place of practice after graduation of students who participated in the Rural Health Multidisciplinary Training (RHMT) program and allied health students' place of origin. Design: Cross‐sectional study. Participants: Graduates who completed their degree in podiatry, occupational therapy and physiotherapy in 2019. Main Outcome Measures: Principal place of practice at first and third years after graduation. Results: In 2020, 40 allied health professionals (AHPs) who graduated from the University of South Australia in 2019 were practising in rural areas but only 26 of them remained in the rural practice in 2022. The retention rate for rural practice was 65% within 2 years. However, in 2022, 25 allied health professionals left their metropolitan employment location and transitioned to rural practice. Of the 25 allied health graduates who joined the rural practice in 2022, most of them (80%, 20/25) had either rural exposure through the RMHT program or were from rural origin. Conclusions: Rural exposure via the RHMT program and allied health students' rural place of origin have an important role for rural principal place of practice at first and third years after graduation. [ABSTRACT FROM AUTHOR]

Objective: To explore the water fluoridation status of rural Victorian towns over 1000 population and document the oral health profile in the local government areas (LGAs) currently with no water fluoridation. To assist/inform future LGA planning, we describe a case study of a community‐based co‐design approach to increase access to fluoridated water in rural communities. Design: A descriptive design and a case study. Setting: Rural Victorian towns over 1000 population. Participants: Twenty‐nine LGAs in rural areas. Main Outcome Measure(s): LGA water fluoridation status and oral health profiles. Results: Sixty‐six (33%) of the 203 Victorian rural towns with >1000 population, representing 149 251 people, did not have access to fluoridated water. Towns in 29 rural LGAs were included with 62% without water fluoridation with many having higher than the Victorian average of preventable hospital admissions due to dental conditions in children aged 0–9 years. Over 50% of children aged 0–12 years living in these rural nonfluoridated LGAs had above‐the‐state average rates of decayed, missing and filled teeth (dmft/DMFT). In those aged 0–5 years, this was the highest with 78% above‐the‐state average. In the case study, meetings were well attended, and the group resolved to lobby for water fluoridation, which was successful. Conclusion: Many Victorian rural towns do not have access to fluoridated water. A community‐based co‐design approach can dispel ill‐informed concerns about dangers of water fluoridation to successfully lobby the state government to fluoridate the local water supply. [ABSTRACT FROM AUTHOR]

Objective: To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID‐19 pandemic. Background: Studies on the impact of COVID‐19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks. Methods: The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi‐square tests. Free‐text comments were analysed using content analysis. Results: Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well‐being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted. Conclusions: This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future‐proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Limited evidence is currently available relating to research acitivity of medical students training in regional or rural areas. Objective: To describe medical student interest and participation in research at The University of Queensland Rural Clinical School (UQRCS). Design: Annual student expression of interest surveys were collated with records of student research participation maintained at UQRCS from 2017‐2022. Additionally, a systematic search was conducted to identify student outputs not captured in internal records. Frequencies and proportions were calculated for all descriptive data along with proportions of students who engaged with a project, and projects that led to a peer‐reviewed publication. Findings: At UQRCS commencement, 55% of research‐interested students reported having basic research skills. Thirty‐nine percent of research‐interested students engaged with a project, most commonly literature reviews (47%) or audits (29%). Thirty‐three percent of completed projects led to a peer‐reviewed manuscript. Discussion: Students who engage with a project are unlikely to receive a project in their preferred clinical area and should be informed about the transferrability of research skills. Most students have basic research skills when commencing a project and therefore require ongoing support and mentorship from staff/supervisors. Conclusion: Publication rates of medical students in regional/rural areas are comparable to those reported by metropolitan medical schools (~30%). [ABSTRACT FROM AUTHOR]

Objective: To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting. Setting: A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services. Participants: Allied health managers employed at the health service were members of an action research group. Design This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis. Results: The action research group met 11 times over a 5‐year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision. Conclusion: The findings from this comprehensive longitudinal study provide evidence‐based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health. [ABSTRACT FROM AUTHOR]

Objective: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. Design: Cross‐sectional design involving face‐to‐face, telephone or video conferencing interviews. Setting: Twelve rural communities across Tasmania and Western Victoria, Australia. Participants: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. Main Outcome Measures: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. Results: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high‐ and low‐performing communities. Overall, the highest‐rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. Conclusions: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community. [ABSTRACT FROM AUTHOR]

Objective: This study explored use and perceived barriers to the use of post‐operative video‐link telehealth among a sample of Australian surgeons shortly before the COVID‐19 pandemic. Methods: During 2019–2020, a survey was mailed to RACS or RANZCOG Fellows. Design: Cross‐sectional survey. Setting and Participants: A total of 907 surgeons practising in Australia completed the survey. Main Outcome Measures: The study‐specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post‐operative teleconsultations, across the domains: quality of care; convenience and efficiency; legal/regulatory issues; financial issues and technological issues. Results: Twenty‐five percent of eligible surgeons returned the survey, with n = 763 pre‐pandemic responses included in analyses. Approximately one‐quarter (26%) of surgeons had used telehealth post‐operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: 'I cannot undertake a patient examination' and 'I cannot provide the same level of care as during an in‐person consultation'; and convenience and efficiency: 'Teleconsultations are more difficult to arrange'. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons. Conclusions: Some surgeons' perceived barriers to telehealth pre‐COVID may be overcome by COVID‐19‐related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic. [ABSTRACT FROM AUTHOR]

Background: An important service system for rural parents experiencing complex trauma is primary health care. Aim: To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma‐informed care in rural primary health care. Material & Methods: This study used a descriptive, cross‐sectional design. It involved an on‐line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study‐developed and included, a 21‐item Knowledge, Attitudes and Practices tool, a 16‐item Barriers and Enablers to Trauma‐Informed Care Implementation tool, and three open‐ended questions. Results: The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma‐informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self‐rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic‐specific services). Open‐ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths‐based and outcome‐focused approaches. Discussion & Conclusion: Primary health care is an important driver of population health and well‐being and critical in rural contexts. Our findings suggest this sector needs a rural trauma‐informed care implementation strategy to address structural barriers. This also requires policy and system development. Long‐term investment in the rural workforce and primary care service settings is essential to integrate trauma‐informed care. [ABSTRACT FROM AUTHOR]

Introduction: The WHO estimates the incidence of iron deficiency anaemia in Australia is 25%. However there is considerable variation during pregnancy and in regional areas. Objective: The aim of this investigation is to quantify the incidence of iron deficiency anaemia during pregnancy within Far North Queensland. Design: This is a single‐centre retrospective cohort study. Cairns Hospital is the main referral centre for complex maternity care in Far North Queensland with an estimated population of 280‐000, which includes many people from rural and remote communities and a high proportion who identify as Aboriginal or Torres Strait Islander. This study included all births at the Cairns Hospital in 2018, a total of 2190 deliveries. Findings: The study randomly sampled 551 mothers from the cohort, and the incidence of iron deficiency anaemia was 34.9%. 48.7% of women who identified as Aboriginal or Torres Strait Islander within the region were anaemic. This was significantly higher than an incidence of 28.9% for the rest of the population. Other risk factors include booking appointment after 28‐weeks, Asian ethnicity and age less than 25‐years. A BMI greater than 35 was protective Discussion: This study will inform antenatal care providers within the region and improve obstetric outcomes by increasing awareness. Identifying risk factors will also facilitate prompt treatment and improve maternity care for vulnerable patient groups. On a broader level, the study provides new data to inform population health estimates both nationally and internationally. Conclusion: The incidence of iron deficiency anaemia during pregnancy in Far North Queensland is significantly higher than previous estimates. [ABSTRACT FROM AUTHOR]

Objective: To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. Design: Multiphase, observational study including a prospective study and a cross‐sectional survey. Setting: Two regional Queensland Hospitals. Participants: Cancer specialist AHPs (n = 13 in a prospective study; n = 7 in a cross‐sectional survey) and generalist AHPs (n = 36 in a cross‐sectional survey), across six disciplines from two regional hospitals and cancer services. Main Outcome Measures: Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. Results: Over 10‐months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs—laryngectomy pre‐operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. Conclusion: There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on‐boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the incidence, characteristics and in‐hospital mortality of non‐ventilator‐associated hospital‐acquired pneumonia (NV‐HAP) in a regional (Modified Monash Model 2) Australian hospital. Methods: All cases with NV‐HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co‐morbidities (measured using the Charlson Comorbidity Index) and in‐hospital mortality were extracted. Incidence rate was calculated as a proportion of NV‐HAP cases per 1000 bed‐days. Design: A retrospective study design was used to review all cases of NV‐HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM‐2). Setting: Rockhampton Hospital, Australia. Participants: Patient cases. Main outcome measures: Incidence rate, Incidence proportion, mortality. Results: A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed‐days over the study period 2013–2018. Cases with NV‐HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in‐hospital mortality rate for NV‐HAP cases was 18.9%. Conclusion: This study revealed an overall incidence rate of 0.98 cases per 1000 bed‐days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV‐HAP at our regional hospital. [ABSTRACT FROM AUTHOR]

Objective: To describe the agents, pattern and trends of unintentional farm fatalities in Australia (2001–2020). Methods: Review of study of National Coronial Information System data. Design: Descriptive. Setting: Australia (2001–2020). Participants: All cases involving fatal work and non‐work injury events on a farm. Main outcome measures: Patterns and agents of injury events, with trends for all‐cause deaths based on rates per 10 000 farms and work‐related incidents (per 100 000 workers and 1 000 000 h worked). Results: There were 1584 unintentional farm fatalities (annual mean 79). Two‐thirds of cases were work‐related (68%). Major agents of injury were farm vehicles (39%) and machinery (26%). Persons aged over 55 years were involved in 58% of all work‐related incidents and were significantly more likely to die than younger cohorts when assessed against hours worked. Death rates involving all on‐farm fatal incidents (both work and non‐work) per 10 000 farms (p = 0.015) and work‐related rates per 100 000 workers (p = 0.015) reduced over the period, with both demonstrating a fluctuating rate. There was no change in the work‐related rates when assessed against hours worked (p = 0.276). Conclusion: Over the period, the annualised number of deaths fell by approximately 24% (98–75), with agents of injury remaining similar. General trends suggest a reduction in the overall death rates for work and non‐work incidents. However, trends were less apparent when the reduction of farms (~19%), workers (~7%) and hours worked (no change), were accounted for. Targeted approaches are required to stimulate improvements in these preventable incidents. [ABSTRACT FROM AUTHOR]

Objectives: To co‐create a culturally responsive student‐implemented allied health service in a First Nations remote community and to determine the feasibility and acceptability of the service. Design: Co‐creation involved a pragmatic iterative process, based on participatory action research approaches. Feasibility and acceptability were determined using a mixed‐method pre/postdesign. Setting: The service was in Nhulunbuy, Yirrkala and surrounding remote First Nations communities of East Arnhem Land, Northern Territory, Australia. Participants: Co‐creation of the service was facilitated by the Northern Australia Research Network, guided by Indigenous Allied Health Australia leadership, with East Arnhem local community organisations and community members. Co‐creation of the day‐to‐day service model involved local cultural consultants, service users and their families, staff of community organisations, students, supervisors, placement coordinators and a site administrator. Findings A reciprocal learning service model was co‐created in which culturally responsive practice was embedded. The service was feasible and acceptable: it was delivered as intended; resources were adequate; the service management system was workable; and the service was acceptable. Health outcome measures, however, were not appropriate to demonstrate impact, particularly through the lens of the people of East Arnhem. Recommendations for the service included: continuing the reciprocal learning service model in the long term; expanding to include all age groups; and connecting with visiting and community‐based services. Conclusion: The co‐created service was feasible and acceptable. To demonstrate the impact of the service, measures of health service impact that are important to First Nations people living in remote communities of northern Australia are required. [ABSTRACT FROM AUTHOR]

Objective: To explore participant experiences of an online co‐design process to develop a web‐based preventative mental health and well‐being intervention targeting primary producers in rural Australia. Setting: Rural Victoria, Australia. Participants: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co‐design and beta testing processes for a primary producer platform. Design: A qualitative study using semi‐structured phone‐based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. Results: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co‐design participation, (3) experiences of the co‐design process, (4) maintaining a shared vision and goals and (5) acting on the co‐design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co‐design using face‐to‐face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face‐to‐face. Conclusions: Using an online co‐design method to develop a preventative mental health and well‐being web‐based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co‐design process and identify opportunities to improve participant engagement and experience with the online format. [ABSTRACT FROM AUTHOR]

Objective: It is essential that the embedded process of rural case selection be highlighted and documented to provide reassurance of rigour across rural surgical services supported by generalist surgeons, general practitioners with enhanced surgical skills and general practitioner anaesthetists. This enables feedback and improves the triage and case selection process to ensure the highest quality outcomes. Therefore, this research aims to explore participants' rational criteria for decision making around rural case selection. Design: Participants participated in a series of semi‐structured in‐depth interviews which were coded and underwent thematic analysis. Setting: Six community hospitals in British Columbia, Canada. Participants: General practitioners with enhanced surgical skills, general practitioner anaesthetists, local maternity care providers, and specialists. Results: Based on participant accounts, rural surgical and obstetrical decision‐making processes for local patient selection or regional referral had five major components: (1) Clinical Factors, (2) Physician Factors, (3) Patient Factors, (4) Consensus Between Providers and (5) the Availability of Local Resources. Conclusion: Decision‐making processes around rural surgical and obstetrical patient selection are complex and require comprehensive understanding of local capacity and resources. Current policies and guidelines fail to consider the varying capacities of each rural site and should be hospital specific. [ABSTRACT FROM AUTHOR]

Introduction: It is well established that rural workforce outcomes are more likely among medical graduates who spend time training in non‐urban areas; however, fewer studies have assessed whether graduates are more likely to return to the specific area where they undertook rural training. Objective: This study aimed to determine whether graduates who had undertaken a regional–rural immersion program in Northland, NZ, were more likely to have returned to work in Northland as of mid‐2021, relative to peers who did not participate. Design: This prospective cohort study used longitudinal tracking survey responses, medical school administrative data and workforce outcome information. A multinomial model, accounting for other covariates, was built to determine the association between graduates practising in Northland (population ⟨ 100 000), which encompasses both rural (population ⟨ 25 000) and regional (25 000 ⟩ population ⟨ 100 000) areas, and having participated in a Northland‐based immersion program during medical school. The study population was University of Auckland domestic medical students graduating between 2009 and 2018, inclusive. Immersion program participants who responded to longitudinal career tracking surveys were included in the study sample. Findings The final sample size was 1320 students (80% of population of interest). Graduates who undertook the Northland immersion program (n = 169) were more likely than non‐participants (n = 1151) to be working in Northland as of 2020–2021 (relative risk: 3.2). Discussion and Conclusion: Regional–rural immersion programs might preferentially build workforces in that specific region; however, further research is required to understand whether these findings are generalizable, and the main reasons for this effect. [ABSTRACT FROM AUTHOR]

Objective: The Australian COVID‐19 Frontline Healthcare Workers study examined the prevalence and severity of mental health symptoms during the second wave of the COVID‐19 pandemic. This substudy examined the differences in psychological well‐being between rural and metropolitan health care workers (HCWs). Design: A nationwide survey conducted between August and October 2020. Setting and Participants: Australian HCWs were recruited through multiple strategies. Main outcome measures: Demographics, mental health outcomes (anxiety, depression, post‐traumatic stress disorder [PTSD] and burnout). Results: Complete responses were included from 7846 participants, with 1473 (18.8%) in regional or remote ('rural') areas and 81.2% in metropolitan areas. Rural participants were older, more likely to work in allied health, nursing or in health administration, and had worked longer in their profession than metropolitan participants. Levels of resilience were similar (p = 0.132), but there was significantly higher prevalence of pre‐COVID‐19 pandemic mental illness in the rural workforce (p < 0.001). There were high levels of current mental health issues: moderate–severe PTSD (rural 38.0%; metropolitan 41.0% p = 0.031); high depersonalisation (rural 18.1%; metropolitan 20.7% p = 0.047); and high emotional exhaustion (rural 46.5%; metropolitan 43.3% p = 0.002). Among rural participants, mental health symptoms were associated with younger age, worry about being blamed if they contracted COVID‐19, fear of transmitting COVID‐19 to their family, experiencing worsening relationships and working in primary care or allied health. Conclusion: Despite having low COVID‐19 case numbers in rural Australian health services compared with metropolitan counterparts over the course of 2020, there were widespread mental health impacts on the workforce. Rural health services need specific and flexible training, education, work policies and practices that support psychological well‐being now in preparedness for ongoing or future crises. [ABSTRACT FROM AUTHOR]

Objective(s): The objective of the study was to validate a clinical aid to guide the assessment and management of a patient's listed beta‐lactam antibiotic allergy for use in rural areas of Australia. Design: Rural generalists, pharmacists and junior doctors completed an online assessment of eight patient case studies using the tool. Setting: The study was conducted in the Southern Downs, QLD. Participants: Twenty‐seven rural generalists, nine pharmacists and eight junior doctors. Main outcome measures: The sensitivity of the selected allergy phenotype and management option for each case study was calculated by profession and overall. Hazardous responses were reported by management category and profession. Results: The sensitivity overall for phenotype selection was 82.4% (95% CI, 78.0–86.2) and for management 88.1% (95% CI, 84.2–91.2). The sensitivity for phenotype selection was lower for junior doctors than other professions 73.4% (95% CI, 60.9–83.7), but did not reach statistical significance (p = 0.08). A total of 10/308 responses for management recommended the least restrictive option of direct delabelling or oral challenge, where the correct answer was skin prick testing or referral to an allergist. Conclusion(s): With further education the tool could be a key component of increased antimicrobial stewardship in rural areas in Australia. [ABSTRACT FROM AUTHOR]

Introduction: Rural Australians have comparatively higher rates of overweight and obesity, as well as some mental health issues. Intuitive eating has been shown to be positively associated with an array of physical and mental health indicators. Few studies, however, have been conducted with general populations, and none has explicitly examined intuitive eating among rural residents. Objective: To investigate the prevalence of intuitive eating, and associations between intuitive eating and indicators of physical and mental health, among a general population of rural adults. Design: Cross‐sectional telephone survey of 200 randomly selected, non‐metropolitan, English‐speaking Australian residents aged 18 or older. Findings: The prevalence of intuitive eating in the sample was 17.6%, with a higher level of intuitive eating among men than women (26.1% vs 9.1%). Bivariate associations between intuitive eating and each of the six health indicators were all positive and mostly statistically significant. Particularly strong was the correlation between intuitive eating and self‐esteem for women (r = 0.53). After controlling for indication of an eating disorder and demographics, the associations between intuitive eating and the outcome variables held for body mass index (BMI), psychological distress and body esteem for men, and for BMI and self‐esteem for women. Post hoc analyses found that BMI did not moderate the relationship for women between intuitive eating and self‐esteem and that body esteem mediates the relationships between intuitive eating and BMI and psychological distress for men, and between intuitive eating and self‐esteem for women. Discussion: Consistent with most prior research, this study finds that intuitive eating is positively associated with several indicators of both physical and mental health among non‐metropolitan residents in Australia. Practice of intuitive eating in this population, however, is low. These findings may help allied health professionals guide rural populations to better health, and may be a particularly effective approach for people for whom the barriers to seeking out health services are high. Conclusion: Intuitive eating appears to have substantial correlations with mental health indicators, and to some extent, physical health indicators, among rural Australians and therefore should be further investigated for its potential to inform public health policy targeted to similar populations. [ABSTRACT FROM AUTHOR]

Objective: To understand how contemporary socio‐cultural factors may impact medical students' rural career intent. Design: Cross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/setting: Medical students across 18 Australian universities who completed a full academic year of clinical training in rural areas in 2019. Main outcome measure(s): Preferred location of practice post‐training reported to be either: (i) a major city; (ii) a regional area or large town; or (iii) a small rural location. Results: In total, 626 students completed the survey (70.1% response rate). A small rural location was the most preferred location of practice after graduation for 28.3% of the students (95% CI 21.6–36.0). Four socio‐cultural factors were positively associated with a preference for a rural career location: poor health status of rural people, motor vehicle traffic congestion in cities, rural generalist training opportunities in the state and the Royal Flying Doctor Service. Other socio‐cultural factors, including specialists' under‐employment, Medicare freeze effect on doctors' income, bullying/sexual harassment in hospitals, climate change/natural disasters or recognised rural health personalities did not influence the investigated outcome. Conclusions: Our findings indicate a novel association between contemporary socio‐cultural factors and rural career intention in a cohort of Australian rural clinical school students. These findings advocate for further consideration of research exploring socio‐cultural factors shaping rural career intent and workforce outcomes. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic. Design: Cross‐sectional survey. Setting: The University of Queensland Rural Clinical School. Methods: Students undertaking one or two years of study at the participating Rural Clinical School in November 2020. Main outcome measure: A 20‐item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree. Results: The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third‐year counterparts. Conclusions: The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements. [ABSTRACT FROM AUTHOR]

Objective: To investigate students' perceptions of the impact of coronavirus SARS‐CoV‐2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. Design: A mixed‐method design comprising an online survey and semi‐structured interviews. Setting: Australia. Participants: Allied health, nursing and medical students with a planned University Departments of Rural Health‐facilitated rural or remote placement between February and October 2020. Intervention: A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. Main outcome measures: Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi‐structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. Results: While coronavirus SARS‐CoV‐2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health‐facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. Conclusions: The coronavirus SARS‐CoV‐2 pandemic was reported to impact the majority of University Departments of Rural Health‐facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence. [ABSTRACT FROM AUTHOR]

The article investigates the rate of faecal occult blood test (FOBT) screening participation in residents aged 50 to 74 years living in Central West New South Wales and their self-reported barriers to screening participation. Topics discussed include colorectal cancer (CRC) screening, demographic variables, and CRC risk factors.

Background: Chronic obstructive pulmonary disease is the third leading cause of death worldwide. Although there is currently no cure for chronic obstructive pulmonary disease, the available self‐management strategies can result in improving the symptoms, slowing the disease progression, reducing the frequency of acute exacerbations, improving the patients' quality of life and minimising health care utilisation‐associated costs. Patient activation is often considered an essential driver of self‐management; however, there are contradictory evidence about its impact on chronic obstructive pulmonary disease self‐management. Objective: This review aims to fill this gap by collating the available evidence on the effectiveness of patient activation‐driven chronic obstructive pulmonary disease self‐management interventions. Methods: Databases including MEDLINE, Academic Search Complete, CINAHL Plus, Science Citation Index, Social Sciences Citation Index, Scopus, APA PsychInfo, EMBASE and ScienceDirect were searched for randomised controlled trials of patient activation‐driven chronic obstructive pulmonary disease self‐management interventions between 2004 and July 2020. The search terms included chronic obstructive pulmonary disease, self‐management/self‐care and patient activation/patient engagement. Findings: The initial search resulted in 645 articles, and after reviewing, 10 randomised controlled trials met the inclusion and exclusion criteria. Our review found that patient activation level had a positive association with chronic obstructive pulmonary disease self‐management and clinical outcomes, and higher patient activation levels led to better outcomes. The interventions also led to moderate improvements in patient activation level. However, improved patient activation levels did not improve hospitalisation rates, quality of life and mental health. Conclusion: Our findings suggest that patient activation can be used as a reliable tool for improving chronic obstructive pulmonary disease self‐management and clinical outcomes; however, it should encompass all aspects of patient activation, especially the emotional aspect. [ABSTRACT FROM AUTHOR]

The article presents a prospective study which aims to assess the quality of rural colonoscopy service at the Mount Gambier and Districts Health Service in South Australia. The hospital provides outreach endoscopy and colonoscopy service to neighboring towns. Topics include the low incidence of mortality among colorectal cancer (CRC) patients in the country due to programs like the colonoscopy service and the National Bowel Cancer Screening Program (NBCSP).

Objective: Growing a strong Aboriginal and Torres Strait Islander health workforce is key to closing the gap in health outcomes between Indigenous and non‐Indigenous Australians. This study sought to explore barriers and enablers to career development for Aboriginal health staff and potential strategies to enhance career pathways. Design: Qualitative study, with data collected primarily through focus group discussions (yarning circles) at different health workplaces. Setting: Western New South Wales. Participants: Aboriginal health staff (n = 54) from Aboriginal Community Controlled Health Services, a Local Health District and a Primary Health Network, and their managers (Aboriginal and non‐Aboriginal; n = 28). Main outcome measures: Identified barriers and enablers and regional strategies for improving career pathways. Results: Aboriginal people interested in pursuing a career in health face barriers in: pre‐employment, recruitment, the workplace and further education and training. Being given practical and emotional support, as well as opportunities, makes a difference at every stage. Family and community are very influential in career decisions. Within the workplace, culturally appropriate human resource systems and management structures are vital. The ability to obtain employment and access education and training locally is important to rural and remote communities. Conclusion: To enhance health career pathways for Aboriginal people, strategies are needed at all levels: community, organisation, system and society. Aboriginal leadership and self‐determination are crucial, as are partnerships within the health sector and between the health and the education and training sectors. Cultural safety is essential to expansion of the Aboriginal workforce, and to health care experiences and outcomes for Aboriginal community members. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of and key factors for sustaining a rural‐based research team focussed on nutrition and dietetics. Design: A longitudinal embedded case study approach with data sourced from publicly available records and observations. Case study sub‐units were developed into 3 phases with analysis using theoretical propositions and pattern matching. Quantitative data were descriptively analysed. Setting: University of Newcastle Department of Rural Health across 4 rural sites. Participants: Publicly available data sources from existing team members. Main outcome measures: Staffing levels, research supervision, internal and external grant outcomes and peer‐reviewed journal publications. Result: Academic staffing has increased by 4 full‐time equivalent positions over 18 years, with 6 current higher‐degree research students. Key factors identified in the development of a discipline‐specific research workforce included staff higher degree by research completions, longevity of staff in research‐active roles, immersive rural placements with a research component and collaborations with nationally competitive researchers. Rural pilot research projects, community connections, understanding of the local context and research networks were fundamental to establishing a viable team. Conclusion: Systematically investing in research that is embedded in local communities will ensure sustainability and relevance, capacity building of existing staff and an ability to problem solve at the local level. Sustained and focussed investment is needed if the current rural research workforce is to develop towards a capacity that meets current demand. [ABSTRACT FROM AUTHOR]

Objective: To explore the pathways recent nursing and allied health graduates have used to gain initial employment in regional and rural Tasmania. Design: A mixed‐methods design comprising an online survey and semi‐structured interviews. Setting: Tasmania, Australia. Participants: Eighty‐four recent nursing and allied health graduates from 18 disciplines. Main outcome measures: Location and pathway to initial employment, job search strategies, number of job applications and length of time taken to gain employment. Results: Participants obtained their qualification from Tasmania or mainland Australia. Rural‐origin graduates were more likely to work in rural locations after graduating. Graduates sought initial regional or rural employment to be close to family; to avail themselves of more job opportunities and less competition from other graduates; and for adventure. An inability to secure metropolitan jobs led others to seek opportunities in regional and rural Tasmania. Graduates that used multiple job search strategies and who were more flexible regarding location and field of initial employment experienced fewer challenges gaining employment. Conclusion: For recent nursing and allied health graduates, securing initial employment can be time‐consuming and labour‐intensive. Being flexible, persistent and willing to adjust expectations about work location will help. Rural employment might provide the right get‐go for a professional career. Understanding the pathways recent graduates have used to gain initial rural employment can help better connect graduates and prospective employers. [ABSTRACT FROM AUTHOR]