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Background: Australia's National Disability Insurance Scheme (NDIS) was launched in 2013 to provide financial support packages for people with disability to purchase supports and services to enhance independence. People with disability are required to develop a plan with the National Disability Insurance Agency (NDIA), the government department responsible for managing the NDIS. This scoping review aims to ascertain the level of research into people's experience of the NDIS planning process in these geographic areas. Methodology: Research publication databases were searched using a specific search string to identify research about people with disability and their families/carer's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications focused on Aboriginal and Torres Strait Islander people were additionally appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications' contents was undertaken to ascertain people with disabilities and carers experience of the NDIS planning process. Results: Ten (N = 10) research papers were found that met the inclusion criteria. Two papers were policy reviews and reported on the improvements of the NDIS planning process since its conception. The analysis found the research archive focused on five themes: (1) healthcare workforce and NDIA staff; (2) NDIS package holders and carers lack of awareness of the NDIS; (3) cultural/socio‐economic barriers; (4) travel funding; and (5) emotional burden of the NDIS planning process. Conclusion: There are limited papers available that explore people's experiences of the NDIS planning process in regional, rural and remote regions of Australia. This systematic review illuminates the difficulties, barriers and concerns of people with disability and their carers about the planning process. [ABSTRACT FROM AUTHOR]

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]

Introduction: Student‐led clinics can provide health services to marginalised groups where service offerings are sparse or difficult to access, such as rural areas. Offering these services to children and young people can promote health and well‐being by addressing the individual challenges and the social determinants of health. There is uncertainty, however, as to whether student‐led clinics can meet Australian accreditation standards for health professionals completing degree programs. Objective: This study aims to determine the capacity for health student placements in school‐based student‐led clinics to meet accreditation standards. Design: A systematic scoping review was conducted based on Arksey and O'Malley's framework and the PRISMA‐ScR statement. Setting: Several databases were examined, including Ebsco (Academic Source and CINAHL), ProQuest (PsycINFO, ERIC) and grey literature sources along with a desktop review of accreditation standards across seven health disciplines. Two independent reviewers screened eligible studies. Findings: The search retrieved 1037 records with 65 full‐text papers assessed for eligibility. Eleven papers met the inclusion criteria. Based on the evidence, both nursing and exercise and sports science accreditation standards were best suited to student‐led clinics. Discussion: Although broad categories of work‐integrated learning activities were applied, it appears feasible to expect accreditation standards for health disciplines at an Australian university to be a good fit for health student‐led school‐based clinics. Conclusion: Increasing health student placement opportunities within student‐led clinics can improve the health and well‐being of children and young people in regional, rural and remote (RRR) areas of Australia who may otherwise have limited access to allied health services. [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]

Introduction: Telehealth has become an increasingly popular method to deliver mental health services to rural and remote youth who are challenged by distance and service availability. However, it remains unclear whether rural and remote youth would prefer to access mental health services via telehealth or by attending services in person. Objective: To systematically review the preferences of rural and remote youth for mental health service access via telehealth versus face‐to‐face consultation. Design: Systematic review of published research papers cited in databases CINAHL, MEDLINE and PubMed databases between 2000 and 2021. Findings From a total of 225 articles identified, four were found to meet inclusion criteria. Three studies reported rural and remote youth preferred to access mental health services face‐to‐face over telehealth. However, three studies also reported youth viewed telehealth as an important adjunct to in person attendance, especially in situations of large travel times. Discussion Although telehealth can facilitate mental health service access, rural and remote youth may prefer to see a mental health professional in person, with telehealth regarded as an adjunct to, not a replacement for, face‐to‐face consultation. Conclusion: Whilst rural and remote youth may prefer to access mental health services in person rather than via telehealth, further well designed research is needed to better understand under what circumstances this preference holds true and why. Caution should be exercised in generalising this finding because of the few studies that met the inclusion criteria and different conditions under which youth made their choice to access mental health services. [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: Commercial tobacco use was systematically embedded as a valuable commodity through colonisation that continues to be exploited for profit by the Tobacco Industry. There have been significant declines in current smoking prevalence among Aboriginal and Torres Strait Islander peoples 18 years and over, from 55% in 1994 to 43% in 2018–2019. This paper seeks to better understand smoke‐free behaviours, and to systematically quantify associations between a range of SDOH and non‐smoking/never‐smoking among Aboriginal and Torres Strait Islander adults (≥18) living in regional Australia. Objective: To explore the social determinants of health (SDOH) related to non‐ and never‐smoking among Aboriginal and Torres Strait Islander peoples in regional Australia. Design: Cross‐sectional analysis of the NATSIHS, weighted to the Aboriginal and Torres Strait Islander adult population living in regional Australia, was conducted. Participants were characterised as people who were current smokers, never‐smokers and non‐smokers (ex‐ and never‐smokers). The social determinants of health exposures related to socioeconomic position, well‐being and access to healthcare. Setting: Regional Australia is distinct from urban and remote areas, based on the ASGS Remoteness Structure (ABS) 2018–2019. Participants: Aboriginal and Torres Strait Islander adults (≥18 years) who were selected, consented and asked questions about smoking in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS 2018/19). Results: High income was associated with non‐smoking (Prevalence Ratio [PR] = 2.07; 95% CI: 1.66–2.57) and never‐smoking (PR = 2.02; 1.46–2.79), as was completing year 10 (non‐smoking PR = 1.34; 1.12–1.61 and never‐smoking PR = 1.56; 1.20–2.03). Better food security was associated with a higher prevalence of never‐smoking (PR = 2.42; 1.48–3.98). Lower psychological distress scores were associated with non‐smoking (PR = 1.30; 1.10–1.53) and never‐smoking (PR = 1.56; 1.21–2.01). Never‐smoking was more frequent in participants reporting no experiences of unfair treatment (PR = 1.59; 1.22–2.06). Having a usual healthcare provider was associated with non‐smoking (PR = 1.38; 1.02–1.86). Positive exposure to the SDOH were associated with non‐ and never‐smoking among Aboriginal and Torres Strait Islander adults in regional Australia. Structural and systemic changes to address the SDOH, including discrimination and racism, are expected to accelerate non‐smoking behaviours and improve health outcomes for Aboriginal and Torres Strait Islander peoples. [ABSTRACT FROM AUTHOR]

Introduction: Australian rural and remote areas are faced with the double burden of an ageing population paired with inequitable access to health resources due to the paradigm of major city centred health care. This complicates fall management within this space. Paramedics are a registered health profession, which provides mobile, equitable health care. However, this resource is not being effectively utilised in rural and remote areas where primary care access barriers may cause patient needs to go unmet. Objective: To describe the existing literature and describe the international scope of current paramedicine practice in the out‐of‐hospital management of falls amongst older adults in rural and remote settings. Design: Joanna Briggs Institute scoping review methodology was employed. CINAHL (EBSCO), MEDLINE (Ovid), EMBASE (Ovid), SCOPUS (Elsevier), Google Scholar and These Global were searched and Australian, New Zealand and the UK ambulance service guidelines were sought. Findings: Two records met inclusion criteria. Currently, rural and remote paramedic fall management involves preventative health promotion through patient education, population‐based screening and referrals. Discussion: The use of paramedics to screen at‐risk populations and refer is vital, as many rural adults had screened positive to fall risks and other unmet needs. There is poor recollection of physically printed education material and low acceptance of further in‐home assessments following paramedic departure. Conclusion: This scoping review has highlighted a significant knowledge gap on this topic. Further research is needed to effectively utilise paramedicine within areas where access to primary care is not possible to achieve downstream, risk reducing care in the home. [ABSTRACT FROM AUTHOR]

Objective: Perioperative initiation of opioids continues to be a major contributor to chronic use, misuse and diversion in regional areas. There is considerable effort to mitigate harm through avoiding excessive prescribing and reducing the risk of persistent postoperative opioid use. Improving perioperative documentation practices has been reported to ensure appropriate opioid initiation and de‐escalation. It has not been established whether these strategies are utilised in regional hospitals. Methods: A retrospective observational study of perioperative opioid prescribing and documentation practices in Goulburn Base Hospital, a regional centre in the Southern New South Wales (NSW) Local Health District. Data were collected from 110 records and validated for adult patients undergoing elective total knee replacement (TKR) or total hip replacement (THR) from 12 January 2020 to 13 January 2021. Outcome Measures: To observe perioperative opioid prescribing and utilisation of harm reduction strategies in a regional hospital. Results: 65% of patients were opioid naïve (ON). Preoperative pain assessments and patient education were completed in 23% and 15% of records, respectively. Postoperative opioids were prescribed for 99% of patients, with 74% prescribed a slow‐release (SR) formulation. 50% of patients were discharged with an SR prescription. Inadequate postoperative pain control was reported in 21% of patients. Of the 103 patients prescribed opioids on discharge, only 20% included a de‐escalation plan and only 35% of discharge summaries included dose and quantity of opioids supplies. Conclusions: This study has identified underutilisation of perioperative harm reduction strategies despite the potential to improve appropriate initiation and de‐escalation of opioids. These findings highlight opportunities for improvement in regional hospitals. [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 explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS. Setting: Rural areas of New South Wales classified as Modified Monash Categories 3–7. Participants: Semistructured interviews were conducted with seven purposively sampled participants who self‐identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW. Design: Data collection and analysis were guided by hermeneutic phenomenology. Findings: We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control. Discussion: The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need. [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: To describe the first 9 months of a newly established computed tomography coronary angiogram (CTCA) over the period of the COVID‐19 pandemic. Methods: A retrospective analysis of the first 9 months of a CT‐CA program. Design: Data were collected for the period of June 2020 to March 2021. Information reviewed included demographics, risk factors, renal function, technical factors and outcomes including Calcium Score and Coronary Artery Disease Reporting and Data System (CAD‐RADS). Setting: A single Rural Referral Hospital in regional New South Wales. Participants: Ninety‐six CTCAs were reviewed. Ages ranged from 29 to 81 years. 37 (39%) male, 59 (61%) female. 15 (15.6%) identified as Aboriginal and/or Torres Strait Islander. Main Objective Outcomes: CTCA is a viable alternative to invasive coronary angiogram in appropriate populations for regional areas. Results: Eighty‐eight (91.6%) were considered technically satisfactory. Mean heart rate was 57 beats per minute with a range of 108. Cardiovascular risk factors included hypertension, dyslipidemia, smoking status, family history and diabetes mellitus. Of patients with CAD‐RADS scores 3 or 4 who underwent subsequent invasive coronary angiogram (ICA), 80% were determined to have operator‐defined significant stenosis. Significant cardiac and non‐cardiac findings were extensive. Conclusions: CTCA is a safe and efficacious imaging modality for low‐ to moderate‐risk chest pain patients. There was acceptable diagnostic accuracy and the investigation was safe. [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]

Objective: To evaluate the contribution of the Adelaide Rural Clinical School (ARCS) longitudinal integrated clerkship to the rural medical workforce. Methods: Design: Retrospective cohort study. Setting: Practice location data were sourced from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021) and matched using university records. Participants: University of Adelaide medical school alumni graduating between 2004 and 2019 (ARCS alumni who completed a full year of rural training [n = 423], metropolitan‐trained peers [n = 1655]). Main outcome measures: The proportions of medical graduates working in a rural location (Modified Monash Model [MMM3‐7] or Australian Statistical Geography Standard [ASGS‐RA2‐5] classifications). Logistic regression was used to examine the association between ARCS training and working rurally, and the influence of rural background and sociodemographic factors. Results: Working in a rural location was almost three times more frequent among ARCS alumni than their metropolitan‐trained peers, using the MMM3‐7 (14.7% vs. 5.3%) classification; for ASGS‐RA2‐5 classification (21.3% vs. 8.9%). In adjusted analysis, working rurally (MMM3‐7) was associated with having a rural/remote residence on enrolment (OR 8.29, 95% CI 4.22–16.26) and was 3.1 times more likely for ARCS alumni (OR 3.06, 95% CI 2.06–4.53) than their peers. The magnitude of the effects of ARCS training on whether they are working rurally was similar among those with metropolitan or rural background (p‐value for interaction 0.873). Similar associations were observed using ASGS‐RA2‐5 classifications. Conclusions: Extended rural placements through the Adelaide Rural Clinical School increased the rural medical workforce, with a similar impact among those with a rural or metropolitan background. [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]

Introduction: Despite the importance of child road traffic death, a limited number of studies have investigated rural child road traffic death in high income countries. Objective: This review estimated the impact of rurality on child road traffic deaths and other potential risk factors in high‐income countries. Design: We searched Ovid, MEDLINE, CINAHL, PsycINFO and Scopus databases and extracted studies focusing on the association between rurality and child road traffic death published between 2001 and 2021. Available data were extracted and analysed, to evaluate the impact of rurality on child road traffic death and explore other risk factors of child road traffic deaths. Findings: We identified 13 studies for child road traffic death between 2001 and 2021. Eight studies reported the impact of rurality on child road traffic death, and all of them alleged that the mortality rate and injury rate of children was significantly higher on rural road than on urban road. The impact of rurality varied between studies, from 1.6 times to 15 times higher incidence of road traffic death in rural areas. Vehicle type, speeding cars, driver loss of control, alcohol and drug use road environment were identified as risk factors of child road traffic death. Conversely, ethnicity, seat belts, nondeployed airbag, child restraint, strict driver licence system, camera law and accessibility of trauma centres were considered protective factors. Other factors, including age, gender and teen passengers, appeared ambiguous for child road traffic death. Discussion: Rurality is one of the most important risk factors of child road traffic death. Therefore, we should consider the impact that rurality has on child road death and resolve the gap between rural and urban areas in order to prevent child road traffic death effectively. Conclusion: The findings of this literature review will assist policy‐makers to prevent child road traffic death by focusing on rural regions. [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]

Introduction: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability. Objective: This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services. Design: A narrative review was conducted using thematic discourse analysis to examine online newspaper content published in Victoria, Australia from 2010 to June 2021. Findings: Local maternity services were a source of community interest for rural people. Coverage of negative outcomes for mothers and babies was highlighted by rural newspapers; however, increased content over the last 12‐month period focused on community support for the sustainability of rural maternity services. Recent community support in newspaper articles coincided with maternity services reviews and retaining some of these rural services. Discussion: Community support in media may provide a protective social pressure, leading rural health services to consider this when reviewing the sustainability or closure of rural maternity services. Conclusion: Media attention about sustaining local maternity services by highlighting issues and representing community voices may influence health executive to consider opportunities to remodel and sustain high‐quality and safe maternity care in rural settings. Knowing how rural health executives consider media, community pressure, and how it impacts expediency of maternity service closure decisions is unknown and an important gap in knowledge to explore and understand. [ABSTRACT FROM AUTHOR]

Objective: Colorectal cancer has geographic inequities in Australia, with higher mortality rates and lower participation in the National Bowel Cancer Screening Program (NBCSP) in remote and rural areas. The at‐home kit is temperature‐sensitive, necessitating a 'hot zone policy' (HZP); kits are not sent when an area's average monthly temperature is above 30°C. Australians in HZP areas are susceptible to potential screening disruptions but may benefit from well‐timed interventions to improve participation. This study describes the demographics of HZP areas and estimates the impacts of potential screening changes. Methods: The number of individuals in HZP areas was estimated, as well as correlations with remoteness, socio‐economic and Indigenous status. The potential impacts of screening changes were estimated. Results: Over a million eligible Australians live in HZP areas, which are more likely to be remote/rural, have lower socio‐economic status and higher Indigenous populations. Predictive modelling estimates that any 3‐month screening disruption would increase CRC mortality rates up to 4.1 times more in HZP areas vs unaffected areas, while targeted intervention could decrease mortality rates 3.4 times more in HZP areas. Conclusion: People living in affected areas would be negatively impacted by any NBCSP disruption, compounding existing inequities. However, well‐timed health promotion could have a stronger impact. [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]

Objectives: To compare processes of care and clinical outcomes of community‐based management of TIAs and minor strokes (TIAMS) between rural and metropolitan Australia. Design: Inception cohort study between 2012 and 2016 with 12‐month follow‐up after index event (sub‐study of INSIST). Setting: Hunter and Manning valley regions of New South Wales, within the referral territory of the John Hunter Hospital Acute Neurovascular Clinic (JHHANC). Participants: Consecutive patients of 16 participating general practices, presenting with possible TIAMS to either primary or secondary care. Main Outcome Measures: Processes of care (referrals, key management processes, time‐based metrics) and clinical outcomes. Results: Of 613 participants with possible TIAMS who completed the baseline interview, 298 were adjudicated as having TIAMS (119 from rural, 179 from metropolitan). Mean age was 72.3 years (SD, 10.7) and 127 (43%) were women. Rural participants were more likely to be managed solely by a general practitioner (GP) than metropolitan participants (34% v 20%) and less likely to be referred to a JHHANC specialist (13% v 38%) or have brain magnetic resonance imaging (MRI) [24% v 51%]. Those rural participants who were referred, also waited longer (both p < 0.001). Recurrent stroke, myocardial infarction and death at 12 months were not significantly different between rural and metropolitan participants. Conclusions: Although TIAMS prognosis in rural settings where solely GP care is common is very good, the processes of care in such areas are inferior to metropolitan. This suggests there is further scope to support rural GPs to optimise care of TIAMS patients. [ABSTRACT FROM AUTHOR]

Introduction: In February 2018 the Remote Medical Practitioner (RMP)‐led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC. Objective: To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia. Design: There were 103 and 72 respondents, respectively, to pre‐ and post‐implementation surveys of remote clinicians and specialist staff. Findings: Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available. Discussion: Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP‐led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills. Conclusion: Given the paucity of literature about optimal models for providing pre‐hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density. [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]

Introduction: Residents of rural areas internationally typically experience chronic disease risk profiles worse than city dwellers. Poor diet, a key driver of chronic disease, has been associated with unhealthy food environments, and rural areas often experience limited access to healthy, fresh and affordable food. Objective: This study aimed to evaluate the first three years of a health promoting social enterprise café established in a small rural health service. Design: A mixed‐methods evaluation study. Quantitative sales data, surveys and key informant interviews that included both quantitative and qualitative responses. Findings: Three years of sales data were included; 111customer surveys and five key informant interviews were conducted. Food and beverages on displayed and sold consistently met or exceeded the healthy criteria set by policy. Stakeholders supported the traffic light system, the social enterprise model and rated the likelihood of sustainability of the café as high. Discussion: Customers used the 'traffic light' system to inform food choices, placed value on the warmth of the staff and on the welcoming environment created through the social enterprise model. Resources remain tight although all stakeholders are committed to the sustainability of the YarriYak café. Conclusion: The study shows the acceptability, feasibility and sustainability of a health promoting social enterprise café in a rural area. [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: To explore reasons for survival disparities for patients with prostate cancer in the Barwon South West area of Victoria. Design, Setting and Participants: We have described incidence, diagnostics, treatment pathways, and survival for four regions of the Barwon South Western Victoria. Analysis included all newly diagnosed prostate cancer patients from 2009 to 2015 in the Evaluation of Cancer Outcomes Barwon South West Registry. Regions included 1: Queenscliffe 2: Geelong, Colac Otway and Corangamite 3: Moyne, Warrnambool and Southern Grampians and 4: Glenelg. Across the four regions, variables were compared using a chi square statistic or analysis of variance and survival data was assessed with the Kaplan–Meier curves. Main Outcome Measures: Incidence, treatment pathways and survival for prostate cancer patients. Results: A total of 1776 patients were diagnosed with prostate cancer from 2009 to 2015 in the Barwon South West area. In regions 1–4, there were 298 (1.04%), 1085 (0.92%), 273 (0.97%) and 120 (1.2%) cases, respectively. There was no significant difference in Gleason score and treatment. The 5‐year survival rate was 85%, 76%, 71% and 80%, respectively, as compared with the national average of 95%. PSA scores >20 ng/ml at diagnosis, as a surrogate for high‐risk disease, occurred in 23%, 29%, 22% and 21%, respectively (p < 0.01). The proportions presenting with stage IV disease were 17%, 26%, 21% and 6%, respectively (p = 0.10). Conclusion: Men diagnosed with prostate cancer in South West Victoria have a considerably lower 5‐year survival compared with the national average with later disease at presentation in some areas. [ABSTRACT FROM AUTHOR]

Objective: To assess awareness and risk of Q fever among agricultural show attendees. Setting: University of New England's Farm of the Future Pavilion, 2019, Sydney Royal Agricultural Show. Participants: Participants were ≥18 years, fluent in English, Australian residents, and gave their informed consent. Main Outcome Measures: Participants reported whether they had ever heard of Q fever and then completed the 'Q Tool' (www.qfevertool.com), which was used to assess participants' demographics and risk profiles. Cross‐tabulations and logistic regression analyses were used to examine the relationship between these factors. Results: A total of 344 participants were recruited who, in general, lived in major NSW cities and were aged 40–59 years. 62% were aware of Q fever. Living in regional/remote areas and regular contact with livestock, farms, abattoirs and/or feedlots increased the likelihood of Q fever awareness. Direct or indirect contact with feral animals was not associated with Q fever awareness after controlling for the latter risk factors. 40% of participants had a high, 21% a medium, and 30% a low risk of exposure. Slightly less than 10% reported a likely existing immunity or vaccination against Q fever. Among those who were not immune, living in a regional or remote area and Q fever awareness were independently associated with increased likelihood of exposure. Conclusions: Awareness of Q fever was relatively high. Although 61% of participants had a moderate to high risk of exposure to Q fever, they had not been vaccinated. This highlights the need to explore barriers to vaccination including accessibility of providers and associated cost. [ABSTRACT FROM AUTHOR]

Objective: Errors in hospital medication charts are commonly encountered and have been associated with morbidity and mortality. This study evaluates the impact of the Partnered Pharmacist Medication Charting (PPMC) model on medication errors in general medical patients admitted to rural and regional hospitals. Design/Method: A prospective cohort study, comparing before and after the introduction of PPMC was conducted in 13 rural and regional health services. This included a 1‐month pre‐intervention phase and 3‐month intervention phase. In the intervention phase, PPMC was implemented as a new model of care in general medical units. Setting: Victoria, Australia. Participants: Patients admitted to General Medical Units. Outcome Measure: The proportion of medication charts with at least one error was the primary outcome measure. Secondary outcome measures included inpatient length of stay (LOS), risk stratification of medication errors, Medical Emergency Team (MET) calls, transfers to ICU and hospital readmission. Results: Of the 669 patients who received standard medical charting during the pre‐intervention period, 446 (66.7%) had at least one medication error identified compared to 64 patients (9.5%) using PPMC model (p < 0.001). There were 1361 medication charting errors identified during pre‐intervention and 80 in the post‐intervention. The median (interquartile range) inpatient length of stay was 4.8 (2.7–10.8) in the pre‐intervention and 3.7 days (2.0–7.0) among patients that received PPMC (p < 0.001). Conclusion: The PPMC model was successfully scaled across rural and regional Victoria as a medication safety strategy. The model was associated with significantly lower rates of medication errors, lower severity of errors and shorter inpatient length of stay. [ABSTRACT FROM AUTHOR]

Objective: To determine whether young rural Australians have higher rates or different underlying causes of out‐of‐hospital cardiac arrest (OHCA). Design: A case–control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non‐cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non‐cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. Setting: A state‐wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). Participants: Victorians aged 1–50 years old experienced an OHCA between April 2019 and April 2020. Main outcome measures: Rates and underlying causes of OHCA in young rural and metropolitan Victorians. Results: Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101–235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71–251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. Conclusion: Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA. [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: There is public concern regarding rural workforce shortages and closure of smaller obstetric centres. Aim: To identify whether safety is a concern for Murrumbidgee hospitals that fit primary medical care models and ascertain general practitioner (GP) obstetricians' perspectives regarding the benefits and challenges to practising in the region. Design: Mixed‐method retrospective analysis of selected outcomes in the NSW Mothers and Babies Reports 2012–2015 and semi‐structured interviews with GP obstetricians. Setting: Murrumbidgee Local Health District. Main outcome measures: Evaluation of the safety of smaller hospitals (i.e. discharge status at birth, neonatal resuscitation and admission to intensive care); and iterative thematic analysis. Results: This study provides evidence that smaller hospitals are providing safe obstetric care. Fewer babies were transferred, with fewer stillbirths, at the smaller hospitals and no difference in newborn deaths. There were more normal vaginal births in the smaller hospitals (70.0%) than in Wagga Wagga Base Hospital (57.2%) or Griffith Base Hospital (58.6%). There were fewer neonatal resuscitations in the smaller hospitals than in Wagga Wagga Base Hospital or Griffith Base Hospital. More than one‐quarter of babies were admitted into the special care/neonatal intensive care for both Wagga Wagga and Griffith Base Hospitals; however, the rate was <3% in the smaller hospitals (p < 0.001). GPs were overwhelmingly positive about the professional rewards of GP obstetric practice and the importance of continuity of care, despite barriers such as workforce shortages, loss of facilities and other staff (midwives and anaesthetists). Possible solutions included fostering support systems, proactive succession planning and improving training support. Conclusions: GP obstetricians are providing a valuable, safe service in MLHD with both personal and community benefits. [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]