Search

Context: Access to healthcare for rural Australians is a wicked problem, particularly for rural people with disability. Contemporary healthcare access frameworks in Australia tend to overlook geography, use a 'one‐size‐fits‐all approach', and disregard the valuable relationships between key rural healthcare stakeholders, including rural people with disability, rural health services and health professionals. The United Nation's Convention on the Rights of Persons with Disabilities requires the Australian Government to engage people with disability in the design of policies that will shape their day‐to‐day lives, including their access to healthcare. However, the nature and extent to which rural people with disability, rural health professionals and other key rural stakeholders are involved in the design of Australian policies impacting the health of rural people with disability are unknown. Aim: This paper examines approaches taken to engage rural people with disability and health professionals in the design of Australian disability policy impacting healthcare access, and reimagines future processes which can improve healthcare access for rural people with disability. Approach: Co‐design and ethics of care lenses are applied to policy design approaches in this paper. We approach this work as rural disability and health academics, rural health professionals, and as rural people with disability, neurodivergence and family members of people with disability. Conclusion: We argue future co‐designed policy approaches could focus on driving change towards equity in healthcare access for rural people with disability by harnessing the relational nature of rural healthcare. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to report on enablers and barriers during the first 2 years of the health systems integration project that included the implementation of a health navigator role. The project aims to improve health outcomes for children and young people residing in out of home care in rural Australia with a health navigator co‐located between child protection practitioners and community health services clinicians. Setting: Rural Northwest Victoria. Participants: Sunraysia Community Health Services and the Department of Health and Human Services. Design: The qualitative design of the project evaluation involved semi‐structured interviews and documentary evidence analysis. Analyses of interviews and documentary data demonstrate the challenging nature of siloed service delivery in rural Australia, particularly during a time that comprised multiple interruptions due to COVID‐19. Results: A limited synergy between organisational priorities and reporting systems hindered project progress. The lack of a shared definition of 'health' challenged the effective collaboration between health clinicians and child protection practitioners and the role of the health navigator. The health navigator raising health awareness through project involvement, training and sector‐wide stakeholder engagement resulted in a slow but steady process of increased prioritisation of health care, increased health literacy among the child protection workforce, and broadening participation of area‐based stakeholders, but did not translate to increased access to health plans for children. Conclusion: Integrating health systems across multiple sites with support of a health navigator revealed difficulties, particularly during COVID‐19. The first phase of the project demonstrated the value of shared governance and partnerships as an imperative foundation for fundamental change. Relationships strengthened throughout the project, leading to a better understanding of area‐based strengths, which in turn supports improved pathways to health care for children and young people in OOHC within rural communities and driving the subsequent phases of the 10‐year project. [ABSTRACT FROM AUTHOR]

Abstract: Visiting health services are a feature of health care delivery in rural and remote contexts. These services are often described as ‘fly‐in fly‐out’ or ‘drive‐in drive‐out’. Posing the question ‘What are the different types of visiting models of primary health care being used in rural and remote communities?’, the objective of this article was to describe a typology of models of health services that visit remote communities. A systematic review of peer‐reviewed literature from established databases was undertaken. Data were extracted from 20 papers (16 peer‐reviewed papers and four from other sources), which met the inclusion criteria. From the available evidence, it was difficult to develop a typology of services. The central feature of service providers visiting rural and remote districts on a regular basis was consistent, although the service provider's geographical base varied and the extent to which the same service provider should be providing the service was not consistently endorsed. While a clear typology did not emerge from the systematic review, it became apparent that a set of guiding principles might be more helpful to service providers and planners. Focusing policy and decision‐making on important principles of visiting services, rather than their typological features, is likely to be of ultimately more benefit to the health outcomes of people who live in rural and remote communities. [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]

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: 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: Farmers face a range of factors that negatively influence their mental health and suicide risk, yet have limited access to appropriate support. Behavioural activation (BA) is an evidence‐based therapy that can be effectively delivered by nonclinical workers. Working with members of farming communities to deliver BA to their peers has the potential to overcome many well‐established barriers to mental health help‐seeking and improve outcomes for this at‐risk group. Objective: This paper describes the findings of a co‐design phase informing the development of a peer (farmer)‐led approach for delivering BA for farmers living with depression or low mood. Design: This qualitative study used a co‐design approach involving members of the target community. Focus groups were transcribed and analysed using Thematic Analysis and the Framework approach. Findings: Ten online focus groups with 22 participants were held over 3 months. Four overarching, interlinked themes were identified: (i) filling the gap in rural mental health support; (ii) alignment with the farming context—tailoring how, where and when we engage about mental health; (iii) the 'messenger' is as important as the message; and (iv) sustainability, governance and support. Discussion: Findings suggest BA could be a contextually appropriate model of support for the farming community—given its practical and solution‐focused approach—and could help improve access to support. Having peer workers deliver the intervention was viewed as appropriate. Ensuring governance structures are developed to support peers to deliver the intervention will be essential to facilitate effectiveness, safety and sustainability. Conclusion: Insights gained through co‐design have been critical to the success of developing this new model of support for members of farming communities experiencing depression or low mood. [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: To explore how four small towns in rural New South Wales known as the 4Ts are addressing challenges accessing quality care and sustainable health services through a collaborative approach to workforce planning using the collaborative care framework. Design: Descriptive case study approach. Setting: The collaborative care project was developed as a result of ongoing partnerships between 2 rural Local Health Districts, 2 Primary Health Networks and a non‐governmental health workforce organisation. The collaboration works with 5 subregions each comprising 2 or more rural communities. This paper focuses on the 4Ts subregion. Participants: Stakeholders of the collaborative design including organisations and the community. Intervention: A place‐based approach to co‐designing health services with community in one sub‐region of Western New South Wales. Main outcome measures: A synthesis of field observations and experiences of community and jurisdictional partners in implementation of the 4Ts subregional model. Mapping of implementation processes against the collaborative care framework. Results: The collaborative care framework is a useful planning and community engagement tool to build health workforce literacy and to impact on system change at the local level. We identify key elements of effectiveness in establishing the 4Ts model, including the need for coordinated health system planning, better integrating existing resources to deliver services, community engagement, building health workforce literacy and town‐based planning. Conclusion: This study adds to the body of knowledge about how to successfully develop a collaborative primary health care workforce model in practice. The findings demonstrate that the implementation of a collaborative primary health care workforce model using the collaborative care framework can improve service access and quality, which in turn might facilitate workforce sustainability. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on the topics including needs of rural, regional and remote seniors; facilitated by the fact that researchers are increasingly encouraged to engage with end‐users; and extend that encouragement to involving seniors in the research and in the shaping of their health care.

This paper nuances the notion of access when considering minority segments and their use of health care services in rural communities. It argues that access needs to be considered as both the availability and the perceived ability to use a service without fear of retribution. By taking such a stance, this paper addresses the inequality in LGBTQI+ care in rural communities. It claims equitable care can only be achieved if the appropriate environment is created where individuals can disclose their identity and seek appropriate treatment. Given the complexity surrounding rural communities, their prevailing culture and perceptions, as well as stigmas and poor health outcome, a multilevel approach is taken to identify implications. It is argued that to address the individual and systemic barriers to equitable health care, a human rights‐centred approach to health needs to be adopted considering the individual, the community and the health system. [ABSTRACT FROM AUTHOR]

Aim: COVID‐19 rapidly transformed how Australians access health care services. This paper considers how the inability for urban patients to access in‐person care expediated the introduction of virtual solutions in health service delivery thus creating a new access paradigm for rural and remote Australians. Context: 'Physical distancing' is a phrase synonymous with public health responses to COVID‐19 in Australia, but distance is a decades‐long problem for rural health access. Counterintuitively, the pandemic and associated restrictions on mobility have reduced in real terms the distance from, and therefore the time taken to access, critical public services. 'Lockdowns' have unlocked health access for rural and remote Australians in ways that had been rejected prior to 2020. The pandemic has disrupted traditional delivery models and allowed the piloting of novel solutions, at the same time as stress‐testing current delivery systems. In the process, it has laid bare a myopia we term 'urban paternalism' in understanding and delivering rural health. Approach: This commentary outlines how the COVID‐19 operating environment has challenged traditional urban‐dominated policy thinking about virtual health care delivery and how greater availability of telehealth appointments goes some way to reducing the health access gap for rural and remote Australians. Conclusion: Australian Commonwealth Government policy changes to expand the Medical Benefit Scheme (MBS) to include telephone or online health consultations are a positive initiative towards supporting Australians through the ongoing public health crisis and have also created access parity for some rural and remote patients. Although initially announced as a temporary COVID‐19 measure in March 2020, telehealth has now become a permanent feature of the Medicare landscape. This significant public health reform has paved the way for a more flexible and inclusive universal health care system but, more importantly, taken much needed steps towards improving access to primary health care for patients in rural and remote areas. Now the question is: Can the health care system integrate this virtual model of delivery into 'business as usual' to ensure the long‐term sustainability of telehealth services to rural and remote Australia? [ABSTRACT FROM AUTHOR]

Objective To examine the association between residential remoteness and stage of cancer at diagnosis, treatment uptake, and survival within the Australian Indigenous population. Design Systematic review and matched retrospective cohort study. Setting Australia. Participants Systematic review: published papers that included a comparison of cancer stage at diagnosis, treatment uptake, mortality and/or survival for Indigenous people across remoteness categories were identified (n = 181). Fifteen papers (13 studies) were included in the review. Original analyses: new analyses were conducted using data from the Queensland Indigenous Cancer Study (QICS) comparing cancer stage at diagnosis, treatment uptake, and survival for Indigenous cancer patients living in rural/remote areas (n = 627, 66%) and urban areas (n = 329, 34%). Main Outcome Measures Systematic review: Papers were included if there were related to stage of disease at diagnosis, treatment, mortality and survival of cancer. Restrictions were not placed on the outcome measures reported (e.g. standardised mortality ratios versus crude mortality rates). Original analyses: Odds ratios (OR, 95%CI) were used to compare stage of disease and treatment uptake between the two remoteness groups. Treatment uptake (treated/not treated) was analysed using logistic regression analysis. Survival was analysed using Cox proportional hazards regression. The final multivariate models included stage of cancer at diagnosis and area-level socioeconomic status (SEIFA). Results Existing evidence of variation in cancer outcomes for Indigenous people in remote compared with metropolitan areas is limited. While no previous studies have reported on differences in cancer stage and treatment uptake by remoteness within the Indigenous population, the available evidence suggests Indigenous cancer patients are less likely to survive their cancer the further they live from urban centres. New analysis of QICS data indicates that Indigenous cancer patients in rural/remote Queensland were less likely to be diagnosed with localised disease and less likely to receive treatment for their cancer compared to their urban counterparts. Conclusion More research is needed to fully understand geographic differentials in cancer outcomes within the Indigenous population. Knowing how geographical location interacts with Indigenous status can help to identify ways of improving cancer outcomes for Indigenous Australians. [ABSTRACT FROM AUTHOR]

Introduction: Although various studies have examined availability, access barriers and patient experiences of rural health services for the ageing population, no synthesis of this literature exists in Australia. Objective: The objective of this study was to examine the current literature surrounding rural service provision and to evaluate the barriers to access for older individuals and to recognise gaps in the literature. Design: A systematic scoping review of peer‐reviewed literature from three online databases (PUBMED, SCOPUS and Web of Science). Findings: Thirty‐two papers were included in analysis. The most prominent types of health service discussed were residential aged care (n = 12) and community health care (n = 10). More studies explored the perspectives of health personnel than the service end users. Qualitative synthesis revealed three themes associated with health service and rural ageing: access to services, health workforce experiences and end user experiences. Discussion: Access to health services for the elderly population is a complex issue. Promoting positive experiences for both health providers and patients is critical to assisting in healthy ageing for people living in rural and remote areas. This requires intervention on a social and institutional level. Key research gaps in the literature include the effectiveness of an integrated approach to institutional interventions, utilisation of preventative measures such as screening programs for cancer and greater identification of the health needs and perceptions among culturally diverse elderly residents. These studies are critical to promote appropriate and patient‐centred care for elderly populations in rural and remote areas. Conclusion: The review highlights the need to address availability, retention and service innovations across health services to improve access to care and health outcomes of rural elderly residents. [ABSTRACT FROM AUTHOR]

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery. [ABSTRACT FROM AUTHOR]

Background: Australian policy reports recommended schools to be leveraged to better support student mental health, with a focus on regional and rural areas where students have poorer mental health outcomes. In designing solutions to address this systemic gap, decision‐makers require an understanding of the barriers and facilitators experienced by regional and rural schools. However, current literature has focused on metropolitan schools and neglected to explore facilitators. Objective: To review the evidence on barriers and facilitators in delivering student mental health support experienced by regional and rural schools in Organisation for Economic Co‐operation and Development nations. Design: A mixed‐methods systematic review of peer‐reviewed and grey literature. Findings: The search identified 4819 studies. A full‐text review by 2 reviewers resulted in 5 papers, which met the inclusion criteria and were assessed using methodological appraisal. One study used qualitative data, 2 studies used quantitative data, and 2 studies were a mixed‐methods design. Discussion: While there was a paucity of studies, this review draws together the most up‐to‐date research. The barriers and facilitators were categorised into 3 themes: access to services and resources; mental health literacy of staff and parents; and communication and collaboration between stakeholders. Conclusion: This review presents a comprehensive synthesis of the literature and highlights opportunities to leverage rural and regional schools to support student mental health, focusing on the quality of communication and collaboration, and increasing access to services and resources, and mental health literacy. Research should explore the unique advantages of rural and regional areas to inform policy, including a focus on strengths. [ABSTRACT FROM AUTHOR]

Introduction: Rural‐urban health inequities, exacerbated by deprivation and ethnicity, have been clearly described in the international literature. To date, the same inequities have not been as clearly demonstrated in Aotearoa New Zealand despite the lower socioeconomic status and higher proportion of Māori living in rural towns. This is ascribed by many health practitioners, academics and other informed stakeholders to be the result of the definitions of 'rural' used to produce statistics. Aims: To outline a protocol to produce a 'fit‐for‐health purpose' rural‐urban classification for analysing national health data. The classification will be designed to determine the magnitude of health inequities that have been obscured by use of inappropriate rural‐urban taxonomies. Methods: This protocol paper outlines our proposed mixed‐methods approach to developing a novel Geographic Classification for Health. In phase 1, an agreed set of community attributes will be used to modify the new Statistics New Zealand Urban Accessibility Classification into a more appropriate classification of rurality for health contexts. The Geographic Classification for Health will then be further developed in an iterative process with stakeholders including rural health researchers and members of the National Rural Health Advisory Group, who have a comprehensive 'on the ground' understanding of Aotearoa New Zealand's rural communities and their attendant health services. This protocol also proposes validating the Geographic Classification for Health using general practice enrolment data. In phase 2, the resulting Geographic Classification for Health will be applied to routinely collected data from the Ministry of Health. This will enable current levels of rural‐urban inequity in health service access and outcomes to be accurately assessed and give an indication of the extent to which older classifications were masking inequities. [ABSTRACT FROM AUTHOR]

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

The article discusses that for city-dwelling Australians, COVID-19 sent the population into a toilet paper stockpiling hysteria, and bushfires were already a dwindling memory. It mentions that people living in rural communities are more likely than their city-dwelling cousins to experience multiple physical and mental health problems; and also mentions that self-management interventions are highly effective at preventing readmission to crisis care.

Objective This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. Design A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. Setting, participants and outcome measures Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership ( CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. Results Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. Conclusions The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs. [ABSTRACT FROM AUTHOR]

Objective To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. Design This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. Setting Two sites in Victoria and one in Western Australia. Participants Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. Interventions Not applicable. Main outcome measures Not applicable. Results Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. Conclusions While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families. [ABSTRACT FROM AUTHOR]

Objective Disparities in outcomes are experienced between people who live in rural and remote areas and those who live in larger cities. This paper explores the ability to deliver specialist cancer care through the use of telehealth models. Design Review of telehealth models for cancer care. Setting, participants and intervention Cancer patients in rural, remote and Indigenous communities who receive their care through telehealth. Outcome measures and results Telehealth models seem to be applicable to all fields of oncology and all health professionals. These models not only facilitate the provision of specialist services closer to home in an acceptable, safe and cost-effective manner, but also help expand the rural scope of practice and enhance service capabilities at rural centres. Conclusion New models of telehealth are another avenue to help further decrease the disparity of access and survival outcomes between rural and urban patients. Implementation of these models requires health system wide approach for development key performance indicators and allocation of resources. [ABSTRACT FROM AUTHOR]

Objective This paper examines health reform which has been designed to improve cancer services across Western Australia. Setting Western Australia is a large state divided into nine regions each with differing demographics. The diversity of the state and the distribution of the population over a large area of land create significant challenge in ensuring equality in service delivery. Design A comparison was conducted looking at cancer services in Western Australia pre-2005 and service delivery in 2014. A review of the partnership initiatives and programs provides a clear discussion on the need for coordination of care between service providers. Main Outcome The approach undertaken in Western Australia has seen an increase in the delivery of cancer services closer to the patient's home as well as greater involvement of primary care professionals in cancer care. This work has resulted in demonstrated improvements in patient care and support. Conclusion Services for cancer patients need to be accessible closer to home with distance being an appreciable barrier to treatment access.A statewide approach needs to be developed to ensure all people have equitable access to service delivery. [ABSTRACT FROM AUTHOR]

Objective: To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives. Design: Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis. Setting: Interviews of people across Australia. Participants: Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life. Main outcome Measure: Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020). Results: Policy changes surrounding border closures negatively impacted people's wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures. Conclusion: Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people's physical, financial, and emotional state. [ABSTRACT FROM AUTHOR]

Objective: This paper explores women's experiences of drought in Australia. Despite the significance of drought for rural life in Australia, there is little research seeking to understand its psychological consequences. There is also a need to recognise gendered experiences of drought and for research that addresses its long-term effects as people age in prolonged drought-affected areas. Design: The study explores longitudinal qualitative data collected by the Australian Longitudinal Study on Women's Health. Free-text comments ( n = 217), collected via mailed survey at five time points (1996, 1998, 2001, 2004, 2007) from the same 77 women, were subjected to a narrative analysis. Participants: Participants from the Australian Longitudinal Study on Women's Health who were aged 45-50 when the study began in 1996. Results: Findings indicate that drought has an impact on women as they age, particularly in reference to menopause, access to support systems and retirement. Conclusion: This study concludes that the experience of drought cannot be disentangled from the realities of gender and ageing. [ABSTRACT FROM AUTHOR]

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

To highlight how evidence from studies of innovative rural and remote models of service provision can inform global health system reform in order to develop appropriate, accessible and sustainable primary health care (PHC) services to 'difficult-to-service' communities. The paper synthesises evidence from remote and rural PHC health service innovations in Australia. There is a strong history of PHC innovation in Australia. Successful health service models are 'contextualised' to address diverse conditions. They also require systemic solutions, which address a range of interlinked factors such as governance, leadership and management, adequate funding, infrastructure, service linkages and workforce. An effective systemic approach relies on alignment of changes at the health service level with those in the external policy environment. Ideally, every level of government or health authority needs to agree on policy and funding arrangements for optimal service development. A systematic approach in addressing these health system requirements is also important. Service providers, funders and consumers need to know what type and level of services they can reasonably expect in different community contexts, but there are gaps in agreed indicators and benchmarks for PHC services. In order to be able to comprehensively monitor and evaluate services, as well as benchmarks, we need adequate national information systems. Despite the gaps in our knowledge, we do have a significant amount of information about what works, where and why. At a time of global PHC reform, applying this knowledge will contribute significantly to the development of appropriate, sustainable PHC services and improving access. [ABSTRACT FROM AUTHOR]

Objective This paper aims to describe cancer survival and examine association between survival and socio-demographic characteristics across Barwon South- Western region ( BSWR) in Victoria, Australia. Design This study is based on the retrospective cohort database of patients accessing oncology services across BSWR. Setting Six rural and three urban hospital settings across the BSWR. Participants The participants were patients who were diagnosed with cancer in 2009. Main outcome measures Overall survival (OS) of participants was the main outcome measure. Results Total of 1778 eligible patients had four-year OS for all cancers combined of 59.7% (95% CI, 57.4-62.0). Improved OS was observed for patients in the upper socio-economic tertile (64.2%; 95% CI, 60.9-67.5) compared to the middle (59.3%; 95% CI, 55.5-63.1) and lowest tertiles (49.6%; 95% CI, 44.2-54.9) ( P < 0.01). On multivariate analyses, higher socio-economic status remained a significant predictor of OS adjusting for gender, remoteness and age ( HR [hazard ratio] 0.81; 95% CI 0.74-0.89; P < 0.01). Remoteness was significantly associated with improved OS after adjusting for age, gender and socio-economic status ( HR 0.86; 95% CI, 0.77-0.97; P = 0.01). Older age ≥70 years compared to <70 years conferred inferior OS ( HR 3.08; 95% CI, 2.64-3.59; P < 0.01). Conclusions Our study confirmed improved survival outcomes for patients of higher socio-economic status and younger age. Future research to explain the unexpected survival benefit in patients who lived in more remote areas should examine factors including the correlation between geographical residence and eventual treatment facility as well as compare the BSWR care model to other regions' approaches. [ABSTRACT FROM AUTHOR]

Objective This paper aims to contribute to the development of a more sustainable Australian rural community mental health workforce by comparing the findings from a literature search investigating impacting factors on retention with the experiences of community mental health service managers running services in rural Australia. Design Semi-structured interviews. Setting Public health sector, rural New South Wales. Participants Five community mental health managers, running services in rural Australia. Main outcome measures Interviews were undertaken as a pilot for a broader qualitative study investigating factors influencing the decision to stay or leave among community mental health professionals working in rural positions. The purpose of undertaking this pilot study was to test for validity and relevance of the retention phenomena and help inform the research design for the main study. Results Three key retention focussed themes were identified: (i) Staffing is a persistent challenge; (ii) Small remote towns pose the biggest challenge; and (iii) The decision to stay or leave is complex and multifactorial. Conclusions The findings of this pilot study support previous research and contribute to the understanding of influences on retention among health professionals working in rural community mental health services. Importantly, those who have worked for several years in rural positions hold important information through which to explore factors that impact retention in rural and remote regions. [ABSTRACT FROM AUTHOR]

Objective: Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high‐acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. Design and setting: A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. Results: Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. Discussion: A typology was developed to account for (a) emergency department staff on‐floor, (b) emergency department staff on‐call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. Conclusion: The proposed five‐tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy‐makers who are seeking to improve health systems and health outcomes. [ABSTRACT FROM AUTHOR]

Objective This paper reflects on the recent growth of cancer research being conducted through some of Australia's rural centres. It encompasses work being done across the fields of clinical, translational and health services research. Design This is a collaborative piece with contributions from rural health researchers, clinical and cancer services staff from several different regions. Conclusion The past decade has seen an expansion in cancer research in rural and regional Australia driven in part by the recognition that cancer patients in remote areas experience poorer outcomes than their metropolitan counterparts. This work has led to the development of more effective cancer networks and new models of care designed to meet the particular needs of the rural cancer patient. It is hoped that the growth of cancer research in regional centres will, in time, reduce the disparity between rural and urban communities and improve outcomes for cancer patients across both populations. [ABSTRACT FROM AUTHOR]

An available and effective rural mental health workforce is critical to the provision of contemporary mental health care. During the last 5 years new mental health plans and strategies have been released every state and territory of Australia. This policy analysis examines the extent to which workforce, and particularly rural workforce issues are considered in these policies. The analysis revealed that rural workforce issues receive scant attention in state and territory mental health plans. Rural Australians comprise 28% of the total population, yet rural workforce issues are canvased, on average only 6% of the time general workforce issues are addressed. National mental health workforce plans do focus on the rural workforce, but these are not referenced in the state or territory strategies or workforce plans. Given the rural mental health workforce shortages, and consumer challenges in accessing rural mental health services, more planning and consideration to supporting and developing a rural workforce appears warranted. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the authors experience of managing this dental problem bringing the mind to the RHMT funding for rural health workforce.

Type 2 diabetes mellitus is an established health problem for Indigenous Australians. One strategy to address this issue is to educate health professionals in diabetes management and education. Objective The objective of this paper is to identify important issues that compromise the clinical practice of rural and remote Aboriginal health workers ( AHWs) and registered nurses ( RNs) who undertook an accredited Australian Diabetes Educators Association diabetes course and to suggest strategies to improve practice. Design The design used a qualitative approach and discussion schedule to elicit responses. Setting The setting involved two Aboriginal community controlled and seven mainstream health services in the Far Western region of New South Wales. Participants The participants were experienced diabetes educators ( RNs and AHWs), managers and students currently enrolled in the course (n = 17). Results The results indicated issues that compromise diabetes practice and identified strategies to improve practice. Issues were: the confusing funding practices by health providers, the duplication of health services, the lack of recognition of diabetes qualifications and the transient nature of Indigenous people. Strategies included the need for: continuous dedicated diabetes health funding, a role clarification for diabetes educators, strategic diabetes planning and the importance of diabetes educators working in partnership. Conclusion The conclusion from this study indicates that if the delivery of diabetes health services to Indigenous Australians is to improve it is necessary to address these identified issues. [ABSTRACT FROM AUTHOR]

Objective There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. Design Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. Setting Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. Participants All patients seen in consultations over a 3-month period. Main outcome measures Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. Results Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. Conclusions Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach practice should be encouraged for surgeons in regional centres. [ABSTRACT FROM AUTHOR]

Objective To obtain information about aged care services in rural New South Wales public hospitals, and to describe key operational aspects of their service delivery models. Design A mixed methods design was used to combine data collected from: (i) a survey of public hospitals and (ii) qualitative site visits in a sample of eleven rural sites. Setting Rural public hospitals in NSW, Australia. Participants Qualitative data were collected from multidisciplinary clinicians, managers and community service providers who participated in site visits in 2010 and from surveys of NSW public hospitals in 2009/10 about aged care and dementia services. Results Survey and site visit findings demonstrated that rural hospitals have fewer secure beds for managing patients with disturbed behaviour due to dementia and delirium and fewer speciality aged care staff than metropolitan hospitals. Site visit participants also described how secure environments can aid care for people with dementia even in the absence of clinical specialists. Conclusion The care of people with dementia in rural hospitals is constrained by access to specialist aged care staff and the physical environment of the hospital. Clinicians are adept at maximising resources to manage diagnosis and transitions for people with dementia. Further understanding of how key operational aspects of clinical leadership and environmental modifications impact on a range of patient outcomes would be valuable. [ABSTRACT FROM AUTHOR]

Objective This study investigates (i) rural women's needs in maternity care in Tasmania; (ii) the current rural maternity services in Tasmania; and (iii) the gap between women's needs and the services provided. Design Mixed methods study was adopted. A questionnaire explored women's views on rural maternity services from antenatal to postnatal care and also invited comments from the participants. Interviews were conducted to provide comprehensive insights into their needs in maternity care. Setting Six rural communities in Tasmania, Australia. Participants Women who have had childbirth experiences in rural areas in Tasmania. Results Two hundred ten women completed the questionnaire with a response rate of 35%. There were over 150 written comments from the survey. Twenty-two follow-up interviews were conducted. This paper reports the written comments from the survey and interviews. Five main themes emerged from the data, namely (i) access needs, (ii) safety needs, (iii) needs for rural birthing services, (iv) support needs and (v) needs for quality services. Conclusion This study has revealed a comprehensive picture of rural women's needs in maternity care throughout their pregnancy to the early postnatal period. There is a major lack of maternity services in rural areas of Tasmania. The lack of rural maternity services shifts cost and risk from the health care system to rural women and their families. Women want to have greater access to maternity services in their local community and be ensured safety for themselves and their babies. Moreover, they need more support from the health care system and they desire quality services. [ABSTRACT FROM AUTHOR]

This paper provides a comprehensive review of the key dimensions of access and their significance for the provision of primary health care and a framework that assists policy-makers to evaluate how well policy targets the dimensions of access. Access to health care can be conceptualised as the potential ease with which consumers can obtain health care at times of need. Disaggregation of the concept of access into the dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness allows policy-makers to identify key questions which must be addressed to ensure reasonable primary health care access for rural and remote Australians. Evaluating how well national primary health care policies target these dimensions of access helps identify policy gaps and potential inequities in ensuring access to primary health care. Effective policies must incorporate the multiple dimensions of access if they are to comprehensively and effectively address unacceptable inequities in health status and access to basic health services experienced by rural and remote Australians. [ABSTRACT FROM AUTHOR]

Background This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. Design, setting, participants Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. Main outcome measures Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. Results Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. Conclusion Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision. [ABSTRACT FROM AUTHOR]

The issue of male farmers' mental health raises many concerns including high rates of psychological distress and suicide amid the poor uptake of health services among this subgroup. Gender is an important social determinant of health, and this paper provides an overview of connections between farming and masculinities in the context of men's mental health disorders. This scoping review summarises findings drawn from 46 studies to discuss male farmers' mental health disorders, psychosocial interventions and barriers to help-seeking. In providing the review, recommendations are made including the need for an array of study and intervention approaches to advance the mental health and well-being of male farmers and their families. [ABSTRACT FROM AUTHOR]

Objective: This paper offers theories to explain persistent rural health challenges and describes their application to rural health and research. Methods: Review of theories from several disciplines. Findings: Key issues in rural health are poorer health status and access to health care, staff shortages, relationship-based health provision and the role of health services in community sustainability. These could be fruitfully addressed by applying theory and findings around social determinants of health, economic sociology, the role of culture and capitals approaches to measuring assets. In particular, the concept of rural health might be a barrier to progressing knowledge; and relational approaches, common in geography, offer a more useful conceptual framework for studying health and place. Conclusions: To move beyond its current stage, rural health needs to look to other disciplines' theories and ideas; particularly, it needs a more contemporary understanding of what place means so that health status and service provision can be improved by more thoughtful research. [ABSTRACT FROM AUTHOR]

This paper, presented at the 2010 rural health researchers' National Scientific Symposium on Rural and Remote Health, provides an overview of large Australian population mental health cohort studies which have a focus on climate‐related and environmental adversity, social factors and mental health. These studies highlight the value of exploiting multiple exceptional datasets to better understand the drivers of rural health, including how to use population‐level research to improve health resources in non‐metropolitan areas. We show how the key characteristics of rural and remote mental health might be explored by exploiting the following cohort studies: Household, Income and Labour Dynamics in Australia Survey; Australian Rural Mental Health Study; Hunter Community Study; and Extending Treatments, Education and Networks in Depression study. Existing cohort studies that focus on significant rural and regional characteristics can be creatively analysed to better understand geographic variation in mental health. They have the potential to move understanding beyond simple prevalence to building knowledge about the trajectories of psychological distress and determinants of mental disorders and outcomes over time. [ABSTRACT FROM AUTHOR]

Access barriers to health care for minority populations has been a feature of medical, health and social science literature for over a decade. Considerations of cultural barriers have featured in this literature, but definitions of what constitutes a cultural barrier have varied. In this paper, data from recent interviews with Aboriginal and Torres Strait Islander people, Aboriginal Health Workers and other non-Indigenous health professionals in north-west Queensland assist to refine the meaning of this term and uncovered other issues disguised as 'cultural' difference. Semistructured interviews with community and health professionals. Mount Isa, Queensland, Australia. Aboriginal and Torres Strait Islanders, Aboriginal Health Workers and other health professionals in Mount Isa between 2007 and 2009. Cultural barriers were considered differently by Aboriginal patients and health practitioners. While Aboriginal patients focused heavily on social relationships and issues of respect and trust, most practitioners seemed more focused on making Aboriginal people feel comfortable with changes to physical environments and systems, with less emphasis on creating strong interpersonal relationships. For Aboriginal patients the focus on interpersonal relationships between themselves and health practitioners is paramount. Creating comforting physical environments and systems that are easier to navigate do assist in overcoming cultural barriers, but are often seen as little more than token gestures if trusting interpersonal relationships are not formed between patient and practitioner. [ABSTRACT FROM AUTHOR]

Objective: The lack of consistent findings regarding comparisons of mental health between rural and urban areas has been attributed in part to methodological shortcomings, including poor conceptualisation of ‘rurality’. To address the diversity of rural and remote communities, an interdisciplinary collaboration sought to establish a database incorporating a range of domains hypothesised to be major influences on the mental health of individuals, families and communities. Design: The database domains included health (physical and mental), health service utilisation, sociodemographic characteristics, climate patterns, agricultural activity and primary industry. Important steps in the development of the database were addressing issues related to ethics, ownership, accessing data sources, sustainability of the database and integration of differing outcomes sought by the collaborators. Results: The paper describes the database while an illustrative example of analysis demonstrates its application. The potential for multilevel analyses between the database and other datasets is discussed as well as challenges for the future development of this valuable resource for rural mental health research. Conclusion: The Centre for Rural and Remote Mental Health database will be a valuable resource for rural mental health research. [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 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]

The article discusses that how all rural health professionals and rural communities can work together to improve the physical health of people living with mental illness. It mentions that people with mental illness are at increased risk of a range of different physical health problems and often have difficulty accessing services; and also mentions that every premature death is tragic and has a devastating impact on the person's family and social network.

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