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Aims: To offer a rough guide to a quality rural/remote interprofessional educational activity. Context: Australian remote and rural interprofessional undergraduate placements offered in Modified Monash Model 3‐6 locations. Approach: Biggs' triple P framework from the interprofessional educational literature and Allport's contact hypothesis are used to describe map, and explore the educational dimensions and positive elements, of a quality rural/remote interprofessional educational activity. Conclusion: Delivery of a quality interprofessional educational activity requires attention to all dimensions of the activity with acknowledgement of the value of the remote or rural contexts. Interprofessional learning requires constructive alignment and positive contact conditions to ensure a quality and sustained experience. [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 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 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]

Objective Previous Australian studies have suggested poorer survival of patients with colorectal cancer in remote areas. To date no studies have assessed the geographic disparity in patients with metastatic disease. This retrospective cohort study looks at geographic differences in the surgical care and survival of patients with metastatic colorectal disease. The paper utilises data from the South Australian Clinical Registry for Metastatic Colorectal Cancer ( SACRMCC). Design, participants, interventions and main outcome measures Data on patients' socio-economic status, primary and metastatic tumour characteristics, treatment and survival was extracted from the SACRMCC database. A binomial model analysis was used to identify geographical differences in the surgical treatment of patients and a Cox proportional hazards model was used to identify any geographic differences in survival. Results The findings showed no differences in the diagnosis of liver metastases or provision of liver surgery between geographic areas, however there was a reduced likelihood of liver surgery with increasing age. The median overall survival rate, from the date of diagnosis of metastatic disease, was 20.0 months and the distribution by geographic remoteness was 19.1 months, 20.2 months, 22.0 months and 20.4 months in Major Cities, Inner Regional, Outer Regional and Remote areas respectively. This was not statistically significant. Conclusion Overall, there was no evidence of a geographical disparity in the diagnosis, surgical treatment or survival in metastatic colorectal cancer. This may be due to the shift toward centralising surgical care in South Australia. Nevertheless, there remains a need to improve the uptake of surgical care in the growing elderly population. [ABSTRACT FROM AUTHOR]

Objective To determine the knowledge and recommendations of rural general practitioners ( GPs) in regard to climate change and the preparedness of rural health services for its health impacts. Design A quantitative descriptive survey distributed in paper-based or electronic form. Setting Rural Southwest of New South Wales. Participants GPs and GP registrars working in Rural Remote Metropolitan Areas ( RRMA) 3-7. Main outcome measures Questionnaire responses analysed with descriptive statistics and inferential tests. Results While the majority of respondents agreed with statements supporting climate science and the impact of climate change on health, between 24% and 34% of respondents were unsure or did not agree. Furthermore, between 33% and 44% of GP respondents working in RRMA 5-7 were unsure or did not agree that their health service had the capacity to provide an initial response to an extreme weather event ( P = 0.01). Strengthening health service acute disaster capacity response was a preferred adaptation strategy for improving health service preparedness of 61% of participants. A greater proportion of GPs were supportive of their role as advocates on general health issues (80%) compared with extreme weather events (60%) or climate change and health (63.5%) ( P ≤ 0.01). For professional development and education, 71% preferred a locally based workshop or seminar. Conclusions The study highlights the need to consider closely the views of GPs when preparing rural communities for the possible health effects of climate change. Findings indicate concern for health service preparedness, particularly in smaller rural communities. Further development of disaster response planning and communication is needed. [ABSTRACT FROM AUTHOR]

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]

The article focuses on the Alliance which has been preventive health, which was included as a theme for discussion at our recent CouncilFest meeting. Topics discussed include this focus is timely as the Australian Government is currently developing a National Preventive Health Strategy; and the Alliance has provided feedback on the National Preventive Health Strategy Consultation Paper which was released earlier this year.

Objective This paper identified barriers which prevent rural health care providers from utilising rt- PA in acute ischaemic stroke and proposes possible support mechanisms to increase its utilisation. Methods This descriptive study uses data from anonymous surveys distributed to health care providers involved in acute stroke patient care in three rural hospitals with rt- PA pathways. Saturation sampling was used. Surveys gathered self assessed ratings of experience, practice environment, attitudes, existing support, barriers and possible enablers regarding rt- PA use in acute stroke. Results Physicians reported the strongest barriers to the use of rt- PA in acute stroke as pre-hospital delays (91%), risk of intracerebral haemorrhage ( ICH) (73%) and clinical diagnostic uncertainty (60%). They reported high levels of confidence in the support received from their stroke units (90%). Nurses identified a poor level of stroke education and knowledge on rt- PA utilisation in acute stroke. A third of nurses could correctly list six different stroke signs. The risk of ICH following rt- PA administration in stroke was also a significant barrier for nurses. Response rate from physicians was 26% (10/38) and 19% (13/69) for nurses. Conclusions To reduce barriers to rt- PA utilisation in rural facilities physicians require education on the calculated risk of ICH as well as exposure and experience to improve their ability to confidently diagnose stroke patients who are eligible for rt- PA treatment. Education for nurses on symptoms of stroke and rt- PA utilisation and administration is recommended. [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]

Objective Only one third of clinically eligible patients attend a cardiac rehabilitation ( CR) program. Few studies have looked at participation in rural cardiac patients. This paper examines the risk profile and participation in CR of rural and urban residents with cardiac disease who enrolled in a telephone coaching program. Design, setting and participants Comparison of baseline characteristics of 173 urban and 140 rural Australians referred to CR, and who enrolled in a telephone-based coaching program. Main outcome measures Sociodemographic characteristics, health behaviours and participation in CR programs. Results Rural residents were more likely to enrol in a telephone coaching secondary prevention program (44.7% versus 25.5%, P < 0.001) than urban residents. For those enrolling in the telephone-based program, rural participants were more likely to be obese (42.0% rural versus 28.8% urban, P = 0.02), to rate their health as fair or poor (45% versus 24.3%, P < 0.001) and less likely to be sufficiently physically active (35.3% versus 53.2%, P = 0.002), or follow a special diet for their heart (40.0% versus 56.6%, P = 0.003) compared with urban participants. Those who attended a CR program were more likely to be from an urban location and live closer to a CR program. Conclusions Rural participants in this study had poorer health profiles and attendance at outpatient CR compared with urban participants. This poses challenges for the provision of secondary prevention programs for rural cardiac patients and highlights opportunities to trial innovative delivery models, such as telephone-based programs, to reach people that would otherwise not have access. [ABSTRACT FROM AUTHOR]

Introduction Student clinical placements away from the university dental school clinics are an integral component of dental training programs. In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural community in Australia. This paper presents a simple cost analysis of the project from mid-2008 to mid-2011. Methods All expenditures of the project are audited by the Financial and Planning Services unit of the university. The budget was divided into capital and operational costs, and the latter were further subdivided into salary and non-salary costs, and these were further analysed for the various types of expenditures incurred. The value of the treatments provided and income generated is also presented. Results Remote rural placements have additional (to the usual university dental clinic) costs in terms of salary incentives, travel, accommodation and subsistence support. However, the benefits of the placement to both the students and the local community might outweigh the additional costs of the placement. Conclusions and implications Because of high costs of rural student clinical placements, the financial support of partners, including the local Shire Council, state/territory and Commonwealth governments, is crucial in the establishment and ongoing sustainability of rural dental student clinical placements. [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]

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.

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]

Objective: The objective of this paper is to highlight, from within a broad study of recruitment/retention, findings that identify personal-professional boundaries as key challenges for rural child and youth mental health clinicians recruited from within the community. Design: Two mixed methods online questionnaires followed by semistructured telephone interviews with a small subset of respondents were administered to clinicians, team leaders, supervisors and managers whose practice responsibilities encompass rural settings in three regions of British Columbia, Canada. Participants: Forty-four clinicians and 27 team leaders/managers participated in the survey while eight clinicians and one team leader/manager participated in the semistructured interviews. Half the clinician respondents were recruited from within the community. Of those recruited from outside the community, half had prior experience living or working in a rural community. Main outcome measures: Levels of satisfaction with lifestyle, practice and preparation for practice were compared across categories of respondents identified earlier. Open-ended comments were coded by theme and also compared across categories of respondents. Results: While expressing their higher levels of satisfaction with rural lifestyle and professional practice, clinicians recruited from within rural communities report significant initial and ongoing stress related to personal-professional boundaries and dual relationships. They also report lower levels of satisfaction with orientation and preparation for practice relevant to dealing with these stressors. Conclusion: Prior attachment to rural communities, increasingly viewed as an effective recruitment and retention strategy, requires better preparation and ongoing supports to enable practitioners to deal with dual relationships and the personal-professional boundary issues that are a direct consequence of their attachments. [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]

Objective: To identify national and international research and literature focussed on policy responses to elder abuse in rural and remote communities to generate recommendations for Australian responses. Design: Scoping literature review. Setting: Australia (some international policy also included). Participants: National and international elder abuse policy documents relating to rural and remote responses were reviewed. Seventy‐two stakeholders were invited to contribute literature that may have been missed in the scoping review. Main outcome measure(s): Identification of the extent to which issues for rural and remote communities were discussed in elder abuse policy. Result: Of the 13 Australian policy documents reviewed, only four made mention of rural and remote communities, though this was generally only in regard to increase in vulnerability. No mention of these communities were identified in reviewed global policy. One document focussing on abuse in rural and remote Indigenous communities highlighted the importance of developing culturally appropriate responses hinged on community collaboration and consultation. Conclusion: Consideration of rural and remote communities in elder abuse policy is generally not meaningful. It is recommended that future policy development includes recognition of the distinct features of elder abuse in rural and remote communities, as well as how these features may impact on prevention and responses in these locations. These features include geographical isolation, lack of access to services and transportation, confidentiality and privacy issues, and the need for culturally sensitive approaches to address elder abuse for Indigenous people which take into account the impact of historical disenfranchisement. [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]

This paper reviews what is known about the challenges of implementing quality improvement programs and draws on data from a systematic continuous quality improvement (CQI) project in remote communities in Australia and Fiji, known as Audit and Best practice for Chronic Disease, to synthesise lessons and discuss the potential for broader application in low and middle income countries, including Pacific Island countries and territories. Although a number of systematic reviews have indicated that quality improvement programs can be effective in changing professional practice and improving the quality of care and patient outcomes, little is known about the key ingredients for change or how services use and implement different strategies to achieve improvements. We identify key features of an innovative CQI model and factors related to implementation that support improvement in diabetes service delivery and intermediate outcomes. Requirements for supporting CQI are identified and the potential for wider application discussed. It is argued that the participatory action research approach supports innovation and broad-based change and the evidence it has produced extends the current knowledge base and facilitates the translation of knowledge into action, for both policy and practice. [ABSTRACT FROM AUTHOR]

Rural South Australia contains a higher share of electronic gaming machines and gambling expenditure per capita than metropolitan areas, raising concerns about the risk of problem gambling in these communities. This paper describes the implementation and outcomes of an outreach behavioural psychotherapy (exposure therapy) program for problem gambling in rural South Australia. A retrospective cohort study design was used for 551 adult treatment-seeking problem gamblers who presented to the Statewide Gambling Therapy Service in South Australia. Fifty-one gamblers were from rural areas and participated in the outreach program. Outcomes were compared between gamblers who participated in either the metropolitan-based or rural outreach program. Outcome measures used: South Oaks Gambling Screen, Kessler Psychological Distress Scale, Work and Social Adjustment Scale, and hours gambled the previous month. Sixty-one per cent of clients (n = 551) completed treatment. There was no significant association between service location and number of treatment completers. Significant improvements were recorded across all outcome measures for both groups with small to large effect sizes, and there were no significant differences in outcomes at post-treatment between the groups while controlling for baseline scores. Both metropolitan and rural clients reported significant clinical improvement. Given the risk of problem gambling in rural communities, these early outcomes are encouraging. These findings will inform future treatment planning and service delivery for rural clients, and guide further research into the effectiveness of exposure therapy for problem gambling. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of the John Flynn Placement Program (JFPP) for medical students. JFPP aims for medical students to experience both rural medicine and rural life as a way of increasing rural career intentions. Medical students experience two weeks a year over four years with a rural doctor. Students are evaluated at the end of each placement for clinical and social experiences and career intent. They are followed up annually to monitor career intent. Mentors are evaluated annually on clinical and rural experiences during a placement. The Australian Government has several initiatives to encourage recruitment into rural medicine. One initiative is the JFPP. Students from all medical schools are placed with experienced general practitioners in rural and remote areas 4-7 locations across Australia. Evaluation data from 1450 placements from 2005-2009 are reported. Data are presented highlighting evaluation of student and mentor perceptions of clinical and social experiences. Longitudinal tracking data provide an indication of the success of the program in terms of recruitment into the rural workforce. Overall mean for clinical and rural experiences is extremely positive for both students and mentors. After four JFPP placements 65% of students intend to work in rural areas. After one JFPP experience 9% indicate intent to practise as a rural general practitioner while after their fourth JFPP nearly 20% are indicating intent to practise as a rural general practitioner. Longitudinal experiences, such as the JFPP, are positively influencing intention to enter the rural workforce but the impact of urban centric vocational training might be negating this impact. [ABSTRACT FROM AUTHOR]

During the early stages of pandemics, when resource planning occurs, the epidemiological parameters of the agent are often poorly described. These estimates are typically derived from metropolitan centres. This paper examines the spread of the 2009 pandemic H1N1 virus in rural and regional New South Wales compared with metropolitan centres. Retrospective statistical analysis of longitudinal data. Ecological examination of spread of influenza in the general community of New South Wales, Australia. Number of notified infections with novel pandemic H1N1 influenza in rural/regional (n = 241) and metropolitan (n = 1788) health service areas of New South Wales during the period 1 June 2009 and 12 July 2009. A comparison of the reproductive number for the 2009 pandemic H1N1 in rural/regional and metropolitan New South Wales. The reproductive number of the pandemic H1N1 in rural New South Wales was 1.26 (95% confidence interval (CI), 1.22-1.30) compared with estimates of metropolitan New South Wales of 1.28 (95% CI, 1.26-1.30). This difference was not statistically significant (P = 0.314). These estimates are lower than those previously published and of the order of magnitude typically observed with seasonal flu. This was consistent with the clinical observations in Greater Southern Area Health Service. The apparent invariance in the rate of spread of influenza between rural and metropolitan areas should provide rural health care providers with confidence in metropolitan derived estimates when planning in future influenza pandemics. [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: This paper draws on questionnaire findings and analysis of students' comments to demonstrate the aspects of rural placements that were effective in engaging students in the learning process. It also examined how a primary health care clinical placement in Aboriginal communities can provide nursing students with a rich and varied learning experience and an insight into the complex aspects of rural life including Aboriginal health. Design: A cohort of eight second-year nursing students from the Australian Catholic University, North Sydney, in partnership with the Broken Hill University Department of Rural Health (BHUDRH), participated in a 4 weeks' rural placement in far western New South Wales. A pre-test/post-test questionnaire was used to capture their experiences with the students completing the questionnaires before and after their clinical placements. Such placements offer students opportunities to deepen their understanding of issues related to rural health in clinical, professional, social and community contexts. Results: The results suggest that clinical experience in rural areas can positively influence attitudes, preparedness for practice and engage students on many levels, deepened their understanding of rural communities and issues related to rural health. Conclusion: This group of undergraduate nursing students indicated they all had a positive learning experience in their rural clinical placement. The value of rural placements as a method for increasing nursing student's practical experience should be promoted. [ABSTRACT FROM AUTHOR]

Objectives: The increase in demand for dental care over the next 10 years is expected to outstrip the supply of dental visits in Australia, resulting in an ongoing shortage of dental practitioners. As trends in medicine have shown, the greatest effect will be felt in rural and remote regions, where an undersupply of dentists already exists. It is clearly evident that it is important to provide strategies that will increase the recruitment and retention of practitioners in rural and remote areas. Previous research suggested an increased likelihood for health graduates to choose rural practice if they have a rural background, or were exposed to rural practice during their education. Short-stay (three to four weeks) placements for final-year dental students has been part of dental education in Western Australia for near on a decade. Methods: This paper reflects on the experiences gained from managing this placement program. Conclusions: Short-stay placements are a quality learning initiative but need a high level of planning and a clear vision to be effective. Implications: The key factors in ensuring sustainable, student centred learning is driven through a small core group of staff who have strong direct links with rural and remote communities, students and support providers. The integration of service, education and research goals have played a critical role in sustaining placements. The philosophy underpinning the rural placements needs to be clearly articulated and applied effectively in each step of their implementation and a highly focused customer-service driven implementation is required to make short-stay rural and remote placements effective. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol is the most commonly used drug within Australia. Recently, there have been indications that there is a greater incidence of high-risk drinking within rural populations as compared with their urban counterparts. High-risk drinking is associated with numerous conditions, such as diabetes, heart attack and cancer, as well as acute harms such as assault, suicide and road accidents. The objective of this article is to review the current research and relevant data pertaining to alcohol use and alcohol-related harms within rural Australia. Methods: This paper is a systematic review of 16 databases, including PubMed, PsycINFO and Google Scholar. Results: Overall, 18 studies describing alcohol consumption or alcohol-related harms were found. Approximately half of these studies were large-scale national population surveys, which were therefore limited in their representativeness of specific regional and rural towns. Most studies examining alcohol consumption used self-report data collection, meaning that interpretation of results needs to be tentative. There is a consistent pattern of higher rates of alcohol consumption and consequent harm within regional and rural Australia than in urban areas. Conclusions: There is emerging research examining alcohol consumption and alcohol-related harms within regional and rural Australia. All studies show that these populations experience disproportionate harm because of alcohol consumption. The causes and mechanism for this have not been investigated, and a program of research is required to understand how and why rural populations experience disproportionate levels of alcohol-related harm and ultimately, what interventions will be most effective in reducing alcohol-related harms. [ABSTRACT FROM AUTHOR]

The article presents information on health reform in Australia from 2007 to 2009. It highlights the establishment of the National Health and Hospitals Reform Commission (NHHRC) on December 20, 2007. Information on the various interim reports released by NHHRC between 2008 and 2009 is offered. The development of a National Primary Health Care Strategy by the government of Prime Minister Kevin Rudd, disclosed by Minister for Health and Ageing Nicola Roxon on June 11, 2008, is detailed. Also noted is the founding of the Preventive Health Taskforce.

Objective: This paper outlines the methods and baseline data from a multisite cohort study of the determinants and outcomes of mental health and well-being within rural and remote communities. Methods: A stratified random sample of adults was drawn in non-metropolitan New South Wales using the Australian Electoral Roll, with the aim of recruiting all adult members of each household. Surveys assessed psychological symptoms, physical health and mental disorders, along with individual-, family/household- and community-level characteristics. A stratified subsample completed a telephone-administered World Mental Health-Composite International Diagnostic Interview (World Mental Health-3.0). Proxy measures of child health and well-being were obtained. Follow up of this sample will be undertaken at one, three and five years. Results: A total of 2639 individuals were recruited (1879 households), with 28% from remote/very remote regions. A significant relationship was found between recent distress (Kessler-10 scores), age and remoteness, with a linear reduction of Kessler-10 scores with age and the lowest mean scores in remote regions. Conclusions: Existing rurality categories cannot address the diverse socio-cultural, economic and environmental characteristics of non-metropolitan regions. While it has limitations, the dataset will enable a fine-grained examination of geographic, household and community factors and provide a unique longitudinal dataset over a five-year period. [ABSTRACT FROM AUTHOR]

Objective: This paper explores pharmacist perceptions of a pilot study assessing the impact of specialist training on depression for rural community pharmacists on their understanding of treatment and psychological well-being of patients. Design: Mixed method survey. Setting: Rural community pharmacies. Participants: Thirty-two rural based community pharmacists. Interventions: Recruited pharmacists were allocated to either the ‘control’ or ‘intervention’ group. Intervention pharmacists were given training in depression and asked to dispense medication with extra advice and support, while control pharmacists provided usual care. Outcome measures: Understanding of depression, current involvement in patients with depression, changes in practice. Results: All pharmacists were more likely to initiate conversation, discuss medication and its side effects, point out the importance of remaining on the medication, provide ongoing follow-up and encourage patients to talk with their GPs and pharmacists by the end of the project. Intervention pharmacists were more likely than the control pharmacists to initiate conversation on dispensing a repeat prescription and to discuss extended support. Conclusion: Response to the project by pharmacists was generally very positive. It is recommended that a longitudinal study based on this project be undertaken which involves pharmacists, GPs and other mental health professionals and trials a holistic approach to mental health care. [ABSTRACT FROM AUTHOR]

Objective: To provide a framework for investigating the influence of socioeconomic and cultural factors on rural health. Design: Discussion paper. Results: Socioeconomic and cultural factors have long been thought to influence an individual's health. We suggest a framework for characterising these factors that comprises individual-level (e.g. individual socioeconomic status, sex, race) and neighbourhood-level dimensions (population composition, social environment, physical environment) operating both independently and through interaction. Recent spatial research suggests that in rural communities, socioeconomic disadvantage and indigenous status are two of the greatest underlying influences on health status. However, rural communities also face additional challenges associated with access to, and utilisation of, health care. The example is given of procedural angiography for individuals with an acute coronary event. Conclusions: Socioeconomic and cultural factors specific to rural Australia are key influences on the health of residents. These range from individual-level factors, such as rural stoicism, poverty and substance use norms, to neighbourhood-level social characteristics, such as lack of services, migration out of rural areas of younger community members weakening traditionally high levels of social cohesion, and to environmental factors, such as climate change and access to services. [ABSTRACT FROM AUTHOR]

Objective: Despite much having been written, both nationally and internationally, about rural suicides, no one in Australia knows either the number of residents on farms or the suicide rate for this group of people. This paper seeks to determine the number of residents on farms in South Australia, along with the suicide rate. Design, setting and participants: A retrospective audit review of the files of suicides completed between the 1 January 1997 and 31 December 2001 was undertaken in the South Australian Coroner's Office. There were 1033 cases examined for sociodemographic details and 380 files were explored in detail. Results: Estimating both the number of agricultural establishments in South Australia and the resident population on farms for 2001, and determining the number of suicides on farms between 1997 and 2001, the farm suicide rate was found to be 33.8 for men, 6.7 for women and 21.6 per 100 000 for persons, much higher than the rural suicide rate for South Australia in 2001 (23.8 for men, 5.6 for women and 14.5 per 100 000 for persons) according to the Australian Bureau of Statistics. Conclusions: This study provides an estimate of the number of farm residents in South Australia in 2001, the number and rate of suicides on farms in South Australia in 2001, and shows that this rate is significantly higher than the overall rate of suicide in South Australia in 2001. [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]

Objective: To explore the impacts and implications of health reform/renewal for rural women in Saskatchewan and Manitoba, Canada. Design: The study was a multiple case study approach using mixed methods of focus groups, individual interviews, and trends/utilization analysis. Setting: Three rural communities – two in Saskatchewan; one in Manitoba. Participants: Rural women; non-health providers. Interventions: None. Outcome Measures: None. Results: This paper presents a four phase Integrated Community Policy Uptake Model which is derived from the experiences of rural women during the operationalizing of health reform policy. The model depicts a four phase integration of the health reform or renewal policy; specifically, ‘Taking In’, ‘Taking On’, ‘Taking Over’, and ‘Taking Beyond’. The Integrated Community Policy Uptake Model is firmly rooted in the perceptions and opinions of rural women, and is informed by their understanding of health policy. Conclusion: The involvement of rural women in the policy process is necessary. The model proposed potentially encourages women to become more directly engaged in future health policy making and planning. There is also significant potential for this model to inform decision makers of the perceptions, needs, and solutions offered by stakeholders such as rural women. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to demonstrate that the medical workforce shortage is an international phenomenon and to review one of the strategies developed in the USA in the late 1960s: the physician assistant model of health service provision. The authors consider whether this model could provide one strategy to help address the medical workforce shortage in Australia. A systematic review of the literature about medical workforce shortages, strategies used to address the medical workforce shortage, and the physician assistant role was undertaken. Literature used for the review covered the period 1967–2006. Physician assistants provide safe, high-quality and cost-effective primary care services under the direction of a doctor and respond to workforce shortages in rural and remote areas, family practice medicine and hospital settings. This model of health care provision has been adopted in several other developed countries, including England, Scotland, the Netherlands and Canada. The physician assistant concept might provide Australia with a novel strategy for addressing its medical workforce shortage, particularly in rural and remote settings. [ABSTRACT FROM AUTHOR]

Objective: This paper repositions the challenge of attracting and retaining rural GPs in a marketing context as a new focus for future research and policy development. Design: Case study with mixed design of surveys of GPs and medical students and depth interviews with GPs, medical students, regional-division administrators and GP recruitment agents. Setting: GP recruitment and retention in the Limestone Coast region of South Australia. Participants: Twenty-seven Limestone Coast (LC) GPs; random sample of medical students from Adelaide University, Adelaide University Rural Health Society and Flinders University; snowball sampling two adjacent rural regions (20 GPs); and administrators from LC and adjacent regions and GP recruitment agencies in Adelaide. Main outcome measures: Drawing from marketing theory, creative suggestion of ‘promotion of the practice and not the region’ offers a means of GP recruitment and retention for structured succession planning for rural general practices. Results: Structural attempts to broaden the GP market with overseas recruitment have done little for improving full-time equivalent GP levels. Market segmentation and market orientation offer a new emphasis on value exchange between the corporation (the practice), customer (GPs) and competition (all practices) to influence future mobility. Conclusion: A marketing orientation to the GP challenge emphasises individual's perceptions of value, GP expectations and practice offerings. Failure to acknowledge benefits of this marketing approach means that solutions such as those developed in the Limestone Coast region are unlikely. Research is now required to define GP satisfaction and value for long-term viability of general practices. [ABSTRACT FROM AUTHOR]

Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice. This paper identifies this evidence gap, examines the concept of rural exposure, and highlights the need to identify which aspects of rural exposure contribute to a positive attitude towards rural practice, thereby influencing students to return to rural areas. The cost of rural exposure through student placements is not insignificant, and there is a need to identify which aspects are most effective in increasing the uptake of rural practice, thereby helping to address the medical workforce shortage experienced in rural Australia. [ABSTRACT FROM AUTHOR]

Objective: This paper evaluates adherence with secondary preventative treatment and follow up of acute rheumatic fever (ARF) within the Katherine region of the Northern Territory after the introduction of an ARF register. We aimed to assess the rate of adherence with penicillin prophylaxis and follow-up guidelines in patients with previous ARF and the effect of factors such as age, sex, disease severity and clinic attendance. Design: Retrospective study. Setting: Five Indigenous Community Health Centres located in the Katherine region of the Northern Territory, Australia. Participants: Fifty-nine people resident in five communities who were prescribed monthly prophylactic penicillin for ARF during the 24 months between September 2002 and September 2004. All subjects were Indigenous. Main outcome measure: Main outcome measures were the number of penicillin injections received over the 24-month period and frequency of echocardiogram and specialist follow up in comparison to Rheumatic Fever Registry Guidelines. Results: Mean adherence with prophylaxis was 56% of prescribed doses. A non-significant trend towards improved adherence was seen in children, patients with less severe disease and those who attended the clinic more frequently. Rheumatic Fever Registry Guidelines for echocardiogram and specialist review were met by 63% and 59% of subjects, respectively. Conclusion: Within this population adherence with penicillin prophylaxis is inadequate to protect against recurrence of ARF and consequent worsening of rheumatic heart disease. In addition, the Rheumatic Fever Registry Guidelines for specialist follow up and echocardiogram are not being adhered to for many patients. [ABSTRACT FROM AUTHOR]

End of life throws up significant mental health challenges. A high proportion of people in the terminal stages of illness experience depressive symptoms. This paper integrates a theory of hierarchy of human needs and empirical research describing experiences of grief and depression in terminal illness, to develop a model of care aimed at reducing depression and suffering. This care attends to physical, psychological, social and spiritual aspects, taking into account the concerns of patients and their families. Professional help can be offered to patients to restore dignity and hope, strengthen their ways of coping, and encourage social connections. To offer this, a well-resourced and coordinated, multidisciplinary and skilled workforce is needed. [ABSTRACT FROM AUTHOR]

This paper addresses a very salient feature of rural life and landscapes in Australia, natural disasters, and offers a psychological perspective on individual and community perceptions, responses, preparedness and planning. The convergent perspective offered reflects research and practice findings and insights from social and environmental psychology, as well as clinical, health and community psychology. The objective is to briefly characterise how these psychological approaches frame the psychological and social reality of these threats and events, and to canvas what insights and evidence-based best practice psychology have to offer allied professionals and paraprofessionals, and rural communities, as they experience and come to terms with the vagaries and extremes of the Australian environment. [ABSTRACT FROM AUTHOR]

There is a growing body of evidence supporting the provision of interprofessional education for pre‐registration health science students. Furthermore, there is emergent evidence supporting the provision of interprofessional opportunities in rural workplaces. The strategies used by tertiary education providers in establishing and sustaining these rural interprofessional initiatives currently remain unclear, including how to foster authentic engagement with indigenous rural communities. This short commentary seeks to provide some practical guidance on how to successfully implement and maintain rural interprofessional experiences for pre‐registration students. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to detect how a leading news paper, the Land Lantbruk in Stockholm, Sweden, informs the public and specifically the rural sector in Sweden and the Scandinavian countries concerning injury events (farm-related injury event) and the use of injury prevention and control. Injury reporting in the Land Lantbruk has been studied from the point of injury prevention and control. A study of injury prevention and rural health and safety in Australia shows that the newspaper The Land that serves Australia’s rural community should ‘be an under-utilised vehicle for news and commentary on rural health and safety issues’. Design: The study period was from January 2000 to February 2005. A total of 178 articles were reviewed and analysed. The articles were available on a newspaper database in the Land Lantbruk newspaper. Articles that addressed farm-related injury event and rural health and safety were chosen and organised into subgroups. Results: Tractor and motor vehicle safety (35%) was most common among the injury reporting. Although the newspaper Land Lantbruk provided excellent coverage of the causes of these events, the reports tended to focus on circumstances and did not provide information on injury prevention or the advantages of also coverage of the social and psychosocial long-term consequences of accidents. Conclusion: In the prevention work of reducing farm-related injuries in the rural sector in the Scandinavian countries and decreasing the human suffering represented by this health problem, rural politicians, insurance companies, rural authorities and also handicap organisations should listen more to the injured individuals and their own experiences relative to the difficulty of life after an accident. The reaction of family and relatives, and experiences of the long-term social consequences, have not been included in the media coverage. Journalists at the Land Lantbruk could also share experiences of the Swedish coverage of rural health and safety from Australian journalists from The Land. [ABSTRACT FROM AUTHOR]

Objective: This paper examines strategies used by nurses to manage patients at risk of deterioration in smaller rural hospitals in Victoria, Australia. Design: A two-stage design comprising a postal questionnaire (n = 20) and case studies (n = 7). Case study participants were interviewed and their practice was observed for one shift. Setting: Smaller rural hospitals in Victoria. Participants: Registered Nurses (Division 1). Main outcome measure: Observed and reported strategies used to manage deteriorating patients. Results: Nurses in this study used clinical strategies and communication strategies when managing patients who might deteriorate. These strategies were adapted to suit the individual rural context. The ability to anticipate patient requirements and confidence to act on clinical presentation were central. Nurses also had to learn the art of referral and they tailored communication according to their perception of the knowledge and skills of medical colleagues. Strategies were also influenced by staffing patterns and expectations of the community and health service. Conclusions: We conclude that rural nurses play an essential role in assessing and managing risk of deterioration across a range of patient presentations and often in challenging situations. Strategies used by nurses required an understanding of the rural context of care delivery. [ABSTRACT FROM AUTHOR]