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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]

Objectives: To highlight the experiences and challenges of international medical graduates (IMGs) living and working in rural and remote Tasmania, and how this informs their acculturation and retention in the state. Design: This paper reports the findings from the Tasmanian IMG questionnaire, which was administered both in hardcopy and online format to all known IMGs within the state. A total of 105 questionnaires were returned, representing a response rate of 30.0%. Results: IMGs were from the 30 countries and the majority were under 49 years of age, had migrated in the past 10 years, with over half having worked in the state for less than 2 years. Many IMGs indicated that they were satisfied with their current employment, the medical facilities, the friendliness of their patients and the friendliness of the community where they lived, and would like to stay much longer in Tasmania. Conclusions: Many IMGs have previously lived and worked in rural areas and are reasonably satisfied with their current employment and lifestyle in Tasmania. However, the following factors play an important part in their views and attitudes: employment satisfaction, access to schools, employment for spouse or partner and access to cultural or religious foods and goods. Nevertheless, beyond employment satisfaction, employment itself, coupled with career pathway and training opportunities, were highlighted as contributory factors for leaving Tasmania. [ABSTRACT FROM AUTHOR]

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 This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. Design This paper was performed on a prospective, self-report cross-sectional on-line survey. Setting The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. Participants Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. Interventions None. Main outcome measures Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. Results Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. Conclusions The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further. [ABSTRACT FROM AUTHOR]

Objective Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice. Design Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience. Participants and Setting GP Registrars ( N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway. Main outcome measure Ordinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables. Results A significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness. Conclusion We present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice. [ABSTRACT FROM AUTHOR]

Objective To examine urban-rural differences and individual risk factors for a late stage of breast cancer at diagnosis in Australian women. Design Individual-level longitudinal data were linked with cancer registry data from New South Wales (New South Wales Cancer Registry linked by the Centre for Health Record Linkage (CHeReL)), Queensland (Queensland Cancer Registry) and Victoria (The Cancer Council Victoria). Setting Participants were drawn from the Australian Longitudinal Study on Women's Health 1946-1951 cohort (n = 13 715). Participants The sample included 195 women identified from the linked cancer registry data with a breast cancer diagnosis. Interventions Rural or urban residence was measured using Accessibility/Remoteness Index of Australia Plus (ARIA+). Individual characteristics and socio-demographic variables examined included survey year, menopausal status, country of birth, education and marital status. Main outcome measures A late stage of breast cancer at diagnosis was defined based on the TNM Classification of Malignant Tumours. Results A late stage of breast cancer diagnosis was observed in 36% of women residing in urban areas and 40% of women residing in rural areas. After adjusting for individual characteristics, we found that obesity was the strongest risk factor for a late stage of breast cancer at diagnosis. Conclusions Given that women are becoming increasingly obese, and that the rate of obesity is higher in the Australian rural population, this paper provides further evidence for targeting interventions for obesity, particularly in rural Australia, as a public health priority. [ABSTRACT FROM AUTHOR]

Objective Little is known about rural-urban cancer disparities, particularly in South Korea, and this study is to identify cancer-specific mortality inequalities between the rural and urban areas of the country. Design, setting, and participants For 11 specific cancer sites, age-standardised mortality rates were analysed for the rural and urban administrative districts of South Korea during 2006-2011. Main outcome measures The Poisson log linear regression models were employed to estimate cancer-specific mortality rates, and Bonferroni comparison method was used to identify rural-urban disparities. Results There were significant rural-urban disparities observed for all cancer sites except prostate, pancreas and leukaemia. The mortality rates of lung, liver and stomach cancers, the three most common cancers in the country, were observed to be significantly higher in rural areas than in metropolitan areas. In contrast, the reverse relationship was observed for the reproductive system (breast and uterus) and colon cancers. Central nervous system cancer mortality was observed to be significantly higher in rural areas than in non-metro urban areas. Conclusions For the first time ever, significant rural-urban disparity patterns in cancer mortality rates in South Korea have been identified in this paper. Future investigations on cancer risk factors for the country should address these disparity patterns. [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]

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 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]

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]

Objective: To investigate the impact of the COVID‐19 pandemic on clinical supervision practices of health care workers in health care settings in one Australian state. Method: A bespoke survey was developed and administered online using Qualtrics™. The survey consisted of Likert scale and closed questions, with options for free text comments. Numerical data were analysed descriptively and using Chi‐Square tests. Textual data were analysed through content analysis. Results: Of the 178 survey respondents, 42% were from allied health disciplines, 39% from nursing and midwifery, and 19% from medicine. The type and mode (i.e., face‐to‐face, telesupervision) of clinical supervision prior to the pandemic and at the time of survey completion (i.e., July–August 2021) were similar. Eighteen percent of respondents had a change in supervision arrangements but only 5% had a change in supervisor. For the 37% who changed roles due to COVID‐19, 81% felt their current supervisor was still able to support them, 69% were still having their supervisory needs met. Analyses of textual data resulted in the development of two categories: Supervision deteriorating, and some clinical supervision functions (i.e., formative and restorative) being more impacted than others (i.e., normative). Conclusion: There were substantial disruptions to several parameters of clinical supervision due to COVID‐19, that may pose a threat to high quality supervision. Health care workers reported pandemic‐induced stress and mental health challenges that were not always addressed by effective restorative supervision practices. [ABSTRACT FROM AUTHOR]

Objective: To report self‐perceived readiness for work as a junior doctor in a national cohort of rural clinical school students. Design: Cross‐sectional study using a self‐report questionnaire. Independent variables included 14 individual readiness items related to clinical and professional tasks, sociodemographic data and reported experience of rural clinical school (RCS) training. Participants were 668 medical students (55.3% females) completing a full academic year in rural Australia. Multivariable analysis explored factors associated with overall readiness for work as a junior doctor. Findings: 86% agreed that RCS experience prepared them to undertake the roles and responsibilities of a junior doctor. Self‐ratings for specific clinical and professional tasks varied from a mean score of 5.9–8.0 out of 10, and 13 of the 14 items were associated with the outcome (p‐value <0.001, except for performing spirometry). Lowest readiness scores were seen for some aspects including raising concerns about a colleague (mean score 6.1) or responding to workplace bullying (mean score 6.0). Aspects of the RCS experience that were strongly associated with overall readiness included: feeling a valued team‐member (OR 9.28, 95%CI 2.43–35.39), feeling well‐supported academically (OR 6.64, 95%CI 3.39–13.00), having opportunity for unsupervised but supported clinical practice (OR 4.67, 95%CI 1.45–15.00), having a rural mentor (OR 3.38, 95%CI 1.89–6.06) and having a previous health professional qualification (OR 2.7, 95%CI 1.32–5.54). Discussion: Most RCS students felt ready for work as a junior doctor. Important aspects of RCS experience are likely to include students feeling integrated within the clinical team and having opportunities for authentic clinical roles. There remains a significant challenge for medical school curricula to address professional areas where graduates felt less prepared. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes is more prevalent among Aboriginal and Torres Strait Islander Peoples, especially those living in rural than urban areas. However, little is known about how diabetes is managed in different settings. Objective: To investigate differences in the prevalence of diabetes and the prescription of antidiabetic medications for Aboriginal and/or Torres Strait Islander Peoples living in urban or rural Australia. Design: Cross‐sectional study using de‐identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (60.4% females; mean age 45.2 ± 17.3 years) regularly attending 528 'mainstream' Australian general practices (MedicineInsight) in 2018. Findings: The prevalence of diabetes was 16.0%, and it was more frequent among those living in rural areas (22.0; 95% CI 19.3–24.4) than inner regional (17.6%; 95% CI 16.0–19.2) or major cities (15.8%; 95% CI 14.7–17.0; p < 0.001). The highest prevalence of diabetes was for males living in rural settings (25.0%). Of those with diabetes, 71.6% (95% CI 69.0–74.0) were prescribed antidiabetics, with a similar frequency in urban and rural areas (p = 0.291). After adjustment for sociodemographics, the only difference in diabetes management was a higher prescription of sulfonylureas in rural areas than in major cities (OR 1.39; 1.07–1.80). Discussion: The prevalence of diabetes was similar to other national data, although we found it was more frequent amongst Aboriginal and/or Torres Strait Islander males, especially those from rural areas. Conclusion: Despite current recommendations, one‐in‐four Indigenous Australians with diabetes were not prescribed antidiabetics. The clinical significance of more frequent prescriptions of sulfonylureas in rural locations remains unclear. [ABSTRACT FROM AUTHOR]

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

Objective: To determine associations between maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW rural hospital, and compare these to state data. Methods: Data (maternal characteristics, labour type, delivery mode and maternal antenatal complications) pertaining to women who had delivered a singleton birth at Griffith Base hospital were analysed. Design: Retrospective data analysis of Griffith Base Hospital 'eMaternity' database Setting: Single large rural town in NSW. Participants: Women who delivered a singleton birth between July 2018 and June 2019 inclusive at Griffith Base Hospital. Main outcome measures: 1. Comparison of maternal characteristics of age, BMI, gravida, parity and gestation data between labour type (spontaneous, augmented, induced and planned caesarean section) and delivery modes (vaginal, instrumental vaginal and caesarean section). 2. Associations between labour type, augmentation or induction method, delivery mode and maternal antenatal complications. 3. Multiple regression analysis for influence of age, BMI, parity and labour type on emergency caesarean section outcome. 4. Comparison of maternal, labour and delivery data with NSW state data. Results: Among 457 women, there were higher rates of obesity and spontaneous labour, lower rates of planned caesarean section and augmented labour, and similar rates of induction of labour and emergency caesarean section, compared with NSW. Emergency caesarean section was significantly associated with older age (β = 0.163), and labour augmentation (β = 0.114) and induction (β = 0.169). Labour augmentation with synthetic oxytocin, and induction with balloon catheter, were associated with the highest rates of emergency caesarean section. Conclusion: This large rural town had fewer labour and delivery medical interventions compared with NSW overall. Augmentation and induction of labour contribute to increasing caesarean section rates: directly via associations with emergency caesarean section, and indirectly because previous caesarean section was the most common reason for elective caesarean section. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to describe the epidemiological features of each presentation with a primary dermatological diagnosis to a regional emergency department (ED). Design: 1‐year retrospective audit. Setting: Regional Victorian hospital emergency department. Participants: Any presentation to this regional emergency department with a dermatological condition from 1 January 2020 to 31 December 2020. Main Outcome Measures: Dermatology presentations to the ED in 2020 and the prevalence of the associated primary diagnosis. Results: In total, 4.7% (n = 1873) of ED presentations had a primary dermatological diagnosis. Of these, 1484 were ≥18 years of age and 389 were ≤17 years of age. Cellulitis (26.1%, n = 388) was the most common primary diagnosis among presentations ≥18 years. Non‐specific rash was the most common diagnosis (23.6%, n = 92) in presentations ≤17 years. Indigenous Australians ≥18 years were more likely to be in a younger age group (p < 0.01), and dermatitis/eczema presentations ≥18 years (n = 10) were the largest diagnostic group referred to a dermatologist. A total of 134 (7.1%) patients ≥18 years travelled more than 50 km to the ED. There were no dermatological emergencies identified. Conclusions: A high proportion of presentations to this regional ED with a dermatological diagnosis could be well managed by a dermatologist or general practitioner (GP) as an outpatient. The findings of this study inform the need for future rural public dermatology services. Options include teledermatology, or a public weekly or fortnightly rapid review dermatology clinic with a visiting dermatologist, in the absence of a dermatologist onsite. [ABSTRACT FROM AUTHOR]

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

Introduction: Residents of rural areas internationally typically experience chronic disease risk profiles worse than city dwellers. Poor diet, a key driver of chronic disease, has been associated with unhealthy food environments, and rural areas often experience limited access to healthy, fresh and affordable food. Objective: This study aimed to evaluate the first three years of a health promoting social enterprise café established in a small rural health service. Design: A mixed‐methods evaluation study. Quantitative sales data, surveys and key informant interviews that included both quantitative and qualitative responses. Findings: Three years of sales data were included; 111customer surveys and five key informant interviews were conducted. Food and beverages on displayed and sold consistently met or exceeded the healthy criteria set by policy. Stakeholders supported the traffic light system, the social enterprise model and rated the likelihood of sustainability of the café as high. Discussion: Customers used the 'traffic light' system to inform food choices, placed value on the warmth of the staff and on the welcoming environment created through the social enterprise model. Resources remain tight although all stakeholders are committed to the sustainability of the YarriYak café. Conclusion: The study shows the acceptability, feasibility and sustainability of a health promoting social enterprise café in a rural area. [ABSTRACT FROM AUTHOR]

Objective: To determine whether young rural Australians have higher rates or different underlying causes of out‐of‐hospital cardiac arrest (OHCA). Design: A case–control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non‐cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non‐cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. Setting: A state‐wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). Participants: Victorians aged 1–50 years old experienced an OHCA between April 2019 and April 2020. Main outcome measures: Rates and underlying causes of OHCA in young rural and metropolitan Victorians. Results: Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101–235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71–251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. Conclusion: Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA. [ABSTRACT FROM AUTHOR]

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

Objective: To explore reasons for survival disparities for patients with prostate cancer in the Barwon South West area of Victoria. Design, Setting and Participants: We have described incidence, diagnostics, treatment pathways, and survival for four regions of the Barwon South Western Victoria. Analysis included all newly diagnosed prostate cancer patients from 2009 to 2015 in the Evaluation of Cancer Outcomes Barwon South West Registry. Regions included 1: Queenscliffe 2: Geelong, Colac Otway and Corangamite 3: Moyne, Warrnambool and Southern Grampians and 4: Glenelg. Across the four regions, variables were compared using a chi square statistic or analysis of variance and survival data was assessed with the Kaplan–Meier curves. Main Outcome Measures: Incidence, treatment pathways and survival for prostate cancer patients. Results: A total of 1776 patients were diagnosed with prostate cancer from 2009 to 2015 in the Barwon South West area. In regions 1–4, there were 298 (1.04%), 1085 (0.92%), 273 (0.97%) and 120 (1.2%) cases, respectively. There was no significant difference in Gleason score and treatment. The 5‐year survival rate was 85%, 76%, 71% and 80%, respectively, as compared with the national average of 95%. PSA scores >20 ng/ml at diagnosis, as a surrogate for high‐risk disease, occurred in 23%, 29%, 22% and 21%, respectively (p < 0.01). The proportions presenting with stage IV disease were 17%, 26%, 21% and 6%, respectively (p = 0.10). Conclusion: Men diagnosed with prostate cancer in South West Victoria have a considerably lower 5‐year survival compared with the national average with later disease at presentation in some areas. [ABSTRACT FROM AUTHOR]

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

Objective There is little evidence that useful electronic data could be collected at Australian small rural emergency services. If in future their funding model changed to the Activity- Based Funding model, then they would need to collect and submit more data. We determine whether it is possible to collect episode-level data at six small rural emergency services and quantify the accuracy of eight fields. Design A prospective cross-sectional study. Setting South-West Victoria, Australia. Participants Six small rural emergency services. Intervention We collected and audited episode-level emergency data from participating services between 1 February 2011 and 31 January 2012. A random sample of these data were audited monthly. Research assistants located at each service supported data entry and audited data accuracy for four hours per week. Main outcome measures Rates for data completeness, accuracy and total accuracy were calculated using audit data. Results Episode-level data were collected for 20 224 presentations across six facilities. The audit dataset consisted of 8.5% (1504/17 627) of presentations from five facilities. For all fields audited, the accuracy of entered data was high (>93%).Triage category was deemed appropriate for 95.9% (95% confidence interval ( CI): 94.9-96.9%) of the patient records reviewed. Some procedures were missing (28.7%, 95% CI: 27.2-30.3%). No significant improvement in data accuracy over 12 months was observed. Conclusion All six services collected useful episode-level data for 12-months with four hours per week of assistance. Data entry accuracy was high for all fields audited, and data entry completeness was low for procedures. [ABSTRACT FROM AUTHOR]

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

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

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

This study examines differences in uptake of the Medicare items rolled out in 2006 under the ' Better Access Scheme' ( BAS) between rural and non-rural Australian women. It compares differences in women's uptake of the BAS services by area of residence ( ARIA +) across time using the Australian Longitudinal Study of Women's Health ( ALSWH) survey data linked to Medicare data. Women aged 28-33 years at the time the BAS was introduced that responded to the self-reported question on depression/anxiety and consented to linkage of their survey data with Medicare data ( n = 4316). Participants were grouped by ARIA + according to BAS use, diagnoses of anxiety/depression but no BAS use and other eligible women. Across all areas, women born 1973-1978 with a self-reported diagnosis of depression/anxiety or having treatment under the BAS had a significantly lower mean mental health score compared to other women. Significantly more women living in non-rural areas had used at least one service provided under the BAS initiative compared to women in outer regional, inner regional or remotes areas (21% versus 18% versus 13% versus 7%, respectively), and across all areas, 12% of women reported having a diagnosis of depression/anxiety but not been treated under the BAS. While there is a gradual uptake of the new BAS services, a large percentage of women who have a diagnosis of depression/anxiety have not been treated under the BAS. The data suggest that women in urban areas have been better able to take up the services compared to non-urban women. [ABSTRACT FROM AUTHOR]

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

To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. The study used a cross-sectional design, utilising a structured questionnaire. Health centres in very remote Australia. Nurses working in very remote Australia experience significantly higher levels of psychological distress and emotional exhaustion, compared with other professional populations. Paradoxically, results also highlight higher than average levels of work engagement. Nurses working in very remote regions in Australia further report moderate levels of job satisfaction. Most significant job demands identified were emotional demands, staffing issues, workload, responsibilities and expectations, and social issues. Key job resources included supervision, opportunities for professional development, and skill development and application. In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long-term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover. [ABSTRACT FROM AUTHOR]

Objective: Early intervention with appropriate first aid following burn injury improves clinical outcomes. Previous evidence suggests geographic remoteness may be a barrier to receiving appropriate burns first aid. This study investigated the prevalence of gold standard first aid in patients managed in Australian burn services and whether geographic remoteness was associated with receiving gold standard first aid. Design: Registry‐based cohort study. Setting: Binational clinical quality registry. Participants: Burn‐injured patients admitted to a specialist Australian burn service. Main outcome measures: Receiving gold standard first aid following a burn injury. Results: Approximately two‐thirds of patients received gold standard first aid. Patients whose burns were sustained in very remote regions had a greater risk of receiving no first aid, compared to gold standard first aid, relative to patients who sustained their burn injuries in major cities. Conclusions: Nearly two‐thirds of patients received gold standard burns first aid following injury. However, patients who were injured in the most remote regions of Australia were at an increased risk of not receiving gold standard first aid treatment within 3 hours of injury. Further examination of factors contributing to poorer first aid standards in remote areas is required. [ABSTRACT FROM AUTHOR]

Objective: To describe the pattern of prescribing long‐acting reversible contraception by Australian general practitioner registrars across different classifications of rurality/urbanicity. Methods: A study nested within the Registrar Clinical Encounters in Training ongoing cohort study of Australian general practitioner registrars' in‐consultation experience. Design: A cross‐sectional analysis of Registrar Clinical Encounters in Training data collected 2010‐2017. Type of contraception prescribed by general practitioner registrars to women aged 12‐55 for contraception‐related indications was documented. Chi‐square statistical analysis was performed to assess association of specific long‐acting reversible contraception methods with rurality/urbanicity. Setting/Participants: General practitioner registrars enrolled in the Australian General Practice Training program in regional training providers/organisations participating in Registrar Clinical Encounters in Training. Main outcome measures: Long‐acting reversible contraception was defined as etonogestrel implant, copper intrauterine device, levonorgestrel intrauterine device and medroxyprogesterone injection. Results: In all 1737 registrars recorded 4073 registrar rounds of data from 2010 to 2017 (response rate 96%). Type of long‐acting reversible contraception prescribed differed significantly across Australian Statistical Geography Standards classification of rurality (Pearson's χ2 = 17, P =.002). Women living in outer regional/remote/very remote regions are prescribed proportionately more medroxyprogesterone injection and less levonorgestrel intrauterine device compared to major cities/inner regional areas. Conclusions: Long‐acting reversible contraception methods prescribed differ across different classifications of rurality. Women living in more rural/remote regions might have access difficulties for the levonorgestrel intrauterine device. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. Design: Cross‐sectional study using data from the national Federation of Rural Australian Medical Educators survey. Participants/Setting: Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. Main outcome measure(s): Career preference in primary care after graduation. Results: The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4‐42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P =.004). Conclusion: Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like‐minded peers and clinicians to preserve the career interest of these students. [ABSTRACT FROM AUTHOR]

Objective: Rural background is associated with greater interest in rural practice. However, there is no universally agreed definition of 'rural' background used in medical school selection. This study explored the association between definitions of 'rural' background and students' intended career locations. Design: Prospective cohort study using survey data on career intention, hometown size, rurality of background, home address, high school and intended career location. Setting: University of Auckland, New Zealand (NZ). Participants: Commencing medical students 2009‐2017, inclusive. Main outcome measures: Univariate associations between student background according to 7 definitions of 'rural', and 3 definitions of intended practice location based on population size: urban intention (>100 000); regional intention (25 000‐100 000); rural intention (<25 000). Results: The sample size was 1592 students. 27.4% had a rural background by at least one definition. All definitions of rural background were associated with a greater rural intention. Applying a restrictive definition of rural (population<25 000) was associated with a higher likelihood of rural intention, but captured a smaller number of students. There was strong agreement between the population size of a student's background and intended practice location (chi‐square P <.0001). Conclusion: Rural intention varies by definition, but the number of students captured by each definition is important. Applying a binary or overly restrictive definition may limit interested students. Medical schools should adopt a definition of 'rural' that optimises the number of eligible students and their propensity to work rurally. Further, alternative ways of identifying students with rural intentions without a rural background should be explored. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to determine the prevalence and risk factors of alcohol use among a cohort of population in Sabah. Design: This is a prospective, cohort study involving rural community residents. Setting: Rural community resident at Bingkor, Keningau, Sabah. Participants: 363 individuals aged 13 years old and above. Intervention: Community‐based participatory research to determine the prevalence and risk factors associated with alcohol use. Main outcome measures: Measurement of alcohol use using Alcohol Use Disorders Identification Test (AUDIT) and assessment of psychiatric morbidity using Mini International Neuropsychiatric Interview (MINI) questionnaires. Results: Most alcohol drinkers aged between 36‐45 years old, followed by 26‐35 years old and 46‐55 years old. Interestingly, there are almost similar female to male ratio. Most were Kadazan‐Dusun ethnic, non‐Muslims, and married. Although only less than a third of the participants received tertiary education, the majority were working. Based on the findings, being a male, non‐Muslim and having an obsessive‐compulsive disorder (OCD) (current) posed a significantly higher risk of alcohol consumption. Conclusion: A worryingly high prevalence of hazardous alcohol consumption among the locals is reported. There is a need for population‐wide intervention towards preventive measures based on the identified risk factors for hazardous alcohol use. [ABSTRACT FROM AUTHOR]

Objective: Assess nursing and allied health student satisfaction with their remote Northern Territory integrated learning placement and consideration of future rural/remote workDescribe the characteristics of these studentsExamine changes in student characteristics over time. Design: A cross‐sectional survey of students and a review of student placement data. Setting: Northern Territory, Australia. Participants: Former students having a work integrated learning placement of more than 1 week in the Northern Territory from 2017 to 2019. Main outcome measure(s): Agreement with the statements 'This placement has encouraged me to consider living and working in a rural or remote location after I graduate' and 'Overall, I was satisfied with my placement.' The administrative record review examined student numbers, and placement length over time. Results: A total of 341 students responded to the online survey. Overall satisfaction with the placement was very high (93%), and 84% agreed/strongly agreed that the placement had encouraged them to consider working in a rural or remote setting. High‐quality clinical supervision and educational resources were associated with overall placement satisfaction. Overall placement satisfaction, prior interest in working remotely and satisfaction with educational resources were associated with consideration of working remotely. The number of students having a placement increased by 29% in 2017 to 2019. The number of placement weeks also increased (35%). Conclusions: The number/placement time of nursing and allied health students has increased in the NT. Satisfaction with remote work integrated learning placements is an the important pathway to growing a local health professional workforce in remote and rural settings. [ABSTRACT FROM AUTHOR]

Objective: To estimate the number of general practice‐appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service. Design: A four‐step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. Setting: A large, remote community with substantial populations of Indigenous peoples and fly‐in, fly‐out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. Participants: Patients attending the emergency department with lower urgency problems. Interventions: ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. Main outcome measures: The proportion of patients attending the ED with GP‐appropriate problems and influences on their decisions to attend the ED. Results: About 48% of all attendances met the agreed definition of GP‐appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. Conclusion: Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice. [ABSTRACT FROM AUTHOR]

Objective: This study examined the impact of introducing Palliative Care Needs Rounds (hereafter Needs Rounds) into residential aged care on hospitalisations (emergency department presentations, admissions and length of stay) and documentation of advance care plans. Design: A quasi‐experimental study. Setting: Two residential aged care facilities in one rural town in the Snowy Monaro region of New South Wales, Australia. Participants: The intervention group consisted of all residents who died during the study period (April 2018‐March 2019), and included a subgroup of decedents who were discussed in a Needs Round. The control cohort included all residents who died in the three‐year period prior to introducing Needs Rounds (2015‐2017). Intervention: Needs Rounds are monthly onsite triage/risk stratification meetings where case‐based education and staff support help to identify residents most at risk of dying without an adequate plan in place. Needs Rounds were attended by residential aged care staff and led by a palliative medicine physician. Main outcome measures: Decedents' hospitalisations (emergency department presentations, admissions and length of stay) in the last three months of life, place of death and documentation of advance care plans. Results: Eleven Needs Rounds were conducted between April and September 2018. The number of documented advance care plans increased (P <.01). There were no statistically significant changes in hospitalisations or in‐hospital deaths. Conclusion: Needs Rounds are an effective approach to increase the documentation of advance care plans within rural residential aged care. Further studies are required to explore the rural influence on outcomes including hospital transfers and preferred place of death. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Deadly Thinking, a social and emotional well‐being promotion program targeted to remote and rural Aboriginal and Torres Strait Islander communities. Deadly Thinking aims to improve emotional health literacy, psychological well‐being and attitudes towards associated help‐seeking. Design: Participants completed pre/post‐test evaluations via a brief self‐report survey immediately before and after the Deadly Thinking workshop. Setting: Aboriginal and Torres Strait Islander communities in rural and regional Australia. Participants: Data were obtained from 413 participants (69.8% female, mean age 41.6 years), of whom 70.4% identified as Aboriginal or Torres Strait Islanders. Intervention: Deadly Thinking workshops involve participant's engaging with a series of videos and facilitated group discussions with other participants related to social and emotional well‐being topics relevant to individuals and communities. Main outcome measures: Participants completed measures of psychological distress, suicidal ideation, substance use, changes in attitudes towards help‐seeking and help‐seeking intentions and satisfaction with the workshop. Additionally, participants in a train‐the‐trainer workshop rated their perceived confidence to deliver the program post‐workshop. Result: Participants reported positive perceptions of community safety and well‐being and low rates of marked distress, with no significant difference between train‐the‐trainer and community workshop participants. Results indicated significant improvement in help‐seeking intentions post‐workshop and high rates of satisfaction with workshop components. Conclusion: Initial evaluation indicates good acceptability and feasibility of delivering the Deadly Thinking program in rural and remote Indigenous communities; however, more robust evaluation of the program is warranted using controlled conditions to measure effectiveness, particularly for changing in help‐seeking behaviour. [ABSTRACT FROM AUTHOR]

While it is known that informal carers provide the majority of caregiving in Australia, there remains limited understanding of the challenges that regional carers face in their caring role and the impact of the caregiving role on carer well‐being. Objective: The aim of this study was to better understand the health status of caregivers as the person they care for was entering the National Disability Support Scheme. Design: This is a mixed‐methods study. Setting: The study was undertaken in regional New South Wales, Australia. Participants: Seventy‐five carers were enrolled into the study. All lived in regional New South Wales. Main outcome measure: The World Health Organization Well‐being Index was used for quantitative data collection, and semi‐structured interviews were undertaken for the collection of qualitative data. Result: Quantitative data indicated that carers from Aboriginal or Torres Strait Islander backgrounds and those from low socio‐economic status had significantly lower scores on the well‐being index. Two key qualitative categories were evident describing carer's journey to resilience by (a) adjusting to reality predominantly through cognitive reframing strategies and (b) carers accessing external supports. Conclusion: The health status of regional carers who are predominantly women is experiencing low levels of well‐being. While many of these carers have initiated successful coping responses to the challenges of caring, there is an urgent need to increase the supports available to this population. As the recent National Disability Support Scheme is embedded, it is of importance to monitor if there are improvements in the health status of carers over time. [ABSTRACT FROM AUTHOR]

Objectives: Hypertension is a leading risk factor for death and disability. We aimed to estimate the prevalence of hypertension in an older rural Australian cohort and identify predictors of hypertension management. Design: Analysis of cross‐sectional data collected from participants in a prospective cohort study. Setting: The Victorian rural towns of Morwell and Sale in 2018‐2019. Participants: A weighted random sample of 1119 eligible participants from Morwell or Sale, aged ≥55‐90 years for men and ≥60‐90 years for women, was drawn from the Hazelwood Health Study's Adult Survey cohort. Main outcome measures: Blood pressure, body mass index, left ventricular hypertrophy by electrocardiogram, estimated glomerular filtration rate and glycosylated haemoglobin (HbA1c) were measured. Participants with hypertension were categorised as managed, undermanaged or unmanaged. Results: Testing undertaken of 498 participants estimated the weighted prevalence of hypertension (defined as blood pressure ≥ 140/90 mm Hg, a self‐reported doctor diagnosis of hypertension or taking antihypertensive medication) to be 79.9% (95% confidence interval: 75.7‐83.4). Of those, 54.5% (49.4‐60.0) had managed hypertension (<140/90 mm Hg), 37.1% (32.3‐42.1) undermanaged hypertension and 8.4% (5.9‐11.9) a new finding of hypertension (unmanaged hypertension). Current employment (relative risk 1.47, 95% confidence interval: 1.06‐2.02) and single marital status (relative risk 1.45, 1.4‐1.84) were associated with under‐ or unmanaged hypertension. Compared with no hypertension, the hypertensive groups were more likely to demonstrate markers of end‐organ damage such as left ventricular hypertrophy and impaired renal function. Conclusion: Hypertension is a highly prevalent condition among older rural Australians which is suboptimally identified and managed. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of patients who used the Royal Flying Doctor Service dental clinics and determine Royal Flying Doctor Service and non‐Royal Flying Doctor Service dental service provision in mainland Australia. Design: A prospective cohort study. Setting: All Royal Flying Doctor Service dental clinics located throughout rural and remote Australia. Participants: All patients who accessed an Royal Flying Doctor Service dental clinic from April 2017 to September 2018. Interventions: Royal Flying Doctor Service mobile dental clinics. Main outcome measures: Patient demographics and dental procedures conducted (by age, sex and Indigenous status); and the dental service provision and coverage (Royal Flying Doctor Service and non‐Royal Flying Doctor Service) within mainland rural and remote Australia. Results: There were 8992 patient episodes comprising 3407 individual patients with 27 897 services completed. There were 920 (27%) Indigenous and 1465 (43%) non‐Indigenous patients (n = 1022 missing ethnicity data). The mean (SD) age was 31.5 (24.8) years; the age groups 5‐9 years and 10‐14 years received 17.6% and 15.1% of the services, respectively. There were 1124 (33%) men and 1295 (38%) women (n = 988 with missing sex data). Women were more likely (all P <.05) to receive preventive services, diagnostic services, restorative services, general services, endodontics and periodontics. Men were more likely (both P <.05) to receive oral surgery and prosthodontics. There are many rural and remote people required to travel more than 60 minutes by vehicle to access dental care. Conclusion: Without increasing dental provision and preventive services in rural areas, it seems likely that there are and will be unnecessary oral emergencies and hospitalisations. [ABSTRACT FROM AUTHOR]

Objective: To describe characteristics and outcomes of women birthing within GP‐obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland. Design: Retrospective descriptive study. Setting: 21 GP‐obstetrician supported birthing units in Queensland. Participants: Women (n = 3111) birthing from January 2017 to December 2017. Main outcome measures: Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data. Results: Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001). Conclusion: GP‐obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety. [ABSTRACT FROM AUTHOR]

Objective: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. Design: A cross‐sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi‐squares. Setting: An Australian regional university. Participants: First year occupational therapy, physiotherapy and speech pathology students. Main outcome measures: Factors influencing the first 6 weeks at university. Results: One hundred and forty‐three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature‐aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. Conclusion: Orientation week activities assist students transition into university and age‐appropriate and family‐friendly activities should be considered for mature‐age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success. [ABSTRACT FROM AUTHOR]

Objective: To investigate the urban‐rural disparities in health risk factors, health status and outcomes in Tianjin, China and to make an international comparison with urban‐rural health in Australia. Design: A descriptive analytical cross‐sectional survey. Setting: Mobile research teams conducted door‐to‐door field surveys of each house or department. The teams included local administrative staff and Tianjin Center for Disease Control and Prevention's epidemiologists, clinicians and laboratory technicians. Participants: A total of 25 288 residents were interviewed and clinically observed, including 8583 urban residents and 16 705 rural residents. Main outcome measure: Health risk factors, health status and outcomes. Results: The age structure in urban areas of Tianjin was growing older. Rural residents received less high school education and university education than did urban residents. Urban residents had higher medical insurance coverage and paid more out‐of‐pocket medical expenditures than did rural residents. The prevalence of smoking and the crude alcohol consumption rate were higher in rural areas than in urban areas. Rural residents had feelings of higher self‐satisfaction concerning their health status than did urban residents. The prevalence of hypertensive disease, type 2 diabetes and heart, stroke and vascular diseases were significantly lower in rural areas than in urban areas. The incidence rate of serious injuries resulting from traffic accidents was significantly higher in rural areas than in urban areas. Conclusion: Contrary to Australian urban‐rural survey outcomes, the health status and outcomes of residents in rural areas of Tianjin seemed to be better than those of their counterparts in urban areas. The underlying determinants of these outcomes need to be explored with further study. [ABSTRACT FROM AUTHOR]

Objective: High‐quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self‐reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001‐2003 and 2014. Design: Repeat cross‐sectional studies conducted over a decade apart. Setting: The projects were conducted in the Goulburn Valley in regional Victoria. Participants: The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. Main outcome measures: Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12 months. Results: The age‐standardised prevalence of depression was higher in the 2014 study than the 2001‐2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age‐standardised diabetes and hypertension was higher in 2014 than 2001‐2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). Conclusion: The results of this study indicate that the prevalence of self‐reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13 years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the adherence to asthma evidence‐based guidelines before and after a quality improvement process. Design: A controlled trial was conducted at two regional hospitals (intervention and control hospitals). We performed a retrospective pre‐intervention audit, followed by a post‐intervention audit 1 year after the implementation of evidence‐based guidelines. Setting: Emergency departments of two neighbouring hospitals serving regional and rural North West Tasmania. Participants: All children (<18 years) with acute presentation of doctor‐diagnosed asthma. Interventions: Implementation of evidence‐based guidelines using the National Asthma Council of Australia and the Global Initiative of Asthma guidelines, at the intervention hospital and care as usual at the control hospital. Main outcome measure(s): The main outcome measures were the compliance to evidence‐based guidelines, pre‐ and postintervention at the intervention hospital, compared to the control hospital. The specific outcomes measure included the clinical presentation, management, referral to asthma and allergy clinic, and hospitilisation. Results: Significantly improved adherence to evidence‐based guidelines were noted post‐intervention at the intervention hospital, that is severity recorded (21.4%‐45.7%, P < 0.001), triggers identified (13.5%‐45.3%, P < 0.001), spirometry usage (3.8%‐25.8%, P = 0.03) and written action plans (29.7%‐58.3%, P < 0.001). There was however no effect on hospitilisation (23.3%‐29.8%, P = 0.48). At the control hospital, however, no significant improved adherence to evidence‐based guidelines were noted. Conclusions: Evidence‐based implementation led to improved adherence to evidence‐based guidelines across an expanded list of domains in a regional setting. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with having a successful treatment plan for managing chronic conditions. Design: Secondary analysis of the Commonwealth Fund's 2014 International Health Policy Survey. Setting: Australia 2014. Participants: A total of 3310 Australian adults over 55 years old. Main outcome measures: Whether respondents: (i) had a treatment plan for their chronic condition; and (ii) believed that the plan was helpful in managing their condition. Methods: We used multiple logistic regressions to assess the association between individual factors (age, income, remoteness, Australian Aboriginal or Torres Strait Islander status) and patient reports of the outcomes of interest. Results: Most respondents reported having a treatment plan for their chronic condition(s); the majority reported that it was helpful in managing their health. Treatment plan provision was associated with age over 75 years, above‐average income, Australian Aboriginal or Torres Strait Islander status and multiple chronic conditions. Plans were less likely for residents of outer regional and remote areas. Indigenous respondents were far less likely than non‐Indigenous respondents to report that their treatment plan helped a lot. Respondents with providers who 'always' explained things were far more likely to say that a treatment plan helped. Conclusion: While the patient–provider relationship influenced the perceived success of treatment plans, inequities in treatment plan provision seemed linked with rurality and income. The higher frequency of treatment plans for Indigenous respondents might reflect access to Australian Aboriginal or Torres Strait Islander health checks, while the plan's perceived lack of efficacy suggests a gap in cultural acceptability. [ABSTRACT FROM AUTHOR]

Objective: To measure the impact of a 6‐month home‐based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. Design: A two‐arm randomised controlled trial of rural adults. Setting: The rural town of Albany in the Great Southern region of Western Australia. Participants: Participants (n = 401) aged 50‐69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. Interventions: A 6‐month intervention program incorporating goal setting, self‐monitoring and feedback, with motivational interviewing was conducted. Main outcome measures: Change in metabolic syndrome status and cardiovascular risk. Results: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (−0.82) were observed for the intervention group relative to control group from baseline to post‐test. Conclusion: This home‐based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long‐term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered. [ABSTRACT FROM AUTHOR]