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

Background: The Australian geographically rural and remote disability workforce has historically demonstrated difficulties to keep up with the demand for quality services and supports for people with disability. In 2013, the National Disability Insurance Scheme (NDIS) was launched to provide individualised disability support packages to meet people's needs. To receive funding, people with disability are required to develop a NDIS plan. That plan is then funded by the National Disability Insurance Agency (NDIA), the government agency responsible for managing the NDIS. Although the NDIS has been operating for almost 10 years, there is limited research into the planning experiences of the workforce in regional, rural and remote regions of Australia. This review aims to ascertain the level of scholarly investigation into workers' experiences of NDIS planning. Methodology: Research publication databases were searched using a specific search string to identify publications that included reference to the workforce's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications that focused on those working with Aboriginal and Torres Strait Islander people were also appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications was undertaken to ascertain disability and health workforce experiences of the NDIS planning process. Results: Seven papers met the selection criteria. Two papers were policy reviews and reported the improvements of the NDIS planning process since its inception. These studies reported four reoccurring themes: (1) cultural/socioeconomic and geographical factors; (2) administrative burden and bureaucracy; (3) values, culture and geography; and (4) burden on allied health workers. Conclusion: The NDIS planning process has developed and progressed since its rollout in 2013. There are limited research papers available that describe the workforce's experience of the planning process in regional, rural and remote regions. More research in this area is needed to identify the experiences of the disability workforce in relation to the NDIS planning process. [ABSTRACT FROM AUTHOR]

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

Objective: To review and synthesise research related to the ageing farming workforce influence on the health and sustainability of agricultural communities. Design: Using the PRISMA framework as a guide, the CINHAL and Medline databases were searched. Search 1 used the key search terms of ageing OR aging, farm*, workforce. Search 2 used health, sustainability and 'agricultural OR farm communit*. Search 3 combined Searches 1 and 2. Search 4 followed journal citations to identify other relevant articles. A process of narrative synthesis was applied to the results through the prism of rural social capital that described the current state of knowledge and understanding under four themes. Result: Database searches and searching of citations identified 16 contemporary articles. Seven of the papers were from Australia, and the balance from five other high‐income countries. The four that themes emerged are: vulnerabilities of ageing farmers; economic and climatic drivers; social capital and sustainability; and integrative strategies, that might offer a way forward. Conclusion: Integrating these forces of nature, economics and sociology to address the ageing farming workforce and the associated health and sustainability of agricultural communities remains a major challenge for researchers, governments, the agricultural sector and rural communities. [ABSTRACT FROM AUTHOR]

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

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

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

Objective: The aim of this paper was to use current stroke care guidelines to identify and discuss current stroke care challenges in rural Australian health care and potential solutions for delivery of evidence‐based practice. Design and setting: A review of national guidelines since 2002 for organised stroke care was undertaken to determine best practice for delivering primary stroke care. We then employed a narrative literature review strategy looking at relevant articles, based on keywords, outlining current stroke service availability in Australia, highlighting the challenges of implementing evidence‐based stroke care in rural areas in Australia based on the current guidelines. Results: Delivery of evidence‐based stroke care in rural Australia is fraught with challenges. Although national best‐practice guidelines for stroke care are well established, the recommendations made in these guidelines do not always reflect the resource availability in rural Australia. Redesigning processes and utilising available resources, such as telemedicine or local clinical pathways, can achieve an evidence‐based standard; however, ultimately better resourcing of these areas is required. Conclusion: Evidence‐based stroke care, aligned with current national standards is the key to providing adequate stroke services in rural Australia. Improved health service resourcing and better utilisation of currently available resources are options for achieving elements of evidence‐based stroke care. Implications for public health: Availability of adequate services for stroke patients directly impacts public health as it determines health outcomes for these patients. Indirect implications for public health include the effects on health professionals and the general public. [ABSTRACT FROM AUTHOR]

Introduction: The Australian Government aims to increase the number of individuals on humanitarian resettlement visas allocated to regional locations to 50% by the year 2022. A significant issue with this, given the substantive body of research identifying that refugee populations face chronic mental health concerns during resettlement, is the lack of health‐related research focusing on the resettlement of individuals of refugee background to rural and regional locations in Australia, especially in the area of mental health. Objective: To provide a foundation for rectifying this omission, this review is the first to synthesise mental health research focusing on individuals of refugee background specifically resettled to rural and regional locations in Australia. Design: The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. Findings were synthesised using thematic analytic techniques. Findings: 14 relevant studies (3 quantitative, one mixed‐method, 10 qualitative) were identified. Findings indicated that individuals of refugee background resettled in rural and regional Australia not only experienced higher levels of psychological distress than the general population but also had significant difficulty and limited options when accessing mental health services. Furthermore, resettlement in rural and regional locations increased the risk of experiencing many interrelated factors associated with adverse mental health outcomes and distress, including very limited access to support services, with the latter being identified as vital for well‐being. Conclusion: This review highlights the disparity between the Australian Government's policies and plans regarding regional resettlement, what is happening on the ground, and identifies key gaps in research and practice which must be addressed. [ABSTRACT FROM AUTHOR]

Distribution of the Australian health workforce is uneven, with the majority of health professionals favouring metropolitan areas over rural and remote regions. Although nurses account for the largest proportion of the Australian rural and remote health workforce, difficulties with staff recruitment and retention can impact the health care outcomes of these vulnerable populations. Satellite university campuses that offer undergraduate nursing programs might therefore contribute to a more sustainable rural and remote nursing workforce. This narrative literature review aimed at investigating the barriers and enablers that affect students enrolled at satellite nursing campuses, education delivery methods and academic and non‐academic strategies employed to enhance the student learning experience. The literature was reviewed across 6 health and education databases. After screening, 12 articles met the inclusion criteria and were analysed, and the data were synthesised using a thematic approach. Three themes arose from the review: student characteristics and associated barriers and enablers to studying nursing at a satellite campus; teaching strategies and learning experiences; and academic and pastoral support. Students studying at satellite campuses were found to have different education experiences and faced challenges unique to their context; however, home support networks and small class sizes were seen as enabling factors. Education delivery methods and support strategies varied depending on remoteness and resources available. Consideration of the factors that affect satellite campus nursing students has the potential to increase student satisfaction and retention, which could result in a more sustainable rural and remote nursing workforce. [ABSTRACT FROM AUTHOR]

Rural medical education is known as one of the most effective strategies in improving rural recruitment and retention. The aim was to identify modes of delivery to improve access to rural postgraduate medical education. Arksey and O'Malley's methodological framework was used for conducting scoping reviews. CINAHL, Google Scholar, ERIC, PsycINFO, Medline and PubMed were searched to identify peer‐reviewed English‐language literature published between 2000 and 2019 focusing on postgraduate rural and regional medical education. A total of 102 articles were identified, with 51 included in the final analysis after applying inclusion and exclusion criteria. Outcome measures included: article type; research methodology; date of publication; country of origin; and study population. Through iterative reading, common themes were identified. A typology of 6 content themes emerged as follows: rural curriculum; procedural skills; rurally based learning; service delivery; workforce; and distance learning. The majority of articles focused on rural curriculum, and rurally based learning, with half originating from Australia or New Zealand. Although results strongly emphasised context and curriculum in rural environments, lack of specific and pragmatic approaches was noted. Surprisingly, few articles focused on rural distance learning utilising information and communication technology. Pathways to improve rural education access include recognition of the unique rural context in curriculums; development of rural educational faculty; and creation of opportunities for rural specialist training. Emphasis should be given for education provided through rural centres rather than urban facilities. Use of information technology could be increased, for example in remote trainee supervision programs. [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: 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]

Introduction: Nurses in remote primary health care settings work in difficult conditions, in isolated and disadvantaged communities, and often must work beyond their scope to provide advanced assessments and treatments to support the community. Therefore, remote area nurses require support to develop their skills and knowledge to work safely within their full scope of practice. Clinical supervision is widely used in health professions for this purpose; however, models of supervision for nursing have not been implemented or evaluated within remote primary health care settings. Objective: The purpose of this study was to search the literature to source suitable clinical supervision models that could pertain to the remote area nursing context. Design: An initial search of the literature found no clinical supervision models developed for remote or isolated practice nurses so a scoping review was conducted searching for publications related to advanced practice generalist health practitioners in primary health care, including practice nurses, nurse practitioners and general practitioners. This was seen as a suitable substitute because the phenomena of interest were the model of supervision rather than the specific skills or knowledge being developed. Findings: The scoping review search yielded 251 articles from 5 journal databases of which 11 articles met the inclusion criteria. Each clinical supervision model was described and synthesised using qualitative description. The 11 models of clinical supervision had differing formats including; individual and group clinical supervision, in‐person, telephone, medical records review and video case study. Discussion: Whilst several models were described in the literature, none were directly transferrable to the remote area context. The absence of supervision for cultural safety was significant. There was a variety of modes including face‐to‐face, virtual, individual and group proposed. Cultural considerations were lacking in all of the models. Conclusion: Our study recommends a hybrid clinical supervision model suitable for consultation and validation through pilot testing with remote area nurses. There is potential for this model to be used globally in isolated contexts due to the option of virtual participation. [ABSTRACT FROM AUTHOR]

Objective: GP vocational training enrolments are declining Australia‐wide and, in the Northern Territory (NT), considered by some as '...the litmus test for the national scene' the decline is precipitous. This research investigates the drivers of declining GP training uptake in the NT and identifies and ranks potential solutions. Setting: NT, Australia. Participants: Ten senior medical students, 6 junior doctors, 11 GP registrars, 11 GP supervisors and 31 stakeholders. Design: Mixed methods: scoping review of Australian literature mapping key concepts to GP training pathway stages and marketing/communications; secondary data analyses; key informant interviews; and a stakeholder validation/prioritisation workshop. Interview data were thematically analysed. Workshop participants received summarised study findings and participated in structured discussions of potential solutions prior to nominating top five strategies in each of five categories. Results: Highly prioritised strategies included increasing prevocational training opportunities in primary care and selecting junior doctors interested in rural generalism and long‐term NT practice. Also ranked highly were: [Medical School] ensuring adequate infrastructure; [Vocational Training] offering high quality, culturally sensitive, flexible professional and personal support; [General Practice] better remunerating GPs; and [Marketing] ensuring positive aspects such as diversity of experiences and expedited GP career opportunities were promoted. Conclusion: Multifaceted strategies to increase GP training uptake are needed, which target different stages of GP training. Effective action is likely to require multiple strategies with coordinated action by different jurisdictional and national key stakeholder agencies. Foremost amongst the interventions required is the urgent need to expand primary care training opportunities in NT for prevocational doctors. [ABSTRACT FROM AUTHOR]

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

Objective To synthesise key Australian empirical rural retention evidence and outline implications and potential applications for policymaking. Design A comprehensive search of Medline, Psych INFO, CINAHL plus, Scopus and EMBASE revealed eight peer-reviewed empirical studies published since 2000 quantifying factors associated with actual retention. Setting and participants Rural and remote Australian primary health care workers. Main outcome measures Hazard ratios (hazard of leaving rural), mean length of stay in current rural position and odds ratios (odds of leaving rural). Results A broad range of geographical, professional, financial, educational, regulatory and personal factors are strongly and significantly associated with the rural retention of Australian primary health care workers. Important factors included geographical remoteness and population size, profession, providing hospital services, practising procedural skills, taking annual leave, employment grade, employment and payment structures, restricted access to provider numbers, country of training, vocational training, practitioner age group and cognitive behavioural coaching. These findings suggest that retention strategies should be multifaceted and 'bundled', addressing the combination of modifiable factors most important for specific groups of Australian rural and remote primary health care workers, and compensating health professionals for hardships they face that are linked to less modifiable factors. Conclusions The short retention of many Australian rural and remote Allied Health Professionals and GPs, particularly in small, outer regional and remote communities, requires ongoing policy support. The important retention patterns highlighted in this review provide policymakers with direction about where to best target retention initiatives, as well as an indication of what they can do to improve retention. [ABSTRACT FROM AUTHOR]

Introduction: There has been a recent surge in the use of teledentistry services in Australia that has paralleled the COVID‐19 pandemic. Due to the limited published literature reflecting on this transition, this article employed a systematic scoping review methodology. Objective: The objective was to explore the role of teledentistry in the provision of clinical dental services in Australia. Design: Two independent reviewers searched PubMed, Embase, Scopus, Web of Science and grey literature sources to identify literature eligible for inclusion. The search was restricted to Australia and service delivery. Data were categorically synthesised by modalities and reported benefits and limitations; findings were cross‐referenced with the COVID‐19 pandemic timeline. Findings The systematic search identified 758 articles, of which 25 met the inclusion criteria. Results highlight a range of service providers and definitions of teledentistry. A shift in modality from asynchronous towards synchronous teledentistry pre‐ and post‐COVID‐19 pandemic is detailed. Discussion: Whilst highly useful during the COVID‐19 pandemic, teledentistry provides a unique opportunity to continue to increase the accessibility of dental services, especially for patients in rural areas or those who are immunocompromised. Conclusion: Clinicians and researchers must consider opportunities to merge existing research with the recent clinical uptake of teledentistry for patients that would benefit from teledental services beyond the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background E-health is increasingly being identified as a cost-effective method to deliver health services and remote monitoring in rural and remote areas. There is a paucity of research that identifies successful implementation of e-health and remote monitoring in rural communities. Objective To identify the evidence relating to the impact of e-health on rural and remote communities and residents. Design A systematic, rapid review of grey and published peer-reviewed literature using CINAHL, MEDLINE, Psych Info, APAIS- Health, ATSI Health, Health Collection, Health & Society, Meditext, RURAL, Pub Med and Google Scholar. Search terms used included telemedicine, telehealth, e-health, regional, rural and remote communities; New South Wales, Australia, and other Organisation for Economic Co-operation and Development countries. Electronic health records and health informatics were excluded. Results The search yielded 105 articles and reports. Following removal of duplicates, initial screening and full text screening, 19 articles remained: 16 peer-reviewed publications and three grey literature. This included two systematic reviews, one literature review, six descriptive reviews of services and nine reviews of specific interventions and identification of barriers and facilitators to implementation of an intervention. There was evidence that e-health can increase access to services across a range of medical specialties without any detrimental effects and improve opportunities for professional development. Conclusion E-health has the potential to increase access to services in rural and remote communities. The evidence shows that it is as safe, effective and reliable as most conventional methods for interacting with patients while enabling people to stay within their own communities. [ABSTRACT FROM AUTHOR]

Objective To review Australian rural health ( ARH) publications in Pub Med from 2006 to 2012 and address ARH issues raised by the 2013 Health and Medical Research report. Design Retrospective observational study. Setting Internet-based bibliometric analysis using Pub Med. MEDLINE-indexed ARH publications from 2006 to 2012 were retrieved using Pub Med queries. ARH publications were defined as Australian publications that explore issues relevant to the health of the regional, rural or remote Australian population. Two authors independently reviewed a random sample of 5% of publications for validity. Main outcome measures Analysis determined country of origin ( Australia); publications relevant to the National Health Priority Areas, the 2013 National Rural Health Alliance priority areas and Rural Clinical Schools/ University Departments of Rural Health; and journal frequencies and publication types. Results ARH publications increased from 286 in 2006 to 393 in 2012 and made up 1.4% of all Australian Pub Med publications. Combined, the health priority areas were addressed in 52% of ARH publications. Rural Clinical Schools/ University Departments of Rural Health articles made up 7% of ARH publications. An increase in cohort studies, systematic reviews and reviews indicated improved quality of articles. ARH articles were most commonly published in the A ustralian J ournal of R ural H ealth (15.9%), R ural and R emote H ealth (13.4%) and the M edical J ournal of A ustralia (6.3%). Striking a balance between broadening the queries (increasing sensitivity) and limiting the false positives by restricting the breadth of the queries (increasing specificity) was the main limitation. Conclusions This reproducible analysis, repeated at given timelines, can track the progress of ARH publications and provide directions regarding future rural health research. [ABSTRACT FROM AUTHOR]

Introduction: Personal, community, and environmental factors can influence the attraction and retention of regional, rural, and remote health workers. However, the concept of place attachment needs further attention as a factor affecting the sustainability of the rural health workforce. Objective: The purpose of this rapid review was to explore the influence of a sense of place in attracting and retaining health professionals in rural and remote areas. Design: A systematic rapid review was conducted based on an empirical model using four dimensions: place dependence, place identity, social bonding and nature bonding. English‐language publications between 2011 and 2021 were sought from academic databases, including studies relevant to Australian health professionals. Findings: A total of 348 articles were screened and 52 included in the review. Place attachment factors varied across disciplines and included (a) intrinsic place‐based personal factors; (b) learning experiences enhancing self‐efficacy and rural health work interest; (c) relational, social and community integration; and (d) connection to place with lifestyle aspirations. Discussion: This rapid review provides insight into the role of relational connections in building a health workforce and suggests that community factors are important in building attachment through social bonding and place identity. Results indicate that future health workforce research should focus on career decision‐making and psychological appraisals including place attachment. Conclusion: An attachment to place might develop through placement experiences or from a strong rural upbringing. The importance of the relational interactions within a work community and the broader community is seen as an important factor in attracting, recruiting, and sustaining a rural health workforce. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to systematically review qualitative evidence regarding the experiences and perceptions of General Practitioners and the factors influencing retention in remote areas of Canada and Australia. The objectives were to identify gaps and inform policy to improve retention of remote doctors, which should in turn reduce health inequalities for remote communities. Design: Meta‐aggregation of qualitative studies of General Practitioners and general practice registrars who had worked in a remote area of Australia or Canada for a minimum of 1 year and/or were intending to stay remote long term in their current placement. Results: Six synthesised findings were identified: peer and professional support, organisational support, uniqueness of remote lifestyle and work, burnout and time off, personal family issues and cultural and gender issues. Conclusions: Long‐term retention of doctors in remote areas of Australia and Canada is influenced by a range of negative and positive perceptions, and experiences with key factors being professional, organisational and personal. All 6 synthesised findings span a spectrum of policy domains and service responsibilities, and therefore, a central coordinating body could be well placed to implement a multifactorial retention strategy. [ABSTRACT FROM AUTHOR]

Objective: To examine unintentional drowning by remoteness in Australia. Design: A systematic review of both peer‐reviewed and grey literature published between January 1990 and December 2019 (inclusive). Method: Using Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines, MEDLINE (Ovid), PubMed, EMBASE, Scopus, PsycINFO (ProQuest), SPORTDiscus and Google Scholar were searched for studies exploring fatal and non‐fatal unintentional drowning by remoteness. Epidemiological data, common factors and prevention strategies were extracted and mapped to Australian standard geographical classifications (major cities, inner regional, outer regional, remote and very remote). Level of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation and prevention strategies aligned to the hierarchy of control. Result: Thirty‐two studies satisfied inclusion criteria (66% reporting epidemiology; 59% risk factors; and 44% prevention strategies). All (100%) included studies were assessed very low against Grading of Recommendations Assessment, Development and Evaluation. Findings indicate rural populations (ie, excluding major cities) have higher rates of drowning positively correlated with increasing remoteness. Common factors included age (child), natural water bodies, undertaking boating and watercraft activities and alcohol consumption. While a range of prevention strategies has been proposed, only one study outlined a rural drowning prevention strategy which had been implemented and evaluated. Strategies were generally low on the hierarchy of control. Conclusion: Rural populations are proportionately overrepresented in drowning statistics. Proposed prevention strategies have unknown efficacy. Greater research into rural drowning of Australians is needed especially exploring behavioural motivations, program delivery, cost‐effectiveness and evaluation. Development and use of a standard definition for remoteness are recommended. Rural populations use water extensively; therefore, there is an urgent need to keep them safe. [ABSTRACT FROM AUTHOR]

Objective: To identify the barriers and facilitators of achieving continuity of care between health services for patients with chronic conditions living in regional, rural and remote Australia. Design: A systematic literature review of peer‐reviewed journal publications between January 1990 and April 2018. Setting: Publications were sourced from medical and scientific databases, including: PubMed; Embase; OvidSP; ProQuest research library; and ScienceDirect. Participants: Studies, involving two groups, were included in the review: (a) Australian adults, residing in non‐metropolitan areas with a chronic condition, who accessed health care services; and (b) health care service providers (eg, doctors) who provided care to non‐metropolitan patients. Main outcome measures: Facilitators and barriers of continuity of care for non‐metropolitan patients with a chronic condition. Results: Initially, 536 studies were included in the review. Of these, 12 studies were found to have met the eligibility criteria and were included in the final analysis. Conclusions: Coordination of health care services for non‐metropolitan patients with chronic conditions substantially improves the outcomes for patients. Overall, communication, availability of resources and location are the major barriers and facilitators to continuity of care, depending on how they are managed. Recommendations have been provided to assist practitioners and policy‐makers to improve the experience of shared care and health outcomes for non‐metropolitan patients. [ABSTRACT FROM AUTHOR]

Psychotherapy services are limited in remote and rural areas in Australia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance ( TA) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO, PsycEXTRA and EMBASE. Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in Australia, 11 in USA, 4 in Canada, 3 in Scotland and 2 in England. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in-person settings across a range of diagnostic groups. Therapists also rated high levels of TA, but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA, including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self-report. [ABSTRACT FROM AUTHOR]

Objective Falls in older adults represent a significant challenge in Australia; however, the focus is often on urban-dwelling older adults. The aim of this review was to explore the literature on falls epidemiology and falls prevention interventions ( FPI). Design A literature review was conducted searching Medline, Scopus, Social Sciences Citation Index, Google Scholar, Google and the Australian Institute of Health and Welfare publication catalogue. Setting Rural and remote Australia. Participants Rural and remote community dwelling Australians aged 50 years and older. Intervention Literature review. Main outcome measures Falls epidemiology and effective falls prevention interventions. Results Twenty references were identified: 14 related to falls epidemiology and 7 to FPI. No significant differences were found between rural, remote and major cities residents in relation to falls hospitalisation, falls mortality or fall-related injuries sustained. There are a wide assortment of health professionals and non-health professionals who are involved in providing FPI in rural and remote Australia. However, there was limited information on the effectiveness of these interventions in influencing falls outcomes. Conclusion Few studies explored falls and their prevention in rural and remote Australia. The limited literature on the topic suggests that a change in focus to one that utilises existing services and resources will be required to create sustainable outcomes. Four areas are proposed for concentrated effort to reduce the impact of fall-related injury in rural and remote Australia: integration and collaboration among health professionals, promotion of physical activity across the lifespan, community involvement and ownership of interventions, and evaluation and publication of findings. [ABSTRACT FROM AUTHOR]

This study aimed to review and synthesise existing literature that investigated the experience of overseas-trained health professionals (OTHPs) in rural and remote areas of destination countries. A systematic literature review was conducted using electronic databases and manual search of studies published from January 2004 to February 2011. Data were analysed from the final 17 original report articles that met the inclusion criteria. The reviewed research studies were conducted in Australia, Canada, New Zealand, the UK and the USA. Overseas-trained medical practitioners were the most frequently researched (n = 14); two studies involved nurses and one study included several health professionals. Three main themes emerged from the review and these were: (i) expectations; (ii) cultural diversity; and (iii) orientation and integration to rural and remote health work environment. The OTHPs were expected to possess the appropriate professional and cultural skills while they themselves expected recognition of their previous experiences and adequate organisational orientation and support. A welcoming and accepting community coupled with a relaxed rural lifestyle and the joy of continued patient care resulted in successful integration and contributed to increased staff retention rates. Recognition of expectations and cultural diversity by all parties and comprehensive orientation with sufficient organisational support are important elements in the integration of OTHPs and subsequent delivery of quality health care to people living in rural and remote areas. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study is to develop a framework to measure the impact of primary health care research, describe how it could be used and propose a method for its validation. Design: Literature review and critical appraisal of existing models of research impact, and integration of three into a comprehensive impact framework. Setting: Centre of Research Excellence focusing on access to primary health care services in Australia. Participants: Not applicable. Interventions: Not applicable. Main outcome measure: The Health Services Research Impact Framework, integrating the strengths of three existing models of research impact. Conclusion: In order to ensure relevance to policy and practice and to provide accountability for funding, it is essential that the impact of health services research is measured and monitored over time. Our framework draws upon previously published literature regarding specific measures of research impact. We organise this information according to the main area of impact (i.e. research related, policy, service and societal) and whether the impact originated with the researcher (i.e. producer push) or the end-user (i.e. user pull). We propose to test the utility of the framework by recording and monitoring the impact of our own research and that of other groups of primary health care researchers. [ABSTRACT FROM AUTHOR]