Search

Introduction: This paper describes the evaluation of an intermediate obstetric ultrasound and emergency medicine ultrasound education workshop for rural and remote Australian doctors, which was developed in response to an educational needs assessment that showed an unmet need in this area. The workshop was held in four Australian states. The participants were 61 rural and remote doctors. Methods: Data from pre- and post-workshop knowledge tests and general workshop evaluation were analysed. Results: Sixty-one doctors attended an ultrasound workshop and self-reported increases in knowledge, confidence and expertise in ultrasound. The mean pretest score for 56 doctors who completed both the pre- and post-workshop knowledge tests was 31.6 and the post-test score mean was 33.3 out of a possible score of 44, which demonstrated a statistically significant increase in knowledge (P = 0.003). Discussion and implications for practice: The evaluation of the workshop demonstrated that it was an effective way of increasing knowledge and confidence in intermediate obstetric ultrasound and emergency medicine ultrasound. The workshop was popular and received very positive feedback from the attendees. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the postoperative pain experiences of Central Australian Aboriginal women and the subsequent interpretation of that pain experience by non-Aboriginal female nurses. Qualitative study using grounded theory methodology. Postoperative surgical setting of a Central Australian regional hospital. Five Aboriginal female clients who had undergone a surgical procedure, eight non-Aboriginal female nurses and four Aboriginal female health workers employed by a Central Australian regional hospital. Aboriginal women have culturally appropriate ways of expressing and managing pain that are not well understood by non-Aboriginal female nurses. In addition, the Aboriginal women inappropriately endow non-Aboriginal nurses with the same powers and skills expected of healers from their culture. This phenomenon resulted in the non-Aboriginal nurses lacking the cultural insight and the appropriate knowledge and tools required to assess and manage the postoperative pain of Central Australian Aboriginal women effectively or efficiently. Non-Aboriginal nurses have a profound knowledge deficit about the postoperative pain experiences of Central Australian Aboriginal women. This deficit is evident through the use of culturally inappropriate and unreliable pain assessment strategies and tools and the misinterpretation of traditional pain relief strategies, such as the use of pituri, rubbing and centreing. The findings of this study suggested that nurse/client interactions related to language and role interpretation were in cultural conflict. The nurses expected the Aboriginal women to adopt pain behaviours as understood from the nurses’ culture. The nurses anticipated that the client would contribute to their own care by communicating pain experiences in ways that are familiar and are believed to be universal. The Aboriginal women expected the nurses to conduct business similar to that of their own traditional tribal healers, ‘to see within’ and to ‘just know’. The National Health and Medical Research Council claim there is a dearth in systematic studies of pain issues for Aboriginal and Torres Strait Islander people. Previous studies conducted suggest that Aboriginal people do not feel pain and have an extraordinary high pain tolerance. However, no significant studies exist in the area of pain management that address the cultural needs of Aboriginal people. Statistical evidence gathered from the informal Acute Pain Service operational within a Central Australian regional hospital, revealed that although the hospital clientele were predominately of Aboriginal descent, the service catered for a greater proportion of non-Aboriginal people. The misconception that Aboriginal people have a high pain tolerance requiring less pain relief is outdated and erroneous, as this paper will reveal. [ABSTRACT FROM AUTHOR]

Australia suffers from a well documented shortage of rural medical practitioners. In an attempt to increase recruitment, it has emerged that rural origin medical students are more than twice as likely as their urban colleagues to become rural practitioners. This has led to a wide range of programs aimed at increasing the number of rural students who apply for and gain entry into medical school. But how do rural students cope with the medical school environment? This paper was based on the results of a survey of senior medical students and looked at how rural students’ fare with the medical school environment compared to their urban counterparts. It was concluded that government initiatives currently supporting rural medical students must be continued into the future and continuously evaluated to ensure that rural students have a positive learning experience in preparation for future rural practice. [ABSTRACT FROM AUTHOR]

This paper argues that lack of adequate research is a barrier to the long-term improvement of the mental health and well-being of rural Australians. Following from national mental health policy, potential research avenues in four broad domains (prevention and early intervention, pathways to care, outcome of illness and aetiology) are defined. These four broad domains are interdependent and research into them can be brought together into a simple framework or model. This model could be used to guide research into rurality and mental health. The proposed model uses the inclusive concept of place to capture the potential complexities of the rural locale as a variable in mental health and disorder. The model's predictor variables include both risk and resilience factors, and the outcome variables extend beyond morbidity to positive psychological wellness. It is proposed that this provisional model, and the strategic research that it directs, will act as a useful counterpoint to the more immediate evaluation and resourcing needs that confront rural mental health. [ABSTRACT FROM AUTHOR]

In this paper the need for further investigation into the mental health of rural Australians will be discussed. It will be argued that while research to date has yielded valuable information, the volume and scope of existing studies has been inadequate to address the needs of the diverse and dynamic communities in non-metropolitan Australia. The diversity that exists within rural Australia is examined and the potential effects of this diversity on mental health status are highlighted. Then a number of issues that are relevant to people living in non-metropolitan areas that underscores the need for further study into rural mental health are identified. Finally, some specific areas that require further examination are outlined and some guiding principles for future mental health research are proposed. [ABSTRACT FROM AUTHOR]

This paper describes the types of, and circumstances surrounding, unintentional farm-related fatal injuries involving young and older adults in Australia. Information was obtained from an inspection of coronial files for the period 1989–1992. Around 14% of all farm-related fatalities in Australia during 1989–1992 were of young adults aged 15–24 years and approximately one-quarter were of older adults aged ≥ 55 years. Young adults were commonly fatally injured in motor vehicle incidents and in incidents involving firearms. Tractors were the most common agent involved in fatal incidents involving older adults. Intervention measures to prevent fatalities of older adults in agriculture should focus on the safe use of tractors, while for young adults it appears prevention efforts should centre around safe use of firearms and operation of motor vehicles on the farm. Ways to overcome barriers to the use of injury prevention measures in rural Australia should be further explored. [ABSTRACT FROM AUTHOR]

The problems associated with rural and remote health have been widely recognised by health workers, rural communities and health professions for some time. Yet it has only been in the past decade that any concerted effort has been made to address rural health issues. Today the state of health in rural Australia remains less than optimal. The tenth anniversary of the Australian Journal of Rural Health provides the opportunity to reflect on what progress has been achieved over the past decade, to recognise those factors that have contributed most to the implementation of policies designed to address the health needs of rural and remote Australians, and to discuss outstanding impediments and barriers to resolving rural health issues. [ABSTRACT FROM AUTHOR]

In 1997, the John Flynn Scholarship (JFS) program was launched as an initiative to increase recruitment of doctors to rural areas. These scholarships enable undergraduate medical students to spend 2 weeks each year for 4 years at the same rural location. Given the magnitude of Australia’s unmet rural health needs, we asked whether the experience could be enhanced by ensuring the students undertook meaningful work that was useful for the community. This paper describes, using case studies, some of the activities in which four JFS students have been involved and the positive contributions that they have made to rural health. The case studies indicate that pre-clinical students can be valuable members of the rural health workforce. We hope that if JFS students are given the opportunity to work as responsible health professionals they will have a better learning experience and will be more likely to return to the bush as doctors. [ABSTRACT FROM AUTHOR]

This paper describes the planning of a community-based approach to injury control and safety promotion, the Kolan Injury Prevention Program. The process involved the establishment of a local steering committee, 11 months of injury surveillance, a critical review of the evidence base, community consultations and assessment of community resources. There were 412 recorded injury cases during the surveillance period, with higher rates among men, manual workers, those aged 15–34 years, sport/leisure activities and around the home and farm. Salient issues for residents included a lack of access to safety information and skills, particularly with regard to first aid and bush fire for isolated residents and rurally inexperienced new residents. While injury prevention was identified as an important issue for the community, the rapidly changing size and nature of the community and its infrastructure made this a particularly challenging issue. Challenges included limited availability of volunteers from key sectors, lack of formal data collection systems, difficulties in mobilising support for a broad issue like injury, limited communication networks and the negative impact of distance and role uncertainty on community ownership of the program. This case study illustrates the steps involved in an effective community-based needs assessment addressing injury prevention. Such an approach, if carried out systematically, will help ensure that the strategies and programs developed will be both appropriate and likely to obtain the support of the local community. [ABSTRACT FROM AUTHOR]

This paper evaluates the effectiveness of the ‘Spot the Hazard’ farm safety resource which employs 3-D visual stimuli to develop rudimentary risk assessment skills in children. Primary school children from three local schools in north-west New South Wales were presented with the resource and talked about the farm hazards present. Children’s recall of the hazards and the extent to which they compared the resource to their own farm was assessed after an initial presentation at post-tests of 1, 14 and 28 days, across three experimental groups. Individual differences in achievement were controlled for using the Wechsler Individual Achievement Test-Screener (WIAT). Analysis revealed that children exposed to the resource recalled significantly more hazards and made more comparisons to their own farm experiences than controls. However, differences on individual achievement were observed between groups due to a lack of randomisation. Farm safety educational resources for children are more effective when verbal and nonverbal strategies are used and when children are exposed to such cues repeatedly. The development of farm safety educational resources for children which employ spatial cues is encouraged. Further clarification of results would entail a more rigorous randomised control trial. [ABSTRACT FROM AUTHOR]

ABSTRACT: The present paper explores the characteristics of rural residents and issues facing rural consumers. Analysis of census data and a survey of 499 rural residents across Australia suggests that cost is their major concern. Rural consumers indicated that they would like to access information through a variety of sources, but local media was the most preferred source. While many would like more consumer information, they would like to know how to access information when needed rather than have it on hand. Most were not concerned about complaint procedures, but many were found to be unaware of where to redress problems with health services. [ABSTRACT FROM AUTHOR]

ABSTRACT The introduction of ‘satellite’ dialysis centres has increased local access to renal services for patients living in rural and remote areas across Australia and is, therefore, consistent with rural health policies. Rural health strategies also aim to maintain and improve the skills of health professionals through regular review of the scope of their practice and evaluation of the education required. Yet, the results of the present national study of nurses working in satellite dialysis centres indicate that, for many, the context of practice influences their ability to access ongoing professional education to support and extend their nursing practice. The present study showed that there was a range of educational backgrounds among nurses working in rural ‘satellite’ centres with reportedly limited access to specific dialysis-related professional development. In the present paper we report on factors that influence the ability of nurses working in satellite dialysis centres to access ongoing professional education. [ABSTRACT FROM AUTHOR]

ABSTRACT It is acknowledged that research outcomes need to be made available to other researchers, practitioners and consumers if the benefits of such research are to be disseminated as quickly as possible to other researchers and translated to influence practice and produce new products. If strategies are to be developed on future research directions, an analysis of current output will provide baseline data as well as a map for analysing gaps and overlaps in the research effort. This paper provides an overview of rural health research output in serial publications from 1990. It highlights the content of such literature, the relationship to the National Health Priority Areas and the types of research produced. The overview showed that there was a yearly increase in the absolute number of defined research articles produced over the period. There was also an increase in the relative number of rural health articles that could be defined as research articles (as opposed to commentary-type articles). Forty per cent of research articles are in the National Health Priority Areas and more than 30% address indigenous health specifically. Fifty per cent of articles address public health or health services issues. These data provide a general picture of the type and content of Australian rural health research that has been reported in the serial literature over the decade. This can be used to inform future strategies, provide the baseline for future targets, as well as giving a general picture of the gaps and overlaps from which more specific data can be compiled. [ABSTRACT FROM AUTHOR]

ABSTRACTTo address the high rate of depression and suicide in rural Australia requires a multifaceted approach to educate the community, improve the skills of health workers and provide user-friendly patient counselling. The present paper describes a model that covers each of these aspects and details the outcomes with respect to the doctors and the community. Improved awareness in the community of mental illness and the availability of treatment, decreasing the stigma of such a diagnosis, and increasing the skills and reducing the isolation of doctors in rural areas who treat mental illness were all positive benefits from this cost-effective way of providing mental health care in a primary setting. The adoption of this model in all primary care settings is advocated. [ABSTRACT FROM AUTHOR]

ABSTRACTKnowledge of the history of remote-area nursing in Australia is necessary if we are to truly understand the processes that have dictated the boundaries and reality of the scope of practice for today’s RANs (remote-area nurses). This paper briefly explores and discusses the social context and history of remote-area nursing in Australia and, in particular, Queensland during the 19th century. [ABSTRACT FROM AUTHOR]

Introduction: Disparities between metropolitan and non‐metropolitan health workforce must be addressed to reduce inequities in health care access. Understanding factors affecting early career practitioners' choice of practice location can inform workforce planning. Objective: To investigate influences on rural practice location preferences of recent graduates. Design: Cross‐sectional analysis linked university enrolment, Graduate Outcomes Survey (GOS) and Australian Health Professional Regulation Agency (Ahpra) principal place of practice (PPP) for 2018 and 2019 nursing and allied health graduates from two Australian universities. Chi‐squared tests and logistic regression compared rural versus urban PPP and locational preference. Findings: Of 2979 graduates, 1295 (43.5%) completed the GOS, with 63.7% (n = 825) working in their profession and 84.0% of those (n = 693) in their preferred location. Ahpra PPP data were extracted for 669 (81.1%) of those working in their profession. Most reported influences were 'proximity to family/friends' (48.5%), 'lifestyle of the area' (41.7%) and 'opportunity for career advancement' (40.7%). Factors most influential for rural PPP were 'cost of accommodation/housing' (OR = 2.26, 95% CI = 1.23–4.17) and 'being approached by an employer' (OR = 2.10, 95% CI = 1.12–3.92). Having an urban PPP was most influenced by 'spouse/partners employment/career' (OR = 0.53, 95% CI = 0.30–0.93) and 'proximity to family/friends' (OR = 0.41, 95% CI = 0.24–0.72). Discussion: While the findings add strength to the understanding that graduates who originated from a rural area are most likely to take up rural practice in their preferred location, varied social and professional factors are influential on decision‐making. Conclusions: It is imperative to recruit students from non‐metropolitan regions into health professional degrees, as well as addressing other influences on choice of practice location. [ABSTRACT FROM AUTHOR]

Introduction: The shortfall in medical workers in rural and remote Australia has led to health discrepancies in these regions. The University of Wollongong's medical program was designed to encourage graduates to work in these regions to address this shortfall. Objective: To compare rural and regional locations of work and choices of speciality between University of Wollongong's graduates and graduates from all Australian universities. Design: We conducted a longitudinal analysis on data available from the Medical Schools Outcome database, with graduate exit surveys linked to registrations of location and speciality. Rural and remote locations were identified as MM2‐7 regions using the Modified Monash Model. In total, 716 graduates from the University of Wollongong and 26 915 graduates from all Australian medical schools completed the MSOD exit survey in 2010‐2021 and registered with the Australian Health Practitioner Regulation Agency in 2022. The main outcome was the relative likelihood (relative risk) of cohorts working in rural and regional areas and of cohorts choosing general practice as their speciality. Findings: University of Wollongong's medical graduates were 1.51 times or 51% more likely to work in regional or rural areas (RR 1.51, 95% CI 1.34 to 1.71, p < 0.0001). Respondents who were 10 or more years post graduation were 1.57 times or 57% more likely to specialise in general practice than all other Australian medical graduates (RR 1.57 95% CI: 1.40 to 1.79, p < 0.0001). Discussion: The University of Wollongong's medical school is producing graduates to meet Australia's rural health workforce needs. This may be due to a higher intake of rural students, and a higher percentage of students taking rural placements. Conclusions: Rural health workforce needs can be addressed through rural‐focussed education strategies. [ABSTRACT FROM AUTHOR]

Introduction: The use and costs of mental health services by rural and remote Australian women are poorly understood. Objective: To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas. Design: Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973–1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services. Findings: 31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively). Discussion: Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas. Conclusion: Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services. [ABSTRACT FROM AUTHOR]

Objectives: To explore if there are differences in shift patterns and work‐related factors between metropolitan and regional/rural healthcare shift workers and their risk of poor sleep and mental health. Furthermore, explore whether these factors impact on medical errors, workplace and car/near car accidents. Design: A cross‐sectional study. Setting: An anonymous online survey of healthcare shift workers in Australia. Participants: A total of 403 nurses, midwives and paramedics completed the survey. Main outcome measures: Sample characteristics, employment location, shift work‐related features, sleep and mental health measurements, workplace accidents, medical errors and car/near car accident post shift. Results: Regional/rural healthcare shift workers were significantly older, had more years' experience, worked more nights, on‐call and hours per week. Those in metropolitan areas took significantly longer (minutes) to travel to work, had higher levels of anxiety, increased risk of shift work disorder, reported significantly more workplace accidents and were more likely to have a car/near car accident when commuting home post shift. Both groups reported ~25% having a medical error in the past year. Workplace accidents were related to more on‐call shifts and poor sleep quality. Medical errors were associated with fewer years' experience, more evening shifts and increased stress. Car accidents were associated with metropolitan location and increased depression. Conclusion: Differences in work‐related factors between metropolitan and regional/rural healthcare shift workers were observed. Some of these factors contributed to occupational health and safety risks. Further exploration is needed to understand how to reduce occupational health and safety risks, and improve employee and patient safety both in both regional/rural and metropolitan areas. [ABSTRACT FROM AUTHOR]

Introduction: The importance of primary health care (PHC) to Aboriginal Australians is widely acknowledged, as is the underservicing of the Aboriginal Australian population. Aboriginal People continue to face significant obstacles when accessing and using health care services. Objective: This study identifies environmental factors (beyond personal and service delivery) that functioned as barriers and enablers to Aboriginal Australians' experiences accessing PHC during crises and recommends approaches during future events. Design: This research utilised a case study approach. Data were collected through in‐depth interviews and analysed using thematic analysis. The study was set in Lakes Entrance, a regional Victorian locality with a sizable Aboriginal community, which was affected by bushfires during 2019/2020 and COVID‐19 restrictions during 2020‐2021. Participants were 18 Aboriginal People over the age of 18 living in the locality during either bushfires or COVID‐19. Findings: The barriers identified included the impact on PHC access of priorities other than health, including housing; financial constraints; difficulties with transport; medical bureaucracy and the physical environment of the health care setting, including appointment‐making processes; interactions with medical reception staff; and waiting room environments. Enablers identified included the supportive role of the local Aboriginal Community Controlled Health Organisations (ACCHO) and their staff, which was highlighted in participant responses. Discussion: The preference of many Aboriginal people to access PHC via their local ACCHO, rather than mainstream health care services, appears even more salient during crises than in normal times. This research identified that ACCHOs are ideally placed to promote and protect the health of Aboriginal communities during crises. Conclusion: Results may help direct interventions to improve PHC access and experiences for regional Aboriginal communities both during and outside periods of crisis. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the impact of funding provided to support the well‐being of rural health practitioners and their practice staff following the 2019–2022 bushfires. Objective: To assess the benefits and implications of grant funding for rural practices to aid recovery following bushfires in NSW, Australia. Design: An explanatory sequential mixed method design consisted of a survey and a thematic analysis of semi‐structured Interviews. Findings: Five key themes emerged from analysis: (1) the disasters altered the role of the practice and therapeutic relationships; (2) the funding had a positive impact on access to professional development; (3) the training had a positive impact on staff well‐being and resilience; (4) the professional development had a positive impact on rural practitioner's sense of capability; and (5) important elements of future grant opportunities. Discussion: The findings indicate the importance of recovering funding to facilitate access to professional development for rural health practioners during natural disasters which improved their mental health and wellbeing, capability and support to clients. Conclusion: Recovery funding facilitated improvement in workforce capability, professional resilience, mental health and well‐being in the face of natural disasters and emergencies. There was a link between training and maintaining the capability of rural health care practitioners and their practice staff. Capability was an important factor in the well‐being and resilience of the health workforce and their ability to support clients. [ABSTRACT FROM AUTHOR]

Introduction: A multidisciplinary Bushfire Recovery Program was developed by Royal Far West focused on reducing the short‐ and medium‐term impacts of the 2019‐2020 bushfires in Australia on children's wellbeing and resilience. Objectives: To evaluate the impact of the Program's psychosocial groups on children's wellbeing and resilience. Design: A two‐phase mixed method approach was used, involving post‐intervention surveys and interviews of children impacted by the 2019‐2020 bushfires in Australia who participated in the Bushfire Recovery Program, their parents/carers, teachers, and the facilitators of the workshops. Statistical analysis was undertaken with quantitative data and content and thematic analysis of qualitative data. Findings: Children learnt to talk to and trust adults, share thoughts and experiences with others, recognise they were not alone in their experiences, build connections with peers, understand and manage feelings, and implement strategies that enabled them to cope with change. Discussion: Psychosocial groups delivered in preschools and schools as part of the Bushfire Recovery Program reportedly led to significant learning and positive impacts for children in the areas of coping, wellbeing, and peer connections. Similar themes occurred across surveys and interviews and findings reflected the perceptions of the children who participated in the groups, and key adults around the children. Conclusions: Community‐based psychoeducational interventions can provide effective support in the short‐ and medium‐term post‐bushfire for children to develop strategies and skills to enable them to cope with changes and their emotional reactions. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence of distress in cancer patients is established at approximately 50%, yet uptake of psychosocial support is minimal. Objective: This study aimed to understand why clinically distressed oncology patients choose not to access psychosocial support, including whether this differs by geographic location. It also aimed to determine the proportion of rural and metropolitan patients experiencing clinical levels of distress, and of these, the proportion who do not wish to access support. Design: The study used a cross‐sectional design. Two hundred and ninety‐eight Australian cancer patients completed an online survey, including the Distress Thermometer and open‐ended questions about reasons for declining support. Descriptive statistics and content analysis were used to analyse the data. Findings: More than half (56%) of participants reported experiencing clinically significant levels of distress. Of these, almost half (47%) declined psychosocial support. Content analysis of reasons for declining psychosocial support resulted in six main concepts: I don't need support; I'm using personal resources to cope; negative perceptions and attitudes; life doesn't stop for cancer; I'm focussed on fighting cancer; and systemic barriers. Rural cancer patients most often indicated using personal resources to cope, while metropolitan participants most commonly indicated not needing support. A range of subconcepts were also identified. Perceiving distress as manageable or transient was almost exclusively reported by metropolitan participants, while stigma was almost exclusively reported by rural participants. Discussion: The findings provided greater depth of insight into reasons cancer patients decline psychosocial support and identified several qualitative differences in the reasons provided by metropolitan and rural patients. Recommendations are provided for clinicians, in particular for clinicians who work with rural cancer patients and their supporters. Conclusion: These findings can inform equitable resourcing of psychosocial support in rural areas and the adaptation of psychosocial interventions to be more flexible and responsive to individual needs. This may help increase patient uptake of support, particularly in rural areas. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Due to ageing populations, prevalence estimates for PD are set to increase in western countries including Australia. Objective: This study aims to investigate the prevalence of PD in regional, rural and remote areas of Australia, to inform the provision of equitable PD‐specific care. Design: A scoping review, following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR), was conducted. An electronic search of four databases and the search engine google scholar was completed in May 2022 and updated in September 2023. Article screening and quality appraisal were undertaken independently by at least two reviewers. Findings: Of 514 records screened, six articles (between 1966 and 2019) were identified and included for review. Wide variations in PD prevalence were evident, ranging from 0.58 to 8.5 per 1000 people. Two studies suggested prevalence may be higher in regional, rural and remote areas of Australia than in urban localities. Discussion: The limited number of studies identified, and wide variation in prevalence rates makes it difficult to draw firm conclusions to inform heath care planning and resource allocation. Conclusion: A paucity of reliable prevalence data indicates the need for well‐designed, country‐specific epidemiological studies to be conducted to estimate the actual impacts of the disease to inform public health planning, particularly in regional, rural and remote areas where access to PD‐specific care is already inequitable. [ABSTRACT FROM AUTHOR]

Introduction: Addressing the imbalance of the health workforce between metropolitan and rural areas requires a clear understanding of trends in choices of work location of health care staff. Objective: Here, we provide an automated and highly reproducible protocol to examine the location of health care workers over multiple years using medical graduates as a case study. Design: Data linkage cohort study. The study cohort examined was University of Wollongong Medical graduates from 2010 to 2021 who were registered to practice in Australia. The main outcome measure was graduate location of practice in Modified Monash regsions MM1 or MM2–7 across multiple postgraduate years. This protocol used R Markdown. Findings: An automated and reproducible protocol was used to analyse choices of work location for the University of Wollongong's medical graduates. Over 90% of graduates were registered with AHPRA. Around 25%–30% of graduates were found to work in MM2–7 regions across their careers, exceeding the national average. Discussion: The protocol presented allows for a fast and reproducible analysis of work location by region for health care workers. This will allow comparisons of outcomes between universities or health professions. [ABSTRACT FROM AUTHOR]

Introduction: Vaccine hesitancy represents a state of uncertainty before a decision about vaccination is made. It can lead to limited vaccine uptake despite adequate supply and an efficacious product. Western Australia (WA) presents a unique challenge with a population widely spread across metropolitan and rural sites and diverse opinions regarding vaccination. Objective: To elicit and compare the common COVID‐19 vaccine concerns in rural and metropolitan WA, and to identify proposed solutions to vaccine hesitancy. Design: A voluntary online survey was distributed via social media over a 2‐week period in August 2021 during Phase 2A of the National COVID‐19 Vaccine Rollout Strategy. General practitioners and members of the public living in rural and metropolitan WA over the age of 18 were surveyed regarding COVID‐19 vaccine concerns (blood clots; long‐ and short‐term side effects; lack of testing; and other concerns) and suggested methods to address vaccine hesitancy. Data were analysed with a sequential mixed methods and thematic analysis approach. Findings: There were 468 general population respondents to our survey, of whom 19.0% (n = 89) lived rurally. A majority (52.6% [n = 246]) of general respondents expressed concerns about COVID‐19 vaccine safety. The commonest concerns were long‐ and short‐term side effects, blood clots and inadequate testing. There was a positive correlation between rurality and vaccine concerns; an inverse relationship between rurality and vaccine uptake; and an inverse relationship between vaccine concerns and uptake. Improved media coverage was the commonest solution suggested to address COVID‐19 vaccine hesitancy. Discussion: A significant proportion of respondents had concerns about vaccine safety; concerns were more common in rural respondents. Rural communities may benefit from location‐targeted media campaigns with a focus on breaking down barriers specific to these members of the population. Vaccine access is more challenging, and consistent messaging from trusted sources is of utmost importance to improve uptake. Conclusion: COVID‐19 vaccine hesitancy is more common in rural populations. Targeted media‐based education regarding vaccine safety may improve COVID‐19 vaccine uptake. [ABSTRACT FROM AUTHOR]

Introduction: Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under‐studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs. Objective: To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region. Design: A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework. Findings: Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive. Discussion: The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services. Conclusion: Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service–user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities. [ABSTRACT FROM AUTHOR]

Introduction: Many Australian Defence Force (ADF) and Veteran families are affected by the stressors of Defence family life, including frequent and prolonged parental deployments, and frequent relocations. Objective: To address a gap in information about Defence and Veteran (hereafter Defence) parents' knowledge, confidence and resources to support their young children's well‐being and build their resilience. Design: This study used a mixed methods design to explore Defence parent's perceptions of their young children's (aged 2–8 years) social and emotional well‐being and understanding of their children's responses to unique stressors as well as their confidence in providing support. Data from 41 parents were available. Findings: Overall, parents reported positive well‐being evaluation of their children. However, just over a third of parents also reported that their children rarely cope well on two indicators combined (adapting to new situations and sharing negative emotions with others). Significantly, more than half of the parents (61%) were only partially confident in their ability to assist their children to cope with unique stressors in military families. Qualitative data provided further insights into children's struggle with relocations and parental absence and the challenges parents face in supporting them. Parents reported having limited access to effective age‐ and culturally appropriate resources to support their young children. Discussion: In a first‐of‐its kind study, we found that Australian Defence parents reported their young children were coping on most of the key well‐being indicators. However, awareness of currently available supports for children remains a barrier as well as access to contextualised, age‐ and culturally appropriate resources are lacking. Conclusion: There is a need for access to free, quality, online, research‐based Australian resources to support young children from Defence families, especially for those living in regional and rural locations and are less likely to have access to mental health and other specialist supports. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the benefits of a pop‐up health screening for cardiovascular risk factors (CVRF) in the Gippsland region, and to assess the acceptability of the screening and to determine whether such a process results in attendance at a general practitioner (GP). Participants: Overall, 454 participants over the age of 18 who were residents of the Gippsland region were enrolled. Methods: This is a community‐based, observational, prospective cohort study using pop‐up screening sites at six retail locations or workplaces, where participants' blood pressure, body weight and lipid profile were measured. The primary outcome was to assess the proportion of participants with at least one unaddressed CVRF (hypertension [blood pressure >140/90 mmHg], overweight and obesity [body mass index >25 kg/m2] or hypercholesterolaemia [low‐density lipoprotein cholesterol >2.5 mmol/L]). Email surveys were performed after 4 weeks of follow‐up. Results: Overall, 85.8% (95% confidence interval [CI], 82.1%–88.8%) of participants had at least one unaddressed CVRF. Among the 54 participants who responded to the email survey, 50 participants (92.6% [95% CI, 81.3%–97.6%]) found the screening approach acceptable, and 31 (57.4% [95% CI, 43.3%–70.5%]) considered a discussion with the GP. Conclusions: This study supported the feasibility and effectiveness of pop‐up screening to detect CVRF in rural communities. [ABSTRACT FROM AUTHOR]

Introduction: A greater understanding of Australian healthcare professionals' perceptions of artificial intelligence (AI) is needed to identify the challenges ahead as this new technology finds its way into healthcare delivery. Objective: The aim of this study was to identify healthcare professionals' perceptions of AI, their understanding of this technology, their education needs and barriers they perceived to its implementation. Design: Healthcare professionals in eight local health districts in New South Wales Australia were surveyed using the Shinners Artificial Intelligence Perception (SHAIP) tool. Findings: The study surveyed 176 participants from regional (59.5%), rural (36.4%) and metropolitan (4.0%) healthcare districts in Australia. Only 27% of all participants stated they are currently using AI in the delivery of care. The study found that Age, Discipline, Use of AI and Desire for Education had a significant effect on perceptions of AI, and that overall healthcare professionals believe AI will impact their role and they do not feel prepared for its use. The study showed that understanding of AI is varied and workforce knowledge is seen as the greatest barrier to implementation. More than 75% of healthcare professionals desire education about AI, its application and ethical implications to the delivery of care. Conclusion: The development of education is needed urgently to prepare healthcare professionals for the implementation of AI. [ABSTRACT FROM AUTHOR]

Introduction: Young people in a regional Central Queensland community identified concerns related to their health and health behaviours, but have limited access to health information. Objective: To explore the youth health perspectives and priorities of young people in regional Queensland and identify how young people prefer to access health information. Design: A participatory action research approach, using applied theatre methods and technology. Findings: The key challenges to youth health in regional Queensland identified by participants were substance use, in particular vaping, and bullying. Short‐form social media videos are an effective channel for communicating youth health information, but to do so must closely align with the predominant formats and trends on social media platforms. Discussion: Young people are not likely to read health information in printed form. Effective communication is the key to empowering young people to make decisions regarding their health behaviours. Our research shows that young people tend to share with other young people, and they are less likely to listen to older people and those in positions of authority. Health concerns raised ranged from cyberbullying and peer pressure to vaping, alcohol and chroming. Conclusion: Young people are more likely to engage with information that reflects their lived experience. The research concludes that we need to reconsider how information is provided for young people. Ways to empower young people and their voices via their preferred genre and format, not only to inform their health behaviours but also other aspects of their lives, is imperative. [ABSTRACT FROM AUTHOR]

Introduction: There is limited research into informal support processes amongst young people supporting a peer through a traumatic event and how this process occurs specifically within a rural setting. Objective: The aim of this research was to understand how the contextual environment impacts on the personal and interpersonal processes of rural‐based young people supporting a peer who experienced a traumatic event. Design: Qualitative interviews were conducted with 22 young people (aged 14–19), who resided in Gippsland, Victoria, Australia. A substantive theory was developed using Charmaz's (1) Constructivist grounded theory methodology. Findings: Young people who shared responsibility for supporting their peer went back to life as normal and felt connected to their community, whereas young people who maintained sole responsibility, experienced mental health problems, disconnected from their community and felt like an outsider. The contextual environmental factors (i.e., service accessibility, limited transport, and internet blackspots) impacted both negatively and positively on young people's ability to provide support as well as influenced whether they felt safe share responsibility. Discussion: This theory implies that providing pathways to reconnecting with place and community, are essential in guiding young people back to their foundations of support. Conclusion: Integrating these insights can create new service models in rural areas, whilst also creating opportunities to form healthy foundations of support. [ABSTRACT FROM AUTHOR]

Introduction: Rural young people have high rates of mental illness and low rates of help‐seeking making it crucial to extend research about service improvement in rural and remote Australia. Objective: To describe what rural young people want from their headspace service, and what rural headspace clinicians understand they provide. Design: This study used a qualitative methodology with reflexive thematic analysis to analyse participant interviews and systematically derive common themes. Findings: Thirteen participants were interviewed comprising young people aged 16 to 18 years who had accessed one of three rural headspace services, together with clinicians working in those services. Key themes for both young people and clinicians comprised accessibility, flexibility, engagement, safety, youth‐focus, and evidence‐based treatment although there were some differences of emphasis amongst themes. There was also an additional theme for young people of awareness, and for clinicians of caring. Discussion: The results supported that what young people were seeking was largely consistent with what headspace clinicians were providing. There were however some specific issues relevant to service provision in a rural context such as increased awareness of services, the need to focus on evidenced based interventions, and better promotion in schools and the local community. Service gaps such as unmet needs for young people with higher risk who might fall outside of agency requirements were also identified. Conclusion: Results of this study help inform better service delivery and increased awareness for mental health of young people in rural communities to improve access and outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the reasons for childhood under-immunisation in Kempsey, New South Wales, among First Nations and non-First Nations families, and potential strategies to improve coverage., Design: The World Health Organization's Tailoring Immunization Programmes guide was employed. Tailoring Immunization Programmes uses social science, qualitative research methods and community participation and is underpinned by the Capabilities Opportunities Motivations-Behaviors (COM-B) theoretical model of behaviour change. A cultural lens was applied throughout the study design. Using a thematic analysis, factors found to influence childhood under-immunisation were loosely mapped against COM-B framework., Setting: Face-to-face interviews and focus groups conducted in locations and at times convenient to participants were audio-recorded and transcribed verbatim., Participants: Fifty-six participants (25 First Nations and 13 non-First Nations mothers and grandmothers, and 18 health service providers) took part in the study (July-October 2019)., Results: Four themes were identified: (a) parents are supportive of immunisation and effective reminders would make it easier to prioritise it (b) services could be more accessible for families (c) addressing workforce shortages could improve access to immunisation services and (d) addressing entrenched racism in the community will help build cultural safety in health services. While parents in Kempsey were supportive of immunisation, resourceful and resilient, many struggled to overcome entrenched structural and cultural barriers to accessing services. This was particularly difficult for First Nations, socially disadvantaged and single mums., Conclusions: Public health services can provide more support to those mothers and grandmothers who need it most, to ensure they are able to access immunisation services without delay., (© 2021 National Rural Health Alliance Ltd.)

Introduction: Inaccessibility of mental health services in rural Australia is widely reported. Community co-produced mental health and well-being initiatives could fill gaps and complement other services., Objective: This scoping review summarises findings from peer-reviewed articles to identify the key features of co-produced Australian rural mental health initiatives that engage communities in their design, delivery or evaluation processes., Design: Between 2009 and 2019 inclusive, 14 articles met inclusion criteria and were reviewed using Arksey and O'Malley's review methodology., Findings: Communities co-produced initiatives through informing, collaborating and instigating them. Some initiatives operated in specific places, for example an art gallery, while others operated across regions. Only two initiatives involved community members in multiple activities targeting prevention, early intervention, education and service accessibility; other initiatives were more focused, for example designing a new service. Over half of initiatives found were targeted at Aboriginal and Torres Strait Islander Peoples. Most articles discussed evaluation approaches, though methods were diverse., Discussion: Published peer-reviewed evidence about Australian rural community co-produced mental health initiatives appears scant. Evidence found suggests they generate a range of supports that could complement or mitigate for lack of, public health services. The overall lack of evidence, diversity of initiatives and inconsistent evaluation makes it difficult to assess effectiveness and which activities might be scaled-up for wider benefit., Conclusion: Rural communities have limited resources, and evidence of what constitutes best practice in co-producing mental health services would help to avoid 'reinventing the wheel.' Greater efforts in evaluating and publishing about initiatives would be helpful., (© 2021 National Rural Health Alliance Ltd.)

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

Introduction: Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas., Objective: This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0-8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings., Design: The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis., Findings: From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer-reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication., Discussion/conclusion: This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family-centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children., (© 2024 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: To measure compliance with Advance Care Directives (ACDs) for decedents in a rural setting., Design: Observational, cross-sectional medical records audit comparing requests in ACDs with actual outcomes., Setting: Rural Australian coastal district., Participants: People who had an ACD, died during the study period (30 May 2020 to 15 December 2021) and participated in a local research project., Main Outcome Measure(s): Compliance was measured by comparing stated requests in the ACD with outcomes recorded in medical records. This included the place of death and a list of 'unacceptable interventions'., Results: Sixty-eight people met the inclusion criteria (age range of 46-92 [mean 67 years; median 74 years]; 42 [62%] male). The main cause of death was cancer (n = 48; 71%). Preferred place of death was not stated in 16 ACDs. Compliance with documented preferred place of death was 63% (33/52): 48% (16/33) when the preferred place of death was home; 78% (7/9) when sub-acute was preferred; and 100% (10/10) when hospital was preferred. Compliance was 100% with 'unacceptable interventions'., Conclusion: These results demonstrate strong compliance with rural patients' requests in ACDs, particularly 'unacceptable interventions'. Home was the most common preferred place of death, but the compliance measure (48%) was the lowest in this study. This requires further exploration., (© 2024 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

The article focuses on the demonstration of the impact of coordinated continual professional development in a remote hospital setting. Topics discussed include Alice Springs Hospital (ASH) is a public teaching hospital which provides care to the population of Central Australia; and Excessive consumption can be associated with detrimental impacts on cognitive functioning due to Wernicke's encephalopathy (WE) and Korsakoff psychosis (KP), the acute and chronic phases.

The article discusses that the building capacity for high-quality primary care in rural and remote Australia will require developing and maintaining a strong GP supervisor workforce. It mentions that the national study showed that over half (58%) of rural GPs supervise registrars and that supervision is significantly associated with being an Australian medical graduate (AMG), being aged 41-55 years, working in a larger practice and supervising interns and medical students.

Rural general practitioners (GPs) traditionally provide the initial care for the very ill and severely traumatised in small and medium-sized rural hospitals. It has been said that these patients would be better managed in a level 1 trauma centre. The present paper will test this hypothesis and shows that the benefits of the expertise available in the large centres may be outweighed by the loss of life in the prehospital phase, most of which occurs before the arrival of the ambulance. General practitioner involvement would enhance the current early retrieval system. Very ill and severe trauma should be assessed and stabilised in the most appropriate local facility. Routine by-passing of local emergency medical services should be avoided. A national standard for training rural GPs in emergency management skills is needed. Emergency facilities and equipment must be maintained and improved throughout rural Australia. These facilities and their staff must be accredited so that the ambulance service can more appropriately determine its transport priorities. [ABSTRACT FROM AUTHOR]

Focuses on the effects of social class and inequality on health in Australia. Factors influencing social inequalities in health; Impact of social inequalities on public health; Establishment of Health Inequalities Research Collaboration.

The article discusses developments in rural health in Australia as of February 2015. Topics covered include issues regarding the care access of people in remote and rural communities as well as the launch of rural cancer services by policy makers. Also mentioned is the comparison of the health challenges faced by patients in rural areas with those in urban areas.

An introduction is presentedin which the editor discusses reports within the issue on topics including the Aboriginal and Torres Strait Islander Health, the value of nurse practitioners in early detection and management of chronic kidney disease for a primary health care service and a detailed examination of the changing midwifery practice and birthing landscape in South Australia.

Introduction: Access to after‐hours care (AHC) is an important aspect of general practice service provision. Objective: To establish the prevalence and associations of early‐career GPs' provision of AHC. Design: An analysis of data from the New alumni Experiences of Training and independent Unsupervised Practice (NEXT‐UP) cross‐sectional questionnaire‐based study. Participants were early‐career GPs (6‐month to 2‐year post‐Fellowship) following the completion of GP vocational training in NSW, the ACT, Victoria or Tasmania. The outcome factor was 'current provision of after‐hours care'. Associations of the outcome were established using multivariable logistic regression. Findings: Three hundred and fifty‐four early‐career GPs participated (response rate 28%). Of these, 322 had responses available for analysis of currently performing AHC. Of these observations, 128 (40%) reported current provision of AHC (55% of rural participants and 32% of urban participants). On multivariable analysis, participants who provided any AHC during training were more likely to be providing AHC (odds ratio (OR) 5.51, [95% confidence interval (CI) 2.80–10.80], p < 0.001). Current rural location and in‐training rural experience were strongly associated with currently providing AHC in univariable but not multivariable analysis. Discussion: Early‐career GPs who provided AHC during training, compared with those who did not, were more than five times more likely to provide after‐hours care in their first 2 years after gaining Fellowship, suggesting participation in AHC during training may have a role in preparing registrars to provide AHC as independent practitioners. Conclusion: These findings may inform future GP vocational training policy and practice concerning registrars' provision of AHC during training. [ABSTRACT FROM AUTHOR]

Introduction: Centralisation of head and neck surgical services means that patients in regional and remote Australia need to travel long distances for treatment and follow‐up, imparting a significant financial burden on patients and the health system. Objective: To estimate costs of travel to local outreach clinics and determine potential cost savings to patients and the health system by avoiding patient travel to major cities for head and neck surgical care. Design: Retrospective audit of three head and neck surgery outreach clinics in New South Wales, Australia over 4 years (2017–2020). Direct costs of travel from a patient's residence to their local outreach clinic were estimated. Costs of travel and accommodation to Sydney for an appointment were calculated for different travel modes. Estimated reimbursements for travel through government support schemes were calculated based on published rates. Findings: Some 657 patients attended the three clinics, accounting for 1981 appointments. Depending on mode of travel, the estimated median cost of return travel (including accommodation) to Sydney was $379 to $739 per patient per trip and the median government reimbursement ranged from $182 to $279 per trip. In comparison, the cost of return travel by car to local outreach clinics ranged from $28 to $163 per appointment. Outreach clinics were estimated to save patients a median of $285 per trip and avoided government reimbursements of $215 per trip. Discussion: Despite uptake in telehealth, outreach medical services remain an important asset for people living in regional areas to address inequities in access. However, the cost benefits are likely to be underestimated as our approach did not account for indirect costs associated with travel. Conclusion: Outreach head and neck surgical services located in regional areas can reduce the financial burden on both patients and the healthcare system. Greater investment in outreach clinics could ensure sustainability of services to promote equitable access to specialised surgical services. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to summarise key evidence from recent Australian rural nutrition research and provide recommendations for future nutrition and dietetics research with rural communities. Context: Clear evidence demonstrates that diet plays a role in the health gap between rural and metropolitan Australia. Despite the opportunity to address the health of rural Australians through better nutrition, alarmingly low investment in nutrition and dietetics research has occurred historically, and over the past decade. Approach: A review of the evidence was undertaken by rural nutrition and dietetics leaders to provide a commentary piece to inform future rural nutrition research efforts. Conclusion: Establishing strong, collaborative place‐based nutrition and dietetics research teams are necessary to combat the significant gaps in the scientific knowledge of solutions to improve nutrition in rural Australia. Further, dieticians and nutritionists who live in and understand the rural contexts are yet to be fully harnessed in research, and better engaging with these professionals will have the best chance of successfully addressing the nutrition‐related disease disparity between rural and metropolitan Australia. [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: 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]