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Objective: Living in regional/rural areas can impact outcomes for people with head and neck cancer (HNC). Using a comprehensive state‐wide dataset, the impact of remoteness on key service parameters and outcomes for people with HNC was examined. Methods: Retrospective quantitative analysis of routinely collected data held within the Queensland Oncology Repository. Design: Quantitative methods (descriptive statistics, multivariable logistic regression and geospatial analysis). Setting: All people diagnosed with HNC in Queensland, Australia. Participants: The impact of remoteness was examined in 1991 people (1171 metropolitan, 485 inner‐regional, 335 rural) with HNC cancer diagnosed between 2013 and 2015. Main Outcome Measures: This paper reports key demographics and tumour characteristics (age, gender, socioeconomic status, First Nations status, co‐morbidities, primary tumour site and staging), service use/uptake (treatment rates, attendance at multidisciplinary team review and timing to treatment) and post‐acute outcomes (readmission rates, causes of readmission and 2‐year survival). In addition to this, the distribution of people with HNC across QLD, distances travelled and patterns of readmission were also analysed. Results: Regression analysis revealed remoteness significantly (p < 0.001) impacted access to MDT review, receiving treatment, and time to treatment commencement, but not readmission or 2‐year survival. Reasons for readmission did not differ by remoteness, with dysphagia, nutritional inadequacies, gastrointestinal disorders and fluid imbalance indicated in the majority of readmissions. Rural people were significantly (p < 0.0001) more likely to travel to care and to readmit to a different facility than provided primary treatment. Conclusions: This study provides new insights into the health care disparities for people with HNC residing in regional/rural areas. [ABSTRACT FROM AUTHOR]

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

The Mental Health Nurse Incentive Program ( MHNIP) was established in Australia during 2007. The program enables mental health nurses to work in partnership with general practitioners ( GPs) in the assessment and treatment of people with severe mental health problems. This paper provides insights into the demographic and clinical profile of 403 people enrolled in the MHNIP in the Ipswich area of Queensland. The clinical presentation (illness severity and symptoms) of those referred to the MHNIP is compared to that of: (i) people referred to a related program known as Access to Allied Psychological Services ( ATAPS); and (ii) to clients admitted to acute inpatient care in Queensland. While people referred to the MHNIP presented with more severe problems than those referred to ATAPS, they had less severe problems than those admitted to acute inpatient care. The findings indicate that the MHNIP is meeting the needs of people with complex mental and physical health problems. Further evaluation work is required to determine if the findings from this study can be generalized more broadly. At the national level, consideration should be given to the routine collection of clinical, cost, and demographic data to enable the ongoing monitoring of the program. [ABSTRACT FROM AUTHOR]

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

Aims: Improving hospital nutrition and mealtime care is complex and often requires multifaceted interventions and implementation strategies to change how staff, wards and systems operate. This study aimed to develop and validate a staff questionnaire to identify multilevel barriers and enablers to optimal nutrition and mealtime care on hospital wards, to inform and evaluate local quality improvement. Methods: Literature review, multidisciplinary focus groups and end‐user testing informed questionnaire development and establishment of content and face validity. To determine the construct validity, the questionnaire was administered to ward staff working in five wards across two facilities (acute hospital, rehabilitation unit). Exploratory factor analysis was used to estimate the number of factors and to guide decisions about whether to retain or reject individual items. Scale reliability was assessed using Cronbach's alpha. Results: The questionnaire was completed by 138 staff, with most respondents being nurses (57%) and working in the acute care facility (76%). Exploratory factor analysis supported construct validity of four of the original seven subscales. The final questionnaire consisted of 17 items and 4 sub sub‐scales related to (1) Personal Staff Role; (2) Food Service; (3) Organisational Support, and (4) Family Involvement; each sub‐scale demonstrated good reliability with Cronbach's alpha values all >0.70. Conclusion: This novel and brief questionnaire shows good reliability and preliminary evidence of construct validity in this small sample. It provides a potentially useful instrument to identify barriers and enablers to nutrition and mealtime care from the staff perspective and inform where improvement efforts should be focused. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. Methods: This mixed‐method study (survey and semi‐structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. Results: This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two‐thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. Conclusion: This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial. [ABSTRACT FROM AUTHOR]

Background Acute rheumatic fever ( ARF) and rheumatic heart disease ( RHD) contribute to Aboriginal Australian and Torres Strait Islander health disadvantage. At the time of this study, specialist ARF/ RHD care in the Kimberley region of Western Australia was delivered by a broad range of providers. In contrast, in Far North Queensland ( FNQ), a single-provider model was used as part of a coordinated RHD control programme. Aims To review ARF/ RHD management in the Kimberley and FNQ to ascertain whether differing models of service delivery are associated with different disease burden and patient care. Methods An audit of ARF/ RHD management. Classification and clinical management data were abstracted from health records, specialist letters, echocardiograms and regional registers using a standardised data collection tool. Results Four hundred and seven patients were identified, with 99% being Aboriginal and/or Torres Strait Islanders. ARF without RHD was seen in 0.4% of Aboriginal and/or Torres Strait Islander residents and RHD in 1.1%. The prevalence of RHD was similar in both regions but with more severe disease in the Kimberley. More FNQ RHD patients had specialist review within recommended time frames (67% vs 45%, χ2, P < 0.001). Of patients recommended benzathine penicillin secondary prophylaxis, 17.7% received ≥80% of scheduled doses in the preceding 12 months. Prescription and delivery of secondary prophylaxis was greater in FNQ. Conclusions FNQ's single-provider model of specialist care and centralised RHD control programme were associated with improved patient care and may partly account for the fewer cases of severe disease and reduced surgical procedures and other interventions observed in this region. [ABSTRACT FROM AUTHOR]