full article:Aust Fam Physician 2003; 32: 750-752
The development of family health nurses and family nurse practitioners in remote and rural Australia
Lauder W, Sharkey S, Reel S
School of Nursing and Health, Central Queensland University, Rockhampton, Queensland. firstname.lastname@example.org
BACKGROUND: The World Health Organisation HEALTH21 strategy has firmly placed families and family oriented services at the core of health care delivery.
OBJECTIVE: In this article we argue that a fundamental reorganisation of primary health care practices in remote and rural Australia needs to be undertaken.
DISCUSSION: Nurses have been shown to be equally effective and less costly than general practitioners. Family nurse practitioners should be a first point of contact, and family health nurses should be responsible for responding to problems of multiple deprivation and social exclusion in remote and rural areas. These practitioners would, in their respective areas of responsibility, identify, diagnose, refer or treat individuals, families and communities. In effect they would act as gatekeepers to health and social care services. Family health nurses would also aim to support the community in developing and sustaining the capacity to take responsibility for its own health and social care. The main obstacles to these initiatives are concerns of general practitioners and nurses, the inertia of large organisations when faced with the need to undertake radical change and the highly unionised and rule bound nature of Australian nursing.
Med Educ 2003; 37: 809-814
Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors
Wilkinson D, Laven G, Pratt N, Beilby J
Division of Health Science, University of South Australia, Adelaide, South Australia, Australia. email@example.com
OBJECTIVE: To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice.
METHODS: National case-control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience.
RESULTS: Rural GPs were more likely to report having had any rural undergraduate training [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.32-1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training (OR 3.14, 95% CI 2.57-3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs (OR 10.52, 95% CI 5.39-20.51). South Australians whose final high school year was rural were more likely to be rural GPs (OR 3.18, 95% CI 0.99-10.22). CONCLUSIONS: Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.
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Med J Aust 2003; 179: 75-79
Factors associated with rural practice among Australian-trained general practitioners
Laven GA, Beilby JJ, Wilkinson D, McElroy HJ
Department of General Practice, The University of Adelaide, Adelaide, SA
OBJECTIVE: To determine the factors associated with general practitioners' current practice location, with particular emphasis on rural location.
DESIGN: Observational, retrospective, case-control study using a self-administered questionnaire.
SETTING: Australian general practices in December 2000.
PARTICIPANTS: 2414 Australian-trained rural and urban GPs. MAIN OUTCOME MEASURE: Current urban or rural practice location.
RESULTS: For Australia as a whole, rural GPs were more likely to be male (odds ratio [OR], 1.42; 95% CI, 1.17-1.73), Australian-born (OR, 1.95; 95% CI, 1.55-2.45), and to report attending a rural primary school for "some" (OR, 2.21; 95% CI, 1.69-2.89) or "all" (OR, 2.79; 95% CI, 1.94-4.00) of their primary schooling. Rural GPs' partners or spouses were also more likely to report "some" (OR, 2.75; 95% CI, 2.07-3.66) or "all" (OR, 2.86; 95% CI, 2.02-4.05) rural primary schooling. A rural background in both GP and partner produced the highest likelihood of rural practice (OR, 6.28; 95% CI, 4.26-9.25). For individual jurisdictions, a trend towards more rural GPs being men was only significant in Tasmania. In all jurisdictions except Tasmania and the Northern Territory, rural GPs were more likely to be Australian-born.
CONCLUSIONS: GPs' and their partners' rural background (residence and primary and secondary schooling) influences choice of practice location, with partners' background appearing to exert more influence.
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Indian J Pediatr 2003; 70: 217-219
Knowledge of diarrhea management among rural practitioners
Alam S, Khan Z, Amir A
Department of Pediatrics, Jawaharlal Nehru, Medical College, Aligarh Muslim University, Aligarh, UP, India. firstname.lastname@example.org
OBJECTIVE: To determine diarrhea management in rural practitioners.
METHODS: This study was conducted among the RMP's of 4 blocks of Aligarh. Pre-coded questionnaire was completed and educational programme followed. 91% were prescribing ORS in various combinations, but only 9.8% were advising ORS and feeding as standard management of diarrhea. Only 12.8% could name a WHO ORS brand and 50% were giving wrong instructions for preparation. 95% were advising inadequate amounts of ORS. Only 43.5% were advising feeding during diarrhea but 86.6% were advising to continue breastfeeding. On an average every 3rd to 4th patient was administered IVF's. 52% felt that drugs should be prescribed.
RESULTS: 90% and 55.3% of RMPs could identify diarrhea and key signs of dehydration.
CONCLUSION: There is a need for hands on training for the practitioners and education of the masses regarding proper management of diarrhea.
N Z Med J 2003; 116: U420
Is the PRIME (Primary Response In Medical Emergencies) scheme acceptable to rural general practitioners in New Zealand?
Hore T, Coster G, Bills J
Christchurch School of Medicine and Health Sciences, University of Otago
AIM: To ascertain the level of acceptance of the PRIME (Primary Response In Medical Emergencies) scheme by rural general practitioners (GPs) in New Zealand.
METHODS: A nationwide, anonymous, postal/email questionnaire was sent to 536 rural/semi-rural GPs, inquiring as to their involvement in and opinions of emergency care, and the acceptability of the PRIME scheme.
RESULTS: The overall response rate was 42%. PRIME training courses and PRIME equipment were regarded as excellent. However, concerns were raised by both PRIME and non-PRIME groups regarding the quality of triaging information given during emergencies and levels of remuneration for call-outs (especially medical call-outs). Additional concerns included lack of flexibility with the PRIME contract in some areas. Some GPs were also concerned that their involvement was less about providing a higher skill level in resuscitation than about filling the gaps in the already-stretched rural ambulance services, which was not the intention of the PRIME scheme.
CONCLUSIONS: The inclusion of rural GPs in emergency care teams needs to be recognised and adequately remunerated, and these issues should be reflected in the ongoing development of pre-hospital emergency service contracts.
Eur J Clin Pharmacol 2003; 58: 761-6. Epub 2003 Feb 18
Doctors perceptions of the influences on their prescribing: a comparison of general practitioners based in rural and urban Australia
Cutts C, Tett SE
School of Pharmacy, University of Queensland, Brisbane, Qld, Australia. email@example.com
OBJECTIVES: To compare and contrast the influences on prescribing perceived by general practitioners in an urban area of Queensland, Australia, to those perceived by general practitioners in rural Queensland.
METHOD: An investigation was undertaken with a group of general practitioners in urban and rural locations of Australia. A self-administered questionnaire requested the doctors' demographic details and their opinions on statements about prescribing. They also reported their prescribing of six recently marketed drugs.
RESULTS: One hundred and forty-two general practitioners from rural areas of Queensland (55% of the eligible population of these doctors) and one hundred and thirty-seven from the urban area (54% response) returned the surveys. The urban group were older and had more experience as general practitioners. Similarities and differences were detected between the two groups. The urban group considered that continuing medical education had a lesser influence on their prescribing than the rural group. The rural general practitioners were more likely than the urban doctors to agree that their information needs on prescribing were not being met in their practice, that their practice location had an effect on their prescribing (and also an effect on their prescribing of new drugs) as well as the remoteness of the patient's address having an effect. The rural doctors agreed more than the urban doctors that they try to avoid drugs requiring a significant amount of monitoring, reinforced by their agreement that they would be more likely to prescribe a newly marketed drug requiring less monitoring. When relating to whether the doctors in the two groups had reported initiating a supply of specific newly marketed drugs, independent of a specialist, rural general practitioners had initiated fewer of these selected new medicines.
CONCLUSION: This study has highlighted some of the differences in perceptions of doctors on the influences on prescribing in rural relative to urban areas of Australia. An understanding of these perceptions will allow targeting and development of location-relevant prescribing interventions and messages.
Aust J Rural Health 2003; 11: 7-14
Professional and social support networks of rural general practitioners
Joyce C, Veitch C, Crossland L
Formerly Rural Health & Workforce Research Unit, School of Medicine, James Cook University, Townsville, Queensland 4811, Australia
This study explored the nature of rural general practitioners' (GPs) professional and personal support networks. A qualitative design was employed, using in-depth interviews with a diverse sample of GPs in rural Queensland. The support network of the rural GPs in this study incorporated the domains of clinical, workforce and social support, with clinical support as the most important domain. There was a preference for face-to-face contact wherever possible. Such contact was particularly important in the process of developing the network and for personal support. Despite this, many network contacts were by telephone out of necessity. There were few notable differences between male and female rural GPs on the issues explored in the present study. General Practitioners' satisfaction with their professional interactions was varied across the sample. The findings suggest that level of satisfaction may be associated with intentions to leave or stay for this group.
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Med J Aust 2003; 179:325-326
Socioeconomic disadvantage and use of general practitioners in rural and remote Australia [letter]
Turrell G, Oldenburg BF, Harris E, Jolley DJ, Kimman ML
School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia. firstname.lastname@example.org
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