Journal Search

Journal Search - issue 1, 2005


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Paul Worley
1 PhD, Editor-in-Chief *


*Prof Paul Worley


1 Rural and Remote Health


31 March 2005 Volume 5 Issue 1


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ACCEPTED: 31 March 2005


Worley P.  Journal Search - issue 1, 2005. Rural and Remote Health 2005; 5: 418.


© Paul Worley 2005 A licence to publish this material has been given to ARHEN,

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Journal Search brings Rural and Remote Health users information about relevant recent publications. This issue includes recent publications in rural health/ primary healthcare journals, worldwide, including a link to the Contents page of a non-English language rural health journal from Norway.


Journal Canadien de la Médecine Rural/Canadian Journal of Rural Medicine [in French and English]

Contents, 2005; 10: (1) Winter 2005 / Hiver 2005
Issue includes:

Obstetric maternal outcomes at Bella Coola General Hospital: 1940 to 2001
Harvey V. Thommasen, Michael C. Klein, Tara Mackenzie, Nancy Lynch, Romina Reyes, Stefan Grzybowski

Objective: To describe obstetric procedures (episiotomy, forceps, vacuum extraction, caesarean section) and maternal outcomes for patients who gave birth in an isolated, rural hospital.
Design: A retrospective cohort study.
Study population: Women beyond 20 weeks' gestation who gave birth between Mar. 7, 1940, and June 9, 2001, inclusive, at the Bella Coola General Hospital (BCGH).
Main outcome measures: Data collected included maternal age, date of delivery, mode of delivery (vaginal delivery v. cesarean section), whether an episiotomy was performed or not, if forceps or vacuum extraction were used, whether analgesia, sedation or anesthesia was used, and maternal mortality.
Results: There were 2373 deliveries, including 12 sets of twins. There were no maternal mortalities. Cesarean sections were not routinely performed until the 1970s. Since then, there has been an increase in cesarean section rates to 11% of all deliveries in the 1990s. In the 1940s 28% of deliveries involved an episiotomy. This increased to 47% in the 1970s and was followed by a sharp decline to 4% in the 1990s. There was an increase, followed by a more gradual decrease in the use of forceps, and there was a recent increase in the use of vacuum extraction. The changes in procedure rates appear to reflect best practice guidelines of the times. In the case of episiotomies, the data suggest rural physicians are capable of rapid incorporation of recent recommendations. Rates for all procedures tended to be lower than those reported elsewhere in Canada and the United States. Narcotics, sedatives, inhalation agents and regional anesthetics were used to relieve the pain of labour and delivery throughout the study period.
Conclusions: Women giving birth in the low technology environment of the BCGH experienced relatively low obstetric procedural rates with excellent maternal outcomes.

Perinatal outcomes at Bella Coola General Hospital: 1940 to 2001
Harvey V. Thommasen, Michael C. Klein, Tara Mackenzie, Stefan Grzybowski

Objective: To describe perinatal outcomes (mortality, weight, condition at birth) at an isolated, rural hospital.
Design: A retrospective cohort study.
Study population: Neonates born to women beyond 20 weeks' gestation who delivered in the Bella Coola General Hospital (BCGH) between Mar. 7, 1940, and June 9, 2001, inclusive.
Main outcome measures: Information collected from the labour and delivery case room record book includes Aboriginal status, date of delivery, birth weight, newborn mortality, and newborn condition at birth.
Results: There were 2373 deliveries, including 12 sets of twins. Total newborn mortality rates declined from approximately 4.7% in the 1940-1954 time period to 0.7% in the 1970-1984 time period and have remained near that level ever since. From 1940-1960 BCGH's perinatal mortality rate was higher than Canada's; it was lower than Canada's in the 1970s, higher in the 1980s and about the same for the 1990s. The condition of the vast majority (approximately 90%) of newborns was described as being "good" at birth. Approximately 5% of newborns had birth weights < 2500 g, and this has not changed much over the years. In the 1951-1962 time period Aboriginal women had a higher percentage (8%) of infants with birth weight < 2500 g compared with non-Aboriginal women (5%), but this percentage has declined over time to the point where the rate for both groups is now around 5%.
Conclusions: Women giving birth in the low technology environment of the BCGH experienced acceptable neonatal outcomes. Trends in perinatal mortality, morbidity and low-birth-weight rates mirror those recorded for Canada.

Sustaining rural maternity care: Don't forget the RNs
Jennifer Mary Medves, Barbara Lynn Davies

Introduction: Registered nurses provide intrapartum care to women who choose to have their babies in hospital. Considering the current national shortage of nurses, the ability of registered nurses to continue to care for women, especially in small rural hospitals, is a critical concern.
Purposes: The purposes of the study were 1) to conduct a systematic review of the maternal-child-nursing literature in rural locations; and 2) to identify one rural Ontario hospital where nurses and physicians deliver care to women with low-risk pregnancies, and then conduct an institutional ethnography to understand the enablers and barriers to low-risk rural maternity care.
Methods: A literature search was conducted to determine the state of rural registered nurses; and a telephone survey of 25 rural Ontario hospitals was undertaken to locate a hospital in which an institutional ethnography study could be conducted.
Results: Registered nurses in rural areas are more likely to be multi-specialists than generalists because of the need to adapt to emergencies across the life continuum. To care for pregnant women and their families, registered nurses require many of the same considerations that physicians have outlined: access to continuing education, appropriate call-back schedules, support from other health care professionals and administrators, and a value system that respects their expertise. Results from the ethnography of one Ontario health care institution revealed that when these aforementioned considerations are addressed, registered nurses are able to provide safe, comprehensive low-risk care in a rural maternity programme.
Conclusions: Registered nurses play an important collaborative role in maternity care. We need Canadian data on registered nurses so that we can educate, recruit and retain them to care for women with low-risk pregnancies in rural and remote ares of Canada. Nursing services should be reviewed. Collaborative care models integrating newer professionals such as midwives, as well as understanding the role of doulas, may help in developing sustainable care to rural women.

A comparison of Canadian medical students from rural and non-rural backgrounds
Jeff C. Kwong, Irfan A. Dhalla, David L. Streiner, Ralph E. Baddour, Andrea E. Waddell, Ian L. Johnson

Context: Very little is known about medical students from rural areas currently enrolled in Canadian medical schools.
Purpose: We aimed to compare rural and non-rural students in terms of demographics, socioeconomic status, financial status and career choices.
Methods: As part of a larger Internet survey of all students at Canadian medical schools outside Quebec, conducted in January and February 2001, we conducted post-hoc analyses to compare students from rural and non-rural areas. Canada Post's classification system was used to determine rural status. To compare differences between rural and non-rural students, we used logistical regression models for categorical variables and factorial analysis of variance for continuous variables.
Results: We received responses from 2994 (68.5%) of 4368 medical students. Eleven percent of Canadian medical students come from rural backgrounds. Rural students tend to be older and originate from families of lower socioeconomic status. Students from rural areas report higher levels of debt, increased rates of paid part-time and summer employment, and greater stress from their finances. Nevertheless, rural students are not more likely to state that financial considerations will affect their choice of specialty or practice location.
Conclusions: Canadian medical students who come from rural backgrounds are different from their non-rural counterparts. Students from rural areas face numerous financial barriers in obtaining a medical education and report greater levels of financial stress. Medical schools should examine and address barriers to admission of rural students and they should consider directing more financial resources toward this financially vulnerable group.


Journal of Rural Health

Contents: 2005; 21 (1): Winter
Issue includes:

Title VII Funding and Physician Practice in Rural or Low-Income Areas
Alex H. Krist, Robert E. Johnson, David Callahan, Steven H. Woolf, David Marsland

Context: Whether Title VII funding enhances physician supply in underserved areas has not clearly been established.
Purpose: To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities.
Methods: A retrospective cross sectional analysis was carried out using the 2000 American Academy of Family Physicians physician database, Title VII funding records, and 1990 U.S. Census data. Included were 9,107 family physicians practicing in 9 nationally representative states in the year 2000.
Findings: Physicians exposed to Title VII funding through medical school and residency were more likely to have their current practice in low-income communities (11.9% vs 9.9%, P_.02) and rural areas (24.5% vs 21.8%, P_.02). Physicians were more likely to practice in rural communities if they attended medical schools (24.2% vs 21.4%; P Œ.009) and residencies (24.0% vs 20.3%; P Œ.011) after the school or program had at least 5 years of Title VII funding vs before. Similar increases were not observed for practice in low-income communities. In a multivariate analysis, exposure to funding and attending an institution with more years of funding independently increased the odds of practicing in rural or low-income communities.
Conclusions: Title VII funding is associated with an increase in the family physician workforce in rural and low-income communities. This effect is temporally related to initiation of funding and independently associated with effect in a multivariate analysis, suggesting a potential causal relationship. Whereas the absolute 2% increase in family physicians in these underserved communities may seem modest, it can represent a substantial increase in access to health care for community members.

Rural-Urban Differences in Employment-Related Health Insurance
Sharon L. Larson, Steven C. Hill

Context: Rural residents are disproportionately represented among the uninsured in the United States.
Purpose: We compared nonelderly adult residents in 3 types of nonmetropolitan areas with metropolitan workers to evaluate which characteristics contribute to lack of employment-related insurance.
Research Design and Analysis: Data were obtained from the Medical Expenditure Panel Survey, pooled across 3 panels (1996-1998) to enhance the rural sample size. Econometric decomposition was used to quantify the contribution of employment structure to differences in the probability of being offered employment-related health insurance.
Findings: The most rural workers are 10.4 percentage points less likely to be offered insurance compared with urban workers; the difference is smaller for residents of other rural areas. In rural counties not adjacent to urban areas, lower wages and smaller employers each account for about one-third of the total difference.
Conclusions: Health insurance disparities associated with rural residence are related to the structure of employment. Major factors include smaller employers, lower wages, greater prevalence of self-employment, and sociodemographic characteristics.

Access to Transportation and Health Care Utilization in a Rural Region
Thomas A. Arcury, John S. Preisser, Wilbert M. Gesler, James M. Powers

Context: Access to transportation to transverse the large distances between residences and health services in rural settings is a necessity. However, little research has examined directly access to transportation in analyses of rural health care utilization.
Purpose: This analysis addresses the association of transportation and health care utilization in a rural region.
Methods: Using survey data from a sample of 1,059 households located in 12 western North Carolina counties, this analysis tests the relationship of different transportation measures to health care utilization while adjusting for the effects of personal characteristics, health characteristics, and distance.
Findings: Those who had a driver's license had 2.29 times more health care visits for chronic care and 1.92 times more visits for regular checkup care than those who did not. Respondents who had family or friends who could provide transportation had 1.58 times more visits for chronic care than those who did not. While not significant in the multivariate analysis, the small number who used public transportation had 4 more chronic care visits per year than those who did not. Age and lower health status were also associated with increased health care visits. The transportation variables that were significantly associated with health care visits suggest that the underlying conceptual frameworks, the Health Behavior Model and Hagerstrand's time geography, are useful for understanding transportation behavior
Conclusions: Further research must address the transportation behavior related to health care and the factors that influence this behavior. This information will inform policy alternatives to address geographic barriers to health care in rural communities.

Cancer Incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia
Eugene J. Lengerich, Thomas C. Tucker, Raymond K. Powell, Pat Colsher, Erik Lehman, Ann J. Ward, Jennifer C. Siedlecki, Stephen W. Wyatt

Context: Composed of all or a portion of 13 states, Appalachia is a heterogeneous, economically disadvantaged region of the eastern United States. While mortality from cancer in Appalachia has previously been reported to be elevated, rates of cancer incidence in Appalachia remain unreported.
Purpose: To estimate Appalachian cancer incidence by stage and site and to determine if incidence was greater than that in the United States.
Methods: Using 1994-1998 data from the central registries of Kentucky, Pennsylvania, and West Virginia, age-adjusted incidence rates were calculated for the rural and nonrural regions of Appalachia. These state rates were compared to rates from the Surveillance, Epidemiology, and End Results (SEER) program for the same years by calculating the adjusted rate ratio (RR) and a 95% confidence interval (CI).
Findings: Both the entire and rural Appalachian regions had an adjusted incidence rate for all cancer sites similar to the SEER rate (RR Œ 1.00 [95% CI, 1.00-1.01] and RRŒ0.99 [95% CI, 0.99-1.00], respectively). However, incidence of cancer of the lung/ bronchus, colon, rectum, and cervix in Appalachia was significantly elevated (RR Œ 1.22 [95% CI, 1.20-1.23], 1.13 [95% CI, 1.11-1.14], 1.19 [95% CI, 1.16-1.22], and 1.12 [95% CI, 1.07-1.17], respectively). Incidence of cancer of the lung/bronchus and cervix in rural Appalachia was even more elevated (RR Œ 1.34 [95% CI, 1.31-1.36] and 1.29 [95% CI, 1.21-1.38], respectively). Incidence of unstaged disease for all cancer sites in Appalachia (RRŒ1.06 [95% CI, 1.05-1.08]), particularly rural Appalachia (RR Œ 1.28 [95%CI, 1.25-1.30]), was elevated.
Conclusions: Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

Predictors of HIV Testing and Intention to Test Among Hispanic Farmworkers in South Florida
M. Isabel FernaŽndez, Jose B. Collazo, G. Stephen Bowen, Leah M. Varga, Nilda Hernandez, Tatiana Perrino

Context and Purpose: This study examined the predictors of HIV testing and factors associated with intention to accept a free HIV test among 244 Hispanic migrant/seasonal farmworkers in South Florida.
Methods: Time and space sampling procedures were used to recruit participants in public venues. Bilingual staff interviewed eligible respondents in these settings.
Findings: Despite high rates of sexual risk, only 21% of respondents had been tested for HIV. The majority of those tested were females tested during prenatal care. In multivariable logistic regression analyses, being female (odds ratio [OR] Œ 3.73), having at least 12 years of education (OR Œ 4.46), earning more than $201 per week (ORŒ2.76), and ever having used marijuana (ORŒ3.31) were positively associated with having been tested for HIV, while not being documented (ORŒ0.24) and having rated one's health as ''very good'' or ''good'' (OR Œ 0.42) were negatively associated with testing. The multivariable predictors of intention to accept a free HIV test were having visited a health care provider and/or an emergency room in the past 12 months (OR Œ 1.97), having been tested for HIV (OR Œ 2.36), preferring an HIV test that used a finger stick for specimen collection with results given in 30 minutes (ORŒ4.47), and worrying ''some'' or ''a lot'' about getting HIV (OR Œ 3.64). Women (OR Œ 0.52) were less likely than men to intend to accept a free HIV test.
Conclusions: Our findings highlight the importance of routinely offering HIV testing to sexually active individuals in high HIV prevalence areas. They also suggest the need to make testing more accessible to migrant and seasonal farmworkers.

Analysis of Prior Health System Contacts as a Harbinger of Subsequent Fatal Injury in American Indians
Teri L. Sanddal, James Upchurch, Nels D. Sanddal, MS, Thomas J. Esposito

Context: Many American Indian nations, tribes, and bands are at an elevated risk for premature death from unintentional injury. Previous research has documented a relationship between alcohol-related injury and subsequent injury death among predominately urban samples. The presence or nature of such a relationship has not been documented among American Indians living in the northern plains.
Purpose: The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation.
Methods: Death certificates of American Indians who died from injury (ICD-9-E 800-999) in a rural IHS area over 6 consecutive years were linked to IHS acute-care facility records and toxicology reports. Deaths and prior IHS contacts were stratified by alcohol use as a contributing factor. Of the 526 injury deaths involving American Indians in the IHS area studied, 411 (78%) were successfully linked to IHS records. One hundred fifty-two of these cases met the inclusion criteria, with an additional 98 cases identified as a comparison
Findings: No differences in alcohol use at time of death between groups with and without prior health care contact (for injury or alcohol) could be determined (81% vs 73%). A significant relationship was found between previous visits for acute or chronic alcohol use and subsequent alcohol-related fatalities (P Œ.01).
Conclusions: Based on these findings, injury-prevention activities in the population studied should be initiated at the time of any health-system contact in which alcohol use is identified. Intervention strategies should be developed that convey the immediate risk of death from injury in these patients.

Perceptions of Local Health Care Quality in 7 Rural Communities with Telemedicine
Thomas S. Nesbitt, James P. Marcin, Martha M. Daschbach, Stacey L. Cole

Context: Rural health services are difficult to maintain because of low patient volumes, limited numbers of providers, and unfavorable economies of scale. Rural patients may perceive poor quality in local health care, directly impacting the sustainability of local health care services.
Purpose: This study examines perceptions of local health care quality in 7 rural, underserved communities where telemedicine was implemented. This study also assesses factors associated with travel outside of local communities for health care services.
Methods: Community-based pretelemedicine and posttelemedicine random telephone surveys were conducted in 7 northern California rural communities assessing local residents' perceptions of health care quality and the frequency of travel outside their community for health care services. Five-hundred rural residents were interviewed in each of the pretelemedicine and posttelemedicine surveys. Between surveys, telemedicine services were made available in each of the communities.
Findings: Residents aware of telemedicine services in their community had a significantly higher opinion of local health care quality (P Œ.002). Satisfaction with telemedicine was rated high by both rural providers and patients. Residents with lower opinions of local health care quality were more likely to have traveled out of their community for medical care services (P Œ.014).
Conclusions: The introduction of telemedicine into rural communities is associated with
increases in the local communities' perception of local health care quality. Therefore, is it possible that telemedicine may result in a decrease in the desire and need for local patients to travel outside of their community for health care services.

Recruiting and Retaining Mental Health Professionals to Rural Communities: An Interdisciplinary Course In Appalachia
Deborah Meyer, Jane Hamel-Lambert, Carolyn Tice, Steven Safran, Douglas Bolon, Kathleen Rose-Grippa

Context: Faculty from 5 disciplines (health administration, nursing, psychology, social work, and special education) collaborated to develop and teach a distance-learning course designed to encourage undergraduate and graduate students to seek mental health services employment in rural areas and to provide the skills, experience, and knowledge necessary for successful rural practice.
Methods: The primary objectives of the course, developed after thorough review of the rural retention and recruitment literature, were to (1) enhance interdisciplinary team skills, (2) employ technology as a tool for mental health practitioners, and (3) enhance student understanding of Appalachian culture and rural mental health. Didactic instruction emphasized Appalachian culture, rural mental health, teamwork and communication, professional ethics, and technology. Students were introduced to videoconferencing, asynchronous and synchronous communication, and Internet search tools. Working in teams of 3 or 4, students grappled with professional and cultural issues plus team process as they worked through a hypothetical case of a sexually abused youngster. The course required participants to engage in a nontraditional manner by immersing students in Web-based teams.
Findings: Student evaluations suggested that teaching facts or ''content'' about rural mental health and Appalachian culture was much easier than the ''process'' of using new technologies or working in teams.
Conclusions: Given that the delivery of mental health care demands collaboration and teamwork and that rural practice relies increasingly more on the use of technology, our experience suggests that more team-based, technology-driven coursesare needed to better prepare students for clinical practice.


Australian Journal of Rural Health

2005; 13 (1)
issue includes:

Preparedness for rural community leadership and its impact on practice location of family medicine graduates
Wayne Woloschuk, Rodney Crutcher, Olga Szafran

Objective: To identify non-clinical dimensions of preparedness for rural practice and to determine whether preparedness for rural practice is predictive of rural practice location.
Design: Cross-sectional postal survey mailed in 2001.
Setting: Communities across Canada where graduates were practising.
Subjects: Graduates (n = 369) of the family medicine residency program at the universities of Alberta (U of A) and Calgary (U of C) between 1996 and 2000, inclusive.
Interventions: Using a 4-point scale, graduates rated the extent to which the residency program prepared them for eight dimensions of rural practice: clinical demands of rural practice, understanding rural culture, small community living, balancing work and personal life, establishing personal/professional boundaries, becoming a community leader, handling a 'fish bowl' lifestyle, and choosing a suitable community.
Main outcome measure: Identification of non-clinical dimensions of preparedness for rural practice and whether scores on preparedness scales are predictive of rural practice location.
Results: The overall response rate was 76.4%. Factor analysis of the eight preparedness items produced two factors, 'rural culture' and 'rural community leader' which explained 72% of the variance. The alpha coefficient for each factor was 0.87. Odds ratios revealed that family medicine graduates prepared for rural community leadership roles were 1.92 (CI = 1.03 3.61) times more likely to be in rural practice. Rural physicians were also 2.14 (CI = 1.13 4.03) times as likely to have a rural background.
Conclusions: Preparedness to be a rural community leader and having a rural background were predictive of rural practice. Educators should consider this in both family medicine residency admissions policy and practice and when designing and implementing family medicine residency curricula.

Support needs of supply nurses in rural and remote Queensland
Steven Fiore, Sanam Souzani, Rita D'Amore, Kieran Behan, Christopher Cutts, Adam La Caze

Objective: The aim of this report is to discuss a needs analysis conducted with rural and remote nurses in Queensland undertaking supply of medications in public hospitals without a pharmacist.
Design: Survey questionnaire.
Methods: A questionnaire was faxed to 65 Queensland Health rural and remote hospitals using supply nurses. It contained six closed questions regarding previously identified medication 'supply' issues, and three open questions to determine additional information.
Results: Of the surveys, 42 (65%) were returned. Major areas of interest included a safety checklist for medication supply (90%, 38/42), more information on medication labelling requirements (83%, 35/42) and timing of medications with regard to food (86%, 36/42). Requirements for patient counselling, increased access to consumer medication information (CMI) (76%, 32/42), and resources regarding doses, indications, interactions and adverse effects also rated highly (73%, 31/42). Thirty-three supply nurses highlighted at least one issue in the open questions: more information on the legal requirements of repackaging medications (39%, 13/42), increased access to CMI and counselling tools (36%, 12/42) and an efficient stock control system (30%, 10/42).
Conclusions: This report highlights the need to broaden current support services available to nurses undertaking the supply of medications. It is vital that support programs, and the laws and guidelines related to supplying medications in rural and remote hospitals, support health care professionals providing quality use of medicines (QUM) and reflect the realities of rural and remote health care.

Doctors in vocational training: rural background and rural practice intentions
Australian Medical Workforce Advisory Committee (AMWAC)

Objective: To report the findings of a national survey of Australian doctors in vocational training about their rural practice intentions and their plans to work full time or part time.
Design: A self-administered mailed survey.
Setting: Vocational training: general practice and other medical college training programs.
Subjects: Australian doctors (i.e. Australian citizens and permanent residents) registered with one of Australia's 17 medical college vocational training programs in September 2002.
Main outcome measures: Intention to practise in a rural area on completion of vocational training; full-time or part-time practice plans; views about rural practice.
Results: Of the 7899 doctors who met the criteria for inclusion in the study, 4259 (54%) responded. In total:14% indicated a preference for rural practice on completion of vocational training; 17% were GP trainees of which 31% preferred rural practice; 83% were registered with one of the other 16 specialist training programs (e.g. adult medicine, paediatric medicine and surgery) of which 10% preferred rural practice; 50% of general practice trainees and 23% of trainees in other specialist training programs with a rural background indicated a preference for rural practice in the long term, compared with 25% and 7%, respectively, of doctors with an urban background; 46% of general practice trainees with intentions to practise in a rural area plan to practise part time.
A positive association was observed between rural background and preference for rural practice (odds ratio (OR) 2.9) and between preference for rural practice and enrolment in the rural general practice training pathway (OR 3.1) and involvement in rural education and training activities (OR 5.1).
Conclusions: The findings of this study support initiatives to increase the number of rural background students entering medical school and rural education and vocational training initiatives. Australia's rural doctor shortage is not likely to be addressed by this cohort of doctors in vocational training. General practice workforce plans, rural and urban, need to take note of the high proportion of doctors who plan to practise part time.

Caring for depressed patients in rural communities: general practitioners' attitudes, needs and relationships with mental health services
Megan J. Wright, Karen D. Harmon, Jennifer A. Bowman, Terry J. Lewin, Vaughan J. Carr

Objective: To examine the needs and practices of rural GPs and their relationships with local acute mental health services, particularly in the provision of care to depressed patients.
Design: Postal survey.
Setting: Rural general practices.
Subjects: Ninety-nine GPs (63 males, 36 females) from the Hunter Valley region of NSW, Australia.
Main outcome measures: GPs' self-reported contact rates, confidence, needs and beliefs.
Results: Depression was the most commonly seen mental disorder, with an average of 1.44 patients per GP per month referred to local acute mental health services, most commonly for suicidality. The preferred form of feedback after the referral of a depressed patient was a follow-up letter, while the most requested type of patient management support was cognitive behavioural therapy (CBT) groups. GPs were most confident in recognising depression, compared to other mental disorders except anxiety, and they were most confident in treating depression, compared to all other mental disorders. The most common barrier to providing care for depressed patients was reported to be 'time constraints' on GPs.
Conclusions: The challenge for mental health services is to develop ways to collaborate more effectively with GPs in the provision of psychological services for depressed patients in rural communities.

Do rural consumers expect a prescription from their GP visit? Investigation of patients' expectations for a prescription and doctors' prescribing decisions in rural Australia
Christopher Cutts, Susan E. Tett

Objective: To assess patients' expectation for receiving a prescription and GPs' perceptions of patient expectation for a prescription.
Design: Matched questionnaire study completed by patients and GPs.
Setting: Seven general practices in rural Queensland, Australia.
Subjects: The subjects were 481 patients consulting 17 GPs.
Main outcome measures: Patients' expectation for receiving a prescription and GPs' perceptions of patients' expectation.
Results: Ideal expectation (hope) for a prescription was expressed by 57% (274/481) of patients. Sixty-six per cent (313/481) thought it was likely that the doctor would actually give them a prescription. Doctors accurately predicted hope or lack of hope for a prescription in 65% (314/481) of consultations, but were inaccurate in 19% (93/481). A prescription was written in 55% of consultations. No increase in patients' expectation, doctors' perceptions of expectation, or decision to prescribe were detected for patients living a greater distance from the doctors.
Conclusions: Rural patients demonstrated similar rates of hope for a prescription to those found in previous urban studies. Rural doctors seem to be similarly 'accurate' and 'inaccurate' in determining patients' expectations. Rates of prescribing were comparable to urban rates. Distance was not found to increase the level of patient expectation, affect the doctors' perception or to influence the decision to prescribe.



[Norwegian medical journal for general practice and public health] [in Norwegian]
Contents 2004: 6

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