Journal Search

Journal Search - issue 1, 2007

AUTHOR

name here
Paul Worley1
PhD, Editor in Chief *

CORRESPONDENCE

* Paul Worley

AFFILIATIONS

1 Rural and Remote Health

PUBLISHED

30 March 2007 Volume 7 Issue 1

HISTORY

RECEIVED: 27 March 2007

ACCEPTED: 30 March 2007

CITATION

Worley P.  Journal Search - issue 1, 2007. Rural and Remote Health 2007; 7: 754. Available: www.rrh.org.au/journal/article/754

AUTHOR CONTRIBUTIONS

© Paul Worley 2007 A licence to publish this material has been given to ARHEN, arhen.org.au

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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 journals worldwide.


Canada


Journal Canadien de la M├ędecine Rural/Canadian Journal of Rural Medicine
[in French and English]
Contents, 2006; 12: (1) Winter 2007 / Hiver 2007
Issue includes:


Response of rural physicians in a non-fee-for-service environment to acute increases in demand due to physician shortages
Michael E. Green

Introduction: The Weeneebayko Health Ahtuskaywin (WHA) is an Aboriginal regional health authority serving a large remote region on the west coast of James Bay. The physicians are all paid on a non-fee-for-service basis. There are periods of acute shortage, periods of relative stability and periods when much of the care is provided by locum physicians. As a closed system, it is ideal for the investigation of physician response to periods of acute increases in demand for service.
Purpose: This study investigated the relationships between staffing levels and service provision to describe the response of physicians to increased demand due to an acute shortage of physicians. It also looked at whether payment options affected these relationships.
Methods: Using an existing administrative database from WHA for the period 1999 to 2002, relationships between staffing levels and service provision were investigated. We looked at the relationship between total physician levels and the number of patients seen per family medicine clinic. We also studied the relationships between total physician staffing levels and the number of patients seen in clinic, in the emergency department (ED), and per ED shift. We also looked at some proxy measures for the level of intensity of the work, including the number of hospital inpatients, the number of medevacs per ED shift and the number of ED shifts per physician. Exploratory graphical analysis was conducted and was followed by linear regression for associations of interest.
Results and Conclusion: During periods of decreased staffing, physicians saw more patients per clinic and ED shift, despite the lack of financial incentives. The study also clearly demonstrates the increased intensity of the workloads carried by rural physicians in times of staffing shortages as noted by increased numbers of ED shifts, increased numbers of medevacs per ED shift and the lack of a decline in inpatient numbers. This highlights the need for ongoing recruitment and retention efforts in rural and remote locations to ensure adequate physician staffing levels, if burnout is to be avoided.



Survey of rural family physician-obstetricians in Southwestern Ontario
Neal Stretch

Introduction: The objectives of this paper are 1) to analyze the characteristics of rural physicians who currently practise obstetrics, their training background and the environment in which they work and 2) to develop strategies to sustain rural obstetrical services.
Methods: Information was gathered using both a survey and brief individual interviews.
Participants: A survey was sent to 56 family physicians who currently practise obstetrics, as well as those who had stopped within the past 2 years, in the Southwestern Ontario communities of Clinton, Goderich, Hanover, Kincardine, Markdale, Mount Forest, Palmerston, Walkerton, Wiarton and Wingham.
Results: Forty-four physicians responded to the survey. Results indicate that current obstetrical training programs are lacking in the following areas: the provision of positive role models/mentors, rural placements, experience in complex decision-making, and instilling confidence in graduates. Physicians appear to be internally motivated to practise obstetrics, claiming it is important to their professional goals and personal values. Support systems of colleagues, nursing staff, administration, family and friends, were identified as vital components of a successful obstetrical program.
Conclusion: Educators are advised to identify students with an internal motivation to practise rural obstetrics early in their medical training and provide them with mentors, rural placements, confidence and experience in complex decision-making.



Shared geriatric mental health care in a rural community
Mary Pat Sullivan

Introduction: A pilot project in shared mental health care was initiated to explore opportunities to increase the capacity of the rural primary care system as a resource for older people with mental health needs. This was done within a framework for the delivery of best practices in geriatric mental health outreach.
Methods: Shared-care strategies combining education and clinical consultation between mentor psychiatrists and family physicians were implemented and then evaluated after one year to identify key factors in the success of approaches to shared mental health care for older people in a rural setting.
Results: Results provided new insights into shared care between primary care and specialty geriatric mental health services, rural geriatric mental health service delivery, developmental phases in service learning approaches, and building knowledge networks to promote continuing best practices.
Conclusion: The results from the project's process evaluation have been integrated into the development of a permanent shared geriatric mental health care service for the rural setting. Preparation for an outcome evaluation that will focus on the impact on patient care has also been initiated.



Telehealth and the recruitment and retention of physicians in rural and remote regions: a Delphi study
Julie Duplantie

Introduction: The availability of a medical workforce is a growing concern for rural and remote communities across Canada. In the last decade, various telehealth experiences have highlighted the potential impact of this technology on professional as well as organizational practices. But could telehealth be a strategy to attract and maintain physicians in rural and remote communities? The objective of this study was to identify a reliable list of recruitment and retention factors on which telehealth could have an impact.
Methods: We conducted 2 literature reviews and a Delphi study among 12 telehealth experts across Canada.
Results: The literature reviews identified 7 categories of recruitment and retention factors on which telehealth could have an impact: 1) individual, 2) familial, 3) contextual, 4) professional, 5) organizational, 6) educational, and 7) economic.
Conclusions: Experts consulted through the Delphi study reached consensus on 31 out of 34 of the proposed statements about the impact of telehealth. This consensus can now be used as a conceptual model for further studies on the topic.


The occasional shoulder dystocia
Peter Hutten-Czapski

You are the only physician in a rural hospital on a Sunday afternoon when Mrs. Smith presents. She's a G5P4 with precipitous births, so it is going to be you who will be delivering. She's now crowning, but after the head is delivered it "turtles" and nothing else happens. The shoulder is stuck!
Although cases of shoulder dystocia are associated with increased risk of fetal injury or death, reduction of the impacted shoulder can be effected calmly, by a series of manoeuvres, and with excellent outcomes.



USA

Journal of Rural Health


Contents: 2007; 23 1
Issue includes:


The Regulatory Environment and Rural Hospital Long-Term Care Strategies From 1997 to 2003
Mary L. Fennell, Susan E. Campbell

Context: Since the passage of the Balanced Budget Act of 1997, rural hospitals have struggled with the need to strategically adapt to an abundance of changing reimbursement and regulatory programs, as well as to respond to the needs of an increasingly frail elder population in need of postacute and long-term care (LTC). Purpose: This article has 2 goals: (1) to provide a summary of the many legislative acts and provisions influencing rural hospital LTC strategies during the 1997-2003 period and (2) to track changes in the LTC strategies of a national sample of rural hospitals through this 7-year period. Methods: A 3-wave panel of rural hospital discharge planners in 540 nonfederal community-general hospitals were interviewed in 1997, 2000, and 2003. Questions focused on hospital structure, discharge planning process, and reports of internal and external organizational arrangements for providing LTC services to hospitalized patients, and changes in LTC strategy since the previous interview. Descriptive statistics are presented on LTC strategies in place in 1997 and dropped or added in 2000 and 2003. Findings and Conclusions: The general shape of the regulatory environment confronting rural hospitals and their LTC strategies during the recent past can be described as complicated, rapidly changing, and at times contradictory in intended effects. There has been a large volume of strategy change during this 7-year period, without the emergence of any identifiable pattern or LTC strategy profile, other than swing-bed participation combined with home health agency ownership.





Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

Jiexin (Jason) Liu, Gail R. Bellamy, Melissa McCormick

Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to a hospital for inpatient care in the past 12 months and lived within 15-20 miles of 25 randomly selected CAHs were surveyed by phone during the period from early February through late July 2005. Survey questions included demographic characteristics, general health status, travel time/distance to health care, questions on satisfaction with local health services, bypass behavior, and solicited suggestions on how local hospitals could retain patients locally. Findings: About 60% of surveyed patients bypassed their local CAHs for inpatient care including 16% who were referred to another facility by the local CAH/health care providers and would use the local hospital if needed services were available. Bypass rates ranged from 16% to 70% across the sampled CAHs. Factors associated with bypass included age, income, satisfaction with the local hospital, and traveling distance/time. Lack of specialty care, limited services, and the quality/reputation of local services/doctors were most frequently mentioned as reasons why patients bypass local CAHs. Conclusions: The bypass rate for sampled CAHs is considerably higher than the 20%-50% bypass rates documented in the literature for all hospitals in general using discharge/administrative data. The sizeable variation in bypass rates across CAHs suggests that the appropriate response/fix should come from the facility/community levels.



Cancer of the Colorectum in Maine, 1995-1998: Determinants of Stage at Diagnosis in a Rural State
Margaret A. Parsons, Kathleen D. Askland

Context: Despite screening for colorectal cancer, mortality in the United States remains substantial. In northern New England, little is known about predictors of stage at diagnosis, an important determinant of survival and mortality. Purpose: The objective of this study was to identify predictors of late stage at diagnosis for colorectal cancer in a rural state with a predominantly white population and a large Franco-American minority. Methods: Incident cases from 1995-1998 were obtained from the Maine Cancer Registry. Individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic status, population density, Franco ancestry proportion, distance to health care, and weather) were modeled with multiple logistic regression for late stage. Findings: Increasing distance to primary care provider was associated with late stage for colorectal cancer. Compared to patients aged ,85 years, those aged 65-84 years were less likely to be diagnosed late, while those aged 35-49 years were more likely-although not significantly-to have late stage at diagnosis. Associations were not found with socioeconomic variables. Conclusions: The finding regarding distance to primary care may be consistent with studies showing that rurality and distance to care predict reduced utilization of health care services and worse health outcomes. The finding regarding age has implications for the education of younger high-risk patients and their physicians. The absence of positive findings with regard to socioeconomic variables may stem from the uniquely mixed sociodemographic profiles in rural and urban regions of Maine. Further research should refine these and other contextual measures to elucidate effects on rural health and should further evaluate the utility of assigning French ethnicity by surname in order to identify health disparities.




Cancer Survival in California Hispanic Farmworkers, 1988-2001
Jennifer L. Dodge, Paul K. Mills, MPH, Deborah G. Riordan

Context: Although epidemiologic studies have identified elevated cancer risk in farmworkers for some cancer types, little is known about cancer survival in this population. Purpose: To determine if cancer survival differs between a Hispanic farmworker population and the general Hispanic population in California. Methods: Hispanic United Farm Workers of America union members and California Hispanics diagnosed from 1988 to 2001 with a first primary cancer were identified from the California Cancer Registry. Kaplan-Meier observed 5-year cause-specific survival rates were calculated, and log-rank tests assessed population differences. Cox proportional hazards models for the most common cancers provided age-, stage-, and year of diagnosis-adjusted hazard ratios. Findings: Observed 5-year cancer-specific survival rates were lower for Hispanic United Farm Workers of America men compared to California Hispanic men for all cancer sites combined (53.7% vs 57.7%, respectively) and colorectal cancer (48.1% vs 60.6%, respectively) and higher for non-Hodgkin's lymphoma (86.7% vs 57.6%, respectively). Only non-Hodgkin's lymphoma survival differences remained significant (P = .021) after adjusting for age and stage at diagnosis. No statistically significant survival differences were detected between United Farm Workers of America and California Hispanic women. Conclusions: Although survival was generally similar between United Farm Workers of America members and California Hispanics, lower crude survival among United Farm Workers of America men for all sites combined and colorectal cancer warrants public health measures to address barriers to cancer screening in California's Hispanic farm-working populations. Histology-specific analyses with larger sample sizes are required before reaching conclusions on non-Hodgkin's lymphoma survival differences.



Individual and Community Predictors of Preterm Birth and Low Birthweight Along the Rural-Urban Continuum in Central Pennsylvania
Marianne M. Hillemeier, Carol S. Weisman, Gary A. Chase, Anne-Marie Dyer

Context: Preterm birth and low birthweight remain high priority public health problems and are associated with increased risk of infant mortality as well as long-term health impairments. Although 20% of all births nationally are to rural women, relatively little attention has been paid to pregnancy outcomes in rural areas relative to more urbanized areas. Purpose: This study examines the relationship of individual- and community-level socioeconomic, health care, and health status-related characteristics to preterm birth and low birthweight outcomes among women living in urban and various types of rural communities. Methods: Vital record data on singleton first births to residents of a 28-county region in central Pennsylvania in 2002 (N = 11,546) were merged with zip code-level information from the census and residence in a primary care health professional shortage area. Rural-urban commuting area codes were also appended. Multiple logistic regression analyses were performed to model risks of preterm birth and low birthweight using generalized estimating equations to account for clustering within zip code. Findings: Women residing in large rural city-focused areas had lower adjusted odds of both preterm birth and low birthweight as compared to urban women, controlling for individual risk factors including maternal demographic characteristics, health conditions, and prenatal care use. In contrast, risks of these adverse birth outcomes were not significantly lower among women living in more rural areas relative to those in urban communities. Conclusions: Reduced risks of preterm birth and low birthweight risk are associated with some, but not all types of rural as compared to urban communities.



Sociodemographic Factors and Self-Management Practices Related to Type 2 Diabetes Among Hispanics and Non-Hispanic Whites in a Rural Setting

Gloria D. Coronado, Beti Thompson, Silvia Tejeda, Ruby Godina, Lu Chen

Context: Hispanics in the United States have a higher prevalence of non-insulin-dependent diabetes mellitus (type 2 diabetes) and experience more complications for the disease than non-Hispanic whites. Differences in medical management or self-management practices may, in part, explain the relative high risk for diabetes complications among Hispanics. Purpose: Using data from a community-randomized intervention study on cancer prevention, we examined the medical management and self-management practices of Hispanics and non-Hispanic whites who have diabetes. Methods: Locally hired bilingual personnel conducted in-person interviews of a random selection of 1,863 adults in 20 communities in the Yakima Valley of eastern Washington State. Findings: A total of 70 Hispanics (11% age-adjusted prevalence) and 87 non-Hispanic whites (7.3% age-adjusted prevalence) reported having type 2 diabetes. Hispanics with a high level of acculturation were slightly more likely to have diabetes, compared to those with a low level of acculturation, though the association was nonsignificant. Hispanics were significantly less likely than non-Hispanic whites to treat their diabetes with diet and exercise (36% vs 61.3%; P ≤ .001). Annual eye examinations were less commonly reported among Hispanics (48.9%) than among non-Hispanic whites (72.7%). Conclusions: Our data indicate that Hispanics engage less frequently in self-management practices to control diabetes than non-Hispanic whites.




Factors in Recruiting and Retaining Health Professionals for Rural Practice
Zina M. Daniels, Betsy J. VanLeit, Betty J. Skipper, Margaret L. Sanders, Robert L. Rhyne

Context: Rural communities, often with complex health care issues, have difficulty creating and sustaining an adequate health professional workforce. Purpose: To identify factors associated with rural recruitment and retention of graduates from a variety of health professional programs in the southwestern United States. Methods: A survey collecting longitudinal data was mailed to graduates from 12 health professional programs in New Mexico. First rural and any rural employment since graduation were outcomes for univariate analyses. Multivariate analysis that controlled for extraneous variables explored factors important to those who took a first rural position, stayed rural, or changed practice locations. Findings: Of 1,396 surveys delivered, response rate was 59%. Size of childhood town, rural practicum completion, discipline, and age at graduation were associated with rural practice choice (P < .05). Those who first practiced in rural versus urban areas were more likely to view the following factors as important to their practice decision: community need, financial aid, community size, return to hometown, and rural training program participation (P < .05). Those remaining rural versus moving away were more likely to consider community size and return to hometown as important (P < .05). Having enough work available, income potential, professional opportunity, and serving community health needs were important to all groups. Conclusion: Rural background and preference for smaller sized communities are associated with both recruitment and retention. Loan forgiveness and rural training programs appear to support recruitment. Retention efforts must focus on financial incentives, professional opportunity, and desirability of rural locations.



Gender Differences in Rural and Urban Practice Location Among Mid-level Health Care Providers
Sally Lindsay

Context: Mid-level providers comprise an increasing proportion of the health care workforce and play a key role in providing health services in rural and underserved areas. Although women comprise the majority of mid-level providers, they are less likely to work in a rural area than men. Maldistribution of health providers between urban and rural practices is an important issue influencing health care. Purpose: To gain further insight into this issue, this study examined how mid-level practice location varied by gender. Methods: Semistructured interviews were conducted with a purposive sample of 55 nurse practitioners, physician assistants, and nurse anesthetists in New York State and Pennsylvania. Findings: Results suggest that family and community ties played a key role in influencing practice location. Men were particularly drawn to the broad scope of practice and autonomous nature of rural practice. Women in rural areas enjoyed the more personable environment and greater respect from colleagues and patients. Both male and female rural providers preferred their location because there were fewer turf issues, while some women were concerned about being professionally isolated. Meanwhile, both men and women enjoyed the fast pace, specialization, and greater opportunities urban areas had to offer. Conclusions: Recruitment efforts should focus on candidates from rural areas and not underestimate the impact of family in decisions about work location.



Rural Health Professions Education at East Tennessee State University: Survey of Graduates From the First Decade of the Community Partnership Program
A. Florence, Bruce Goodrow, Joy Wachs, Susan Grover, Kenneth E. Olive

Context: To help meet rural Appalachian needs, and with initial support from the W.K. Kellogg Foundation, East Tennessee State University partnered with 2 counties to implement a health curriculum for nursing, public health, and medical students in a rural setting. The Community Partnerships Program 3-year longitudinal curriculum included theoretical, conceptual, and practice elements of the 3 disciplines incorporated into an experiential, inquiry-based, service-learning program. Interdisciplinary learning, problem solving, and reinforcement of career choices in medically underserved rural communities were emphasized. Purpose: To compare career choices, attitudes, and practice locations of Community Partnerships Program graduates with traditional graduates. Methods: Surveys were mailed to Community Partnerships Program and traditional program graduates matriculating from 1992 to 2002 (response rates 58/84 and 72/168, respectively). Findings: Community Partnerships Program graduates indicated a significantly greater interest in rural primary care, care for the underserved and interdisciplinary group collaboration, and were more likely to practice in rural locations than did their traditionally educated peers. Family, personal factors, and the availability of employment were major influences in determining the decision to choose a career in a rural location. Community Partnerships Program graduates indicated they were better prepared to work in interdisciplinary teams and were more likely to work in community-based programs and activities than did the traditional graduates. Conclusion: A program that enrolls students interested in rural health care and provides training in rural communities produces graduates who will practice in rural areas.




Assessing Health Disparities in Rural Hawaii Using the Hoshin Facilitation Method
Kelley Withy, January May Andaya, Judith S. Mikami, Seiji Yamada

Context: Health disparities between rural and urban communities are well documented. There are many suggested causes and many proposed solutions but no one-size-fits-all answer. The most successful community interventions have been introduced by communities themselves. However, before communities invest in such interventions, each group must identify and prioritize their needs. Purpose: This article describes the Hoshin facilitation method as a practical option assisting communities in assessing their needs and gaining consensus for future steps. Methods: Thirty-four meetings were held in 11 rural communities in Hawaii using the Hoshin process to identify factors that impact rural health. Themes were identified by constant comparative analysis and thematic frequency described. Commonality of responses between communities was examined. Informal feedback was collected from meeting participants. Findings: There was a great deal of commonality between community responses, with economic factors, drug use, lack of community leadership, lack of health care services and access to services, lack of healthy activities for youth, and poor public education being the most common issues noted. Group involvement in the meetings was high, and the facilitation method received positive feedback from participants. Conclusions: The Hoshin facilitation method is a very useful tool to help communities rapidly identify and prioritize areas for programmatic attention.




Initiation of Farm Safety Programs in the Arkansas Delta: A Case Study of Participatory Methods
Jan S. Richter, Becky G. Hall, G. David Deere

Context: Outreach to high-risk communities is one of the goals of Area Health Education Centers. One such population is the farm community, which is known to suffer high rates of traumatic events. Purpose: To describe a participatory methods initiative by the Arkansas Delta Area Health Education Center and other agencies to address farm-related health hazards in a 7-county region. Methods: Regional injury and fatality data were gathered from sources including Arkansas Farm Bureau Federation insurance claims, the Arkansas Statistical Service Phone Survey, the National Agricultural Statistics Service, and the Cooperative Extension Service Division of Agriculture at the University of Arkansas. Focus groups were held to assess farmer perceptions and recommendations. Findings and Recommendations: Accidents involving tractors accounted for 42% of deaths, and accidents with crop-spraying aircraft accounted for 36%. Focus group participants agreed that planting and harvesting seasons were particularly dangerous. Recommendations included educating motorists to be more cautious on agricultural area roads, using local farmers to provide farm safety training, and making safety equipment more available.


Identifying Rural Health Care Needs Using Community Conversations
Patricia L. Moulton PhD, Marlene E. Miller MSW, LCSW, Sue M. Offutt PhD, Brad P. Gibbens

Context: Community input can lead to better-defined goals in an organization. With this in mind, the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences embarked on a series of 13 meetings with representatives of organizations serving rural communities, including 5 Native American reservations. Purpose: To give a detailed description of the steps involved in planning, and the outcomes and lessons learned from the meetings. Organizations will be able to use this information when incorporating community involvement as part of their planning process. Project: Each meeting included a presentation of the Center for Rural Health efforts throughout the state and a discussion in which residents were asked about health care barriers they have encountered and how the Center for Rural Health could align its efforts to assist communities. Conclusions: The conversations from these meetings have provided a wealth of information about barriers to providing quality health care facing rural and Native American residents. The Center for Rural Health has incorporated this information into its strategic planning process and has formed several work groups to address issues raised. Community conversations allow organizations to better determine priorities that will be valid and realistic to the communities they serve.



Australia


Australian Journal of Rural Health



2007; 15 (1)
issue includes:



Consideration of the determinants of women's mental health in remote Australian mining towns
Sanjay Sharma, Susan Rees

Families in remote mining towns constitute a specific sociological group living under unique geographical and sociocultural circumstances. Isolation from friends and relatives and limited resources and opportunities for family members of mine workers are some of the distinct disadvantages of these towns. Decades ago it was observed that a large number of women in new and remote mining towns suffered from neurotic problems. In contemporary times there is a deficit of knowledge about the mental health of women in remote mining towns. However, there are certain indicators of significant mental distress among women living in these particular environments. Deriving from a review of literature, this paper explores various mining work-related issues and sociocultural settings and processes within remote mining towns that could possibly exert coercive pressures on the psychological health of female partners of mine workers and their relationship well-being. The paper suggests that work schedules and preponderance of men in mining jobs help promote a patriarchal culture within the community and the family; thereby marginalising women to a secondary status. Limited opportunities and resources within the community isolate women to domestic lives; while atypical work rosters associated with mining employment could negatively impact on the relationship well-being of couples. The paper recommends that an inquiry into psychiatric well-being among women of remote mining communities needs to consider the sociocultural structure and processes within these communities, and the structural nature of the mining job that could be responsible for role strain-induced stress and mental health problems among these women.



Double-bundle reconstruction of the anterior cruciate ligament
Thomas Nau, Matthew Spotswood

Injuries of the anterior cruciate ligament often present in rural practices and rural regional hospitals. Surgical reconstruction is the treatment of choice in the young and active patient. Better biomechanical understanding has led to a further improvement of the surgical technique. The double-bundle reconstruction, which aims to address both functional bundles of the anterior cruciate ligament, represents the latest development in this field. In this review article the basic biomechanical principles as well as a new surgical technique are presented for practitioners in rural practice and rural regional hospitals.



Medical students and rural general practitioners: Congruent views on the reality of recruitment into rural medicine
Diann Eley, Louise Young, Marilyn Shrapnel, David Wilkinson, Peter Baker, Desley Hegney

Objective: In-depth exploration of the perceptions, experiences and expectations of current long-term rural GPs and medical students intent on a rural career, regarding the current and future state of rural medicine.
Design: Qualitative study using semistructured interviews.
Setting: Rural and remote towns in Central and Southern Queensland and the School of Medicine, University of Queensland.
Participants: Thirteen rural GPs with 10-40 years experience. Medical students (five second- and seven third-year), all of whom are members of a rural students' club and have an intention to pursue rural practice. Interviews were conducted between August and December 2004.
Main outcome measures: Emergent themes relating to participant perceptions of the current and future state of rural medicine.
Results: Despite large differences in generation and experience, medical students and rural GPs hold similar perceptions and expectations regarding the current and future state of rural practice. In particular, they cite a lack of professional support at the systems level. This includes specific support for: continuing medical education to obtain and retain the skills necessary for rural practice; dealing with the higher risks associated with procedural work; and consequences of medico-legal issues and workforce shortage issues such as long hours and availability of locums.
Conclusions: Issues relating to recruitment and retention of the rural health workforce are identified by both cohorts as relating to professional support. Medical schools and institutional support systems need to join forces and work together to make rural practice a viable career in medicine.





Use of clinical placements as a means of recruiting health care students to underserviced areas in Southeastern Ontario: Part 1 - Student perspectives
Michelle MacRae, Kelly van Diepen, Margo Paterson

Objective: This two-part study examines the present gap between financial and educational incentives required and the recruitment strategies used to draw health science students to underserviced areas in Southeastern Ontario. Part 1 explores the impact of offering travel stipends, rent-free accommodation and interprofessional educational opportunities to health science students on their willingness to participate in clinical placements in underserviced areas.
Design: Mixed-method two-part study using a self-administered questionnaire.
Setting: Canadian university campus.
Participants: Four hundred and sixty-eight senior level medical, nursing, occupational therapy, physical therapy and X-ray technology students from a Canadian university and affiliated professional school.
Main outcome measures: The influence of currently established incentives on student willingness to complete a clinical placement in designated underserviced communities in Southeastern Ontario.
Results: Based on a 75% response rate, the results demonstrate that, in general, students agree that they are more willing to complete a clinical placement in an underserviced community if provided travel stipends (75%), rent-free housing (92%) and interprofessional educational opportunities (65%). Students also identified 15 additional factors influencing willingness.
Conclusions: Students are more willing to complete clinical placements in underserviced communities if provided incentives. The findings of this study support an interprofessional clinical education and recruitment enhancement program in Southeastern Ontario.




Use of clinical placements as a means of recruiting health care professionals to underserviced areas in Southeastern Ontario: Part 2 - Community perspectives
Kelly van Diepen, Michelle MacRae, Margo Paterson

Objective: Part 2 of this two-part study identifies current recruitment strategies and existing incentives used by underserviced communities to recruit health science students during the clinical placement stage. Discussion surrounding current gaps in recruitment strategies and potential funding sources are explored.
Design: Mixed-method two-part study using a self-administered questionnaire.
Settings: Six community hospitals and one private practice.
Participants: Community resource contact from seven underserviced communities in Southeastern Ontario.
Main outcome measures: Level of community agreement that current recruitment strategies include travel stipends, rent-free accommodation and interprofessional education opportunities.
Results: A 100% response rate established that one sample community provides travel stipends, three provide rent-free accommodation, and four offer interprofessional education opportunities. These incentives were frequently offered exclusively to medical students.
Conclusions: When considering the results from part 1 of the study, there is a substantial gap between financial incentives students deem important in the creation of an appealing clinical placement opportunity and the provisions offered to them by the sample communities. The findings of this study support the need for a recruitment enhancement program in Southeastern Ontario.




'Shared Care - Shared Dream': Model of shared care in rural Australia between mental health services and general practitioners

D. Chinna Samy, Philip Hall, Jacquie Rounsevell, Rodney Carr

Objective: To identify a working model between rural and remote mental health services and the local GPs in Australia.
Design: Postal questionnaire to assess the GPs' satisfaction level with the involvement of the mental health services in their ongoing management of mentally ill in the community.
Result: There was a greater sense of satisfaction with the mental health services over the five years this program was implemented.
Conclusion: This study offers a model on how a rural mental health service could enter into a shared care program with the local GP practice and achieve a greater level of satisfaction in serving the rural communities in Australia.




Medical clinic facilities and doctor characteristics: What older rural men value

Fiona J. Newton, Michael T. Ewing, Sue Burney, Dianne Vella-Brodrick

Objective: To identify the medical clinic facilities and doctor characteristics deemed important to older men living in a rural area of Australia.
Design: Cross-sectional study using a self-report questionnaire.
Setting: Mildura Rural City Council, located in north-west Victoria.
Participants: Eighty-two men aged 55 + years living in the precincts of the Mildura Rural City Council with the capability to read and write in English.
Main outcome measures: Factors perceived as important characteristics of medical facilities and GPs.
Results: Between high- and lower-income-status participants, the provision of bulk-billing services was a significant predictor of clinic features deemed essential. Approximately 70% of participants wanted a GP who conveys information in an understandable manner and allows them time to ask questions and to discuss their problems. Participants perceived GP qualifications as more important than gender or nationality.
Conclusions: The findings highlight the need for medical training institutions to ensure that medical graduates have well-developed communication skills. Older men on low incomes are particularly concerned about the provision of bulk-billing services. Any further reduction to the number of these services has the potential to further limit patient choice of GP and might have significant implications for general well-being.



Health professional partnerships and their impact on Aboriginal health: An occupational therapist's and Aboriginal health worker's perspective
Kerry Hooper, Yvonne Thomas, Michelle Clarke

Objective: To describe the extent and nature of demonstrated professional partnerships between occupational therapists and Aboriginal health workers in rural and remote communities of North Queensland. The study identifies ways in which professional partnerships improve client services and enhance occupational therapy outcomes through exploring the aspects of communication, collaboration and bridging cultural boundaries.
Design: Data collected via in-depth, semistructured telephone interviews.
Setting: Aboriginal and mainstream health and human service organisations in rural and remote North Queensland. Rural and remote areas were identified using the Accessibility and Remoteness Index of Australia codes.
Participants: Seven participants working in rural and remote areas of North Queensland, comprising four occupational therapists and three Aboriginal health workers. All participants were female.
Results: Participants identified five core themes when describing the extent and nature of professional partnerships between occupational therapists and Aboriginal health workers. Themes include: professional interaction; perception of professional roles; benefits to the client; professional interdependence; and significance of Aboriginal culture. According to participants, when partnerships between occupational therapists and Aboriginal health workers were formed, clients received a more culturally appropriate service, were more comfortable in the presence of the occupational therapist, obtained a greater understanding of occupational therapy assessment and intervention, and felt valued in the health care process.
Conclusions: This study substantiates the necessity for the formation of professional partnerships between occupational therapists and Aboriginal health workers. The findings suggest that participation in professional partnerships has positive implications for occupational therapists working with Aboriginal clients and Aboriginal health workers in rural and remote regions of North Queensland.



Cultural and communication awareness for general practice registrars who are international medical graduates: A project of CoastCityCountry Training
Geraldine F. Duncan, David Gilbey

Objective: (1) To generate discussion about Australian culture and language with GP registrars using the medium of poetry; and (2) to introduce discussion about language and communication skills in a role-play format that GP registrars would embrace as part of their clinical training.
Design: (1) A variety of Australian poems was selected to reflect six themes: men, women, the Bush, ANZACS, Aboriginal Australia and migrants, which would provide a basis for discussion on a range of cultural issues to aid a medical professional trained overseas in developing further understanding of aspects of Australian culture. (2) A series of role plays was developed to reflect the clinical themes of each Day Release education program. These were enacted in a small group setting by preselected GP registrars with feedback from a medical educator and an English as a Second Language teacher.
Setting: The Riverina/Murrumbidgee area of New South Wales, one of the three local training groups of CoastCityCountryTraining.
Participants: GP registrars attached to the Riverina/Murrumbidgee Local Training Group.
Main outcome measures: To show that discussion of poetry and participation in role plays are active language- and cultural-learning environments capable of enhancing understanding of a range of issues about Australia that are relevant to a GP registrar.
Results: There was increased participation by GP registrars in accessing the set material prior to each session. It was noted that there was also increased active involvement of all registrars in discussion within the group throughout the year. Discussion allowed clarification of aspects of Australian culture to participants with different international medical backgrounds, as well as providing an opportunity for GP registrars to share their own experiences.



Informing rural and remote students about careers in health: The effect of Health Careers Workshops on course selection
Robert M. Eley, Natalie Hindmarsh, Elizabeth Buikstra

Objective: Since 1994, as part of the Health Careers in the Bush program, Queensland Health has run residential workshops to provide secondary school students from rural and remote areas with information about health careers. This study reports on the influence of the program on tertiary course selection.
Design: Self-administered mail survey and telephone interviews.
Setting: Secondary schools.
Participants: Past students who had in year 10 attended residential career workshops run by Queensland Health.
Main outcome measures: Tertiary courses; self-reported influence of the workshop program on raising awareness and course selection.
Results: Over 90% of participants reported that the workshops had a major impact on their course and career selection. The workshops provided exposure to a wide variety of health-related disciplines, enabling students to be better informed about their course and career plans within the industry. Half of the students changed their course as a result of attending a workshop, and 83% enrolled in a health-related course. The 17% who did not enrol in a health-related course also recognised the value of the workshop program.
Conclusion: The workshop program raised awareness of health professions and offered valuable information to rural students about a wide range of health careers. Results suggest that provision of such information in a residential-workshop format contributed significantly to tertiary course selection of rural and remote students. The benefit to the health industry from these workshops has been substantial in relation to the small amount of funds invested.


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