Volume twenty-two, Issue 4

It seems certain that the near future will include the use of telemedicine in daily primary care practice, particularly in areas with widely dispersed populations where it has the potential to overcome the challenges caused by distance. During the recent COVID-19 pandemic, remote consultations helped reduce the level of contact between people and prevent cross-contamination, but privacy, security and quality of service are still issues to be resolved. This mixed-methods cross-sectional study reports on the changes in patient consultations in European rural primary care during the COVID-19 pandemic. Across all of the countries studied, senior rural family doctors preferred the more traditional teleconsultations (e.g. telephone) to the newer ones, such as video consultations.

Social support is often protective of health, particularly in the context of disaster. In 2016, Manabí province, Ecuador was the epicenter of one of the most destructive earthquakes in the country’s history. Manabí also has fragmented social and health services, and three out of every four people live in poverty. This study examines levels of social support, differences in social support among different demographic groupings, and relationships among social support and health outcomes and protective health behaviors in rural Manabí.

COVID-19 has caused unprecedented social and economic disruption, accompanied by the enactment of a multitude of public health measures to restrain disease transmission. These public health and social measures have had a considerable impact on lifestyle and mental wellbeing, which has been well-studied with metropolitan populations, but less well studied in rural areas. This study examined the associations between psychological distress and changes in SNAPS health behaviours (smoking, nutrition, alcohol, physical activity, sleep) since the onset of COVID-19 in a drought-affected rural Australian region.

This research examined the perspectives that rural residents from six Canadian provinces have about current suicide research information gaps and how research can be mobilized to reach rural communities. Findings point to several recommendations, particularly towards setting a lived experience agenda for rural suicidality research.

An adequate healthcare workforce is essential for the health of rural communities. Strategies to address rural health workforce challenges have often centred on the medical and nursing workforce; however, addressing the rural pharmacist workforce is also critical, as pharmacists are often the first point of contact for health advice. Initiatives have increased pharmacist supply but key issues such as poor attraction, recruitment, and retention to rural areas remain. This study presents a Pharmacy Community Apgar Questionnaire (PharmCAQ) to support the recruitment and retention of pharmacists in rural areas.

According to the latest United Nations data, over half of the world’s population has access to the Internet. Patients’ use of online health information to investigate health matters before or after medical consultations has also increased; however, users do not necessarily have the knowledge or skills to determine the veracity of the information they find, potentially impacting their health status and their relationships with doctors. This study investigates how frequently rural primary care patients seek health information on the Internet and the factors associated with it.

On the North Coast of NSW, Aboriginal and/or Torres Strait Islander peoples have the highest rates of hospitalisations in the state for all health issues, including chronic disease. Low medication adherence rates in chronic disease are common among all population groups, so personal management of medication regimens and improvement of medication-taking behaviours may require various levels of support, education, engagement and barrier reduction from health services and or pharmacists. The use of Dose Administration Aids (DAAs) may improve medication management for some people, and therefore may facilitate positive health benefits. This study explores Aboriginal and Torres Strait Islander peoples’ lived experiences and preferences in relation to the use of DAAs.

As emergency care in rural areas is increasingly turning towards telemedicine, patient participation in tele-emergencies needs to be better understood. Patient participation, an important factor in a patient’s experience of health care, and involvement in decision-making can be challenged in emergency care by short encounters, deteriorating patients and a stressful work situation. This study explores the perspectives of healthcare professionals on patient participation in 'tele-emergencies' in northern rural Sweden.

Disasters significantly affect communities, economies and healthcare institutions globally. In rural and remote areas, where resources are already limited, disasters further disrupt the capacity of the health system to anticipate, adapt and cope. Nurses who work in rural and remote areas are often involved in disaster response, but their role remains largely under-reported. This Scoping Review provides an overview of the literature regarding the experiences of rural and remote nurses during and following disasters.

This scoping review identified articles that examined interprofessional education (IPE) and interprofessional practice (IPP) initiatives aimed at promoting interprofessional collaboration (IPC) in rural and remote primary healthcare (PHC) facilities. Findings point to barriers and facilitators to implementation of IPE and IPP in rural and remote PHC facilities.

Motor vehicle collisions (MVCs) are the leading cause of death for children and young adults globally. Rural areas have particularly high rates of MVC fatalities because of faster speeds, longer distances, lower quality road conditions, overstretched and low-resource health services that can be long distances away and more difficult access for emergency vehicles. The World Health Organization has predicted that without higher investment and evidence-based interventions, the sustainable development goal to ‘halve road traffic deaths by 2030’ will not be achieved. This scoping review examines the epidemiology, risk factors, prevention strategies and future research needs related to rural road fatalities in Australia and Canada.

Interprofessional education – when students from two or more professions learn about, from and with each other – is crucial for developing tomorrow's healthcare workforce. The Flinders Northern Territory Medical Program and University Department of Rural Health conducts an annual cultural immersion program near Katherine, Northern Territory, Australia to introduce students to local Aboriginal and Torres Strait Islander cultures and interprofessional learning. This evaluation reports on the views of staff, Aboriginal and Torres Strait Islander contributors and students about the program.

Planning for acute care of COVID patients in remote Central Australia was challenged by the vast distances between remote communities, poor access to acute health care for many communities and the difficulty for people with infection to isolate in conditions with overcrowding and poor quality housing. For remote living Indigenous people, there is a strong preference to receive care without leaving their community if at all possible. In response, the NT Health Central Australian Region service (NTHCAR) in partnership with The Royal Flying Doctor Service (RFDS) developed a risk stratification and remote support model for COVID on Country for remote communities. This Project Report describes the COVID on Country program and discusses lessons learned by its implementation.

After a COVID-19 outbreak in the Torres and Cape region of Far North Queensland in December 2021, a COVID-19 Care at Home program was created to support the health and non-health needs of COVID-19 cases and their families throughout the mandatory isolation periods. The program included centralising the coordination and delivery of COVID-19 therapeutics. It demonstrated a novel, public-health-led approach to delivering time-critical medications across a large, remote, and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.

Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) are often used to treat dyslipidaemia in patients with high cardiovascular risk. Liver toxicity is a known but rare side effect of statins, but little has been reported of the role of different statins in the susceptibility to liver injury. This Research Letter reports on a case that illustrates that single statins have different risk profiles for liver toxicity.