Rural and Remote Health Rural and Remote Health is an open-access international academic journal serving rural and remote communities and publishing articles by rural health practitioners, educators, researchers and policy makers. en-gb Thu, 08 Jun 23 15:47:39 +0000 Papir Journal Platform (Melissa Storey) (Webmaster) Rural and Remote Health Significant delay and decreased chance of treatment for acute ischemic stroke patients on remote outer islets of China compared with the main island: the PUTUO Study China has the heaviest burden of stroke in the world, and this burden has increased in the past 30 years. Stroke outcomes are worse in rural areas than in urban areas as a result of poorer living conditions but also because of the time it takes to access time-sensitive treatment. Rural and regional clinics and hospitals often lack the necessary imaging equipment and there is often a long travel distance to access appropriate care. Using data available in patient records, this Original Research article reports on the time lags from the onset of stroke symptoms to arrival at a stroke center for two archipelagic regions in China: main island (urbanized) and outer islets (rural). Wed, 07 Jun 23 00:00:00 +0000 Extent of caregiver burden among informal caregivers of persons with severe mental disorders in rural South Africa Severe mental disorders (eg major depressive disorder, bipolar mood disorder, schizophrenia and other psychotic disorders) affect 4% of the adult population globally and account for 26.1% of reported mental disorders in South Africa. Informal caregivers are the backbone of recovery for persons with severe mental disorders, particularly in rural areas where access to mental health services is limited. This article reports on the extent of subjective and objective burdens among informal caregivers of persons with severe mental disorders in rural South Africa. Fri, 02 Jun 23 00:00:00 +0000 Relative remoteness and wage differentials in the Canadian allied health professional workforce This unique population-based study explored the role of wage differentials among allied health professionals across urban, rural and remote settings. Important imbalances were found in the gender and geographic distribution of the allied health workforce, although the impact of wage was not demonstrated as a financial incentive for rural and remote practice. This paper adds considerably to the rural healthcare literature by focusing on AHPs, a critical asset for the healthcare system. Fri, 02 Jun 23 00:00:00 +0000 Frequency and determinants of technical procedures in French general practice: a cross-sectional study In general practice, technical procedures have many areas of application, including prevention (eg vaccination or cervical smear), diagnosis (eg group A streptococcus testing), and treatment (eg wound dressing). These procedures require specific skills that are based on both knowledge and manual abilities. Along with communication, knowledge, clinical reasoning, emotions, values and reflection, technical skills are a dimension of medical competence and a part of the general practice curriculum in many countries. Lists of core technical procedures have been developed in Canada, the USA and Australia to serve as bases for training general practice students, but none is currently available in France. This study uses data collected as part of the ECOGEN study from 20,613 patient–GP encounters in rural and urban locations to describe the frequency and type of technical procedures in French general practice. Thu, 25 May 23 00:00:00 +0000 Barriers to rural health care from the provider perspective Rural populations routinely rank more poorly than urban populations on common health indicators. Although the complex interplay of various social determinants of health may partially explain this, some of this disparity may result from unique challenges healthcare providers face in rural settings. This Original Research article identifies several multidimensional barriers to healthcare access by patients and provision by healthcare providers in rural western Pennsylvania, USA. Patients experience cost-related barriers, more providers are needed to combat workforce shortage and burnout, and care delivery methods such as telehealth, satellite clinics, or advanced practice providers can help bridge the gaps caused by geographic dispersion. The authors recommend that policy efforts target all these aspects to appropriately address rural healthcare needs. Wed, 17 May 23 00:00:00 +0000 Developing conceptually sound items for a clinical courage questionnaire With the worldwide shortage of physicians living and practicing in rural and remote areas, it is important to understand better the nature of rural practice. A recent study that investigated the lived experience of rural doctors introduced the concept of clinical courage: a rural doctor's adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This article describes the steps taken to develop a sound clinical courage questionnaire and presents the questionnaire, ready for testing with rural clinicians and refinement. Sun, 07 May 23 00:00:00 +0000 Aeromedical retrievals as a measure of potentially preventable hospitalisations and cost comparison with provision of GP-led primary health care in a remote Aboriginal community Kowanyama, a very remote community in Cape York, northern Queensland, has a very high burden of disease and is ranked among the top five most disadvantaged communities in Australia. The community has access to 2.5 days per week of fly-in, fly-out GP-led Primary Health Care (GPLPHC) for a population of 1200 people. All patients requiring higher-level health care undergo aeromedical retrieval to a larger centre. This Short Communication reports that, on the basis of a clinical audit of aeromedical retrievals in 2019, greater access to GPLPHC may lead to fewer retrievals/hospital admissions for potentially preventable conditions and it might be cost-effective and improve patient outcomes to have a full-time on-site Rural Generalist GP-led service in this and other remote communities. Thu, 27 Apr 23 00:00:00 +0000 Factors influencing the retention of specialist doctors in the placement area: realist evaluation approach in the specialist doctor utilization program Attracting and retaining healthcare workers in remote and rural areas is still a global challenge, but is critical for achieving sustainable development goals. In Indonesia, to meet the target of universal health coverage, the government has established the National Social Security System - Healthy Indonesia Card with the Social Security Administering Agency managing health insurance and services for the community. To support this, it is necessary to have an equal distribution of health workers, including specialist doctors in hospitals. This Original Research study analyses the contextual factors that influence the retention of specialist doctors in rural Indonesia. Wed, 19 Apr 23 00:00:00 +0000 Nurses’ preparedness for disaster response in rural and urban primary healthcare settings in Tanzania Nurses are often on the frontline of disaster management, providing care to patients with physical, mental, and emotional turbulence and acting as educators for disaster prevention. However, the literature suggests that nurses are underprepared to respond to disasters. This study examined the preparedness for disaster response among nurses in rural and urban primary healthcare settings in Tanzania. The results suggest that nurses are poorly prepared for disaster responses, while those in rural settings are at a great disadvantage. Mon, 17 Apr 23 00:00:00 +0000 Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management Delivering high-quality medical education in rural areas is of critical importance for producing skilled graduates who may be more inclined to later practice rurally. However, little attention has been given to understanding how rural clinical training may impact patients, host organisations, and rural communities where students undertake their training, despite engagement from these stakeholders being crucial to the success of rural training opportunities. This article describes how a series of consecutive student placements in a single practice of a small rural community have driven a series of clinical audits and interventions that continuously fed into the next placement, resulting in improved management of chronic disease. This evidence is important in demonstrating the impact that rural clinical training can have on health care and local health outcomes, while maintaining a high-quality student experience, and for identifying the program elements contributing to its success so that similar strategies can be more widely adopted. Mon, 17 Apr 23 00:00:00 +0000 Impact of SARS-CoV-2 on surgical services in a Scottish remote and rural setting The SARS-CoV-2 (COVID-19) pandemic brought about instability in healthcare providers worldwide, including in rural settings. In 2020, non-urgent elective care was suspended to free up hospital capacity in response to the pandemic. This Original Research article reports on the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland. Sun, 16 Apr 23 00:00:00 +0000 The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study People residing in rural areas of New Zealand have poorer health outcomes than those living in urban areas and this is accentuated for Māori. Internationally, in high income-countries, rural hospitals have been recognised as important healthcare providers, improving access to and integration of health services for rural communities. It is estimated that around 15% of New Zealanders rely on rural hospitals for health care, but there is no current description of rural hospital services and little published research regarding their role or value. This Original Research article presents the results from an exploratory study of the perspectives of rural hospital leadership on the place of rural hospitals in the New Zealand health system. Thu, 13 Apr 23 00:00:00 +0000 The development of accessible and sustainable transgender health education for rural-serving medical providers in Appalachia Transgender patients experience a myriad of barriers to accessing health care and receiving high-quality, non-discriminatory care. In rural Appalachia, people with intersectional identities often have limited choices in providers along with other systemic barriers to obtaining competent and safe health care and experience increased risk of poorer health outcomes. This article reports on the development and implementation of a transgender healthcare provision training program for rural-serving medical residents in primary care in South Central Appalachia. Wed, 12 Apr 23 00:00:00 +0000 Using the socio-ecological model to appraise perspectives on health workforce retention and intention to leave in Malawi and Tanzania: a qualitative longitudinal study Although the output from health training institutions is increasing in most low-resource settings, the rural workforce availability remains low and suffers frequent rural-urban attrition. Improved retention - having healthcare workers stay longer in the post - is likely to alleviate the crisis. We interviewed healthcare workers and policymakers in Malawi and Tanzania to explore their perspectives on factors affecting retention. While policymakers' views centred around the national-level retention policies, health workers considered the welfare of families and the immediate community more important in deciding to stay or relocate from a post. This article highlights the need to align retention policies with healthcare workers' expectations. Thu, 30 Mar 23 00:00:00 +0000 Time to commencement of effective treatment in patients with drug-resistant tuberculosis diagnosed in the Torres Strait-Papua New Guinea cross-border region In Papua New Guinea (PNG), tuberculosis (TB) is the leading cause of death from an infectious agent and many cases are multidrug-resistant. Optimising models of care for TB patients living in the Torres Strait/PNG international border region has been particularly difficult; geographical, geopolitical and socioeconomic challenges in the region have created healthcare disparities that affect diagnosis, referral pathways, treatment and management of TB patients. Delays between symptom onset and commencement of effective treatment contribute to ongoing TB transmission. This study assessed improvements in time to commencement of effective treatment in patients diagnosed with drug-resistant TB in the Torres Strait/Papua New Guinea cross-border region. Tue, 28 Mar 23 00:00:00 +0000 Fostering community engagement, participation and empowerment for mental health of adults living in rural communities: a systematic review Poor mental health is under-recognised in rural locations. Although the prevalence of mental disorders is similar in rural and urban areas, suicide rates are 40% higher in rural communities. The level of readiness and engagement of rural communities to adapt to, or even acknowledge, poor mental health can impact effective interventions. This Review examines how community engagement, participation and empowerment were used in the development and implementation of interventions aimed at improving mental health of adults residing in rural communities of the USA, UK and Guatemala. Sun, 26 Mar 23 00:00:00 +0000 What tuberculosis infection control measures are effective in resource-constrained primary healthcare facilities? A systematic review of the literature Despite the availability of preventive medication, tuberculosis (TB) kills millions of people every year. People in vulnerable populations (eg people with HIV/AIDS, health professionals, and those living in poverty) in low and middle-income countries are at particularly high risk. Practical public health strategies are required to effectively reduce the global TB burden. TB infection control measures emerged as a potential preventive public health strategy to prevent TB transmission in a health setting and spreading into the community. This review examined the current evidence for tuberculosis infection control measures, including administrative, environmental, and respiratory controls, in reducing TB transmission and explored the barriers and enablers of these measures in resource-constrained primary healthcare settings. Wed, 22 Mar 23 00:00:00 +0000 Debriefing after critical incidents in rural and remote healthcare settings - a remote clinician perspective Debriefing following a critical incident is utilised across many different fields, including the military, aviation and health care, and is associated with clear benefits for team performance. Healthcare professionals working in rural and remote areas face a variety of unique barriers that may make debriefing challenging. This Commentary presents an example that illustrates the complexities of a critical incident in a remote service and outlines evidence-based strategies to support team members in rural and remote areas to debrief effectively, including the use of technology, formal teaching in university curriculums and regular practice via simulation. Wed, 22 Mar 23 00:00:00 +0000 Osteopathy in rural and remote Australia: analysis of demographic, practice and clinical management characteristics from a nationally representative sample of 992 osteopaths Significant policy initiatives have been implemented in Australia to ensure people in rural and remote areas have appropriate access to health services, with increasing interest in allied health. The allied health focus has been centred on pharmacy and physiotherapy so far, and there is limited evidence about the role osteopathy plays in rural and remote populations. In Australia, osteopaths are university-trained and government-registered allied health professionals who manage predominantly musculoskeletal complaints using manual therapy, exercise and patient education. This Short Communication reports on the demographic, practice, and clinical management characteristics of Australian osteopaths in rural and remote settings. Tue, 21 Mar 23 00:00:00 +0000 Teleneurology via tablet technology: an effective low-cost method to increase healthcare accessibility This research reports on patient and community physician satisfaction with a teleneurology program that provided consultations to 14,241 patients at 12 community-based hospitals between 2014 and 2021. Results show high levels of satisfaction with using tablet technology for teleneurology consultation. Mon, 20 Mar 23 00:00:00 +0000