Sharing Narratives Online: An international, self-organising curriculum in rural health

The aim of the Rural Medicine Rotation (RMR) at the University of Queensland (UQ) is to give all third year medical students exposure to and an understanding of, clinical practice in Australian rural or remote locations. A difficulty in achieving this is the relatively short period of student clinical placements, in only one or two rural or remote locations. A web-based Clinical Discussion Board (CDB) has been introduced to address this problem by allowing students at various rural sites to discuss their rural experiences and clinical issues with each other. The rationale is to encourage an understanding of the breadth and depth of rural medicine through peer-based learning. Students are required to submit a minimum of four contributions over the course of their six week rural placement. Analysis of student usage patterns shows that the majority of students exceeded the minimum submission criteria indicating motivation rather than compulsion to contribute to the CDB. There is clear evidence that contributing or responding to the CDB develops studentâ??s critical thinking skills by giving and receiving assistance from peers, challenging attitudes and beliefs and stimulating reflective thought. This is particularly evident in regard to issues involving ethics or clinical uncertainty, subject areas that are not in the medical undergraduate curriculum, yet are integral to real-world medical practice. The CDB has proved to be a successful way to understand the concerns and interests of third year medical students immersed in their RMR and also in demonstrating how technology can help address the challenge of supporting students across large geographical areas. We have recently broadened this approach by including students from the Rural Program at The Ohio State University College of Medicine. This important international exchange of ideas and approaches to learning is expected to broaden clinical training content and improve understanding of rural issues.

Rural Health Program Update, 2014

Rural Health works with key partners to explore and fund innovative means of delivering rural health services.

Iowa Rural Health IT Collaborative "It Worker", December 19, 2012

The purpose of this paper is to share information about the Iowa Rural HIT Collaborative efforts to help rural hospitals and providers attain electronic medical records meaningful use status. Information from this paper can be helpful to others who are pursuing solutions related to integration of health information technology in rural areas.

Key Facts in Rural Health : Vulnerable Rural Counties : The Changing Rural Landscape, 2000-2010

In 2008, the U.S. experienced its worst recession since the Great Depression, particularly affecting rural America. The South Carolina Rural Health Research Center used county-level data to examine rural demographic changes over the last decade. Most counties experienced increased levels of poverty between 2000-2010. Rural counties were disproportionately affected. Rural counties experienced a growth in the 65 and older population while losing children. Rural counties gained in racial/ethnic diversity.

New money for mental health : will it make things better for rural and remote Australia?

New Australian government funding for the Better Outcomes in Mental Health Care initiative is a significant step forward for mental health, with general practitioners now able to offer direct referrals to psychologists, social workers, occupational therapists and Aboriginal health workers. Incentives for better teamwork between GPs and other mental health professionals have been introduced, but may have unintended consequences, including an exacerbation of workforce shortages in rural and remote areas. Possible solutions to these shortages include rural scholarships for students in the mental health professions; recruitment and retention of students coordinated by university departments of rural health; better access to continuing professional development; and federally funded rural positions and additional financial incentives for rural mental health practitioners.

Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Improving transfer of mental health care for rural and remote consumers in South Australia

In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.

Preventive social health programs : are they Australia's answer to rising health care costs in rural communities?

Although we have good evidence to support the notion that early intervention, prevention and community education programs can mitigate the impact of preventable disease, expanded primary health care is also being promoted by Australian governments as a panacea for reducing growth in demand generally. While preventive programs do reduce acute demand, they may not do so the extent that resources, currently allocated to the acute sector, can be substituted to provide the additional primary care services necessary to reduce acute demand permanently. These developments have particular relevance for rural and isolated communities where access to acute services is already very limited. What appears to be occurring, in rural South Australia at least, is that traditional acute services are being reduced and replaced with lower level care and social intervention programs. This is well and good, but eventually the acute care being provided in rural health units now will still need to be provided by other units elsewhere and probably at much higher cost to the system and to consumers. Where rural communities have previously managed much of their own acute service demand, they may now be forced to send patients to more distant centres for care but at much greater social and economic cost to individuals and the system.

What health services within rural communities tell us about Aboriginal people and Aboriginal health

There is a growing body of literature within social and cultural geography that explores notions of place, space, culture, race and identity. When health services in rural communities are explored using these notions, it can lead to multiple ways of understanding the cultural meanings inscribed within health services and how they can be embedded with an array of politics. For example, health services can often reflect the symbolic place that each individual holds within that rural community. Through the use of a rural health service case study, this paper will demonstrate how the physical sites and appearances of health services can act as social texts that convey messages of belonging and welcome, or exclusion and domination. They can also produce and reproduce power and control relations. In this way, they can influence the ways that Aboriginal people engage in health service environments – either as places where Aboriginal people feel welcome, comfortable, secure and culturally safe and happy to use the health service, or as places where they utilise the service provided with a great deal of effort, angst and energy. It is important to understand how these complex notions play out in rural communities if the health and wellbeing of Aboriginal people is going to be addressed.

A sustainable approach to community based rehabilitation in rural and remote Australia

This paper presents a summary of an extensive review of the health, disability and rehabilitation literature conducted for the purposes of informing the formulation of a sustainable approach to community based rehabilitation in rural and remote Australia. It begins with a review of definitions of disability and rehabilitation, which is followed by differentiating 'rehabilitation in the community' and 'community based rehabilitation'. Finally, a network of community based rehabilitation coalitions is proposed as a sustainable approach to community based rehabilitation in rural and remote Australia. Each coalition would have a community rehabilitation facilitator and community specific database of resources, as well as a register of local community rehabilitation assistants who can support the work of health professionals by providing rehabilitation interventions under the latter's direction. In this approach, rehabilitation is conceptualised as being about people's lives rather than only a series of interventions provided by health care professionals. As such, rehabilitation becomes everybody's business.