VALUE-ADDING IN THE RURAL TRAINING STREAM: A RELEASE PROGRAM FOR HOSPITAL-BASED RURAL TRAINING STREAM REGISTRARS

ABSTRACT: This paper describes a release program developed in 1995 for year 1 hospital based GP registrars in the Rural Training Stream of the Royal Australian College of General Practitioners Training Program in South Australia. Background, objectives, content and organisation, and evaluation are described. The 1996 program that developed from this pilot is also described.     

EVALUATION OF THE PROVISION OF FIELD WORK TRAINING THROUGH A RURAL STUDENT UNIT

ABSTRACT: A Rural Student Unit was established as a pilot project to trial a model of rural fieldwork placement provision. The Unit aimed to increase the number of student placements available in rural areas and provide undergraduate students with a positive fieldwork experience. The results indicate that the Unit was successful in overcoming some of the barriers to rural fieldwork, for both students and supervisors, and substantially increased the number of students undertaking fieldwork in this area. The results support the further trialling and expansion of the model.     

THE UNIVERSITY OF SYDNEY RURAL CAREERS PROJECT: A NURSING PERSPECTIVE

ABSTRACT: This paper describes the nursing involvement in the University of Sydney Rural Careers Project. Funded by the Rural Health Support Education and Training (RHSET) programme, the project was initiated to stimulate the awareness of undergraduate healthcare students to the professional opportunities within the rural setting. During 2 years of operation meetings have been convened for interested students to learn about working and living conditions in a rural community. Speakers from a variety of healthcare settings have provided a wide range of insights into rural working and social conditions. Scholarships are offered to cover travel and accommodation costs for students to attend placements in rural areas and annual excursions to rural communities provide students with experience of rural life and health-care practice. Although the limitations of such activities are acknowledged, it is believed that students who have several positive experiences of rural professional life may be more likely to try a longer period after graduation.     

EDUCATION AND TRAINING: ROLE OF RURAL HEALTH TRAINING UNITS

ABSTRACT: To improve the adequacy and appropriateness of education and training of the rural health workforce, Commonwealth and State governments have undertaken several initiatives. Foremost is the establishment of Rural Health Training Units (RHTU) in regional centres across Australia. While the structure and emphases of RHTU vary to meet the specific circumstances of regions, the recent National Association of Rural Health Training Units' Conference agreed with the Australian Health Ministers' Advisory Council's recognition of the need to develop a common set of principles and objectives to guide education and training for rural health workers. A national framework that identifies the role of RHTU within the broader State and Commonwealth context was outlined. This framework formed the basis for recommendations governing the future role of RHTU in achieving national health goals, and the education and training objectives of State and National Plans.     

RURAL HEALTH IN QUEENSLAND: A CHANGING FOCUS

ABSTRACT: This paper describes the development of Queensland's rural health policy approach over the past 5 years. The period is marked by significant political, structural and philosophical changes at state and departmental levels. The regionalisation of Queensland's public health services and introduction of strategic management, a commitment to social justice principles and a social view of health, and the acceptance of 'rurality' requiring a special focus have been key factors in the rural health policy arena. Queensland's policy formulation process was also influenced by national developments in the emergence of a national rural health strategy. In addition, the recognition that outcomes for rural communities reflect decisions made by a number of agencies has seen the creation of new and influential rural policy co-ordinating bodies with a total Government focus.     

UNRESOLVED HEALTHCARE ISSUES IN RURAL AND REMOTE AUSTRALIA: PRELIMINARY FINDINGS FROM A NATIONAL RURAL HEALTH UNIT SURVEY

ABSTRACT: A preliminary analysis of a survey answered by 317 health practitioners with interests in heath in rural and remote Australia is described. The most important unresolved issues in rural health were service delivery problems, difficulties experienced with attracting and retaining staff, continuing education, Aboriginal health and shortage of finance.     

TRAINING AND SUPPORT PROGRAM FOR PHARMACISTS IN RURAL VICTORIA

ABSTRACT: The 'Rural Pharmacist Training and Support Program' was a pilot project that was conducted by the Monash University Centre for Rural Health. It examined the implementation of Pharmacy Board of Victoria Guidelines to Residential Care Facilities in the Loddon Mallee region of Victoria. Through a series of workshops, pharmacists were encouraged to discuss and address difficulties that were impeding implementation of the guidelines. These included upskilling in clinical pharmacy and ways to overcome the shortage of pharmacists in rural areas. Furthermore, the project was a catalyst for eight additional outcomes. This project highlighted the challenges facing rural pharmacists as they seek to implement the guidelines and resulted in a number of recommendations that addressed workforce issues, training and continuing education, Pharmacy Board requirements, improved communication with other health professionals and undergraduate training.     

A Model Rural Health Orientation Course Using Interdisciplinary,Community Oriented,Inquiry Based Strategies

Introduction to Rural Health was developed as the introductory course for the Community Partnerships in Health Education – a new curriculum educating students using interdisciplinary, community oriented, and inquiry based strategies. Medical students, nursing students, and public health students participated in an elective curriculum designed to teach interdisciplinary groups of students to deliver primary health care in under-served communities. The curriculum began with an intensive one-week course designed to introduce students to the community, its people, their health care needs, and the process of working in interdisciplinary groups. The course was taught using a variety of community based activities. Student evaluations indicated that students strongly agreed that the course objectives were met using this nontraditional methodology. Qualitative analysis indicated that students regarded the team-building aspects of the course as the most influential. Community members indicated a high level of satisfaction with their input in the developmental process and with the extent to which community resources and interests were included. This revised version was published online in July 2006 with corrections to the Cover Date.     

A PICTURE OF LOCATIONAL-OCCUPATIONAL DIVERSITY: AN ANALYSIS OF THE NEEDS OF RURAL AND REMOTE HEALTHCARE WORKERS WHEN WRITING RHSET APPLICATIONS

ABSTRACT: Methods for meeting the research needs of rural/remote health workers have been assessed on the assumption that these workers form a seemingly homogeneous group. This paper provides a picture of locational-occupational diversity not previously considered when addressing the needs of rural health workers writing research and project grant submissions. Rural/remote health workers and researchers were surveyed about their needs when seeking assistance with the development, implementation and evaluation of funded project/program proposals. New South Wales respondents were differentiated according to five geographical locations and 10 occupational categories. The results suggest that geographical location and occupational category are major factors in determining research requirements for rural/remote health workers and researchers, and should be considered when identifying barriers to the development and implementation of research projects in rural/remote health care issues. Those health workers most isolated required access to resource information and research and grant writing skills development, while researchers in metropolitan areas were more inclined to seek funding information and general assistance. Those in occupational categories who do not generally receive research and grant writing skills training are less likely to attract funding than their more 'academic' counterparts.     

DEVELOPMENT OF ORAL HEALTH TRAINING FOR RURAL AND REMOTE ABORIGINAL HEALTH WORKERS

ABSTRACT: Research data exists that highlight the discrepancy between the medical/dental status experienced by Aboriginal people compared with that of their non-Aboriginal counterparts. This, coupled with a health system that Aboriginal people often find alienating and difficult to access, further exacerbates the many health problems they face. Poor oral health and hygiene is an issue often overlooked that can significantly impact on a person's quality of life. In areas where Aboriginal people find access to health services difficult, the implementation of culturally acceptable forms of primary health care confers significant benefits. The Aboriginal community has seen that the employment and training of Aboriginal health workers (AHW), particularly in rural and remote regions, is significantly beneficial in improving general health. In the present study, an oral health training program was developed and trialed. This training program was tailored to the needs of rural and remote AHWs. The primary objective was to institute a culturally appropriate basic preventative oral health delivery program at a community level. It is envisaged that through this dental training program, AHWs will be encouraged to implement long-term preventive measures at a local level to improve community dental health. They will also be encouraged to pursue other oral health-care delivery programs. Additionally, it is considered that this project will serve to strengthen a trust-based relationship between Aboriginal people and the health-care profession.     

PROMOTING BREASTFEEDING IN RURAL COMMUNITIES: BREAST IS BEST AND BOTTLE IS A LAST RESORT

ABSTRACT: 'Breast is best and bottle is a good second best' has been a common infant nutrition axiom in Australia in recent times. The impact of the widespread recognition of breastfeeding as the most appropriate form of infant nutrition for the first six months of life has been softened by this almost favourable premise about the suitability of artifical feeding. The promotion of breastfeeding becomes that much more difficult if bottle feeding is seen to be, and promoted as, a comparable alternative to breastfeeding by health professionals and the broader community. There is accumulating evidence to suggest that this is not the case, and that infant feeding with artificial formulas increases the risk of short- and long-term morbidity and mortality. This review of breastfeeding promotion challenges health professionals in rural Australia to adopt the more appropriate axiom that 'breast is best and bottle is a last resort'.     

NUTRITION EDUCATION IN RURAL AUSTRALIA: WHY,WHO AND HOW?

ABSTRACT: Improving nutrition knowledge through nutrition education had been a major strategy used by nutritionists and health educators to improve the dietary intake of Australians. This approach continues to be supported by contemporary practice, and nutrition and health policy documents at a national and state level. In Australia, the delivery of nutrition education services to rural and remote populations is limited by a scarcity of nutrition specialists such as dietitian/nutritionists. This review highlights the importance of nutrition education in promoting the nutritional health of Australians in rural and remote areas, and describes a model for nutrition education service delivery based on generalists supported by specialists.     

MEN'S HEALTH IN RURAL NEW SOUTH WALES

ABSTRACT: This paper describes three developing approaches to men's health: (i) locally-based clinics and programs targeting men; (ii) large scale campaigns directed at males by special interest groups and; (iii) an epidemiological approach found in national public health policy documents. The women's health movement does not provide for an effective model for the establishment of alternative male health centres. However, two important areas that concern women are relevant to men: a social view of health, and representation in health decision making. The implications for rural health workers are to involve established male organisations, such as the New South Wales Farmers' Association to promote the health of men and boys.     

CHOOSING A CAREER IN RURAL PRACTICE IN QUEENSLAND

ABSTRACT: As part of a broader investigation into the training needs of rural doctors, the reasoning behind decisions of graduates to enter rural practice in North Queensland was explored. North Queensland is a growing and diverse region that is home to 500 000 people but has had no local production of medical graduates. While prior rural exposure was found to be a powerful influence on the decision of some, a small number of those interviewed entered rural practice almost by chance, liked it and stayed. Should this finding be confirmed in more formal investigation, workforce planners would need to continue initiatives to recruit graduates who have no prior connection to rural life.     

COMMUNITY VENTURES IN RURAL HEALTH: THE ESTABLISHMENT OF COMMUNITY HEALTH TRUSTS IN SOUTHERN NEW ZEALAND

ABSTRACT: During the 1990s, a shortage of funds and a competitive market for public sector health services created both threats and opportunities for rural health services in New Zealand. In three of the four regional funding areas, rural health services experienced increased levels of closure or privatisation. In the fourth area, the Southern Region, the initiative of the community and the response of the funder combined to produce an alternative response; the formation of community health trusts that allowed local communities to own their own health facilities and to contract to run the services. Through a survey of community trusts this research analyses the process of trust formation and assesses the critical success factors in the community (local leadership, local financial and other commitment, involvement of local professionals, learning from each other, local operational efficiency) which allowed the trusts to survive and thrive.     

RURAL ATTACHMENTS FOR STUDENTS IN THE HEALTH PROFESSIONS: ARE THEY WORTHWHILE?

ABSTRACT: In the period 1991–96, 156 undergraduates from 14 health disciplines at the University of Sydney completed rural attachments in rural and remote areas of Australia as part of the Rural Careers Project. On return from their attachment, students were encouraged to write a brief report of their experiences. Ninety-two available reports were analysed as one means of assessing the success of the attachments with respect to informing students about rural health issues and stimulating their interest in rural careers after graduation. A content analysis of the students' written comments about their perceptions and experiences was completed. Students were extremely positive about the value of the attachments and expressed more positive than negative comments regarding their perceptions of rural life and work. The results show that rural attachments are indeed worthwhile learning opportunities.     

HEALTH RESEARCH LITERACY: A NEW APPROACH TO INVOLVING RURAL GENERAL PRACTITIONERS IN RESEARCH AND EVALUATION

ABSTRACT: Rural general practitioners (GPs) are currently involved in two concurrent and systematic programs of research/evaluation. These programs are generated, respectively, by initiatives in rural health and in general practice. This paper examines the consequences of this involvement by GPs as implementers and/or targets of components of each of these programs, and concludes that it is appropriate that they be provided in a systematic way with the knowledge and skills base they need to empower them to participate in (both developmentally and at the implementation level) and/or to appraise the research impinging on their lives. Six broad levels of involvement in rural health research are identified for rural doctors in this paper, which proposes an innovative strategy — health research literacy — to assist doctors at these various levels of involvement.     

CATALYSING IMPROVEMENTS IN RURAL HEALTH

ABSTRACT: The National Rural Health Alliance is the peak non-government body working to improve rural health and health services. It has been fully operational since August 1993 and has produced submissions to government on a number of rural health issues. Through its work it has increased the public profile of rural health policy in Australia, without endangering the autonomy of the 15 national bodies which constitute the Alliance. Given the proliferation of individual bodies concerned with various aspects of rural health, and the complex and changing policy situation, the Alliance has a crucial role to play in helping to manage the interface between governments, consumers and rural health providers. The mission of the Alliance is informed by a strong philosophy of increased consumer involvement in the design, management and evaluation of local health services. The Alliance reflects the aspirations of rural and remote people for high quality and accessible health services. The chances of this mission being accomplished will be increased to the extent that individual professional bodies and local groups work in partnership with central organisations like the Alliance.     

RURAL HEALTH POLICY: THE THIRD NATIONAL RURAL HEALTH CONFERENCE

ABSTRACT: The Third National Rural Health Conference was convened at Mt Beauty in February 1995, by the National Rural Health Alliance, to promote the continuing improvement of the health and well-being of people in rural and remote Australia. The agenda reflected the initiatives of the National Rural Health Strategy, developed as the result of earlier National Conferences. The conference aimed to share information and direct it to relevant institutions, to strengthen bonds and communication within the rural health field and to encourage the advocacy role of delegates within their own organisations. By drawing the themes together, the conference program highlighted the principle of equity, the plight of Aboriginal health, the right of the community to self determination and participation, and the needs, entitlements and roles of consumers. The conference further emphasised the need for an integrated or holistic approach to service planning and the need for service delivery to reflect the specific needs of rural communities. Delegates, led by the Federal Minister for Health, identified specific strategies for reinforcing and implementing programs that promote dialogue between community, workforce and government and contribute to a cohesive national and state agenda in rural health. Delegates recognised that the rural health community is now much better organised, but considerable inequities remain and must be addressed urgently.