IS AUSTRALIAN RURAL PRACTICE CHANGING? FINDINGS FROM THE NATIONAL RURAL GENERAL PRACTICE STUDY

ABSTRACT: The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996–1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State-based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.     

RURAL PRACTICE EVALUATION: HOW DO RURAL PHYSICIANS EVALUATE THEIR WORKING CONDITIONS?

ABSTRACT: Evaluating the quality of rural doctors' working conditions is essential for retaining physicians in rural areas. We carried out a trial to investigate those aspects of working conditions that are important to rural physicians and with which aspects they are satisfied or dissatisfied. Questionnaires were mailed to 204 doctors who were working in rural clinics in Japan. The professional conditions of rural clinic practices were classified into 17 items. The doctors were then asked to evaluate the importance of and degree of satisfaction with each item. Among the 17 items, the clinic's equipment, the municipal government's attitude and the base hospital were evaluated to be more important than the overall average. With regard to satisfaction, the distance to major cities, the municipal government's attitude and locum availability were rated significantly lower than that overall. There were some items where there was a discrepancy between the importance and the degree of satisfaction. Identifying these discrepancies may contribute to creating an environment that will raise the level of rural physicians' satisfaction.     

GETTING THE BALANCE RIGHT? GPS WHO CHOSE TO STAY IN RURAL PRACTICE

Background: Despite major challenges to the retention of rural GPs in Australia, little is known about why some rural GPs stay long‐term within their communities. Method: A group of rural GPs interviewed as part of another study about 10 years ago were re‐interviewed to explore their attitudes to their reasons for staying. Results: Eighteen of the original group of 23 could be contacted and 13 were interviewed. Factors that appeared to promote staying in rural practice were: strong attachment to the community; and practice arrangements that allow for adequate time off‐call and for holidays. However, several GPs were stressed and some had considered leaving. The stressors were similar to those identified in earlier research, including overwork and having to send children to boarding school. Conclusion: Personal and professional support arrangements within the community appear to be associated with decisions by rural GPs to remain in practice for substantial periods of time. Retention strategies should focus on facilitation of local integration. What is already known: Some doctors stay for prolonged periods of time in rural practice, although most leave after a few months or years. The reasons why rural doctors stay have until now not been explored. What this study adds: Rural doctors who stay for prolonged periods of time, defined in this study as 10 or more years, have established personal and professional support networks that have provided protection from the more negative aspects of rural professional life.     

RURAL DOCTORS AND RURAL BACKGROUNDS: HOW STRONG IS THE EVIDENCE? A SYSTEMATIC REVIEW

Objective: We sought to summarise the evidence for an association between rural background and rural practice by systematically reviewing the national and international published reports. Design: A systematic review. Setting: A search of the national and international published reports from 1973 to October 2001. Subject: The search criteria included observational studies of a case‐control or cohort design making a clear and quantitative comparison between current rural and urban doctors, this resulted in the identification of 141 studies for potential inclusion. Results: We systematically reviewed 12 studies. Rural background was associated with rural practice in 10 of the 12 studies, in which it was reported, with most odds ratios (OR) approximately 2–2.5. Rural schooling was associated with rural practice in all 5 studies that reported on it, with most OR approximately 2.0. Having a rural partner was associated with rural practice in 3 of the 4 studies reporting on it, with OR approximately 3.0. Rural undergraduate training was associated with rural practice in 4 of 5 studies, with most OR approximately 2.0. Rural postgraduate training was associated with rural practice in 1 of 2 studies, with rural doctors reporting rural training about 2.5 times more often. Conclusions: There is consistent evidence that the likelihood of working in rural practice is approximately twice greater among doctors with a rural background. There is a smaller body of evidence in support of the other rural factors studied, and the strength of association is similar to that for rural background. What is already known on this subject?: It is widely perceived that doctors with a rural background are more likely to return to work in rural areas and major policy initiatives in Australia rely on this assumption. It is recognised that other factors such as location of primary and secondary education, rural medical training and spouse or partner background may also be influential. In order to determine the strength of the evidence for an association between rural background and rural practice we did a systematic review of the published reports. What does this study add?: This systematic review provides good evidence that doctors with a rural background are about twice as likely to work as rural doctors, compared with those with an urban background. Rural background seems to be an important factor that can be employed in policy and practice, however, the problem of increasing the number of rural doctors is multifactorial and so is the solution.     

WHITHER RURAL HEALTH? REVIEWING A DECADE OF PROGRESS IN RURAL HEALTH

ABSTRACT: The problems associated with rural and remote health have been widely recognised by health workers, rural communities and health professions for some time. Yet it has only been in the past decade that any concerted effort has been made to address rural health issues. Today the state of health in rural Australia remains less than optimal. The tenth anniversary of the Australian Journal of Rural Health provides the opportunity to reflect on what progress has been achieved over the past decade, to recognise those factors that have contributed most to the implementation of policies designed to address the health needs of rural and remote Australians, and to discuss outstanding impediments and barriers to resolving rural health issues.     

RURAL URGENT CARE MODELS: WHAT ARE THEY MADE OF?

ABSTRACT: The study aimed to identify the elements that constitute rural urgent care systems. Participation in the study was sought from health professionals, welfare and emergency services sectors, and community members. Primary data were collected from informants through interviews and focus groups in five rural communities of different sizes. Twelve common elements to rural urgent care systems were identified and divided into two categories: (i) infrastructure; and (ii) personnel. Infrastructure included organisational support, community support, transport, communication and coordination processes, facilities and equipment, and community knowledge and information. Personnel included nurses, doctors, community leaders, health and welfare professionals, emergency service workers and ambulance officers. The study's major outcome was the recognition that rural urgent care systems consist of a balance of interrelated elements. These elements are context driven, with geographical, social and economic environments having a substantial impact on the ability of rural communities to develop and sustain their urgent care systems.     

A PILOT STUDY OF AN ALCOHOL EDUCATION COURSE FOR YOUNG WOMEN OFFENDERS: WHAT'S GOOD FOR THE GOOSE?

Although the provision of Alcohol Education Courses (AECs) formale offenders has increased steadily in the last 10 years,treatment interventions for women have continued to be neglectedand under-researched. An Alcohol Education Course designed forwomen offenders was piloted in a prison. This report outlinesthe content of the course and the rationale for its development.Facilitatory and oppositional factors experienced in conductingwork in this setting are discussed. Application of this workis limited to female offenders aged 17–24 with drink-relatedoffending. This pilot study awaits replication in non-institutionalsettings.     

CIRCUMSTANCES AND EFFORTS: HOW IMPORTANT IS THEIR CORRELATION FOR THE MEASUREMENT OF INEQUALITY OF OPPORTUNITY IN HEALTH?

The way to treat the correlation between circumstances and effort is a central, yet largely neglected issue in the applied literature on inequality of opportunity. This paper adopts three alternative normative ways of treating this correlation championed by Roemer, Barry and Swift and assesses their empirical relevance using survey data. We combine regression analysis with the natural decomposition of the variance to compare the relative contributions of circumstances and efforts to overall health inequality according to the different normative principles. Our results suggest that, in practice, the normative principle on the way to treat the correlation between circumstances and effort makes little difference on the relative contributions of circumstances and efforts to explained health inequality. Copyright © 2013 John Wiley & Sons, Ltd.     

DOES ONE SIZE REALLY FIT ALL? WHY THE MENTAL HEALTH OF RURAL AUSTRALIANS REQUIRES FURTHER RESEARCH

ABSTRACT: In this paper the need for further investigation into the mental health of rural Australians will be discussed. It will be argued that while research to date has yielded valuable information, the volume and scope of existing studies has been inadequate to address the needs of the diverse and dynamic communities in non-metropolitan Australia. The diversity that exists within rural Australia is examined and the potential effects of this diversity on mental health status are highlighted. Then a number of issues that are relevant to people living in non-metropolitan areas that underscores the need for further study into rural mental health are identified. Finally, some specific areas that require further examination are outlined and some guiding principles for future mental health research are proposed.     

WHY IS POOR VENTILATION HARMFUL?: A DISCUSSION OF THE FUNDAMENTAL PSYCHOLOGIC BASES FOR CURRENT VIEWS

Ventilation is a much discussed matter in which doctors and engineers are by no means all agreed. Mr. Reed presents a comprehensive, up-to-date consideration that is enlightening. He says that the last word has not been said yet. Note his careful bibliography.     

RURAL ORIGIN MEDICAL STUDENTS: HOW DO THEY COPE WITH THE MEDICAL SCHOOL ENVIRONMENT?

Australia suffers from a well documented shortage of rural medical practitioners. In an attempt to increase recruitment, it has emerged that rural origin medical students are more than twice as likely as their urban colleagues to become rural practitioners. This has led to a wide range of programs aimed at increasing the number of rural students who apply for and gain entry into medical school. But how do rural students cope with the medical school environment? This paper was based on the results of a survey of senior medical students and looked at how rural students’ fare with the medical school environment compared to their urban counterparts. It was concluded that government initiatives currently supporting rural medical students must be continued into the future and continuously evaluated to ensure that rural students have a positive learning experience in preparation for future rural practice.