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.     

'Infront outback' goes national

The National Rural Health Alliance, the Toowoomba Hospital Foundation and the Cunningham Centre have agreed to merge the two biennial conferences for rural and remote health that have been running in alternate years since 1991. This means that in March 2001, the National Rural Health Conference will, for the first time, incorporate 'Infront Outback', the Australian Rural and Remote Health Scientific Conference. There will, therefore, be one major biennial rural heath conference, dealing coherently with health scientific research and policy development. The recommendations to governments and national bodies that result should be even stronger and more highly regarded than has been the case to date.     

Using cohort studies to investigate rural and remote mental health

This paper, presented at the 2010 rural health researchers' National Scientific Symposium on Rural and Remote Health, provides an overview of large Australian population mental health cohort studies which have a focus on climate-related and environmental adversity, social factors and mental health. These studies highlight the value of exploiting multiple exceptional datasets to better understand the drivers of rural health, including how to use population-level research to improve health resources in non-metropolitan areas. We show how the key characteristics of rural and remote mental health might be explored by exploiting the following cohort studies: Household, Income and Labour Dynamics in Australia Survey; Australian Rural Mental Health Study; Hunter Community Study; and Extending Treatments, Education and Networks in Depression study. Existing cohort studies that focus on significant rural and regional characteristics can be creatively analysed to better understand geographic variation in mental health. They have the potential to move understanding beyond simple prevalence to building knowledge about the trajectories of psychological distress and determinants of mental disorders and outcomes over time.     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

Wisdom from the drought: recommendations from a consultative conference

OBJECTIVE: Drought is a serious and recurring problem for rural and remote Australia. This paper reports the proceedings of a consultative conference concerning the mental health effects of drought held at the Centre for Rural and Remote Mental Health, Orange, in December 2003. The conference objective was to record the collective experience of government and non-government agencies dealing with the effects of drought in rural areas and to collate information for the development of a mental health strategy for future drought. DESIGN: Participants were recruited in consultation with rural mental health organisations. Questions about mental health service strategies to minimise and respond to the mental health impact of the drought were posed to participants. Qualitative data were collected using a Nominal Group Technique. SETTING: The Centre for Rural and Remote Mental Health, Bloomfield Hospital, Orange, New South Wales. PARTICIPANTS: Twenty-three professionals participated, including representatives from New South Wales Health, Mental Health, and Agriculture; the Department of Community Services, and Rural Financial Counsellors. MAIN OUTCOME MEASURE: Qualitative analysis of participant responses. RESULTS: Three general strategies emerged as the most beneficial in minimising adverse mental health outcomes in times of drought: community-building and education about the physical, financial and mental health effects of drought; co-operation between and co-ordination of agencies in delivering mental health and other drought support; and continuity and planning of improved mental health services. CONCLUSIONS: Drought has a serious effect on the mental health of communities. It is important to plan a response beyond the end of the drought, bringing together different government and non-government agencies to build community capacity to address common mental health needs.     

The National Rural Faculty Bursary Essay--to promote remote: a positive approach to rural general practice

Australian Family Physician is proud to publish the winning essay in the inaugural National Rural Faculty Bursary, an award offered by the National Rural Faculty (NRF) of The Royal Australian College of General Practitioners to a medical student who is a member of a Rural Health Students Club at an Australian University.     

Need for dedicated focus on urban health within National Rural Health Mission

National Rural Health Mission represents an important public health initiative to address essential health needs of the country's underserved population. For the Mission to achieve its goals, urban population needs to be included in its scope. Urban poor population constitutes nearly a third of India's urban population and is growing at three times the national population growth rate. Health status and access of reproductive and child health services of slum dwellers are poor and comparable to the rural population. Efforts to improve the conditions of urban poor necessitate strengthening national policy and fiscal mandate, augmenting and strengthening the urban health delivery system, coordinating among multiple stakeholders, involving private sector, strengthening municipal functioning and building community capacities. National Rural Health Mission should be broadened to National Public Health Mission. This paper discusses issues pertaining to health conditions of the urban poor, present status of services, challenges and suggests options for NRHM to bridge the large gap.     

The emergence of rural health research in Australia

ABSTRACT: The late 1980s saw a renewed interest in rural health in its own right with State jurisdictions establishing defined rural health units. There was recognition that health professionals in rural communities often needed training to fulfil their roles in rural and remote communities. Simultaneously, the number of regional universities increased. A number of such universities grouped to form a consortium and were funded through the Australian Health Ministers' Advisory Council (AHMAC) to form the Australian Rural Health Research Institute. Consequently, a series of conferences specifically addressing rural health research needs occurred, and the Australian Journal of Rural Health was established. Through both of these avenues a trend towards more research presentations and publications can be seen. The National Health and Medical Research Council, under the auspices of AHMAC, has provided an overview of the state of rural health research in Australia and developed recommendations, which form the framework for a future strategy for rural health research. These recommendations have been endorsed by AHMAC, which has now funded the initiation of the implementation of the strategy.     

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.     

The economics of primary healthcare reform in Australia - towards single fundholding through development of primary care organisations

Objective: A strong primary care sector is widely acknowledged as a fundamental component of a well functioning health system and thus has been the focus of strategic reforms in a number of countries. This paper provides an economic analysis of primary healthcare reform, with the aim of identifying the key structural elements that are necessary to support enhanced models of primary health in the Australian context. Approach: This paper utilises economic theory, and draws upon empirical evidence and international experience to analyse primary healthcare reform to identify the structural elements necessary for an enhanced primary care sector. The aim of which is to improve health system performance. These structural elements are then critically examined in the Australian health system setting. Conclusion: For enhanced models of primary healthcare to promote efficiency, they must incorporate a number of key structural elements; notably: governance and purchasing responsibilities for primary care devolved to a meso‐level organisational structure through capitated single fundholding arrangements; blended payment methods for reimbursing providers; the establishment of a national quality and performance framework; and the development of primary care infrastructure. Implications: As the Federal government attempts to address recommendations of the National Health and Hospital Reform Commission, a window of opportunity now exists to pursue long overdue structural reforms to deal with the challenges facing the Australian health system. The paper advances the important structural features to primary healthcare that need to be embraced as the government attempts to pursue its health reform agenda.     

The National Conference of Rural Health Training Units

ABSTRACT: Following the establishment of Rural Health Training Units in most States and the Faculty of Rural Medicine (RACGP), a National Conference of Rural Health Training Units was held on 11 and 12 December 1992, at Moe. Primary focus of the conference was on vocational training for rural general practice, with a secondary focus on development of a multidisciplinary approach in Rural Health Training Unit curricula. It was very much a business meeting in which those actively involved in development and implementation of rural practice training came together and worked through a range of important issues. Recommendations from the conference cover the roles and responsibilities of Rural Health Training Units, curricula and accreditation of rural general practice training, and the importance of adopting a multidisciplinary teamwork approach in developing training programs. The conference recommended formation of a National Association of Rural Health Training Units, which subsequently held its inaugural meeting at the National Rural Health Conference at Armidale in February 1993.     

Planning and implementing the first stage of an oral health program for the Pika Wiya Health Service Incorporated Aboriginal community in Port Augusta, South Australia

The oral health of the Indigenous community in South Australia's mid-north has been a concern for some years. There has been a history of under-utilisation of available dental services by the local community. This is in part due to the services not meeting their cultural and holistic health care needs. The Indigenous community resolved to establish a culturally sensitive dental service within the Aboriginal Health Service already operating in Port Augusta in South Australia's mid-north. To achieve this, a partnership between Pika Wiya Health Service Incorporated, the South Australian Dental Service, the University of Adelaide Dental School and the South Australian Centre for Rural and Remote Health was formed. The aim of the project partners was to establish a culturally sensitive, quality dental service that caters to the needs of the Indigenous community serviced by Pika Wiya Health Service Inc. This article describes the process of planning and implementing the first stage of this project.     

Approach to sustainable primary health care service delivery for rural and remote South Australia

ABSTRACT: We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.     

Book Reviews

Book reviewed in this article:
From Clinician to Manager: An Introduction to Hospital and Health Services Management
Health Service Frameworks for Small Rural and Remote Communities: Issues and Options
Medicine: A Guide for Prospective Students Patrick Mackerras 1996. Australian Government Publishing Service     

Editorial – Health promotion: essential to a national preventative health strategy

In April 2008 the Australian Government announced the establishment of a National Preventative Health Taskforce (NPHT) with the primary function of developing a national preventative health strategy. In October 2008 a discussion paper and three technical reports1 were released with a call for input from individuals and organisations, professional and consumer groups. This editorial outlines four key issues from the Australian Health Promotion Association's (AHPA) submission:

• the importance of a broad social determinants of health approach;
• clear explanations of ‘prevention’ and ‘health promotion’;
• establishing health promotion high on the political agenda; and
• building the capacity of Australia's highly skilled health promotion workforce to strengthen health promotion action across Australia.

     

Value adding through regional coordination of rural placements for all health disciplines: The Broken Hill experience

OBJECTIVE: To describe the experience of the University of Sydney's Broken Hill Department of Rural Health (BHUDRH) delivering a regional program in far western NSW. DESIGN: Case Study Setting: The Australian Government's University Departments of Rural Health Program, established in 1997, has been responsible for setting up regionally coordinated rural placement programs for students from all health disciplines in each state and territory. RESULTS: Over nine years the BHUDRH has harnessed both academic and administrative resources to achieve greater efficiency in program delivery, increased support for students during their placement, and enhanced educational opportunities that draw on regional issues. The Broken Hill program accepts students from 22 Australian universities and places more students in the region, for longer periods than previously (271 students in 2005 compared with 140 students in 1998). CONCLUSION: Regional coordination, linked to investments in rural-based infrastructure and support systems can provide a sustainable platform from which to provide quality rural placements for students from all health disciplines, while at the same time increasing regional capacity to take students.     

Establishing a new university department of rural health: the first 2 years of the South Australian Centre for Rural and Remote Health

ABSTRACT: This study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public dental waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on.     

Rural and remote Australian general practitioners' educational needs in radiology

BACKGROUND: The Australian College of Rural and Remote Medicine (ACRRM) was funded by the Commonwealth Department of Health and Aged Care to set up a quality assurance and continuing medical education program for rural and remote general practitioners in radiology to begin in January 2001. An extensive literature search failed to uncover any previous publications on the specific educational or quality assurance needs for rural general practitioners in radiology. Broader educational needs assessments of rural general practitioners in Australia had identified radiology as an important skill for which improvement was desired. METHOD: A national steering committee consisting of four rural general practitioners and three radiologists, with the assistance of a program manager, developed and piloted a self-administered postal questionnaire to determine the educational and quality assurance needs of rural and remote general practitioners. The questionnaire was sent to all rural and general practitioners holding a remote radiology exemption using the Health Insurance Commission database. RESULTS: A total of 287 completed questionnaires were returned from all states in the country, except the Australian Capital Territory. The information gave a comprehensive picture of the self-reported radiology education needs of these doctors, who practice in isolation from radiologists and other specialists. The three areas in which the general practitioners were least confident in radiology were chest, cervical spine, and skull radiology. Their highest priority areas of need for education were chest radiology, film interpretation, and spinal radiology. The top preferred quality assurance activity was image review with a radiologist, followed by clinical audit, image review by peers, and measuring practice against guidelines. FINDINGS: Local ownership of education is important to successful program development and evaluation. Information obtained from the educational needs assessment was used to develop the Radiology Quality Assurance and Continuing Medical Education Program for Rural and Remote General Practitioners.     

The Southern Rural Access Program and Alabama's Rural Health leaders Pipeline: A Partnership to Develop Needed Minority Health Care Professionals

ABSTRACT: Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities, Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments.     

Rural and remote health research: key issues for health providers in southern Queensland

OBJECTIVE: To determine what community health service providers in rural southern Queensland considered were major issues affecting their efficacy. Results will inform the future research strategy of the Centre for Rural and Remote Area Health with the aim of addressing specific regional needs. DESIGN: Interactive research workshops. SETTING: Health providers and other key stakeholders. SUBJECTS: Participants from organisations directly involved with health care were complemented by representatives from local government, the police service and church groups. MAIN OUTCOME MEASURES: The workshops used the nominal group technique to identify what participants considered were key health issues in their locations. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. RESULTS: Seventeen themes were identified, with workforce by far the major concern of health providers. Recruitment and retention of health workers were the principal issues of concern. The other four highest ranked themes across all workshops were mental health care, access to health services, perceptions and expectations of consumers, and interagency cooperation. The workshops provided important information to the Centre for Rural and Remote Area Health for developing research strategy. Additionally, new alliances among health providers were developed which will support sharing of information and resources. CONCLUSION: The workshops enabled organisations to meet and identify the key health issues and supported research planning. New alliances among health providers were forged, and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange.