Use of the Internet as a medical resource by rural physicians

BACKGROUND: Internet has become an integral tool for modern physicians, and those not ready to embrace this new technology will be missing a valuable resource. This pilot study reviews rural physicians' usage patterns of the Internet as a medical resource and examines the barriers that might preclude rural providers from using this technology. METHODS: We undertook a questionnaire survey of rural providers in Wyoming, Montana, and Idaho. Information was elicited about the physicians' Internet access, frequency of Internet use, the different Internet categories used, and the barriers they encountered to using the Internet. A background MEDLINE search was performed using the MeSH headings "Internet," "medical informatics," "and rural health." RESULTS: Eighty-five percent of providers had Internet access, and 75% of respondents reported using the Internet either daily or one to four times a week. E-mail was the most frequently used category. The next most frequent categories were on-line literature search, professional organizations, special interest Web sites, clinical reference Web sites, on-line journals, and patient education. Lack of time and having no computer were the most important barriers cited. CONCLUSIONS: Although the findings of this survey suggest that, compared with broader physician populations, rural physicians are using the Internet with the same frequency, their scope of use might be much more limited. Barriers to using the Internet are difficult to determine, but lack of time, hardware, and a sense of need appear to be important factors.     

Context counts: training health workers in and for rural and remote areas

Access to well trained and motivated health workers is the major rural health issue. Without local access, it is unlikely that people in rural and remote communities will be able to achieve the Millennium Development Goals. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (i) a rural background; (ii) positive clinical and educational experiences in rural settings as part of undergraduate medical education; and (iii) targeted training for rural practice at the postgraduate level. This paper presents evidence for policy initiatives involving the training of medical students from, in and for rural and remote areas. We give examples of medical schools in different regions of the world that are using an evidence-based and context-driven educational approach to producing skilled and motivated health workers. We demonstrate how context influences the design and implementation of different rural education programmes. Successful programmes have overcome major obstacles including negative assumptions and attitudes, and limitations of human, physical, educational and financial resources. Training rural health workers in the rural setting is likely to result in greatly improved recruitment and retention of skilled health-care providers in rural underserved areas with consequent improvement in access to health care for the local communities.     

Physiotherapy in rural and regional Australia

OBJECTIVE: To inform rural physiotherapy recruitment and retention strategies by describing physiotherapists in the Shepparton region: reasons for career choice, education and physiotherapy professional issues. DESIGN: Survey. SETTING: Health service providers. PARTICIPANTS: Practising and non-practising physiotherapists. MAIN OUTCOME MEASURE: Survey responses. RESULTS: Survey response rate 79%. Eighty four physiotherapists (79 practicing and 5 non-practicing; 80% female) clustered in main regional centres responded. Two-thirds worked part-time with most in the public sector (70%), with one third holding more than one position. One-third considered themselves generalists and one-third specialists. Physiotherapy was first career choice for 83% who made this decision between 14 and 19 years old (16.8-2.5 years) because of contact with a physiotherapist. Professional issues challenging physiotherapists in a rural location are compounded by lack of career path, professional support, access to professional development and postgraduate education. Additional issues are the costs and time to attend courses and conferences, travel/distance, and inadequate resources. Positive elements of rural practice were part-time employment opportunities, independence as primary health providers, practice variety and community recognition. CONCLUSION: Rural physiotherapy recruitment and retention strategies must address resource shortcomings by developing career paths, access to postgraduate education and support. Enhancing workforce capacity could enable more students to have meaningful rural experience to assist recruitment. Strategies highlighting existing positive features of rural practice, reinforced with tangible rewards and recognition of physiotherapists' contribution to the health care of Australians are recommended.     

Australian GPs are satisfied with their job: even more so in rural areas

BACKGROUND: Australia has seen a constriction of the scope of practice and of professional prerogatives for GPs in the 1990s, which is said to have led to lower job satisfaction, particularly for rural GPs. OBJECTIVE: The aim of this study was to determine levels of job satisfaction and mental health in a rural and an urban sample of GPs, and to correlate population and practice characteristics with lower job satisfaction and morale. METHODS: A postal survey of GP members of two urban and four rural Divisions of General Practice in New South Wales was carried out using the Wall-Cook-Warr scale and the 12-item General Health Questionnaire (GHQ-12). The overall response rate was 74%. RESULTS: Both urban and rural Australian GPs were generally satisfied with their jobs; however, rural GPs had significantly higher job satisfaction scores. The highest levels of satisfaction were recorded for factors denoting autonomy. The lowest ranked factors were hours of work, income and government policy in general practice. GPs without psychological disturbance were significantly more satisfied with their work than those who were disturbed. Lower job satisfaction was significantly associated with urban GPs, GPs who worked full-time and those who used a language other than English during consultations. Poor mental health and working in an urban area were predictive of lower job satisfaction in men, and bulk-billing all patients (i.e. not charging patients a co-payment, but making a consolidated claim to the government funder Medicare) and working full-time were predictive of lower job satisfaction in women. CONCLUSIONS: Both urban and rural GPs derive a large measure of satisfaction from their job. In particular, rural GPs are satisfied, especially so with their autonomy. Poor mental health was the strongest predictor of lower job satisfaction. The high percentage of GPs with psychological disturbances raises the problem of their access to appropriate mental health services, in particular in rural areas.     

Education of Physician Assistants, Nurse Midwives, and Nurse Practitioners for Rural Practice

Physician assistants, nurse midwives, and nurse practitioners have been described as a vital and unique solution to the problem of providing adequate access to high quality health care for many Americans. Each of these classifications of health care providers has been accepted as separate professions with their own standards and identities. Their curricula and educational pathways have developed into clearly distinguishable educational tracks that complement the larger disciplines of nursing and medicine. Physician assistants, nurse midwives, and nurse practitioners have been singled out in federal legislation for their potential contribution to underserved rural communities (e.g., the Rural Health Clinics Services Act of 1977 and its subsequent amendments). This designation is partly due to the fact that certified nurse midwives, nurse practitioners, and physician assistants traditionally chose to practice in rural, underserved areas, and because their skills and practice structures were well matched to the needs and resources of rural areas. That pattern of practice, however, appears to have changed and the distribution of these practitioners has begun to resemble the distribution of physicians and other clinicians with heavy concentrations in urban areas and a growing shortage in rural and underserved areas.     

Adaptations to health care barriers as reported by rural and urban providers

Barriers to ethical and effective health care in rural communities have been well-documented; however, less is known about strategies rural providers use to overcome such barriers. This study compared adaptations by rural and urban health care providers. Physical and behavioral health care providers were randomly selected from licensure lists for eight groups to complete a survey; 1,546 (52%) responded. Replies indicated that health care providers from small rural and rural communities were more likely to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, seek out additional expertise, and adjust treatment styles than were providers from small urban and urban communities. Behavioral health care providers were more likely than physical health care providers to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, and adjust their treatment styles; physical health care providers were more likely than behavioral health care providers to make attempts or have options to seek out additional expertise.     

The interrelationship of organizational characteristics of magnet hospitals,nursing leadership,and nursing job satisfaction

This study examined whether magnet hospitals continue to provide higher levels of job satisfaction and empowerment among nurses when compared with non-magnet hospitals. Also studied at both types of hospitals was whether job satisfaction discrepancy was interlinked with leadership effectiveness and support of professional nursing practice. Nurses employed at magnet hospitals experienced higher levels of empowerment and job satisfaction due to greater access to work empowerment structures. The elements accounting for differences in empowerment and job satisfaction scores included: (1) greater accessibility of magnet nurse leaders, (2) better support of clinical nurse autonomous decision making by magnet nurse leaders, and (3) greater access to work empowerment structures such as opportunity, information, and resources at magnet hospitals.     

Providing Rehabilitative Services in Rural Communities: Report of a Conference

Rural communities have a disproportionate need for rehabilitative services, partly attributable to an aging population and higher incidence of occupational injuries. Despite increased need, many rural communities find rehabilitative services unavailable due to personnel shortages, maldistribution of health care personnel, and related recruitment and retention issues. The National Rural Health Association and the Division of Associated, Dental, and Public Health Professions of the Health Resources and Services Administration co-sponsored a conference to explore issues related to ensuring that rural communities have access to vital rehabilitation services provided by allied health professionals. The status of rehabilitative care in rural settings and the barriers to improvement in services delivery were described by consumers, providers, educators, and public and private agency representatives. Recommendations directed to state and federal authorities, educational institutions, and professional organizations centered around increasing the supply of appropriately trained allied health providers. Improving retention of rehabilitative personnel in rural areas could be achieved by specific changes to the practice climate.     

Communication Technology Access, Use, and Preferences among Primary Care Patients: From the Residency Research Network of Texas (RRNeT)

Objective: The digital revolution is changing the manner in which patients communicate with their health care providers, yet many patients still lack access to communication technology. We conducted this study to evaluate access to, use of, and preferences for using communication technology among a predominantly low-income patient population. We determined whether access, use, and preferences were associated with type of health insurance, sex, age, and ethnicity. METHODS: In 2011, medical student researchers administered questionnaires to patients of randomly selected physicians within 9 primary care clinics in the Residency Research Network of Texas. Surveys addressed access to and use of cell phones and home computers and preferences for communicating with health care providers. RESULTS: In this sample of 533 patients (77% response rate), 448 (84%) owned a cell phone and 325 (62%) owned computers. Only 48% reported conducting Internet searches, sending and receiving E-mails, and looking up health information on the Internet. Older individuals, those in government sponsored insurance programs, and individuals from racial/ethnic minority groups had the lowest levels of technology adoption. In addition, more than 60% of patients preferred not to send and receive health information over the Internet, by instant messaging, or by text messaging. CONCLUSIONS: Many patients in this sample did not seek health information electronically nor did they want to communicate electronically with their physicians. This finding raises concerns about the vision of the patient-centered medical home to enhance the doctor-patient relationship through communication technology. Our patients represent some of the more vulnerable populations in the United States and, as such, deserve attention from health care policymakers who are promoting widespread use of communication technology.     

基于供方视角的山东省农村地区家庭医生工作满意度及影响因素分析

目的基于供方的视角,了解山东省农村地区家庭医生工作满意度现状,并分析影响因素,为农村地区家庭医生签约服务稳定发展提供政策建议。方法于2018年采取多阶段分层随机抽样的方法,对山东省农村地区的家庭医生进行问卷调查;采用描述性分析描述调查对象的人口学特征及工作满意度情况,采用二元Logistic回归探讨工作满意度的影响因素。结果山东省农村地区195名家庭医生中,家庭医生工作满意率为57.4%;家庭医生工作压力、工作需要、工作职责、上级支持满意程度、报酬与工作量匹配程度、家庭医生培训是家庭医生工作满意度的影响因素(P<0.05)。结论提升农村地区家庭医生医疗专业能力和建立科学有效的绩效考核机制、激励机制,是提高农村地区家庭医生工作满意度的有效方法,是保证家庭医生签约服务持续稳定发展的重要条件。     

Professional Expertise of Community-Based Occupational Therapists

SUMMARY

As the health care system changes, it is increasingly important to define the roles and contributions of individual professions. The goal of this study was to identify job roles, job skills, and professional expertise of community-based therapists. The Community Practice Project survey was mailed to 200 AOTA registered community-based therapists. There were 84 (42%) surveys returned. The results provided a profile of community-based therapists. Principal roles, job skills, and areas of professional expertise were identified. Educational preparation was assessed. Respondents reported that they were not prepared to use the skills of networking, consulting, and communication. They were not prepared in expertise areas such as community resources, self-directed learning, and client-centered approach to practice. Overall, therapists expressed satisfaction with work in community-based positions.     

Physicians' Internet information-seeking behaviors

INTRODUCTION: Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they apply to Internet use and applications for continuing education providers to more effectively support learning. METHODS: A survey about Internet use and physician information seeking was administered by facsimile transmission to a random sample of 3,347 physicians. RESULTS: Almost all physicians have access to the Internet, and most believe it is important for patient care. The most frequent use is in accessing the latest research on specific topics, new information in a disease area, and information related to a specific patient problem. Critical to seeking clinical information is the credibility of the source, followed by relevance, unlimited access, speed, and ease of use. Electronic media are viewed as increasingly important sources for clinical information, with decreased use of journals and local continuing medical education (CME). Barriers to finding needed information include too much information, lack of specific information, and navigation or searching difficulties. DISCUSSION: The Internet has become an important force in how physicians deliver care. Understanding more about physician information-seeking needs, behaviors, and uses is critical to CME providers to support a self-directed curriculum for each physician. A shift to increased use of electronic CME options points to new demands for users and providers. Specific information about how physicians create a question and search for resources is an area that requires providers to develop new skills.     

安徽省农村基层卫生人员工作满意度及影响因素简

目的：分析农村基层卫生人员满意度及影响因素,为加强卫生人才队伍建设提供参考。方法：在安徽省抽取3个样本县发放调查问卷,共调查380名乡镇卫生院人员和村医,用多元线性回归方法分析工作满意度的影响因素,对定性资料的主要问题和观点进行提炼。结果：基层卫生人员总体满意度水平较低,仅有40．90％的人对工作满意;不同满意度因子中,对收入水平、福利等最不满意;不同专业人员中,村医满意度最低。收入水平低、工作量大是工作满意度低的主要影响因素。结论：较低的工作满意度会导致较低的服务质量和较高的人员流失率,亟需将增加的政府投入转变为卫生人员收入与福利水平的改善,进而提高工作满意度水平,这是吸引和留住农村基层卫生人才的关键。     

The Primary Care Physician Workforce in Massachusetts: Implications for the Workforce in Rural,Small Town America

ABSTRACT: Context: Small towns across the United States struggle to maintain an adequate primary care workforce. Purpose: To examine factors contributing to physician satisfaction and retention in largely rural areas in Massachusetts, a state with rural pockets and small towns. Methods: A survey mailed in 2004‐2005 to primary care physicians, practicing in areas designated by the state as rural, queried respondents about personal and practice characteristics as well as workforce concerns. Predictors of satisfaction and likelihood of remaining in current or rural practice somewhere were assessed. Findings: Of 227 eligible physicians, 160 returned their surveys (response rate, 70.5%). Approximately one third (34.0%) reported they had grown up in communities of 100,000 or larger. Factors associated with higher overall practice satisfaction included not feeling overworked (P = .043) or professionally isolated (P = .004), and being involved in their practice (P = .045) and home communities (P = .036) as well as ease of seeking additional physicians for practice and obtaining CME credits (P = .014 and P = .017, respectively). Female physicians were more likely to report an intention to remain in rural practice somewhere for the next decade (P = .034). In rating their satisfaction with various aspects of the rural practice environment, physicians reported greatest satisfaction with their practice overall (67%) and their call group size (66%). They were least satisfied with their current (30%) and likely future income (40%). In multivariate analyses, larger practice community size was positively related to the dependent variable of overall satisfaction and negatively related to likelihood of staying in current practice or in rural practice somewhere. Conclusions: Our findings reaffirm the importance of rural medical education opportunities in physician recruitment, retention, and practice satisfaction. They also indicate that in a small New England state, a major source of physicians for rural and small town communities is physicians who have been raised in urban/suburban communities and who were trained outside of the region but who were prepared to live and to practice in rural and small town communities.     

吸引和稳定农村基层卫生人员的影响因素及其干预策略研究进展*

目的总结国内外有关农村基层卫生人员吸引和稳定的影响因素及其主要干预策略的研究进展,为改善我国农村基层卫生人员的招募和留用提供参考。方法对国内外基层卫生人力资源现状、离职意愿和工作意愿、工作选择的影响因素、主要干预策略和效果以及离散选择实验方法的应用等进行文献复习和研究。结果农村基层卫生人员尤其是骨干人员招募难、留用难,且存在较高的离职意愿,个人、工作和生活等相关因素是选择或留在农村基层的主要考虑因素。国内外采取了多种有效的干预措施,但缺乏对干预效果的评价。结论农村基层卫生人员招募难、留用难限制了我国农村基层卫生人力资源整体素质的提升,必须采取具有成本效果的干预策略加以改善。     

Rural and Urban Physicians' Perceptions Regarding the Role and Practice of the Nurse Practitioner, Physician Assistant, and Certified Nurse Midwife

ABSTRACT: Context: There is a dearth of literature citing the differences in rural and urban physicians' perceptions of the role and practice of nurse practitioners, physician assistants, and certified nurse midwives (nonphysician providers). Purpose: The purpose of this study was to investigate and compare differences, if any, between rural and urban primary care physicians' perceptions of the role and practice of nonphysician providers. Results: Despite a 15.55% response rate using a mail-out survey in South Carolina, data from 681 rural and urban primary care physicians indicated that they perceived that nonphysician providers possess the necessary skills and knowledge to provide primay care to patients, are an asset to a physician's practice, free the physician's time to handle more critically ill patients, and increase revenue for the practice, but increase the risk of patient care mistakes and a physician's time in administrative duties. Urban physicians' mean scores were higher for perceiving that nonphysician providers are able to see as many patients in a given day as a physician but experience impediments in the delivery of patient care. Conclusions: Results will be used to clarify physicians' perceptions regarding the role and practice of nonphysician providers to reduce impediments to patient care access.     

Job Satisfaction and Retention of Rural Community Health Nurses in North Dakota

A correlation between job satisfaction and employment longevity has been demonstrated by a number of researchers. However, the measurable aspects of job satisfaction only partially explain an individual's tenure at a particular job. Information about the relationship between job satisfaction and retention of community health nurses in a rural state was provided by 258 community health nurses in North Dakota who responded to a mailed questionnaire. Job satisfaction assessment included measures of autonomy, task requirements, salary, benefits, rewards, professional status, organizational climate, and interpersonal interactions. Job satisfaction was analyzed by taking into account the individual importance of each component. While the majority (61%) of the responding nurses indicated that they expected to stay in their current jobs for a period of five years or more, they were dissatisfied with various aspects of their jobs. The greatest factor influencing the nurses' choice of current position was job availability, followed by preferences for the particular health care agencies or communities. These findings indicate that retention of rural nurses should focus on strategies that go beyond improving job satisfaction.     

Oral health workforce in rural and remote Western Australia: practice perceptions

OBJECTIVE: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. DESIGN: A postal survey was undertaken among all registered oral health professionals in Western Australia. SETTING: Rural and remote Western Australia. PARTICIPANTS: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. RESULTS: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. CONCLUSIONS: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.     

Attraction and retention of qualified health workers to rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria

INTRTODUCTION: A shortage of health workers is a major problem for Nigeria, especially in rural areas where more than 70% of the population live. At the primary care level, trained community health officers provide services normally reserved for doctors or medical specialists. The community health officers must therefore be supported and motivated to provide effective quality healthcare services. This study aimed to determine factors that will attract and retain rural and urban health workers to rural Nigerian communities, and to examine differences between the two groups. METHODS: A cross-sectional survey measured health workers' work experience, satisfaction with, and reasons for undertaking their current work; as well as reasons for leaving a work location. Data were also gathered on factors that attract health workers to rural settings and also retain them. RESULTS; Rural health workers were generally more likely to work in rural settings (62.5%) than their urban counterparts (16.5%). Major rural motivators for both groups included: assurances of better working conditions; effective and efficient support systems; opportunities for career development; financial incentives; better living conditions and family support systems. The main de-motivator was poor job satisfaction resulting from inadequate infrastructure. Rural health workers were particularly dissatisfied with career advancement opportunities. More urban than rural health workers expressed a wish to leave their current job due to poor job satisfaction resulting from poor working and living conditions and the lack of career advancement opportunities. CONCLUSIONS: Motivational factors for attraction to and retention in rural employment were similar for both groups although there were subtle differences. Addressing rural health manpower shortages will require the development of a comprehensive, evidence-based rural health manpower improvement strategy that incorporates a coordinated intersectoral approach, involving partnership with a range of stakeholders in rural health development.