Evaluation of the Allied Health Rural Generalist Program 2017-2019

Sustaining our rural allied health workforce: experiences and impacts of the allied health rural generalist pathway

INTRODUCTION

Rural and remote communities face significant disadvantages accessing health services and have a high risk of poor health outcomes. Workforce challenges in these areas are multifaceted, with allied health professionals requiring broad skills and knowledge to provide vital services to local communities. To develop the expertise for rural and remote practice, the allied health rural generalist pathway (AHRGP) was introduced to develop and recognise specialist skills and knowledge required for rural and remote practice, however the experiences of professionals has not been explored. This study gained the experiences and perceptions of allied health professionals undertaking the pathway as well as their clinical supervisors, line managers, profession leads and consumer representatives.

METHODS

A qualitative study was undertaken drawing on pragmatic approaches across four research phases. This study was one component of a larger mixed methods study investigating the experience, impact and outcomes of the AHRGP across six regional Local Health Networks in South Australia (SA). Interviews, surveys and focus groups were conducted to explore the perceptions and experiences of participants. Data was analysed thematically across participant groups and research phases.

RESULTS

A total of 54 participants including 15 trainees, 13 line managers, nine clinical supervisors, six profession leads, four program managers and seven consumer representatives informed this study. Five themes were generated from the data; gaining broad skills and knowledge for rural practice, finding the time to manage the pathway, implementing learning into practice, the AHRGP impacts the whole team and confident, consistent, skilled allied health professionals positively impact consumers.

CONCLUSION

The AHRGP is offering allied health professionals the opportunity to develop skills and knowledge for rural and remote practice. It is also having positive impacts on individuals' ability to manage complexity and solve problems. Findings indicated consumers and organisations benefited through the provision of more accessible, consistent, and high quality services provided by trainees. Trainees faced challenges finding the time to manage study and to implement learning into practice. Organisations would benefit from clearer support structures and resourcing to support the pathway into the future. Incentives and career advancement opportunities for graduates would strengthen the overall value of the AHRPG.

Profile of occupational therapy services in non-urban settings: A global scoping review

INTRODUCTION

Regional, rural, and remote people represent nearly half the world's population yet experience disproportionally higher disease, mortality, and disability rates, coupled with limited healthcare access. Occupational therapy has committed to occupational justice, yet no descriptive framework of services provided by occupational therapists in non-urban locations exists. Understanding current non-urban service practices will provide a basis for non-urban service development and research to reduce this inequity.

METHODS

Four databases were systematically searched for publications describing non-urban occupational therapy services, from any country, written in English, French, Portuguese, or Spanish, from 2010 to 2020. Publications were screened against criteria for inclusion, and data were identified using an extraction tool and presented in a frequency table, on a map, and in a searchable supporting information Table S1.

RESULTS

Only 117 publications were included discussing services provided to populations across 19 countries. They were mostly published in English (98%) and about populations from English-speaking countries (70%). Included publications discussed individualist services (65%), for defined age groups (74%), and for people with specific medical diagnoses (58%). Services were commonly provided in the client's community (56%), originating from urban locations (45%) where the provider travelled (26%) or contacted clients using telehealth (19%). Individual 1:1 enabling strategies were most described (59%), including remediation (34%), compensation (9%), or education (7%). Community enablement strategies were infrequently described (14%), focused primarily on transformation to improve existing service delivery (9%), with some redistributive justice (3%), and one community development strategy (1%). Exploratory research services accounted for the remaining studies (27%). Differences were noted between Global North and South approaches.

CONCLUSION

Globally, occupational therapy has limited focus on non-urban services and favours individualist rehabilitative strategies provided by therapists remote from the client's context. Further research is required on the effectiveness and appropriateness of occupational therapy strategies to improve rural/urban inequity and health outcomes.

Experiences of working as early career allied health professionals and doctors in rural and remote environments: a qualitative systematic review

Background

Maintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are  generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience.

Methods

Qualitative studies that include early career allied health professionals’ or doctors’ experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach.

Results

Of the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors.

Conclusions

Strategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion.

Systematic review registration number

PROSPERO CRD42021223187.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08261-2.