Survey of the rural allied health workforce in New South Wales to inform recruitment and retention

Disability workforce and the NDIS planning process in regional, rural and remote regions of Australia: Scoping review

BACKGROUND

The Australian geographically rural and remote disability workforce has historically demonstrated difficulties to keep up with the demand for quality services and supports for people with disability. In 2013, the National Disability Insurance Scheme (NDIS) was launched to provide individualised disability support packages to meet people's needs. To receive funding, people with disability are required to develop a NDIS plan. That plan is then funded by the National Disability Insurance Agency (NDIA), the government agency responsible for managing the NDIS. Although the NDIS has been operating for almost 10 years, there is limited research into the planning experiences of the workforce in regional, rural and remote regions of Australia. This review aims to ascertain the level of scholarly investigation into workers' experiences of NDIS planning.

METHODOLOGY

Research publication databases were searched using a specific search string to identify publications that included reference to the workforce's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications that focused on those working with Aboriginal and Torres Strait Islander people were also appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications was undertaken to ascertain disability and health workforce experiences of the NDIS planning process.

RESULTS

Seven papers met the selection criteria. Two papers were policy reviews and reported the improvements of the NDIS planning process since its inception. These studies reported four reoccurring themes: (1) cultural/socioeconomic and geographical factors; (2) administrative burden and bureaucracy; (3) values, culture and geography; and (4) burden on allied health workers.

CONCLUSION

The NDIS planning process has developed and progressed since its rollout in 2013. There are limited research papers available that describe the workforce's experience of the planning process in regional, rural and remote regions. More research in this area is needed to identify the experiences of the disability workforce in relation to the NDIS planning process.

Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

BACKGROUND

Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).

METHODS

We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.

RESULTS

Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%).

CONCLUSION

Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

The experiences of people with disability and their families/carers navigating the NDIS planning process in regional, rural and remote regions of Australia: Scoping review

BACKGROUND

Australia's National Disability Insurance Scheme (NDIS) was launched in 2013 to provide financial support packages for people with disability to purchase supports and services to enhance independence. People with disability are required to develop a plan with the National Disability Insurance Agency (NDIA), the government department responsible for managing the NDIS. This scoping review aims to ascertain the level of research into people's experience of the NDIS planning process in these geographic areas.

METHODOLOGY

Research publication databases were searched using a specific search string to identify research about people with disability and their families/carer's experiences of the NDIS planning process in regional, rural and remote regions of Australia. The Mixed Methods Appraisal Tool (MMAT) was adopted to appraise the quality of the research publications. Research publications focused on Aboriginal and Torres Strait Islander people were additionally appraised using the Aboriginal and Torres Strait Islander Quality Appraisal Tool developed by the Centre for Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange. A thematic synthesis of the publications' contents was undertaken to ascertain people with disabilities and carers experience of the NDIS planning process.

RESULTS

Ten (N = 10) research papers were found that met the inclusion criteria. Two papers were policy reviews and reported on the improvements of the NDIS planning process since its conception. The analysis found the research archive focused on five themes: (1) healthcare workforce and NDIA staff; (2) NDIS package holders and carers lack of awareness of the NDIS; (3) cultural/socio-economic barriers; (4) travel funding; and (5) emotional burden of the NDIS planning process.

CONCLUSION

There are limited papers available that explore people's experiences of the NDIS planning process in regional, rural and remote regions of Australia. This systematic review illuminates the difficulties, barriers and concerns of people with disability and their carers about the planning process.

Understanding workforce needs of allied health staff in regional cancer care centres: Informing recruitment and succession planning

OBJECTIVE

To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions.

DESIGN

Multiphase, observational study including a prospective study and a cross-sectional survey.

SETTING

Two regional Queensland Hospitals.

PARTICIPANTS

Cancer specialist AHPs (n = 13 in a prospective study; n = 7 in a cross-sectional survey) and generalist AHPs (n = 36 in a cross-sectional survey), across six disciplines from two regional hospitals and cancer services.

MAIN OUTCOME MEASURES

Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs.

RESULTS

Over 10-months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs-laryngectomy pre-operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs.

CONCLUSION

There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on-boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.

Managing an ageing healthcare workforce: a systematic literature review

PURPOSE

The aim of this paper is to review research conducted on managing the ageing healthcare workforce and identify gaps for further research.

DESIGN/METHODOLOGY/APPROACH

A systematic literature search of studies in the English language was carried out in Scopus and Web of Science databases.

FINDINGS

The study consists of an analysis of 75 published articles. The majority of the papers were published in recent years, indicating a growing interest in the field. The authors specified the following inclusion criteria: all years, articles/reviews, English language and full text in the Web of Science and Scopus databases. The authors of the paper illustrated seven major categories with different topics that were suggested for future research. It included: challenges of labor market in the healthcare field, age-related changes and their influence on work ability, training opportunities and lifelong learning among ageing health workforce, motives of early retirement, ageing and its relationship to Occupational Health and Safety. Longitudinal studies and case study strategy with mixed-methods approaches were suggested for future research by the authors.

ORIGINALITY/VALUE

The paper summarizes knowledge related to the management of ageing health workforce, describes topics researched and as a result, presents findings on and conclusions about the most important future implications of the ageing workforce for management in the healthcare field providing lines for further research. To the authors' knowledge, no holistic systematic literature reviews have been published in academic journals targeted specifically to ageing healthcare workers.

Responding to rural allied health workforce challenges in the public health system: Evaluation of the Allied Health Rural Generalist Pathway pilot in western New South Wales

OBJECTIVE

The Allied Health Rural Generalist Pathway pilot aimed to improve consistent access to physiotherapy services in rural communities using the "grow own" workforce strategy and existing resources.

DESIGN

A summative evaluation of the quality improvement project used to implement the Allied Health Rural Generalist Pathway was completed. A mixed method design was used and included focus groups and a framework analysis.

PARTICIPANTS

The temporary redesign of specific workforce resources created "development" positions. A shared same-discipline supervisor resource supported five early-career physiotherapists, the participants.

SETTING

The project was undertaken in rural New South Wales in the public health system.

MAIN OUTCOME MEASURES

The main outcome measures included a number of chronically vacant physiotherapy positions and stakeholder satisfaction.

RESULTS

Targeted vacancies were filled, services sustained with minimal service gaps and mean retention rate of 2.9 years. A statistically significant increase in service activity to patients in rural locations occurred as a result of the intervention (R-squared 29%, P < .05). Four out of five early career physiotherapists fulfilled terms of their contract and secured senior positions within the region. Whilst participants developed professionally, they did not complete the tertiary education component.

CONCLUSIONS

The Allied Health Rural Generalist multi-factorial approach supported recruitment, retention and capacity building within the targeted discipline of the allied health workforce. Patient need was met. The rural pipeline capacity was developed. The pathway was complementary of existing NSW Health systems. Systemic change is needed to overcome inefficiencies experienced during implementation and to ensure sustainability. Further research to develop discipline-specific clinical training guidance through the stages of a rural allied health professionals' career may be helpful.

Factors that influence workplace location choices in the different allied health professions: A systematic review

INTRODUCTION

The maldistribution of health care workers between metropolitan, rural or remote areas is globally recognised. Allied health professional's workplace location choice is a complex interplay between professional and non-professional elements. Policy-makers should understand factors that influence workplace location choices when designing structures to attract allied health professionals to rural practice.

OBJECTIVE

To determine factors influencing recruitment and retention of allied health professionals in metropolitan, rural and remote locations.

DESIGN

Systematic review.

FINDINGS

Twenty-two studies met inclusion criteria. Extracted data were synthesised into subthemes: (a) opportunities for career development, (b) clinical load, (c) organisational and workplace structure, (d) previous location exposure and (e) personal factors. Of these 22 studies, 12 reported organisational/workplace structure and personal factors positively impacting recruitment and 11 studies discussed organisational and workplace structure also negatively impacting on retention. Career opportunities positively impacted on recruitment, while lack of opportunity negatively affected retention. Previous location exposure positively impacted recruitment however had limited impact on retention. Similarly, a diverse clinical load was reported as being attractive during recruitment, but unmanageable caseloads affected retention.

DISCUSSION

This review identifies the need for effective and sustainable solutions for the issues with recruitment and retention of allied health professionals. While the different allied health professions share similar recruitment and retention challenges, further research is needed to isolate factors impacting each discipline.

CONCLUSIONS

Retention and recruitment of different allied health professions is multifactorial. Organisational and workplace structure and opportunities for career development emerged as having impact on the recruitment of allied health professionals.

'Empowering clinicians in smaller sites': A qualitative study of clinician's experiences with a rural Virtual Paediatric Feeding Clinic

OBJECTIVE

To explore the experiences of 'spoke site' allied health and child and family health clinicians in the provision of care through a pilot 'hub and spoke' model Virtual Paediatric Feeding Clinic (VPFC) outreach service.

DESIGN

The study was qualitative, with data from virtual interview transcripts analysed using thematic analysis.

SETTING

Orange Health Service ('hub site') and seven community health centres within the Western NSW Local Health District ('spoke sites').

PARTICIPANTS

Nine 'spoke site' clinicians (from dietetics, speech pathology, occupational therapy and child and family health nursing), who had participated in the pilot clinic.

INTERVENTIONS

Participants took part in a semi-structured interview with a member of the research team.

MAIN OUTCOME MEASURES

Spoke site clinicians experiences and perceptions of the VPFC.

RESULTS

Four key themes emerged: (1) impact of the VPFC on 'spoke site' clinicians, (2) benefits for clients and families, (3) perceptions of the virtual model of care and (4) VPFC service challenges.

CONCLUSION

The expansion of an existing interdisciplinary Paediatric Feeding Clinic into a virtual service demonstrates the use of technology to bridge a gap in healthcare. Clinicians reported benefits not only for families, but for their own knowledge and confidence in provision of care and reduced professional isolation through connection with discipline-specific colleagues.

Regional and rural allied health professionals in Australia need better information services training and support for evidence-based practice

BACKGROUND

Evidence-based practice requires health professionals to recognise situations of uncertainty in their practice, translate that uncertainty into answerable questions, and find and appraise information relevant to those questions. No research to date has explored the research-based information needs of allied health professionals (AHPs) in regional and rural Australia.

OBJECTIVE

To examine the information-seeking experiences and needs of AHPs in regional and rural Australia.

METHODS

A total of 80 AHPs, predominantly occupational therapists and physiotherapists, practising in regional and rural areas of Australia completed an online survey.

RESULTS

Almost all respondents reported having questions requiring research evidence, but most of their questions were worded non-specifically. Respondents practising in rural areas had greater perceived difficulty in obtaining relevant evidence than their regional counterparts. Many respondents reported wanting additional support to find relevant research evidence.

DISCUSSION

The findings offer insights regarding information-seeking challenges AHPs face and potential solutions, including improved training and increased health librarian support. However, due to sampling limitations, the results cannot be generalised to all allied health professions.

CONCLUSION

Allied health professionals may require more training and support to engage in efficient and effective information-seeking behaviours. Health librarians have a valuable role to play in providing this training and support.

Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review

INTRODUCTION

Rural children are likely to benefit from the telehealth delivery of multidisciplinary allied healthcare. This study aimed to (a) identify the scope of literature describing the telehealth delivery of allied health services to children living in rural areas and (b) understand the extent to which implementation - that is, specific activities designed to put telehealth into practice - has been investigated in such literature.

METHODS

Systematic scoping review methodology was used to locate studies in which telehealth delivered allied health services to children aged 0-12 who lived rurally (January 1998-January 2018). Two reviewers screened the studies, extracted data and appraised quality with Critical Skills Appraisal Programme checklists. Databases searched were PubMed, MEDLINE, CINAHL, PsycINFO, ERIC and Cochrane Library.

RESULTS

Data were extracted from 23 papers (two randomised controlled trials, one pseudorandomised controlled trial, one non-randomised experimental trial, two interrupted time series without parallel control groups, 10 case series and seven studies of diagnostic yield). Most were level III (n = 4) or IV (n = 17) when classified according to National Health and Medical Research Council guidelines. One study met all Critical Skills Appraisal Programme quality criteria. Allied healthcare interventions were aimed at improving functioning in communication (n = 10), behaviour and socio-emotional domains (n = 8) and identifying hearing concerns (n = 5). Many studies (n = 12) identified implementation facilitators, largely training and equipment. Only one study referred to an explicit framework for telehealth implementation (user-centred design).

DISCUSSION

Future research should target occupational therapy, physiotherapy, dietetics and social work, and determine the implementation factors and models likely to create successful telehealth services for this population.

A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia

This exploratory randomised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor, imitation, language and social skills in young children with ASD who reside in regional areas. Fifty-nine participants were recruited and randomised to either a therapy-as-usual group or intervention group. With the exception of the expressive language subscale on the Mullen Scales of Early Learning, no significant between-group differences were recorded for visual motor, imitation, receptive language and social skills of participants between baseline and post-intervention. When all participants were pooled and measured over time, improvements were shown in receptive and pragmatic language and social skills; these gains were maintained, thus suggesting skill acquisition.

The human right to communicate: A survey of available services in Saudi Arabia

Article 19 of the Universal Declaration of Human Rights states: "Everyone has the right to freedom of opinion and expression." However, people with communication disabilities may be more likely to lose the right to express their opinions as a consequence of their atypical communication methods; hence they may be denied a basic human right. The purpose of the current study was to investigate the availability of speech-language pathology services in Saudi Arabia's public-health sector. The data were collected using a telephone survey. The results found a shortage of and an uneven distribution of health-based speech-language pathology services. Of the 196 major governmental hospitals surveyed, 29 were identified as having speech-language pathology services, which were distributed over 7 of Saudi Arabia's 13 Administrative Regions. Obtaining accurate information regarding the availability of these services is an important first step in informing policy development and aiding health-service planners to train more professional staff, expand services methodically and use existing resources effectively to meet the rights of people with communication disabilities.

Physical activity of rurally residing children with a disability: A survey of parents and carers

BACKGROUND

Children residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child.

OBJECTIVE

The aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area.

METHODS

A mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis.

RESULTS

There were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child.

CONCLUSION

The children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development.

Health workforce metrics pre- and post-2015: a stimulus to public policy and planning

BACKGROUND

Evidence-based health workforce policies are essential to ensure the provision of high-quality health services and to support the attainment of universal health coverage (UHC). This paper describes the main characteristics of available health workforce data for 74 of the 75 countries identified under the 'Countdown to 2015' initiative as accounting for more than 95% of the world's maternal, newborn and child deaths. It also discusses best practices in the development of health workforce metrics post-2015.

METHODS

Using available health workforce data from the Global Health Workforce Statistics database from the Global Health Observatory, we generated descriptive statistics to explore the current status, recent trends in the number of skilled health professionals (SHPs: physicians, nurses, midwives) per 10 000 population, and future requirements to achieve adequate levels of health care in the 74 countries. A rapid literature review was conducted to obtain an overview of the types of methods and the types of data sources used in human resources for health (HRH) studies.

RESULTS

There are large intercountry and interregional differences in the density of SHPs to progress towards UHC in Countdown countries: a median of 10.2 per 10 000 population with range 1.6 to 142 per 10 000. Substantial efforts have been made in some countries to increase the availability of SHPs as shown by a positive average exponential growth rate (AEGR) in SHPs in 51% of Countdown countries for which there are data. Many of these countries will require large investments to achieve levels of workforce availability commensurate with UHC and the health-related sustainable development goals (SDGs). The availability, quality and comparability of global health workforce metrics remain limited. Most published workforce studies are descriptive, but more sophisticated needs-based workforce planning methods are being developed.

CONCLUSIONS

There is a need for high-quality, comprehensive, interoperable sources of HRH data to support all policies towards UHC and the health-related SDGs. The recent WHO-led initiative of supporting countries in the development of National Health Workforce Accounts is a very promising move towards purposive health workforce metrics post-2015. Such data will allow more countries to apply the latest methods for health workforce planning.

Allied health research positions: a qualitative evaluation of their impact

Background

Research positions embedded within healthcare settings have been identified as an enabler to allied health professional (AHP) research capacity; however, there is currently limited research formally evaluating their impact. In 2008, a Health Practitioner industrial agreement funded a research capacity building initiative within Queensland Health, Australia, which included 15 new allied health research positions. The present project used a qualitative and realist approach to explore the impact of these research positions, as well as the mechanisms which facilitated or hindered their success within their respective organisations.

Methods

Forty-four AHP employees from six governmental health services in Queensland, Australia, participated in the study. Individual interviews were undertaken, with individuals in research positions (n = 8) and their reporting line managers (n = 8). Four stakeholder focus groups were also conducted with clinicians, team leaders and professional heads who had engaged with the research positions.

Results

Nine key outcomes of the research positions were identified across individual, team/service and organisational/community levels. These outcomes included clinician skill development, increased research activity, clinical and service changes, increased research outputs and collaborations, enhanced research and workplace culture, improved profile of allied health, development of research infrastructure, and professional development of individuals in the research positions. Different mechanisms that influenced these outcomes were identified. These mechanisms were grouped by those related to the (1) research position itself, (2) organisational factors and (3) implementation factors.

Conclusions

The present findings highlight the potential value of the research positions for individuals, teams and clinical services across different governmental healthcare services, and demonstrate the impact of the roles on building the internal and external profile of allied health. Results build upon the emerging evidence base for allied health research positions and have important implications for a number of stakeholders (i.e. individuals in the research positions, AHPs and their managers, university partners and state-wide executives). Key recommendations are provided for all stakeholders to enhance the ongoing impact of these roles and the potential advocacy for additional positions and resources to support them.

Electronic supplementary material

The online version of this article (doi:10.1186/s12961-016-0166-4) contains supplementary material, which is available to authorized users.

Shape of allied health: an environmental scan of 27 allied health professions in Victoria

Objective In 2015, the Victorian Department of Health and Human Services commissioned the Victorian Allied Health Workforce Research Program to provide data on allied health professions in the Victorian public, private and not-for-profit sectors. Herein we present a snapshot of the demographic profiles and distribution of these professions in Victoria and discuss the workforce implications. Methods The program commenced with an environmental scan of 27 allied health professions in Victoria. This substantial scoping exercise identified existing data, resources and contexts for each profession to guide future data collection and research. Each environmental scan reviewed existing data relating to the 27 professions, augmented by an online questionnaire sent to the professional bodies representing each discipline. Results Workforce data were patchy but, based on the evidence available, the allied health professions in Victoria vary greatly in size (ranging from just 17 child life therapists to 6288 psychologists), are predominantly female (83% of professions are more than 50% female) and half the professions report that 30% of their workforce is aged under 30 years. New training programs have increased workforce inflows to many professions, but there is little understanding of attrition rates. Professions reported a lack of senior positions in the public sector and a concomitant lack of senior specialised staff available to support more junior staff. Increasing numbers of allied health graduates are being employed directly in private practice because of a lack of growth in new positions in the public sector and changing funding models. Smaller professions reported that their members are more likely to be professionally isolated within an allied health team or larger organisations. Uneven rural–urban workforce distribution was evident across most professions. Conclusions Workforce planning for allied health is extremely complex because of the lack of data, fragmented funding and regulatory frameworks and diverse employment contexts. What is known about this topic? There is a lack of good-quality workforce data on the allied health professions generally. The allied health workforce is highly feminised and unevenly distributed geographically, but there is little analysis of these issues across professions. What does this paper add? The juxtaposition of the health workforce demographics and distribution of 27 allied health professions in Victoria illustrates some clear trends and identifies several common themes across professions. What are the implications for practitioners? There are opportunities for the allied health professions to collectively address several of the common issues to achieve economies of scale, given the large number of professions and small size of many.

Investigation of training and support needs in rural and remote disability and mainstream service providers: implications for an online training model

Objectives It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle. Technology provides a possible solution not only for increasing access to these opportunities, but also in building community capacity to support children with autism. The aim of the present study was to investigate the current learning and support needs within rural and remote professionals prior to setting up a model of support. Methods An online survey was used to gather information from service providers in rural and remote communities on their demographics, current skills and confidence in working with clients on the autism spectrum, current supervision and professional development, identified learning and support needs, and the availability and uptake of technology for accessing professional development. Results Respondents reported below average levels of perceived confidence and skills when working with children with autism, most notably children with challenging behaviour. Half the respondents do not currently attend supervision sessions, with only 15% receiving regular supervision (fortnightly or more often), and 66% of respondents had travelled more than 3h to access professional development workshops. The majority of participants had access to technology and over half had already used this for online training. Conclusion Overall, service providers in rural and remote areas are generally not currently meeting their needs in terms of frequency of supervision and professional development. The present needs analysis identifies key areas for learning, the ideal frequency of support and the acceptability of using technology to deliver this support. This information will guide future researchers in the development of an evidence-based model that will be accessible and meaningful to its participants. What is known about the topic? It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle, which may be triggered by geographical isolation. Technology-delivered intervention and support, also known as eHealth or Telehealth, has been used successfully in the disability sector for medical rehabilitation, direct intervention, employment support and support groups, but there is little evidence as to how technology is received by and implemented with disability and mainstream service providers supporting children with autism living in remote regions. What does this paper add? This paper provides an insight into the current skills and confidence of a broad range of service providers, including educators, allied health therapists and therapy and community support workers, in working with children with autism. This paper also investigates the experience, feasibility and potential uptake of a technology-driven program of support and professional development in rural and remote Australia. Finally, this paper provides an insight into the desired frequency of training and support, as well as identified learning support needs. What are the implications for practitioners? These findings have and will continue to guide practitioners in the development of an evidence-based, technology-driven model of supporting rural and remote staff working with children with autism. Technology has the potential to provide practitioners in geographically isolated areas with access to more responsive, collaborative and individualised professional support and training. Such practice may improve the skills of practitioners and the level of support they can provide their clients with autism, with the added potential of increasing staff retention in rural and remote areas of Australia.

Development and validation of an instrument to assess job satisfaction in eye-care personnel

PURPOSE

The aim was to develop and validate an instrument to measure job satisfaction in eye-care personnel and assess the job satisfaction of one-year trained vision technicians in India.

METHODS

A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians' job satisfaction and factors such as age, gender and experience were analysed using t-test and one-way analysis of variance.

RESULTS

Rasch analysis confirmed that the 15-item job satisfaction in eye-care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non-financial incentives, salary and workload were the most important determinants of job satisfaction.

CONCLUSIONS

The 15-item JSEP instrument is a valid instrument for assessing job satisfaction among eye-care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction.

The changing landscape of physiotherapy student clinical placements: An exploration of geographical distribution and student performance across settings

OBJECTIVE

To describe the geographical distribution of physiotherapy clinical placements and investigate the relationship between geographical setting and clinical placement marks in physiotherapy students.

DESIGN

A retrospective cohort design was used for this study.

SETTING

The University of Newcastle, New South Wales.

PARTICIPANTS

Data from entry-level Bachelor of Physiotherapy student clinical placements.

MAIN OUTCOME MEASURE(S)

Data from all clinical placements in the Physiotherapy program between 2003 and 2014 were included. For all clinical placements, student assessment mark, year of study, type of placement and placement location were collected. Placement location was then classified using the Modified Monash Model (MMM) categories: one (most metropolitan) to seven (most remote).

RESULTS

Over the 12 year period of the study 3964 placements were completed. Between 2003 and 2005 the average proportion of clinical placements occurring in metropolitan areas (MMM1) was 78% and in rural areas (MMM categories 3-6) was 22%. In 2014 these proportions had changed to 59% (MMM1) and 40% (MMM3-6). There were significant differences in clinical placement grades between MMM1 and all other categories except MMM2, with lower assessment marks in MMM1 than other categories.

CONCLUSIONS

The changing distribution of physiotherapy clinical placements may be reflective of increasing student numbers and greater efforts to support students completing rural and remote placements. This change may lead to a positive effect on the rural and remote physiotherapy workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural and remote settings.

Building workforce capacity for ethical reflection in health promotion: a practitioner's experience

Health promotion does not have a code of ethics, although attempts have been made to assist practitioners in their understanding and application of ethical concepts. This article describes and analyses one such attempt, sustained from 2006 to 2014 in rural South Australia. The attempt comprised capacity-building activities that were informed by principles of organisational change management, especially the principle of creating champions. The article also presents a framework (largely comprising ethical questions) that may help practitioners as a prompt and guide to ethical reflection. The framework was developed to be as accessible as possible in light of the diverse educational backgrounds found in rural settings. Finally, the article highlights some philosophical dimensions to the framework and defends its role, proposing that ethical reflection is integral to good practice and never simply the province of theorists. The article does all this with a view to stimulating discussion on how to increase the frequency and quality of ethical reflection undertaken by health promotion practitioners.

Comparison of research experience and support needs of rural versus regional allied health professionals

OBJECTIVE

We compared the research experience or support needs of allied health professionals in rural versus regional cities to identify if they were the same or different.

DESIGN

Descriptive study using a cross sectional survey.

SETTING

This study was carried within Queensland Health's northern six health services.

PARTICIPANTS

Queensland health staff classified as Health Practitioners.

INTERVENTIONS

This survey was conducted as part of a research capacity building initiative within Queensland Health to increase AHPs' participation in research in regional cities and rural areas of Queensland.

MAIN OUTCOME MEASURES

Questions in the survey identified demographics, research experience, need for research support, research knowledge and beliefs about research. Data were compared using Chi-square and t-tests.

RESULTS

The total response rate was 54.5% with 18% of the HPs located in rural communities of less than 5000 people and the rest from the three major cities in northern Queensland. Rural HPs have less research experience in most research activities than regional city HPs and need more research support. Rural HPs have more qualitative research experience than regional city HPs and research is perceived positively by both. Barriers to conducting research were similar across both groups and included insufficient time, lack of staff and no statistical support.

CONCLUSION

Rural HPs are younger and have less research experience than their counterparts working in regional cities. Therefore, building rural HP research capacity initiatives may require more access to facilitators such as the Research Fellows.

Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia

INTRODUCTION

The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.

OBJECTIVE

This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists - "therapists") living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention.

METHODS

A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs' current job, and their workforce preferences were explored using a best-worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs' relative preferences for six different job attributes.

RESULTS

One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, "high autonomy of practice" is the most valued attribute level, followed by "travel BWSDCE arrangements: one or less nights away per month", "travel arrangements: two or three nights away per month" and "adequate access to professional development". On the other hand, the least valued attribute levels were "travel arrangements: four or more nights per month", "limited autonomy of practice" and "minimal access to professional development". Except for "some job flexibility", all other attributes had a statistical influence on AHPs' job preference. Preferences differed according to age, marital status and having dependent children.

CONCLUSIONS

This study allowed the identification of factors that contribute to AHPs' employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention.

Occupational therapists' experiences of career progression following promotion

BACKGROUND/AIM

The recruitment and retention of a skilled occupational therapy workforce is highlighted as a key issue for the profession, and yet there have been relatively few studies into the career progression of occupational therapists.

METHODS

A qualitative, naturalistic approach was adopted to answer the research question, using semi-structured interviews to gather data. Eleven purposefully selected participants at an Australian health service were interviewed as part of this study. Categories representing the most common themes and topics supplied by participants within their individual interviews were identified and consolidated by the research team. The trustworthiness of this study was supported by strategies to maximise its credibility, dependability and confirmability.

RESULTS

Four main themes were elicited from the data - (i) Readiness for progression, (ii) Tools and processes, (iii) Expectations and (iv) What I wish I had known first. Within these themes, related findings were also identified by both Grade 2 and Grade 3 staff.

CONCLUSIONS

This study indicates that the readiness of occupational therapists to climb the career ladder is influenced by the tools and processes they can utilise, and the expectations they have around the realities of their new position. With hindsight, participants highlighted some things they wish they had known at the time of transition, which appeared to have been implicit.

SIGNIFICANCE OF STUDY

This study is the first to address the common issues for occupational therapy staff around progression between grade levels. It therefore provides a basis for further research in other practice settings and for the development of supports for therapists climbing the career ladder.

Establishing and delivering pulmonary rehabilitation in rural and remote settings: The opinions, attitudes and concerns of health care professionals

OBJECTIVE

Pulmonary rehabilitation is recommended for people with chronic lung disease however access remains limited in rural and remote settings. The aim of this project was to explore the perspectives of rural and remote health care professionals regarding the establishment and delivery of pulmonary rehabilitation.

SETTING

Rural (NSW) and remote (NT) Australian healthcare settings.

PARTICIPANTS

Health care professionals (n = 25) who attended a training program focussing on the delivery of pulmonary rehabilitation.

MAIN OUTCOME MEASURE(S)

Surveys with open written questions were completed by participants following the training program. Key informants also participated in face-to-face interviews. Thematic analysis was undertaken of data collected on participant opinions, attitudes and concerns regarding the establishment and delivery of pulmonary rehabilitation in their individual situation.

RESULTS

Participating health care professionals (predominantly nurses and physiotherapists) identified a number of issues relating to establishing and delivering pulmonary rehabilitation; including staffing, time and case load constraints, patient and community attitudes, lack of professional knowledge and confidence and inability to ensure sustainability. The practicalities of delivering pulmonary rehabilitation, particularly exercise prescription and training, were also important concerns raised.

CONCLUSIONS

Lack of health care professional staffing, knowledge and confidence were reported to be factors impacting the establishment and delivery of pulmonary rehabilitation. This study has facilitated a greater understanding of the issues surrounding the establishment and delivery of pulmonary rehabilitation in rural and remote settings. Further research is required to investigate the contribution of health professional training and associated factors to improving the availability and delivery of pulmonary rehabilitation in rural and remote settings.

Allied health growth: what we do not measure we cannot manage

BACKGROUND

Data describing the Australian allied health workforce is inadequate and so insufficient for workforce planning. National health policy reform requires that health-care models take into account future workforce requirements, the distribution and work contexts of existing practitioners, training needs, workforce roles and scope of practice. Good information on this workforce is essential for managing services as demands increase, accountability of practitioners, measurement of outcomes and benchmarking against other jurisdictions. A comprehensive data set is essential to underpin policy and planning to meet future health workforce needs.

DISCUSSION

Some data on allied health professions is managed by the Australian Health Practitioner Regulation Agency; however, there is limited information regarding several core allied health professions. A global registration and accreditation scheme recognizing all allied health professions might provide safeguards and credibility for professionals and their clients. Arguments are presented about inconsistencies and voids in the available information about allied health services. Remedying these information deficits is essential to underpin policy and planning for future health workforce needs. We make the case for a comprehensive national data set based on a broad and inclusive sampling process across the allied health population.

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development

OBJECTIVE

This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas.

METHODS

Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison.

RESULTS

Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes.

CONCLUSION

The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs).

Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?

OBJECTIVE

Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions.

METHODS

The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR.

RESULTS

The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support.

CONCLUSIONS

The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.

Exploring a public-private partnership new-graduate physiotherapy recruitment program: a qualitative study

OBJECTIVE

Difficulty in attracting allied health staff to rural areas is well known. In 2012, a small rural health facility and local private practice created an informal public-private partnership to recruit two new-graduate physiotherapists. Graduates were employed part-time in both the public and private sectors.

DESIGN

This qualitative case study employed an appreciative enquiry framework to explore this partnership model. Three focus groups were held, and a combination of content and thematic analysis was used to derive and organise themes arising from the data.

SETTING

A regional public health service and private physiotherapy practice in the Bega Valley region of south-eastern New South Wales, Australia.

PARTICIPANTS

New-graduate and second-year physiotherapists (n = 5), private sector managers (n = 3), and public sector managers (n = 4).

MAIN OUTCOME MEASURES

Perceived benefits of the partnership model and improvements that could be made to further develop the model.

RESULTS

Organisational benefits of a shared public-private role included the ability to attract high-quality applicants to difficult-to-fill positions, reduced the risk of new-graduate attrition due to social isolation, enhanced networking between sectors, and enhanced staff skill development through a broad range of clinical and non-clinical experiences. The model relied on management flexibility and has potential to expand to other areas and professions. Dedicated funding support, targeted recruitment strategies and increased planning to ease the transition into the workplace would further enhance the model.

CONCLUSIONS

An informal public-private partnership to overcome established workforce shortages has proven successful to the benefit of the new graduates and both the public and private sectors.

What does personality tell us about working in the bush? Temperament and character traits of Australian remote allied health professionals

OBJECTIVE

To describe the personality (temperament and character traits) of remote Australian allied health professionals (AHPs). Recent research shows that health professionals can be differentiated by personality traits but little is known about the personality traits of AHPs.

DESIGN

Cross-sectional (online) survey design with snowball sampling of participants.

SETTING AND PARTICIPANTS

Australian AHPs (N = 561; women, n = 502) classified into Remote (n = 266), Not Remote (n = 295).

MAIN OUTCOME MEASURE(S)

Demographic variables and the Temperament and Character Inventory (TCI R-140).

RESULTS

Remote AHPs were higher in novelty seeking (P = 0.037) and self-transcendence (P = 0.042). Remote women were lower in harm avoidance (P = 0.042). Older remote AHPS were lower in reward dependence (P = 0.001); younger remote AHPs were lower in self directedness (P = 0.001) and higher in harm avoidance (P < 0.001). Women were more reward dependent (P < 0.001) and cooperative (P = 0.008) than men.

CONCLUSIONS

The sample demonstrated personality trait levels aligned with research on rural doctors and nurses and which might be advantageous for working in a challenging environment. Exploring the more stable nature of temperament traits coupled with the modifiable potential of character traits provides new insight into people who choose to work as a remote AHP. These findings might contribute to a better understanding of the personality trends in these AHPs which might provide clues to improve recruitment and retention strategies.

The paradoxical effects of workforce shortages on rural interprofessional practice

RATIONALE AND AIM

While interprofessional practice has been promoted as a solution to the challenges besetting rural health services, current evidence does not offer a clear explanation as to why it is effective in some domains and yet is not successful in others. At the same time, rural clinicians are frequently faced with major workforce pressures and this has a significant influence on professional practice. The aim of this study was to explore how these pressures impact on rural interprofessional practice.

METHOD

This study is part of a larger project investigating factors that enhance and detract from effective interprofessional working. We utilised a modified realistic evaluation approach to analyse the context, mechanisms and outcomes of rural interprofessional practice. Approval for this study was granted by an accredited research ethics committee. Semi-structured interviews were conducted with 22 rural clinicians who were purposively recruited from a range of settings, roles, locations and professions.

FINDINGS AND DISCUSSION

We found that clinicians often invested in interprofessional practice because of the need to manage intense workloads and this necessitated sharing of responsibilities across disciplines and blurring of role boundaries. Paradoxically, participants noted that workload pressures hampered interprofessional working if there were long-term skill shortages. Sharing workload and responsibility is an important motivator for rural practitioners to engage in interprofessional practice; however, this driver is only effective under circumstances where there are sufficient resources to facilitate collaboration. In the context of intransient resource challenges, rural health service managers would be best to focus on enabling IPP through facilitating role understanding and respect between clinicians. This is most feasible via informal workplace learning and allowing time for teams to reflect on collaborative processes.

Regional and remote occupational therapy: a preliminary exploration of private occupational therapy practice

BACKGROUND/AIM

Private providers of Medicare funded services are an integral part of the Australian primary health-care system. Evidence on private occupational therapy practice in rural and remote Australian settings is sparse.

METHODS

Providers of private occupational therapy services in outer regional and remote areas were surveyed regarding location and type of services provided, practice models and demographics. Descriptive statistics were used to summarise the findings.

RESULTS

Thirty-seven respondents completed the survey. In remote areas a number of occupational therapy services are not provided and no practices are based in very remote towns. One quarter of respondents visit at least five towns each week and one third had other paid employment. Nearly half indicated they will leave private practice within the next five years and nearly one third believed they could not sustain their practice. Medicare Chronic Disease Management was the main income source of only around half the respondents.

CONCLUSIONS

There is a potential market failure of private occupational therapy in rural and remote areas, impacting on people who need these services and on workforce replacement. Contributing factors include population imbalance between cities and regional/remote areas, financial implications where only face-to-face contact is paid for and low incomes and levels of health insurance in regional/remote areas. Potential strategies include addressing the lack of reimbursement for travel, enabling private providers to overcome barriers to providing student placements and recognising rural practice as a specialist field.

Carer and service providers' experiences of individual funding models for children with a disability in rural and remote areas

There is a global movement for people with a disability towards person-centred practices with opportunities for self-determination and choice. Person-centred approaches may involve individual funding (IF) for the purchase of required support. A shift to a person-centred model and IF should allow people with a disability and their carers greater choice in therapy access. However, individuals who live in rural and remote areas have less choice and access to therapy services than their metropolitan counterparts. Drawing on data from a larger study into therapy service delivery in a rural and remote area of New South Wales, Australia, this study describes some benefits and barriers to using IF to access therapy services in rural areas. Ten carers and 60 service providers participated in audio-recorded focus groups and individual interviews during which IF was discussed. Transcribed data were analysed using thematic analysis and constant comparison. Greater access to and choice of therapy providers were identified as benefits of IF. Four barriers were identified: (i) lack of information and advice; (ii) limited local service options and capacity; (iii) higher costs and fewer services and (iv) complexity of self-managing packages. A range of strategies is required to address the barriers to using IF in rural and remote areas. Carers indicated a need for: accessible information; a local contact person for support and guidance; adequate financial compensation to offset additional travel expenses and coordinated eligibility and accountability systems. Service providers required: coordinated cross-sector approaches; local workforce planning to address therapist shortages; certainty around service viability and growth; clear policies and procedures around implementation of IF. This study highlights the need for further discussion and research about how to overcome the barriers to the optimal use of an IF model for those living in rural and remote areas.

Factors associated with reported service use for mental health problems by residents of rural and remote communities: cross-sectional findings from a baseline survey

BACKGROUND

The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia.

METHODS

A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables.

RESULTS

The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services.

CONCLUSIONS

An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity.

Retention of the rural allied health workforce in New South Wales: a comparison of public and private practitioners

Background

Policy initiatives to improve retention of the rural health workforce have relied primarily on evidence for rural doctors, most of whom practice under a private business model. Much of the literature for rural allied health (AH) workforce focuses on the public sector. The AH professions are diverse, with mixed public, private or combined practice settings. This study explores sector differences in factors affecting retention of rural AH professionals.

Methods

This study compared respondents from the 2008 Rural Allied Health Workforce (RAHW) survey recruiting all AH professionals in rural New South Wales. Comparisons between public (n = 833) and private (n = 756) groups were undertaken using Chi square analysis to measure association for demographics, job satisfaction and intention to leave. The final section of the RAHW survey comprised 33 questions relating to retention. A factor analysis was conducted for each cohort. Factor reliability was assessed and retained factors were included in a binary logistic regression analysis for each cohort predicting intention to leave.

Results

Six factors were identified: professional isolation, participation in community, clinical demand, taking time away from work, resources and ‘specialist generalist’ work. Factors differed slightly between groups. A seventh factor (management) was present only in the public cohort. Gender was not a significant predictor of intention to leave. Age group was the strongest predictor of intention to leave with younger and older groups being significantly more likely to leave than middle aged.

In univariate logistic analysis (after adjusting for age group), the ability to get away from work did not predict intention to leave in either group. In multivariate analysis, high clinical demand predicted intention to leave in both the public (OR = 1.40, 95% CI = 1.08, 1.83) and private (OR = 1.61, 95% CI = 1.15, 2.25) cohorts. Professional isolation (OR = 1.39. 95% CI = 1.11, 1.75) and Participation in community (OR = 1.57, 95% CI = 1.13, 2.19) also contributed to the model in the public cohort.

Conclusions

This paper demonstrates differences between those working in public versus private sectors and suggests that effectiveness of policy initiatives may be improved through better targeting.

How prepared are rural and remote health care practitioners to provide evidence-based management for people with chronic lung disease?

OBJECTIVE

To investigate the existing experience, training, confidence and knowledge of rural/remote health care practitioners in providing management for people with chronic obstructive pulmonary disease (COPD).

DESIGN

  Descriptive cross-sectional, observational survey design using a written anonymous questionnaire. This study formed part of a larger project evaluating the impact of breathe easy walk easy (BEWE), an interactive education and training program for rural and remote health care practitioners.

SETTING

Rural (n = 1, New South Wales) and remote (n = 1, Northern Territory) Australian health care services.

PARTICIPANTS

Health care practitioners who registered to attend the BEWE training program (n = 31).

MAIN OUTCOME MEASURES

Participant attitudes, objective knowledge and self-rated experience, training and confidence related to providing components of management for people with COPD.

RESULTS

Participants were from a variety of professional backgrounds (medical, nursing, allied health) but were predominantly nurses (n = 13) or physiotherapists (n = 9). Most participants reported that they had minimal or no experience or training in providing components of management for people with COPD. Confidence was also commonly rated by participants as low. Mean knowledge score (number of correct answers out of 19) was 8.5 (SD = 4.5). Questions relating to disease pathophysiology and diagnosis had higher correct response rates than those relating more specifically to pulmonary rehabilitation.

CONCLUSION

The results of this study indicate that some rural and remote health care practitioners have low levels of experience, knowledge and confidence related to providing components of management for people with COPD and that education and training with an emphasis on pulmonary rehabilitation would be beneficial.

The South Australian Allied Health Workforce survey: helping to fill the evidence gap in primary health workforce planning

There is a lack of detailed evidence about the allied health workforce to inform proposed health care reforms. The South Australian Allied Health Workforce (SAAHW) survey collected data about the demographic characteristics, employment, education and recruitment and retention of allied health professionals in South Australia. The SAAHW questionnaire was widely distributed and 1539 responses were received. The average age of the sample was 40 years; males were significantly older than females, the latter making up 82% of respondents. Three-quarters of the sample worked in the city; 60% worked full time and the remainder in part-time, casual or locum positions. 'Work-life balance' was the most common attraction to respondents' current jobs and 'Better career prospects' the most common reason for intending to leave. Practice in a rural location was influenced by rural background and rural experience during training. A greater proportion of Generation Y (1982-2000) respondents intended to leave within 2 years than Generation X (1961-81) or Baby Boomers (1943-60). Most respondents were satisfied with their job, although some reported lack of recognition of their knowledge and skills. Systematic, robust allied health workforce data are required for integrated and sustainable primary health care delivery.

Retention of allied health professionals in rural New South Wales: a thematic analysis of focus group discussions

BACKGROUND

Uneven distribution of the medical workforce is globally recognised, with widespread rural health workforce shortages. There has been substantial research on factors affecting recruitment and retention of rural doctors, but little has been done to establish the motives and conditions that encourage allied health professionals to practice rurally. This study aims to identify aspects of recruitment and retention of rural allied health professionals using qualitative methodology.

METHODS

Six focus groups were conducted across rural NSW and analysed thematically using a grounded theory approach. The thirty allied health professionals participating in the focus groups were purposively sampled to represent a range of geographic locations, allied health professions, gender, age, and public or private work sectors.

RESULTS

Five major themes emerged: personal factors; workload and type of work; continuing professional development (CPD); the impact of management; and career progression. 'Pull factors' favouring rural practice included: attraction to rural lifestyle; married or having family in the area; low cost of living; rural origin; personal engagement in the community; advanced work roles; a broad variety of challenging clinical work; and making a difference. 'Push factors' discouraging rural practice included: lack of employment opportunities for spouses; perceived inadequate quality of secondary schools; age related issues (retirement, desire for younger peer social interaction, and intention to travel); limited opportunity for career advancement; unmanageable workloads; and inadequate access to CPD. Having competent clinical managers mitigated the general frustration with health service management related to inappropriate service models and insufficient or inequitably distributed resources. Failure to fill vacant positions was of particular concern and frustration with the lack of CPD access was strongly represented by informants.

CONCLUSIONS

While personal factors affecting recruitment and retention of allied health study participants were similar to doctors, differences also existed. Allied health professionals were attracted by advanced work roles in a context of generalist practice. Access to CPD and inequitable resource distribution were strong 'push' factors in this group. Health policy based on the assumption of transferability between professions may be misguided.

Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the 'wobbly hub and double spokes' project

BACKGROUND

Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia.

METHODS/DESIGN

The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and evaluate the implementation and impact of new or adapted policies that arise from the preceding stages.

DISCUSSION

The project will provide policy makers with research evidence to support consideration of the complex balance between: (i) the equitable allocation of scarce resources; (ii) the intent of current eligibility and prioritisation policies; (iii) workforce constraints (and strengths); and (iv) the most effective, evidence-based clinical practice.