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Dhupelia D, Van Erp A, Collins J, Sen Gupta T. A Post-Fellowship Support Framework for Rural Doctors: the Queensland experience. MEDEDPUBLISH 2024; 14:6. [PMID: 38765714 PMCID: PMC11099509 DOI: 10.12688/mep.20025.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 05/22/2024] Open
Abstract
Background International workforce shortages have prompted many initiatives to recruit, train and retain rural doctors, including Australia's emerging National Rural Generalist Pathway. This project explored an important component of retention, rural doctors' post-Fellowship support needs, to develop and validate a post-Fellowship support framework. There has been considerable international attention on social accountability in medical education and how medical schools and other institutions can address the needs of the communities they serve. The recognition that rural and remote communities globally are underserved has prompted numerous educational approaches including rurally focused recruitment, selection, and training. Less attention has been paid to the support needs of rural doctors and how they can be retained in rural practice once recruited. Methods The project team reviewed international and Australian rural workforce and medical education literature and relevant policy documents to develop a set of guiding principles for a post-Fellowship support framework. This project utilised a mixed methods approach involving quantitative and qualitative methodologies. A range of rural doctors, administrators, and clinicians, working in primary and secondary care, across multiple rural locations in Queensland were invited to participate in interviews. Thematic analysis was undertaken. Results The interviews validated ten interconnected guiding principles which enabled development of a grounded, contextually relevant approach to post-Fellowship support. This framework provides a blueprint for a retention strategy aiming to build a strong, skilled, and sustainable medical workforce capable of meeting community needs. Conclusions The ten principles were designed in the real-world context of a mature Queensland Rural Generalist Pathway. Four themes emerged from the inductive thematic analysis: connecting primary and secondary care; valuing a rural career; supporting training and education; and valuing rural general practice. These themes will be used as a basis for engagement and consultation with rural stakeholders to develop appropriate retention and support strategies.
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Affiliation(s)
- Dilip Dhupelia
- Darling Downs Health, Queensland Country Practice, Brisbane, QLD, 4001, Australia
| | - Ansmarie Van Erp
- Darling Downs Health, Queensland Country Practice, Brisbane, QLD, 4001, Australia
| | - James Collins
- Darling Downs Health, Queensland Country Practice, Brisbane, QLD, 4001, Australia
| | - Tarun Sen Gupta
- Darling Downs Health, Queensland Country Practice, Brisbane, QLD, 4001, Australia
- College of Medicine & Dentistry, James Cook University, DOUGLAS, Queensland, 4811, Australia
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Botes M, Bruce J, Cooke R. Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study. Glob Health Action 2023; 16:2156114. [PMID: 36602063 PMCID: PMC9828674 DOI: 10.1080/16549716.2022.2156114] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking. OBJECTIVES This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level. METHODS Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level. RESULTS Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III. CONCLUSION Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.
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Affiliation(s)
- Meghan Botes
- Department of nursing education, University of the Witwatersrand, Parktown, South Africa,CONTACT Meghan Botes Department of nursing education, University of the Witwatersrand, 7 York road, Parktown, Gauteng2193, South Africa
| | - Judith Bruce
- Department of nursing education, University of the Witwatersrand, Parktown, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Parktown, South Africa
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Matiwane BP, Blaauw D, Rispel LC. Examining the extent, forms and factors influencing multiple job holding among medical doctors, professional nurses and rehabilitation therapists in two South African provinces: a cross-sectional study. BMJ Open 2023; 13:e078902. [PMID: 38128938 DOI: 10.1136/bmjopen-2023-078902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Multiple job holding (MJH), or working in more than one paid job simultaneously, is a common characteristic of health labour markets. The study examined the extent (prevalence), forms and factors influencing MJH among public sector medical doctors, professional nurses and rehabilitation therapists in two South African provinces. DESIGN A cross-sectional, analytical study. SETTING 29 public sector hospitals in the Gauteng and Mpumalanga provinces of South Africa. PARTICIPANTS Full-time public sector medical doctors, professional nurses and rehabilitation therapists. RESULTS We obtained an overall response rate of 84.3%, with 486 medical doctors, 571 professional nurses and 340 rehabilitation therapists completing the survey. The mean age was 39.9±9.7 years for medical doctors, 43.7±10.4 years for professional nurses and 32.3±8.7 years for rehabilitation therapists. In the preceding 12 months, the prevalence of MJH was 33.7% (95% CI 25.8% to 42.6%) among medical doctors, 8.6% (95% CI 6.3% to 11.7%) among professional nurses and 38.7% (95% CI 31.5% to 46.5%) among rehabilitation therapists. Medical doctors worked a median of 20 (10-40) hours per month in their additional jobs, professional nurses worked 24 (12-34) hours per month and rehabilitation therapists worked 16 (8-28) hours per month. Private practice was the most prevalent form of MJH among medical doctors and rehabilitation therapists, compared with nursing agencies for professional nurses. MJH was significantly more likely among medical specialists (OR 4.3, p<0.001), married professional nurses (OR 2.4, p=0.022) and male rehabilitation therapists (OR 2.4, p=0.005). CONCLUSION The high prevalence of MJH could adversely affect the care of public sector patients. The study findings should inform the review and revision of existing MJH policies.
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Affiliation(s)
- Busisiwe Precious Matiwane
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Duane Blaauw
- Centre of Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Laetitia Chairmaine Rispel
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Kimura K, Inoue K, Ando T, Ito M. Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014. BMC Health Serv Res 2023; 23:1404. [PMID: 38093353 PMCID: PMC10720184 DOI: 10.1186/s12913-023-10258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors. METHODS We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians' gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience. RESULTS The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315-0.298-0.298 (male physicians: 0.311-0.289-0.283, female physicians: 0.394-0.385-0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas. CONCLUSION Female physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.
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Affiliation(s)
- Kazuki Kimura
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima City, Japan, 1-2-3 Kasumi, Minami-ku, Hiroshima Prefecture.
| | - Kazuo Inoue
- Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
| | - Takahito Ando
- Laboratory of Pharmaceutical Care and Community Medicine, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima City, Japan, 1-2-3 Kasumi, Minami-ku, Hiroshima Prefecture
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Tort-Nasarre G, Vidal-Alaball J, Pedrosa MJF, Abanades LV, Arcarons AF, Rosanas JD. Factors associated with the attraction and retention of family and community medicine and nursing residents in rural settings: a qualitative study. BMC MEDICAL EDUCATION 2023; 23:662. [PMID: 37705018 PMCID: PMC10500790 DOI: 10.1186/s12909-023-04650-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The current shortage of primary care doctors and nurses is causing difficulties in replacement, and this shortage is expected to increase. This situation is more pronounced in rural environments than in urban ones. Family and community care specialty training is a key component of both the transition to clinical practice and the retention of new professionals. The aim of this study is to explore the attitudes and perceptions of internal medicine residents and internal nurse residents trained in a rural teaching unit on factors associated with recruitment and retention, including the role of the specialty training programme. METHODS A qualitative study was conducted. Purposive sampling was used, and thirteen residents from the central Catalonia teaching unit who were in their final year of training participated in semistructured interviews. The data were collected during 2022 and were subsequently analysed with thematic analysis. The study is reported using the COREQ checklist. RESULTS Six themes emerged from data related to perceptions and attitudes about the factors associated with recruitment and retention: training programme, characteristics of the family and community specialty, concept of rural life, family and relational factors, economic and resource factors, and recruitment and job opportunities. CONCLUSIONS Family and community medicine and nursing residents trained in rural settings expressed satisfaction with the specialty programme and most features of primary care, but they experienced a wide range of uncertainties in deciding on their professional future in terms of living in rural areas, family support, financial support and recruitment. This study identifies individual and structural factors that could be of great use to retain doctors and nurses in rural areas.
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Affiliation(s)
- G Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, Lleida, 25198, Spain
- SAP ANOIA. Gerencia Territorial Catalunya Central, Institut Català de La Salut, Igualada, 08700, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Sant Fruitós del Bages, 08272, Spain.
- Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, 08272, Spain.
- University of Vic-Central University of Catalonia, Vic, 08500, Spain.
| | - M J Fígols Pedrosa
- Unitat Docent Multiprofessional d'AFiC Catalunya Central, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, 08272, Spain
| | - L Vazquez Abanades
- Unitat Docent Multiprofessional d'AFiC Catalunya Central, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, 08272, Spain
| | - A Forcada Arcarons
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 13-15, Sant Fruitós de Bages, 08272, Spain
| | - J Deniel Rosanas
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, Lleida, 25198, Spain
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McGrail MR, Nasir BF, Chater AB, Sangelaji B, Kondalsamy-Chennakesavan S. The value of extended short-term medical training placements in smaller rural and remote locations on future work location: a cohort study. BMJ Open 2023; 13:e068704. [PMID: 36707116 PMCID: PMC9884882 DOI: 10.1136/bmjopen-2022-068704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate the effects of extended short-term medical training placements in small rural and remote communities on postgraduate work location. DESIGN AND SETTING Cohort study of medical graduates of The University of Queensland, Australia. PARTICIPANTS Graduating medical students from 2012 to 2021 who undertook a minimum of 6 weeks training in a small rural or remote location. Some participants additionally undertook either or both an extended short-term (12-week) placement in a small rural or remote location and a long-term (1 or 2 years) placement in a large regional centre. PRIMARY OUTCOME MEASURE Work location was collected from the Australian Health Practitioner Regulation Agency in 2022, classified as either rural, regional or metropolitan and measured in association with rural placement type(s). RESULTS From 2806 eligible graduates, those participating in extended small rural placements (n=106, 3.8%) were associated with practising rurally or regionally postgraduation (42.5% vs 19.9%; OR: 2.2, 95% CI: 1.1 to 4.6), for both those of rural origin (50% vs 30%; OR: 4.9, 95% CI: 2.6 to 9.2) or metropolitan origin (36% vs 17%; OR: 2.8, 95% CI: 1.7 to 4.8). Those undertaking both an extended small rural placement and 2 years regional training were most likely to be practising in a rural or regional location (61% vs 16%; OR: 8.6, 95% CI: 4.5 to 16.3). Extended small rural placements were associated with practising in smaller rural or remote locations in later years (15% vs 6%, OR: 2.7, 95% CI: 1.3 to 5.3). CONCLUSION This work location outcome evidence supports investment in rural medical training that is both located in smaller rural and remote settings and enables extended exposure with rural generalists. The evaluated 12-week programme positively related to rural workforce outcomes when applied alone. Outcomes greatly strengthened when the 12-week programme was combined with a 2-year regional centre training programme, compared with either alone. These effects were independent of rural origin.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, Queensland, Australia
| | - Bushra F Nasir
- Rural Clinical School, The University of Queensland Faculty of Medicine, Toowoomba, Queensland, Australia
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Alan Bruce Chater
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Bahram Sangelaji
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
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Bishop JL, Ping S. Evaluation of a novel salaried medical officer position on service provision and performance at a rural health service: An exploratory mixed-methods study. Aust J Rural Health 2021; 30:65-74. [PMID: 34932247 DOI: 10.1111/ajr.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/18/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the impact of a new salaried medical officer position on health service provision and organisational performance. DESIGN Health service staff were invited to complete a survey to ascertain their overall satisfaction with the salaried medical officer position and impact on their workflow. Purposive sampling identified respondents for interviews to further explore the experiences of health service staff. Financial, administrative and quality information was extracted for analysis. SETTING Medium size rural health service in Victoria, Australia. PARTICIPANTS All general practitioner, nursing and allied health staff employed by, or who provide services to, the health service. MAIN OUTCOME MEASURES Satisfaction with the salaried medical officer position, ability to address patient concerns, themes from interviews, organisational performance data. RESULTS Forty surveys (general practitioner, nursing and allied health) were returned and 10 interviews completed. The mean rating for satisfaction with the salaried medical officer position was 8.4 out of 10. Addressing patient care concerns was rated significantly easier by nursing and allied health staff when the salaried medical officer was working. The interviews identified three broad themes: improved efficiency, increased accessibility and eliminated service gaps. CONCLUSION Health service staff reported that a salaried medical officer position at a rural health service improved work efficiency, increased accessibility to timely medical advice and improved quality of care, particularly patients at risk of sudden deterioration.
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Affiliation(s)
| | - Sophie Ping
- East Grampians Health Service, Ararat, Vic., Australia
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Characterising generalism in clinical practice: a systematic mixed studies review protocol. BJGP Open 2021; 5:BJGPO.2021.0029. [PMID: 33910918 PMCID: PMC8450881 DOI: 10.3399/bjgpo.2021.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Generalist physician care is associated with improved patient outcomes. Despite initiatives to promote generalism in educational settings, recruitment to generalist disciplines remains less than required to serve societal needs. Increasingly this impacts not just general practice but also generalist specialties such as internal medicine, surgery, and paediatrics. One potential factor for this deficit is a lack of explicit attention to generalism as a praxis, including clarifying key aspects of generalist expertise. AIM To examine empirical clinical literature on generalism, and characterise how generalism is described and delivered by physicians in primary and secondary care. DESIGN & SETTING A systematic mixed studies review (SMSR) including quantitative, qualitative, mixed-methods studies, and systematic reviews of physician generalist practice. METHOD MEDLINE, Psycinfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science will be searched for English language studies from 1999 to present, using a structured search. Given study heterogeneity, quality appraisal will not be performed. Two reviewers will perform study selection for each study. Data extraction will focus on how generalism is defined and characterised, including the clinical care provided by generalists and patient experiences of generalist care. Quantitative and qualitative data will be summarised in tabular and narrative form. Convergent synthesis design will then be used to synthesise quantitative and qualitative data. CONCLUSION Findings will characterise generalism and generalist practice from a grassroots clinical perspective. By identifying similarities and differences across generalist disciplines, this work will inform more focused educational initiatives on generalism at undergraduate and postgraduate level, including collaborations between generalist disciplines.
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Wilson E, Hanson LC, Tori KE, Perrin BM. Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions. BMC Health Serv Res 2021; 21:819. [PMID: 34391412 PMCID: PMC8364439 DOI: 10.1186/s12913-021-06864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
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Affiliation(s)
- Elena Wilson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
| | - Lisa C Hanson
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Kathleen E Tori
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked Bag 1351, Launceston, Tasmania, 7250, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
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Kitchener S, Douyere J, Bond D. Queensland Rural Generalist Pathway: why do trainees separate without achieving a Rural Generalist end point? AUST HEALTH REV 2021; 45:377-381. [PMID: 33906718 DOI: 10.1071/ah19158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022]
Abstract
The aim of this study was to learn from trainees separating from the Queensland Rural Generalist Pathway (QRGP) the reasons and circumstances around their decision so as to improve the efficiency of the program and experience of trainees. Forty-one QRGP trainees who separated without achieving a Rural Generalist (RG) end point to training were interviewed regarding their reasons for separation and thoughts on improving the program. The mean period of time enrolled in the QRGP was 2.87 years. Broadly, the cohort divided into those separating for specialist training, those moving into non-RG general practice and those undecided. Separation for specialist training tended to occur during prevocational years and that to general practice later in the program before trainees had completed advanced skill training. Female trainees were over-represented among trainees separating without completing training. This cohort provided their opinions on the strengths of the QRGP and possible improvements. Understanding and addressing the reasons for early separation suggested several strategies to improve the efficiency of the QRGP in selecting and retaining trainees. Lessons learned included the value of employer-provided coordinated prevocational placements and training, potential benefits of guiding rural-interested medical graduates who ultimately enter other specialist training and the need for greater liaison with external Australian General Practice Training administration organisations to coordinate transition of trainees. There is a need to further address accessibility of advanced training for all trainees.
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Affiliation(s)
- Scott Kitchener
- Queensland Rural Generalist Pathway, Queensland Rural Medical Services, Darling Downs Hospital and Health Service, Level 18, 41 George Street, Brisbane, Qld 4000, Australia. ; ; and Corresponding author.
| | - John Douyere
- Queensland Rural Generalist Pathway, Queensland Rural Medical Services, Darling Downs Hospital and Health Service, Level 18, 41 George Street, Brisbane, Qld 4000, Australia. ;
| | - Deanne Bond
- Queensland Rural Generalist Pathway, Queensland Rural Medical Services, Darling Downs Hospital and Health Service, Level 18, 41 George Street, Brisbane, Qld 4000, Australia. ;
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Barker R, Chamberlain-Salaun J, Harrison H, Nash R, Nielsen I, Harvey D, Sim J, Ciccone N, Carr J, Bird K, Palermo C, Devine S. Evaluation of the Allied Health Rural Generalist Program 2017-2019. Aust J Rural Health 2021; 29:158-171. [PMID: 33982849 DOI: 10.1111/ajr.12745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the development and implementation of the Allied Health Rural Generalist Program, a two-level online post-graduate education program, which includes Level 1, an entry-level non-award pathway program, and Level 2, a Graduate Diploma in Rural Generalist Practice. DESIGN A convergent mixed methodology evaluation in two overlapping stages: a process evaluation on quality and reach, together with a mixed method case study evaluation on benefits, of the program. SETTING Rural and remote Australia across ten sites and seven allied health professions: dietetics; occupational therapy; pharmacy; physiotherapy; podiatry; radiography; speech pathology. PARTICIPANTS Process evaluation included 91 participants enrolled in all or part of the Rural Generalist Program. Case study evaluation included 50 managers, supervisors and Rural Generalist Program participants from the ten study sites. INTERVENTIONS The Allied Health Rural Generalist Program. MAIN OUTCOME MEASURES Process evaluation data were derived from enrolment data and education evaluation online surveys. Case study data were gathered via online surveys and semi-structured interviews. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated to identify consistency, expansion or discordance across the data. RESULTS The Rural Generalist Program was viewed as an effective education program that provided benefits for Rural Generalist Program participants, employing organisations and consumers. Key improvements recommended included increasing profession-specific and context-specific content, ensuring Rural Generalist Program alignment with clinical and project requirements, strengthening support mechanisms within employing organisations and ensuring benefits can be sustained in the long term. CONCLUSION The Rural Generalist Program offers a promising strategy for building a fit-for-purpose rural and remote allied health workforce.
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Affiliation(s)
- Ruth Barker
- James Cook University, Cairns, QLD, Australia
| | | | | | - Robyn Nash
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Ilsa Nielsen
- Allied Health Professions Office of Queensland, Queensland Health, Brisbane, QLD, Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Jenny Sim
- Monash University, Melbourne, Vic., Australia
| | | | | | | | | | - Sue Devine
- James Cook University, Cairns, QLD, Australia
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Reed K, Reed B, Bailey J, Beattie K, Lynch E, Thompson J, Vines R, Wong KC, McCrossin T, Wilson R. Interprofessional education in the rural environment to enhance multidisciplinary care in future practice: Breaking down silos in tertiary health education. Aust J Rural Health 2021; 29:127-136. [PMID: 33982852 DOI: 10.1111/ajr.12733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Western Sydney University has implemented a rural interprofessional learning programme to promote collaborative care approaches to enhance cross-discipline communications, improve knowledge and clarity of roles and improve patient care and outcomes. DESIGN Rural interprofessinal learning is an interprofessional educational approach, consisting of simulations of complex health events. Simulation methodology frames the study with a focus on human interaction. A mixed-methods evaluation has been conducted, incorporating pre- and post- event participant surveys along with semi-structured focus groups. SETTING Simulations are conducted in the rural setting, including community settings, working farms and rural hospitals. MAIN OUTCOME MEASURES Reflexive thematic analysis was used to identify themes measuring students' perceptions of interdisciplinary care, knowlede of other health discipline roles and skills and how they believe the exercise will influence their future practice. Facilitator feedback regarding the efficacy of the simulations was also recorded and analysed using reflexive thematic analysis. PARTICIPANTS Care of simulated patient(s)/bystander(s) is primarily provided by paramedicine, nursing and medical students; however, increasing interest has expanded the programme to include students from a range of allied health professions. Simulations are facilitated by a multidisciplinary team of experienced practitioners and specialists. INTERVENTION Four rural interprofessional learning events have been held. RESULTS 120 students have participated in the evaluation. Findings include increased understanding of the contributions of other disciplines in enhancing patient care, team approaches, cross-discipline communication and a need to engage in collaborative care in future practice. CONCLUSION Creating a collaborative learning environment creates a culture of multidisciplinary care, enhancing patient care and improving outcomes. The rural interprofessional learning model is an effective interprofessional educational approach, which can be repeated, refined and improved for continual professional development.
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Affiliation(s)
- Krista Reed
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia.,School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Buck Reed
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Jannine Bailey
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Karen Beattie
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Elizabeth Lynch
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Jane Thompson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Robyn Vines
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Kam Cheong Wong
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Tim McCrossin
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
| | - Ross Wilson
- Bathurst Rural Clinical School, School of Medicine, Western Sydney University, Bathurst, NSW, Australia
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13
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McIver L, Manahan D, Jones S, 'Ulufonua L. Rocketship and the Rural Health Workforce Revolution in the Pacific: Growing Skilled Medical Generalists Across the "Blue Continent". Front Public Health 2021; 8:612531. [PMID: 33614569 PMCID: PMC7887312 DOI: 10.3389/fpubh.2020.612531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Dramatic shifts are occurring in the size, shape and skill of rural health workforces in Pacific island countries (PICs) due to an unprecedented convergence of political agreement, policy commitment, donor support and technical assistance. In particular, the impact of "medical internationalism" is being felt across the Pacific region, with new doctors returning home in far greater numbers than ever before, the majority having graduated from medical schools in Cuba, China and other countries outside the region, in addition to the more typical numbers graduating and returning home from the region's main medical schools in Fiji and Papua New Guinea. With an agreed regional vision of "Healthy Islands" across the Pacific, the main objective of expanding overseas training opportunities for Pacific island medical students has been to correct the widespread centralization and maldistribution of the medical workforce in PICs and improve health access and quality of care in rural areas by deploying the new graduates to outer-island facilities. However, the return of these new graduates in several PICs has demonstrated that additional training is required to equip them with the knowledge and skills necessary to practice safely and sustainably in unsupervised settings. Thus, the development of specific postgraduate programmes has been urgently needed to provide pathways to vocational training and specialization in rural medicine appropriate to the Pacific region. Rocketship Pacific Ltd. (Rocketship) is an international health charity, based in Australia, dedicated to improving health in Pacific island countries through stronger primary care. Rocketship's particular focus to date has been on education and capacity-building for doctors and nurses working in rural communities and outer-island facilities. Since 2015, Rocketship has been working in partnership with the Ministries of Health and other key partners in Solomon Islands, Timor-Leste, Tonga and Vanuatu to design and deliver postgraduate training programmes in the core generalist disciplines family, community and rural hospital medicine. To date, this has resulted in new postgraduate Family Medicine courses being established in Timor-Leste and Tonga; a rural medical workforce support programme being delivered in Vanuatu; and a new Postgraduate Diploma in Rural Generalist Medicine being designed in Solomon Islands. These new programmes, as well as other notable initiatives elsewhere in the Pacific such as the Master of Medicine (Rural) programme in Papua New Guinea, the Diploma and Master of Family Medicine programme in Fiji and the Cook Islands Fellowship in General Practice, are transforming the health workforce in PICs with the potential to benefit island people across the "Blue Continent." This paper describes the establishment of new postgraduate training programmes in family, community and rural hospital medicine in Timor-Leste, Tonga, Solomon Islands and Vanuatu from the perspective of Rocketship, the non-profit organization engaged by each country's Ministry of Health (or equivalent) to provide expert technical assistance with their initiative.
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Affiliation(s)
| | - Dan Manahan
- Rocketship Pacific Ltd., Melbourne, VIC, Australia
| | - Sam Jones
- Rocketship Pacific Ltd., Melbourne, VIC, Australia
| | - Lisiate 'Ulufonua
- Rocketship Pacific Ltd., Melbourne, VIC, Australia.,Ministry of Health, Tongatapu, Tonga
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14
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O’Sullivan B, McGrail M, Gurney T, Martin P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228566. [PMID: 33218189 PMCID: PMC7699208 DOI: 10.3390/ijerph17228566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
There is a lack of theory about what drives choice to be a generalist or specialist doctor, an important issue in many countries for increasing primary/preventative care. We did a realist evaluation to develop a theory to inform what works for whom, when and in what contexts, to yield doctors’ choice to be a generalist or specialist. We interviewed 32 Australian doctors (graduates of a large university medical school) who had decided on a generalist (GP/public health) or specialist (all other specialties) career. They reflected on their personal responses to experiences at different times to stimulate their choice. Theory was refined and confirmed by testing it with 17 additional doctors of various specialties/career stages and by referring to wider literature. Our final theory showed the decision involved multi-level contextual factors intersecting with eight triggers to produce either a specialist or generalist choice. Both clinical and place-based exposures, as well as attributes, skills, norms and status of different fields affected choice. This occurred relative to the interests and expectations of different doctors, including their values for professional, socio-economic and lifestyle rewards, often intersecting with issues like gender and life stage. Applying this theory, it is possible to tailor selection and ongoing exposures to yield more generalists.
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Affiliation(s)
- Belinda O’Sullivan
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
- Correspondence: ; Tel.: +61-4-2740-5030
| | - Matthew McGrail
- Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia;
| | - Tiana Gurney
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
| | - Priya Martin
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
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15
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Johnston K, Guingona M, Elsanousi S, Mbokazi J, Labarda C, Cristobal FL, Upadhyay S, Othman AB, Woolley T, Acharya B, Hogenbirk JC, Ketheesan S, Craig JC, Neusy AJ, Larkins S. Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries? Front Public Health 2020; 8:582464. [PMID: 33194989 PMCID: PMC7604342 DOI: 10.3389/fpubh.2020.582464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 11/13/2022] Open
Abstract
Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.
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Affiliation(s)
- Karen Johnston
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Monsie Guingona
- Ateneo de Zamboanga University School of Medicine, Zamboanga City, Philippines
| | | | - Jabu Mbokazi
- School of Medicine, Walter Sisulu University, Mthatha, South Africa
| | - Charlie Labarda
- School of Health Sciences, University of the Philippines, Manila, Philippines
| | | | | | | | - Torres Woolley
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | | | - John C Hogenbirk
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada
| | - Sarangan Ketheesan
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Sarah Larkins
- Anton Breinl Research Centre of Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia
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16
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Kim EE, Araujo D, Dahlman B, Agarwal S, Prasad P, Johnson W, Park KB. Delivery of essential surgery by family physicians. Bull World Health Organ 2020; 98:766-772. [PMID: 33177773 PMCID: PMC7607462 DOI: 10.2471/blt.20.252056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/27/2022] Open
Abstract
Primary health care provides the framework for delivering the socially-informed, comprehensive and patient-centred care underlying robust health-care systems and is, therefore, central to achieving universal health coverage. Family physicians are best placed to embody primary health care’s dual focus on community and population health because they are often employed in rural or district hospitals with limited human resources, particularly a lack of specialists. Here we want to illustrate how additional training for family physicians, the key clinicians in primary care, can play a critical role in reducing disparities in access to surgical, obstetric and anaesthesia care in low- and middle-income countries and in rural or remote settings. Examples are given of how training programmes can be developed in low-resource settings to equip family physicians with life-saving surgical skills and of how family physicians in high-income countries can be trained in the surgical skills essential for working overseas in low-income settings. Policy-makers should promote surgical practice among family physicians by supporting family medicine programmes that include additional surgical skills training and by expanding opportunities and incentives for family physicians to serve in rural areas. Moreover, national surgical plans should include a primary health care strategy for surgical care and, globally, family physicians should be considered in discussions of surgical care. Finally, surgeons, anaesthesiologists, obstetricians and family physicians should be encouraged to collaborate in ensuring that all patients, regardless of place of residence, receive safe and timely surgical care.
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Affiliation(s)
- Eliana E Kim
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, United States of America (USA)
| | - David Araujo
- Ventura County Medical Center, Ventura, California, USA
| | | | - Shivum Agarwal
- Department of Family & Community Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Pratap Prasad
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Walter Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, United States of America (USA)
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17
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McGrail MR, O’Sullivan BG. Faculties to Support General Practitioners Working Rurally at Broader Scope: A National Cross-Sectional Study of Their Value. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4652. [PMID: 32605246 PMCID: PMC7370017 DOI: 10.3390/ijerph17134652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022]
Abstract
Strategies are urgently needed to foster rural general practitioners (GPs) with the skills and professional support required to adequately address healthcare needs in smaller, often isolated communities. Australia has uniquely developed two national-scale faculties that target rural practice: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM). This study evaluates the benefit of rural faculties for supporting GPs practicing rurally and at a broader scope. Data came from an annual national survey of Australian doctors from 2008 and 2017, providing a cross-sectional design. Work location (rurality) and scope of practice were compared between FACRRM and FARGP members, as well as standard non-members. FACRRMs mostly worked rurally (75-84%, odds ratio (OR) 8.7, 5.8-13.1), including in smaller rural communities (<15,000 population) (41-54%, OR 3.5, 2.3-5.3). FARGPs also mostly worked in rural communities (56-67%, OR 4.2, 2.2-7.8), but fewer in smaller communities (25-41%, OR 1.1, 0.5-2.5). Both FACRRMs and FARGPs were more likely to use advanced skills, especially procedural skills. GPs with fellowship of a rural faculty were associated with significantly improved geographic distribution and expanded scope, compared with standard GPs. Given their strong outcomes, expanding rural faculties is likely to be a critical strategy to building and sustaining a general practice workforce that meets the needs of rural communities.
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Affiliation(s)
- Matthew R. McGrail
- Rural Clinical School, The University of Queensland, Rockhampton 4700, Australia;
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18
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Larkin JW, Han M, Han H, Guedes MH, Gonçalves PB, Poli-de-Figueiredo CE, Cuvello-Neto AL, Barra ABL, de Moraes TP, Usvyat LA, Kotanko P, Canziani MEF, Raimann JG, Pecoits-Filho R. Impact of hemodialysis and post-dialysis period on granular activity levels. BMC Nephrol 2020; 21:197. [PMID: 32450793 PMCID: PMC7249440 DOI: 10.1186/s12882-020-01853-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Physical activity (PA) is typically lower on hemodialysis (HD) days. Albeit intradialytic inactivity is expected, it is unknown whether recovery after HD contributes to low PA. We investigated the impact of HD and post-HD period on granular PA relative to HD timing. Methods We used baseline data from the HDFIT trial conducted from August 2016 to October 2017. Accelerometry measured PA over 1 week in patients who received thrice-weekly high-flux HD (vintage 3 to 24 months), were clinically stable, and had no ambulatory limitations. PA was assessed on HD days (0 to ≤24 h after start HD), first non-HD days (> 24 to ≤48 h after start HD) and second non-HD day (> 48 to ≤72 h after start HD). PA was recorded in blocks/slices: 4 h during HD, 0 to ≤2 h post-HD (30 min slices), and > 2 to ≤20 h post-HD (4.5 h slices). Blocks/slices of PA were captured at concurrent/parallel times on first/second non-HD days compared to HD days. Results Among 195 patients (mean age 53 ± 15 years, 71% male), step counts per 24-h were 3919 ± 2899 on HD days, 5308 ± 3131 on first non-HD days (p < 0.001), and 4926 ± 3413 on second non-HD days (p = 0.032). During concurrent/parallel times to HD on first and second non-HD days, patients took 1308 and 1128 more steps (both p < 0.001). Patients took 276 more steps and had highest rates of steps/hour 2-h post-HD versus same times on first non-HD days (all p < 0.05). Consistent findings were observed on second non-HD days. Conclusions PA was higher within 2-h of HD versus same times on non-HD days. Lower PA on HD days was attributable to intradialytic inactivity. The established PA profiles are of importance to the design and development of exercise programs that aim to increase activity during and between HD treatments. Trial registration HDFIT was prospectively registered 20 April 2016 on ClinicalTrials.gov (NCT02787161)
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Affiliation(s)
- John W Larkin
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil. .,Global Medical Office, Fresenius Medical Care, Waltham, MA, USA.
| | - Maggie Han
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.,Research Division, Renal Research Institute, New York, NY, USA
| | - Hao Han
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Murilo H Guedes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | | | | | | | | | - Thyago Proença de Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Len A Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Peter Kotanko
- Research Division, Renal Research Institute, New York, NY, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Roberto Pecoits-Filho
- School of Medicine, Pontifícia Universidade Católica do Paraná, Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
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