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Seal A, McGrail MR, Bain-Donohue S, Fuller L, Kirke A, Garne D, Luscombe G, Allen P, Wright J, Burrows JM. Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities. BMJ Open 2024; 14:e086850. [PMID: 38889942 PMCID: PMC11191762 DOI: 10.1136/bmjopen-2024-086850] [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] [Received: 03/25/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE This study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/experience. DESIGN AND SETTING A cohort study of medicine graduates from nine Australian universities. PARTICIPANTS 1220 domestic medicine graduates from the class of 2011. OUTCOME MEASURES Practice location recorded by the Australian Health Practitioner Regulation Agency in PGY10; matched graduate movement between PGYs 5, 8 and 10 as classified by the Modified Monash Model, stratified by specialty type (predominantly grouped as general practitioner (GP) or non-GP). RESULTS At PGY10, two-thirds (820/1220) had achieved fellowship. GPs were 2.8 times more likely to be in non-metropolitan practice (28% vs 12%; 95% CI 2.0 to 4.0, p<0.001) than graduates with non-GP (all other) specialist qualifications. More than 70% (71.4%) of GPs who were in non-metropolitan practice in PGY5 remained there in both PGY8 and PGY10 versus 29.0% of non-GP specialists and 36.4% of non-fellowed graduates (p<0.001). The proportion of fellowed graduates observed in non-metropolitan practice was 14.9% at PGY5, 16.1% at PGY8 and 19.0% at PGY10, with this growth predominantly from non-GP specialists moving into non-metropolitan locations, following completion of metropolitan-based vocational training. CONCLUSIONS There are strong differences in practice location patterns between specialty types, with few non-GP specialists remaining in non-metropolitan practice between PGY5 and PGY10. Our study reinforces the importance of rural training pathways to longer-term work location outcomes and the need to expand specialist vocational training which supports more rural training opportunities for trainees outside general practice.
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Affiliation(s)
- Alexa Seal
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Matthew R McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Suzanne Bain-Donohue
- Rural Clinical School, School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lara Fuller
- Rural Community Clinical School, Deakin University Faculty of Health Medicine Nursing and Behavioural Sciences, Colac, Victoria, Australia
| | - Andrew Kirke
- Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
| | - David Garne
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina Luscombe
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia
| | - Penny Allen
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Julian Wright
- Department of Rural Health, Rural Clinical School, The University of Melbourne, Shepparton, Victoria, Australia
| | - Julie M Burrows
- The University of Newcastle, Tamworth, New South Wales, Australia
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Kavanagh BE, Corney KB, Beks H, Williams LJ, Quirk SE, Versace VL. A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. BMC Health Serv Res 2023; 23:1060. [PMID: 37794469 PMCID: PMC10552307 DOI: 10.1186/s12913-023-10034-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Inadequate healthcare access and utilisation are implicated in the mental health burden experienced by those living in regional, rural, and remote Australia. Facilitators that better enable access and utilisation are also reported in the literature. To date, a synthesis on both the barriers and facilitators to accessing and utilising mental health services within the rural Australian context has not been undertaken. This scoping review aims to (1) synthesise the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia, as identified using the Modified Monash Model; and (2) better understand the relationship between barriers and facilitators and their geographical context. METHODS A systematic search of Medline Complete, EMBASE, PsycINFO, Scopus, and CINAHL was undertaken to identify peer-reviewed literature. Grey literature was collated from relevant websites. Study characteristics, including barriers and facilitators, and location were extracted. A descriptive synthesis of results was conducted. RESULTS Fifty-three articles were included in this scoping review. Prominent barriers to access and utilisation included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. The variability of the included studies precluded the geographical analysis from being completed. CONCLUSION Both healthcare providers and service users considered a number of barriers and facilitators to mental health service access and utilisation in the regional, rural, and remote Australian context. Barriers and facilitators should be considered when re-designing services, particularly in light of the findings and recommendations from the Royal Commission into Victoria's Mental Health System, which may be relevant to other areas of Australia. Additional research generated from rural Australia is needed to better understand the geographical context in which specific barriers and facilitators occur.
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Affiliation(s)
- Bianca E Kavanagh
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia.
| | - Kayla B Corney
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Hannah Beks
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio, Finland
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, Princes Highway, Warrnambool, VIC, 3280, Australia
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Dunlop TJ. Seize the opportunity: How to fit rural and remote emergency medicine into the new training pathway. Emerg Med Australas 2023; 35:152-154. [PMID: 36596570 PMCID: PMC10107814 DOI: 10.1111/1742-6723.14159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/11/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Tahnee J Dunlop
- Emergency Department, South West Healthcare, Warrnambool, Victoria, Australia.,Centre for Rural Emergency Medicine, Deakin University, Warrnambool, Victoria, Australia
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Sutarsa IN, Kasim R, Steward B, Bain-Donohue S, Slimings C, Hall Dykgraaf S, Barnard A. Do General Practitioners in a Visiting Medical Officer Arrangement Improve the Perceived Quality of Care of Rural and Remote Patients? A Qualitative Study in Australia. Healthcare (Basel) 2022; 10:healthcare10061045. [PMID: 35742096 PMCID: PMC9223112 DOI: 10.3390/healthcare10061045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In rural and remote Australia, general practitioners (GPs) provide care across the continuum from primary to secondary care, often in Visiting Medical Officer (VMO) arrangements with a local hospital. However, little is known about the role of GP-VMOs in improving the perceived quality of care and health outcomes for rural and remote communities. Methods: We collected qualitative data from three GP-VMOs (all aged >55 years) and 10 patients (all aged over 65 years) in three local health districts of New South Wales, Australia. Thirteen in-depth interviews were conducted between October 2020 and February 2021. We employed thematic analysis to identify key roles of GP-VMOs in improving the perceived quality of care and health outcomes of rural and remote patients. Results: Our study advances the current understanding regarding the role of GP-VMOs in improving the perceived quality of services and health outcomes of rural and remote patients. Key roles of GP-VMOs in improving the perceived quality of care include promoting the continuity of care and integrated health services, cultivating trust from local communities, and enhancing the satisfaction of patients. Conclusions: GP-VMOs work across primary and secondary care creating better linkages and promoting the continuity of care for rural and remote communities. Employing GP-VMOs in rural hospitals enables the knowledge and sensitivity gained from their ongoing interactions with patients in primary care to be effectively utilised in the delivery of hospital care.
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Affiliation(s)
- I Nyoman Sutarsa
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar 80232, Bali, Indonesia
- Correspondence:
| | - Rosny Kasim
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Ben Steward
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Suzanne Bain-Donohue
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Claudia Slimings
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Sally Hall Dykgraaf
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
| | - Amanda Barnard
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, ACT 2601, Australia; (R.K.); (B.S.); (S.B.-D.); (C.S.); (S.H.D.); (A.B.)
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