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Verhagen R, Kaserzon SL, Thomas KV, Mueller JF, Tscharke BJ. Exploring drug consumption patterns across varying levels of remoteness in Australia. Sci Total Environ 2023; 903:166163. [PMID: 37574069 DOI: 10.1016/j.scitotenv.2023.166163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/21/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
Wastewater-based epidemiology (WBE) relies on representative sampling that is typically achieved with autosamplers that collect time, flow, or volume proportional samples. The expense, resources and operational know-how associated with autosampler operation means they are only typically available at major wastewater treatment plants (WWTPs). This results in a lack of data on consumption levels in regional and remote areas, or in countries that lack the financial means. The aim of this study was to estimate and investigate trends in drug consumption across varying levels of remoteness in Australia. Field-calibrated, microporous polyethylene passive samplers were deployed over 2 periods (Aug/Sept 2019 and 2020) at 43 treatment plants covering all five categories of remoteness, as per Australian Bureau of Statistics definitions (Major cities, Inner regional, Outer regional, Remote, and Very remote). The per capita consumption of cocaine, methylamphetamine, nicotine, oxycodone and MDMA were estimated. No spatial trends between remoteness and drug consumption were observed, except for cocaine, where Major cities had a 5-to-10-fold higher consumption compared to the other levels of remoteness in 2019 and 2020, respectively. Outer regional sites had the highest and lowest methylamphetamine consumption. The variance in drug use among sites was much higher in Remote (and Inner/Outer regional) sites when compared with Major cities. A significant and consistent decrease in oxycodone consumption was observed at all sites between 2019 and 2020, possibly related to regulatory changes and the COVID-19 pandemic where elective surgeries were suspended. The majority of sites experienced a decrease in cocaine and methylamphetamine consumption, possibly due to border restrictions or changes in supply and demand dynamics. This was the first extensive passive sampling study to assess drug consumption in urban, regional, and remote locations, demonstrating that passive samplers can facilitate extension of wastewater-based drug monitoring programs to sites where other representative sampling options are very difficult to implement.
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Affiliation(s)
- Rory Verhagen
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia..
| | - Sarit L Kaserzon
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
| | - Benjamin J Tscharke
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, 20 Cornwall Street, Woolloongabba, Queensland 4102, Australia
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Johnson LG, Robinson L, John E, Rummery I, Taylor C, Sham Ku K. Practitioner Reflections on Sex Offender Treatment in Remote Communities. Curr Psychiatry Rep 2023; 25:247-253. [PMID: 37162660 PMCID: PMC10170033 DOI: 10.1007/s11920-023-01424-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW We offer reflections on practitioner service provision for sex offenders when working in remote communities. The social ecological model framework is used to capture the influence on practitioner working at an individual, relationship, community, and societal level. RECENT FINDINGS The social construction and geographic conditions of sexual offending within remote communities present myriad challenges for professionals working in these isolative settings in which they are embedded. Challenges include being the sole expert in a community, unavoidable dual relationships, community anxieties, and restrictive guidelines and assessment measures. Despite the challenges presented to practitioners operating in remote communities, many opportunities are available for building local and international peer relationships, connecting with the community, individualized treatment for clients, and flexibility in the adaptation of best practice to fit the needs of remote communities while maintaining ethical integrity.
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Affiliation(s)
| | | | | | - Ian Rummery
- St Helena Government Health and Social Care Portfolio, St. Helena, UK
| | | | - Kimberly Sham Ku
- The Tamarind Centre, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
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He VY, Guthridge S, Su JY, Howard D, Stothers K, Leach A. The link between hearing impairment and child maltreatment among Aboriginal children in the Northern Territory of Australia: is there an opportunity for a public health approach in child protection? BMC Public Health 2020; 20:449. [PMID: 32252723 PMCID: PMC7132974 DOI: 10.1186/s12889-020-8456-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background International studies provide evidence of an association between child disabilities, including hearing impairment (HI), and child maltreatment. There are high prevalences of ear disease with associated HI, and child maltreatment among Australian Aboriginal children, but the link between HI and child maltreatment is unknown. This study investigates the association between HI and child maltreatment for Aboriginal children living in the Northern Territory (NT) of Australia. Methods This was a retrospective cohort study of 3895 Aboriginal school-aged children (born between 1999 and 2008) living in remote NT communities. The study used linked individual-level information from health, education and child protection services. The outcome variables were child maltreatment notifications and substantiations. The key explanatory variable, HI, was based on audiometric assessment. The Kaplan–Meier estimator method was used in univariate analysis; Cox proportional hazards regression was used in multivariable analysis. Results A majority of the study cohort lived in very remote (94.5%) and most disadvantaged (93.1%) regions. Among all children in the study cohort, 56.1% had a record of either HI or unilateral hearing loss (UHL), and for those with a history of contact with child protection services (n = 2757), 56.7% had a record of HI/UHL (n = 1564). In the 1999–2003 birth cohort, by age 12 years, 53.5% of children with a record of moderate or worse HI had at least one maltreatment notification, compared to 47.3% of children with normal hearing. In the 2004–2008 cohort, the corresponding results were 83.4 and 71.7% respectively. In multivariable analysis, using the full cohort, children with moderate or worse HI had higher risk of any child maltreatment notification (adjusted Hazard Ratios (adjHR): 1.16, 95% CI:1.04–1.30), notification for neglect (adjHR:1.17, 95% CI:1.04–1.31) and substantiation (adjHR:1.20, 95% CI:1.04–1.40), than children with normal hearing. In the 2004–2008 birth cohort, children with moderate or worse HI had higher risk of a substantiated episode of physical abuse (adjHR:1.47, 95% CI:1.07–2.03) than children with normal hearing. Conclusion Our findings demonstrate the urgent need for HI and child maltreatment prevention strategies through raised community awareness and inter-agency collaboration. Effective information-sharing between service providers is a critical first step to a public health approach in child protection.
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Affiliation(s)
- Vincent Yaofeng He
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia.
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
| | - Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
| | - Damien Howard
- Phoenix Consulting, Nightcliff, Northern Territory, 0810, Australia
| | - Kylie Stothers
- Indigenous Allied Health Australia, Katherine, Northern Territory, 0850, Australia
| | - Amanda Leach
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, 0811, Australia
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Demant MN, Jensen RG, Bhutta MF, Laier GH, Lous J, Homøe P. Smartphone otoscopy by non-specialist health workers in rural Greenland: A cross-sectional study. Int J Pediatr Otorhinolaryngol 2019; 126:109628. [PMID: 31445480 DOI: 10.1016/j.ijporl.2019.109628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Greenland has one of the highest prevalences of otitis media in the world. However, access to ear specialists throughout Greenland is limited and currently there are no national guidelines for treatment or prevention. Tele-otoscopy may be beneficial in optimizing diagnosis and treatment. The smartphone otoscopy device, Cupris®, has previously been validated when used by medical doctors on a population primarily consisting of adults. In this study we evaluated the usability of the Cupris® otoscope when used by local health care workers with different levels of training and education, examining children aged 1-6 years. METHODS We conducted a cross-sectional study in three Greenlandic towns. Health care personnel were asked to perform video-otoscopy on children contacting the health clinic for any reason. The videos were sent for remote evaluation by three ear specialists who rated the videos on a five-point Likert scale and provided information on challenges with the videos. The dichotomous outcome "not useful/useful" was defined as 1-3 and 4-5 on the Likert scale, respectively. RESULTS In total, 142 videos were recorded on 84 patients. Mean proportion of useful videos was 18.1%, with a modified Fleiss' Kappa interrater agreement coefficient of 0.67 95% CI [0.57-0.76] corresponding to substantial agreement among the three raters. CONCLUSIONS In this study the usefulness of the Cupris® TYM otoscope did not prove to be sufficient with the presented instruction in the hands of local health care workers when examining Greenlandic children. Focus on training and education of local health personnel is crucial and warranted before advantageous implementation for non-specialist health care workers can be expected.
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Affiliation(s)
- Malene Nøhr Demant
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark; University of Greenland, Ilisimatusarfik, Manutooq 1, 3905, Nuussuaq, Greenland.
| | - Ramon Gordon Jensen
- Department of Otolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Mahmood F Bhutta
- Ear, Nose and Throat Department, Brighton and Sussex University Hospitals, Eastern Road, Brighton, East Sussex, BN2 5BE, United Kingdom
| | | | - Jørgen Lous
- Institute of Public Health, Research Unit for General Practice, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark; University of Greenland, Ilisimatusarfik, Manutooq 1, 3905, Nuussuaq, Greenland; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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He VY, Su JY, Guthridge S, Malvaso C, Howard D, Williams T, Leach A. Hearing and justice: The link between hearing impairment in early childhood and youth offending in Aboriginal children living in remote communities of the Northern Territory, Australia. Health Justice 2019; 7:16. [PMID: 31667630 PMCID: PMC6822356 DOI: 10.1186/s40352-019-0097-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/09/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND High prevalence of chronic middle ear disease has persisted in Australian Aboriginal children, and the related hearing impairment (HI) has been implicated in a range of social outcomes. This study investigated the association between HI in early childhood and youth offending. METHOD This was a retrospective cohort study of 1533 Aboriginal children (born between 1996 and 2001) living in remote Northern Territory communities. The study used linked individual-level information from health, education, child protection and youth justice services. The outcome variable was a youth being "found guilty of an offence". The key explanatory variable, hearing impairment, was based on audiometric assessment. Other variables were: child maltreatment notifications, Year 7 school enrolment by mother, Year 7 school attendance and community 'fixed- effects'. The Cox proportional hazards model was used to estimate the association between HI and youth offending; and the Royston R2 measure to estimate the separate contributions of risk factors to youth offending. RESULTS The proportion of hearing loss was high in children with records of offence (boys: 55.6%, girls: 36.7%) and those without (boys: 46.1%; girls: 49.0%). In univariate analysis, a higher risk of offending was found among boys with moderate or worse HI (HR: 1.77 [95% CI: 1.05-2.98]) and mild HI (HR: 1.54 [95% CI:1.06-2.23]). This association was attenuated in multivariable analysis (moderate HI, HR: 1.43 [95% CI:0.78-2.62]; mild HI, HR: 1.37 [95% CI: 0.83-2.26]). No evidence for an association was found in girls. HI contributed 3.2% and 6.5% of variation in offending among boys and girls respectively. Factors contributing greater variance included: community 'fixed-effects' (boys: 14.6%, girls: 36.5%), child maltreatment notification (boys: 14.2%, girls: 23.9%) and year 7 school attendance (boys: 7.9%; girls 12.1%). Enrolment by mother explained substantial variation for girls (25.4%) but not boys (0.2%). CONCLUSION There was evidence, in univariate analysis, for an association between HI and youth offending for boys however this association was not evident after controlling for other factors. Our findings highlight a range of risk factors that underpin the pathway to youth-offending, demonstrating the urgent need for interagency collaboration to meet the complex needs of vulnerable children in the Northern Territory.
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Affiliation(s)
- Vincent Yaofeng He
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory NT 0811 Australia
| | - Jiunn-Yih Su
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory NT 0811 Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory NT 0811 Australia
| | - Catia Malvaso
- University of Adelaide, Adelaide, South Australia SA 5005 Australia
| | - Damien Howard
- Phoenix Consulting, Nightcliff, Northern Territory NT 0810 Australia
| | - Tamika Williams
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory NT 0811 Australia
| | - Amanda Leach
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory NT 0811 Australia
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Abstract
AIMS The aims of this systematic scoping review were to characterize the extent to which diabetes prevention programs have focused on rural populations in North America and where possible, identify efficacious program components. METHODS The review was guided by the PRISMA statement and five steps for scoping studies. Searches were conducted in August 2017 in Tucson, Arizona. Two teams of three independently screened full texts, excluding prior reviews, systematic reviews, and opinion pieces. Two authors abstracted data, which were reviewed by other team members. RESULTS Of the 12,840 articles identified, 12 met all criteria. Nine studies were based in the USA and three were Canadian. Demographics reflected high enrollment of underrepresented minorities, adults, and females. Methodological rigor was low; most studies were single-arm interventions evaluated using pre-/post-measures. Weight was measured across all studies, although biological, behavioral, and psychosocial outcomes were inconsistently assessed. Eight studies reported significant changes in primary outcomes. Duration and intensity were variable; delivery was led by trained volunteers or health professionals. Seven studies reported recruitment, retention, and adherence data. CONCLUSIONS Surprisingly, few rural diabetes prevention studies have been published. Published programs were notable for lack of youth and/or family involvement, integrated prevention and treatment programs, and heavy reliance on self-reported outcomes.
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Affiliation(s)
| | - Eliza Short
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E 4th Street, Shantz Building Room 328, Tucson, AZ, 85721, USA
| | - Martina Rahim-Sepulveda
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E 4th Street, Shantz Building Room 328, Tucson, AZ, 85721, USA
| | - Carol L Howe
- Health Sciences Library, University of Arizona, Tucson, AZ, USA
| | - Vanessa da Silva
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E 4th Street, Shantz Building Room 328, Tucson, AZ, 85721, USA
- Arizona Cooperative Extension, University of Arizona, Tucson, AZ, USA
| | - Karen Alvarez
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E 4th Street, Shantz Building Room 328, Tucson, AZ, 85721, USA
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E 4th Street, Shantz Building Room 328, Tucson, AZ, 85721, USA.
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Mitra S, Rachlis B, Krysowaty B, Marshall Z, Olsen C, Rourke S, Kerr T. Potential use of supervised injection services among people who inject drugs in a remote and mid-size Canadian setting. BMC Public Health 2019; 19:284. [PMID: 30849946 PMCID: PMC6408761 DOI: 10.1186/s12889-019-6606-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While supervised injection services (SIS) feasibility research has been conducted in large urban centres across North America, it is unknown whether these services are acceptable among people who inject drugs (PWID) in remote, mid-size cities. We assessed willingness to use SIS and expected frequency of SIS use among PWID in Thunder Bay, a community in Northwestern, Ontario, Canada, serving people from suburban, rural and remote areas of the region. METHODS Between June and October 2016, peer research associates administered surveys to PWID. Sociodemographic characteristics, drug use and behavioural patterns associated with willingness to use SIS and expected frequency of SIS use were estimated using bivariable and multivariable logistic regression models. Design preferences and amenities identified as important to provide alongside SIS were assessed descriptively. RESULTS Among 200 PWID (median age, IQR: 35, 28-43; 43% female), 137 (69%) reported willingness to use SIS. In multivariable analyses, public injecting was positively associated with willingness to use (Adjusted Odds Ratio (AOR): 4.15; 95% confidence interval (CI): 2.08-8.29). Among those willing to use SIS, 87 (64%) said they would always/usually use SIS, while 48 (36%) said they would sometime/occasionally use SIS. In multivariable analyses, being female (AOR: 2.44; 95% CI: 1.06-5.65) and reporting injecting alone was positively associated with higher expected frequency of use (AOR: 2.59; 95% CI: 1.02-6.58). CONCLUSIONS Our findings suggest that SIS could play a role in addressing the harms of injection drug use in remote and mid-sized settings particularly for those who inject in public, as well as women and those who inject alone, who report higher expected frequency of SIS use. Design preferences of local PWID, in addition to differences according to gender should be taken into consideration to maximize the uptake of SIS, alongside existing health and social service provisions available to PWID.
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Affiliation(s)
- Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, H.R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada
| | - Beth Rachlis
- Institute for Clinical and Evaluative Sciences, 2075 Bayview Avenue, G172, Toronto, ON, M4N 3M5, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Bonnie Krysowaty
- Lakehead Social Planning Council, #38-125 Syndicate Avenue South, Thunder Bay, ON, P7E 6H8, Canada
| | - Zack Marshall
- School of Social Work, McGill University, 3506 University Street, Room 300, Montreal, QC, H3A 2A7, Canada
| | - Cynthia Olsen
- Thunder Bay Drug Strategy, City of Thunder Bay, 500 Donald Street East, P.O. Box 800, Thunder Bay, ON, P7C 2K4, Canada
| | - Sean Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria Street, 3rd Floor, Toronto, ON, M5B 1T8, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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McGrail MR, Russell DJ, O'Sullivan BG, Reeve C, Gasser L, Campbell D. Demonstrating a new approach to planning and monitoring rural medical training distribution to meet population need in North West Queensland. BMC Health Serv Res 2018; 18:993. [PMID: 30577775 PMCID: PMC6303935 DOI: 10.1186/s12913-018-3788-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the health of rural populations requires developing a medical workforce with the right skills and a willingness to work in rural areas. A novel strategy for achieving this aim is to align medical training distribution with community need. This research describes an approach for planning and monitoring the distribution of general practice (GP) training posts to meet health needs across a dispersed geographic catchment. METHODS An assessment of the location of GP registrars in a large catchment of rural North West Queensland (across 11 sub-regions) in 2017 was made using national workforce supply, rurality and other indicators. These included (1): Index of Access -spatial accessibility (2); 10-year District of Workforce Shortage (DWS) (3); MMM (Modified Monash Model) rurality (4); SEIFA (Socio-Economic Indicator For Areas) (5); Indigenous population and (6) Population size. Distribution was determined relative to GP workforce supply measures and population health needs in each health sub-region of the catchment. An expert panel verified the approach and reliability of findings and discussed the results to inform planning. RESULTS 378 registrars and 582 supervisors were well-distributed in two sub-regions; in contrast the distribution was below expected levels in three others. Almost a quarter of registrars (24%) were located in the poorest access areas (Index of Access) compared with 15% of the population located in these areas. Relative to the population size, registrars were proportionally over-represented in the most rural towns, those consistently rated as DWS or those with the poorest SEIFA value and highest Indigenous proportion. CONCLUSIONS Current regional distribution was good, but individual town-level data further enabled the training provider to discuss the nuance of where and why more registrars (or supervisors) may be needed. The approach described enables distributed workforce planning and monitoring applicable in a range of contexts, with increased sensitivity for registrar distribution planning where most needed, supporting useful discussions about the potential causes and solutions. This evidence-based approach also enables training organisations to engage with local communities, health services and government to address the sustainable development of the long-term GP workforce in these towns.
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Affiliation(s)
- Matthew R McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, QLD, 4700, Australia.
| | - Deborah J Russell
- Northern Territory Medical Program, Flinders University, PO Box 41326, Casuarina, NT, 0815, Australia
| | - Belinda G O'Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC, 3550, Australia
| | - Carole Reeve
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | - Lee Gasser
- College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, QLD, 4811, Australia
| | - David Campbell
- Australian College of Rural and Remote Medicine, GPO Box 2507, Brisbane, QLD, 4001, Australia
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