A required rural health module increases students' interest in rural health careers.
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INTRODUCTION: The Australian Commonwealth Department of Health and Ageing has funded University Departments of Rural Health (UDRHs) to facilitate student placements with the goal of encouraging students to choose rural health practice. The objective of this article is twofold: first, to report student feedback regarding The University of Melbourne-UDRH required 4 week Rural Health Module based in Shepparton, Victoria, at the School of Rural Health, with placements in communities in rural northeast Victoria; and second, to identify students' attitudes about practising in rural areas at the completion of the course. METHODS: Student evaluations conducted at the completion of the program were analysed utilising both quantitative and qualitative survey questions. RESULTS: Of 393 students who completed the course, 93% participated in the evaluation. Over half (70%) said that the course increased their interest in rural health issues more than 'somewhat', and 47% stated that the course increased their interest in practising rurally more than 'somewhat'. Students valued their community placements highly but wanted greater clinical focus. CONCLUSIONS: A required community-based rural health course positively influences many medical students' reported intention toward rural practice and increases most students interest in rural health. Rural general practice placements are in short supply. This course offers valuable rural experience to students without depending significantly on GPs, but student feedback has increased efforts to make the course more clinically focussed. (+info)
Evaluating Australian Indigenous community health promotion initiatives: a selective review.
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Effective health promotion interventions are critical to addressing the health needs of Indigenous people. We reviewed published and unpublished evaluation reports between 2000 and 2005 to identify practice issues pertinent to evaluators of Aboriginal and Torres Strait Islander health promotion initiatives. While the review of the literature was not systematic it was sufficiently comprehensive to provide a snapshot of evaluation practice currently in place within the Australian context. We found that published evaluation literature infrequently referred to the utilisation of guidelines for ethical research with Aboriginal and Torres Strait Islander peoples. The implications of this are that the importance and relevance of the guidelines for evaluative research are not being widely promoted or disseminated to evaluation practitioners and the role of the guidelines for improving evaluation practice remain unclear. While many innovative health promotion programs appear to have been highly regarded and well received by communities, the evaluation studies were not always able to report conclusively on the impact and health outcomes of these interventions or programs. This was due mainly to limitations in evaluation design that in some cases were insufficiently robust to measure the complex and multifaceted interventions described. To enhance rigour, evaluators of community health promotion initiatives could utilise mixed method approaches overtly informed by appropriate ethical guidelines, together with a broader range of qualitative methods aided by critical appraisal tools to assist in the design of evaluation studies. (+info)
Feasibility and costs of water fluoridation in remote Australian Aboriginal communities.
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BACKGROUND: Fluoridation of public water supplies remains the key potential strategy for prevention of dental caries. The water supplies of many remote Indigenous communities do not contain adequate levels of natural fluoride. The small and dispersed nature of communities presents challenges for the provision of fluoridation infrastructure and until recently smaller settlements were considered unfavourable for cost-effective water fluoridation. Technological advances in water treatment and fluoridation are resulting in new and more cost-effective water fluoridation options and recent cost analyses support water fluoridation for communities of less than 1,000 people. METHODS: Small scale fluoridation plants were installed in two remote Northern Territory communities in early 2004. Fluoride levels in community water supplies were expected to be monitored by local staff and by a remote electronic system. Site visits were undertaken by project investigators at commissioning and approximately two years later. Interviews were conducted with key informants and documentation pertaining to costs of the plants and operational reports were reviewed. RESULTS: The fluoridation plants were operational for about 80% of the trial period. A number of technical features that interfered with plant operation were identified and addressed though redesign. Management systems and the attitudes and capacity of operational staff also impacted on the effective functioning of the plants. Capital costs for the wider implementation of these plants in remote communities is estimated at about $US 94,000 with recurrent annual costs of $US 11,800 per unit. CONCLUSION: Operational issues during the trial indicate the need for effective management systems, including policy and funding responsibility. Reliable manufacturers and suppliers of equipment should be identified and contractual agreements should provide for ongoing technical assistance. Water fluoridation units should be considered as a potential priority component of health related infrastructure in at least the larger remote Indigenous communities which have inadequate levels of natural fluoride and high levels of dental caries. (+info)
Education, training and support needs of Australian trained doctors and international medical graduates in rural Australia: a case of special needs?
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INTRODUCTION: Little attention has been paid to issues relating to the education, training and support needs of Australian medical graduates and international medical graduates (IMGs) in rural practices. The focus continues to be on recruiting to rural areas. The aim of this article was to document the education, training and support needs of rural GPs. METHODS: Cross-sectional surveys were made of rural GPs working in rural north-west New South Wales, Australia. The main outcome measures were the key factors influencing rural GPs to stay in rural practice. RESULTS: Australian medical graduates and IMGs largely agree on key education, training and professional support needs. Continuing professional development, training opportunities, professional support and networking, as well as financial support are the doctors' shared top priority issues. Rural GPs satisfied with their current medical practice, intend to remain in rural practice for 40% longer than those who are not satisfied (11.5 years compared with 8.2 years). Rural GPs contented with their life as a rural doctor intend to remain in rural practice for 51% longer than those who are discontented (11.8 years compared with 7.8 years). CONCLUSION: While there is merit in delivering specially designed initiatives to target groups, such as male or female GPs, registrars or GPs, our results support the notion that IMGs should not so much be considered to have special needs, but rather an integral part of the region's medical workforce. (+info)
Improving access to medicines in urban, regional and rural Aboriginal communities--is expansion of Section 100 the answer?
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The poor health of Indigenous Australians is highlighted by the fact that their life expectancy is 17 years less than that of non-Indigenous Australians. The cause of this health disparity is multifactorial, and includes the under use of health services and medications. Distance, cost, and embarrassment, or fear of seeking help from culturally inappropriate services have all contributed to the reduced health status of Indigenous Australians. The introduction of Aboriginal medical services (AMS), Aboriginal health workers, and Section 100 (S100) of the Australian Pharmaceutical Benefits Scheme (PBS) have been important steps towards improving Aboriginal access to health services and medications. Despite this, spending on pharmaceuticals under the PBS per capita among the Indigenous population remains significantly lower than that of the non-Indigenous population. Because Aboriginal people from all areas experience similar barriers in their access to medicines, it has been suggested that the S100 scheme be made available to all AMS. Ensuring quality use of medicines needs to be addressed because patient counselling is carried out by the clinic staff, rather than the pharmacist and, therefore, in this case the pharmacist's role converts to one of training and providing information to the AMS. This expansion of S100 services may lead Indigenous health down a path of separation from mainstream services, which in turn would require nearly no adjustment by pharmacies and pharmacists to meet the needs of Indigenous people. Unfortunately, for no known reasons, previous suggestions to improve Aboriginal people's utilisation of mainstream health services and pharmacies have not been actioned. (+info)
Understanding barriers to health care: a review of disparities in health care services among indigenous populations.
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OBJECTIVES: To review the current status of health care access and utilization among Indigenous people in the North America, Australia and New Zealand. STUDY DESIGN: Literature review. METHODS: A systematic search and critical review of relevant studies using online searches of electronic databases (PubMed, PsychINFO, MEDLINE) that examined issues relating to health care utilization and access. RESULTS: Most studies found that health care access and utilization rates were found to be significantly lower among Indigenous populations. Factors such as rural location, communication and socio-economic status were found to be barriers to health care services that disproportionately affected Indigenous communities compared with the general population. CONCLUSIONS: Inequalities in health care access and utilization among Indigenous populations may play an important role in understanding why disparities in the health status of Indigenous populations continue to exist despite public health interventions. Further research is needed to understand the factors that contribute to these inequalities and to develop specific interventions to increase access and utilization among Indigenous populations. (+info)
Pharmacists' views on Indigenous health: is there more that can be done?
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INTRODUCTION: Our previous study explored the views of Aboriginal health workers (AHWs) in mid western New South Wales (NSW), Australia, in relation to pharmacy and the access to, and use of medicines by Indigenous Australians. That study also explored suggestions made by AHWs to improve the situation. This research aimed to ascertain the readiness and willingness of community pharmacists in rural and remote NSW to take on a greater role in relation to Indigenous health by exploring their knowledge and opinions about Indigenous health, their current interaction with Indigenous people, and their views as to feasible and achievable ways to help. Pharmacists' views were compared with those of the AHWs elicited in the previous study and any differences in perceptions noted. METHODS: Twenty seven semi-structured, face-to-face, in-depth interviews were carried out with NSW community pharmacists working in areas with an Indigenous population. All except one of the 27 pharmacists were based in a rural or remote setting. A qualitative research method was used and the concepts explored in the interviews included pharmacists' current knowledge of Indigenous health, views on the feasibility of proposed new programs from the previous study, and any other ideas that may improve Indigenous health. The interviews were audio recorded, transcribed verbatim, then thematically content analysed. RESULTS: Pharmacists identified chronic diseases as the main health concerns and many felt their Indigenous customers experienced these at a high rate, at a young age of onset and generally had poor management of the condition. They were aware that AHWs were available in their community but interaction varied. Almost all pharmacists felt that Indigenous people were comfortable shopping in their pharmacies, and identified lack of money as the major barrier to access to medicines. Many pharmacists felt that Indigenous patients would be best served in the pharmacy if medications were available at no charge; however, they seemed to be unaware that Indigenous people often feel uncomfortable entering their pharmacies. The majority felt the AHWs' ideas, such as periodically having an AHW in the pharmacy, cultural awareness training and increased collaboration between pharmacists and AHWs, may be of benefit. CONCLUSION: Despite the potential for expansion of the role of the pharmacist in Indigenous health, the majority of participants in this study were reluctant to commit themselves more than at present unless the financial barriers were removed. In addition, although they expressed an openness to undergoing training in cultural safety, and a willingness to have a greater understanding of Indigenous culture, they were very conscious of a lack of time to do so, a situation generally resulting from a shortage of pharmacists. Their awareness of and current interactions with AHWs were limited, but all participants could see the potential value of working more closely with these important members of the healthcare team. If the proposed extension of Section 100 of the Australian Pharmaceutical Benefits Scheme goes ahead and financial barriers are removed, it then remains for pharmacists to take up the challenge to increase their own understanding of Indigenous health issues and form collaborative partnerships with their AHW counterparts. Then a real change for the better in mainstream pharmacy services may be achieved. (+info)
An innovation in Australian dental education: rural, remote and Indigenous pre-graduation placements.
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Anticipating the looming crisis in access to dental services in rural and remote areas, the Western Australian Centre for Rural and Remote Oral Health developed an undergraduate rural placement program to provide dental students of The University of Western Australia opportunities for direct experience of rural and remote practice during the final year of the undergraduate curriculum. The Rural, Remote and Indigenous Placement program started in 2002 and, to the end of 2005, had placed 78 final year dental students in supervised clinical practice in rural, remote or Indigenous practice. In this study, the evolution of the program (2002-2005) is described and student evaluation of the program is reported. While involved in the rural placement program, students were assessed by experienced dental practitioners and provided program evaluation. This structured feedback allowed continuous improvement of the program. Data from each year's graduates was also analysed to examine the question of influence of placements on practice location during the first 6 months after graduation. Although it will be many years before the effects of outplacement programs can be specifically attained, the evidence to date indicates that the program may be a valuable tool among the plethora of strategies being investigated to augment Australia's rural oral health workforce. (+info)