Interpreter use in sustained nurse home visiting: interpreter experience and support.

BACKGROUND: The aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency. METHODS: A mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework. RESULTS: Three themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters' challenges; working with nurses; and client session related issues. CONCLUSION: Quality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

Do UK Allied Health Professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations?

OBJECTIVES: The COVID-19 pandemic caused a rapid shift to remote consultations. United Kingdom (UK) NHS Allied Health Professional (AHP) services may have been unprepared for telehealth implementation. This study explored these services' organisational readiness regarding telehealth guidelines implementation and staff training. METHODS: A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK AHPs and AHP service managers between May and June 2021. RESULTS: 658 participants answered the survey (119 managers and 539 clinicians). Most services, in which telehealth was in place, had implemented telehealth guidelines (clinicians, 64%; managers, 82%), with most guidelines produced by the NHS staff who use them for their consultations. Most clinicians reported that guidelines had ambiguous areas (e.g., regarding protection from litigation and dealing with emergencies), whereas most managers reported the opposite opinion. Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients, while recommended consultation length and how to conduct telehealth with certain population groups were least reported. Clinicians lacked training in most telehealth aspects, while managers reported that staff training focused on telehealth software and hardware. For both clinicians and managers, training is needed on how to deal with emergencies during telehealth. CONCLUSIONS: UK NHS AHP services are not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities and hinder the success of the NHS digital transformation. The absence of national guidelines highlights the need for uniform AHP telehealth guidelines.

Underrepresentation of Respiratory Therapists as Experts in Delphi Studies on Respiratory Practices and Research Priorities.

Delphi survey techniques are a common consensus method used to collect feedback from an expert panel to inform practices, establish guidelines, and identify research priorities. Collecting respiratory therapists' (RT) expertise and experiences as part of consensus-building methodologies is one way to ensure that they align with RT practices and to better influence respiratory care practice. This narrative review aimed to report the RT representation in expert panels of Delphi studies focused on respiratory therapy practices and research priorities. The research question that guided this review is: to what extent are RTs included as expert participants among published Delphi studies relate to respiratory therapy and research topics? We conducted a structured search of the literature and identified 23 papers that reported Delphi studies related to respiratory care practices and 15 that reported on respiratory-related research priorities. Delphi studies that focused on reporting consensus on respiratory care practices included the following: (1) mechanical ventilation, (2) high-flow nasal cannula therapy, (3) COVID-19 respiratory management, (4) home oxygen therapy, (5) cardiopulmonary monitoring, and (6) disease-specific guidelines. Delphi studies that focused on establishing respiratory research priorities included the following: (1) theory and practice-orientated knowledge gaps, and (2) priority research topics for empirical investigation. The results of this review suggest that RTs were rarely included as expert participants and, when involved, were minimally represented (5% to 33%). Given RTs' diverse and relevant experience in respiratory care, incorporating their perspectives to inform future education, respiratory care practices, and research priorities would allow evidence to better align with knowledge gaps deemed important for the respiratory therapy profession.

Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision.

The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

Changes of working conditions and job-related challenges due to the SARS-CoV-2 pandemic for medical assistants in general practices in Germany: a qualitative study.

BACKGROUND: In Germany, general practices are usually contacted first by patients with health complaints, including symptoms characteristic of SARS-CoV-2. Within general practices, medical assistants (MAs) are the first contact person for patients and perform various tasks in close physical patient contact. Working conditions of MAs have been characterized as challenging, e.g., due to low salaries, a high workload, time pressure and frequent interruptions. The potential changes of working conditions and job-related challenges experienced by MAs due to the SARS-CoV-2 pandemic have not been fully explored. We aimed to address this knowledge gap among MAs working in general practices in Germany. METHODS: Semi-structured telephone interviews were conducted between March and April 2021 with 24 MAs. Medical assistants of legal age, who worked in general practices in Germany, and who were continuously employed and without change of employer in 2020 were eligible for participation. Interview recordings were transcribed verbatim and content-analyzed using MAXQDA, using deductive and inductive coding. RESULTS: The SARS-CoV-2 pandemic posed great challenges for MAs, including a dramatic increase in workload, changes in occupational tasks, increased hygiene measures, rearrangements of work organization, childcare issues, and structural and personnel challenges within their practice. Participants described both improved but also worsened collaboration with their employers and colleagues due to the pandemic. Many MAs complained about issues regarding SARS-CoV-2-related billing processes and an increase in unpleasant patient behavior, including disregard of practice rules or frequent verbal insults. Many also did not feel adequately appreciated by politics, media, or society for their efforts during the pandemic. Positive changes were perceived to be the expansion of digital communication channels and a growing social cohesiveness of practice teams. CONCLUSIONS: Our study suggests that the SARS-CoV-2 pandemic posed great challenges for MAs. The pandemic seems to have worsened MAs' working conditions, which had been described as challenging already prior to the pandemic. In order to improve job satisfaction and to prevent loss of healthcare personnel, measures must be taken to improve working conditions of MAs in general practices.

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors.

BACKGROUND: There is a paucity of evidence about effective implementation strategies to increase treatment response and prevent drop-out among children receiving evidence-based treatment. This study examines patient, therapist, and implementation factors and their association to nonresponse and drop-out among youth receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). METHODS: Youth (n = 1240) aged 6-18 (M = 14.6) received TF-CBT delivered by 382 TF-CBT therapists at 66 clinics. Odds ratio analyses were used to investigate whether pretreatment child (age, gender, number of trauma experiences, post-traumatic stress symptoms (PTSS), therapist (education), and implementation strategy factors (high-low, low-low, low-high intensity therapist and leadership training respectively) or tele-mental health training during the Covid-19 pandemic are associated with nonresponse (above clinical PTSS level post-treatment) and drop-out (therapist-defined early termination). Fidelity checks were conducted to ensure that TF-CBT was used consistently. RESULTS: One fourth of the children (24.4%) were nonresponders and 13.3 percent dropped out. Exposure to three or more traumatic experiences were related to nonresponse and drop-out. Higher baseline PTSS was related to a higher probability of nonresponse. There was no effect of therapist education or child gender on nonresponse and drop-out, whereas children over 15 years had a higher likelihood of both. After controlling for baseline PTSS, the effect of age on nonresponse was no longer significant. Drop-out was related to fewer sessions, and most dropped out during the first two phases of TF-CBT. Fidelity was high throughout the different implementation phases. High-intensity therapist training was related to a lower probability of both nonresponse and drop-out, whereas low therapist and leadership training were related to a higher likelihood of both. Multivariate analysis revealed higher child age and higher PTSS baseline scores as significant predictors of nonresponse, and number of trauma experiences (> = 3) at baseline as the only predictor of drop-out. CONCLUSIONS: High-intensity therapist training seem key to prevent patient nonresponse and drop-out. Leadership training might positively affect both, although not enough to compensate for less intensive therapist training. More complex cases (higher PTSS and exposure to more traumas) predict nonresponse and drop-out respectively, which underscores the importance of symptom assessment to tailor the treatment. The lack of predictive effect of therapist education increases the utilization of TF-CBT. TRIAL REGISTRATION: Retrospectively registered in ClinicalTrials, ref. nr. NCT05248971.

Wellbeing and coping of UK nurses, midwives and allied health professionals during COVID-19-a cross-sectional study.

Nurse, Midwives and Allied Health Professionals (AHPs), along with other health and social care colleagues are the backbone of healthcare services. They have played a key role in responding to the increased demands on healthcare during the COVID-19 pandemic. This paper compares cross-sectional data on quality of working life, wellbeing, coping and burnout of nurses, midwives and AHPs in the United Kingdom (UK) at two time points during the COVID-19 pandemic. An anonymous online repeated cross-sectional survey was conducted at two timepoints, Phase 1 (7th May 2020-3rd July 2020); Phase 2 (17th November 2020-1st February 2021). The survey consisted of the Short Warwick-Edinburgh Mental Wellbeing Scale, the Work-Related Quality of Life Scale, and the Copenhagen Burnout Inventory (Phase 2 only) to measure wellbeing, quality of working life and burnout. The Brief COPE scale and Strategies for Coping with Work and Family Stressors scale assessed coping strategies. Descriptive statistics and multiple linear regressions examined the effects of coping strategies and demographic and work-related variables on wellbeing and quality of working life. A total of 1839 nurses, midwives and AHPs responded to the first or second survey, with a final sample of 1410 respondents -586 from Phase 1; 824 from Phase 2, (422 nurses, 192 midwives and 796 AHPs). Wellbeing and quality of working life scores were significantly lower in the Phase 2 sample compared to respondents in Phase 1 (p<0.001). The COVID-19 pandemic had a significant effect on psychological wellbeing and quality of working life which decreased while the use of negative coping and burnout of these healthcare professionals increased. Health services are now trying to respond to the needs of patients with COVID-19 variants while rebuilding services and tackling the backlog of normal care provision. This workforce would benefit from additional support/services to prevent further deterioration in mental health and wellbeing and optimise workforce retention.

Academic writing retreats for nurses and allied health professionals: developing engagement, dissemination and collaboration opportunities.

BACKGROUND: COVID-19 raised the profile of nursing globally, with widespread recognition of nurses' valuable roles during the pandemic. There is a unique opportunity to capitalise on this momentum to support nurses to become more engaged in and disseminate their research widely. One way to enable this is to develop academic writing retreats for nurses. AIM: To report on the development of academic writing retreats to engage nurses in research. DISCUSSION: Four writing retreats were set up in the south of England between September 2019 and April 2021. Two were delivered face to face on hospital premises and two online. The retreats provided uninterrupted time for writing an academic publication, mentorship, peer support networks, and question and answer sessions. The retreats were attended by 42 health professionals, with more than 25 papers published in peer-reviewed journals. The retreats have enabled learning communities to develop, fostering long-term networking opportunities. CONCLUSION: Academic writing retreats for nurses have widespread benefits, providing nurses with uninterrupted time and space to focus on writing high-quality publications and creating networking opportunities through peer support and mentorship channels. IMPLICATIONS FOR PRACTICE: Academic writing retreats are a simple, yet effective way to get nurses to engage in research by writing about their own spheres of practice.

Increased demand for paramedic transports to the emergency department in Ontario, Canada: a population-level descriptive study from 2010 to 2019.

PURPOSE: We examined changes in annual paramedic transport incidence over the ten years prior to COVID-19 in comparison to increases in population growth and emergency department (ED) visitation by walk-in. METHODS: We conducted a population-level cohort study using the National Ambulatory Care Reporting System from January 1, 2010 to December 31, 2019 in Ontario, Canada. We included all patients triaged in the ED who arrived by either paramedic transport or walk-in. We clustered geographical regions using the Local Health Integration Network boundaries. Descriptive statistics, rate ratios (RR), and 95% confidence intervals were calculated to explore population-adjusted changes in transport volumes. RESULTS: Overall incidence of paramedic transports increased by 38.3% (n = 264,134), exceeding population growth fourfold (9.4%) and walk-in ED visitation threefold (13.4%). Population-adjusted transport rates increased by 26.2% (rate ratio 1.26, 95% CI 1.26-1.27) compared to 3.4% for ED visit by walk-in (rate ratio 1.03, 95% CI 1.03-1.04). Patient and visit characteristics remained consistent (age, gender, triage acuity, number of comorbidities, ED disposition, 30-day repeat ED visits) across the years of study. The majority of transports in 2019 had non-emergent triage scores (60.0%) and were discharged home directly from the ED (63.7%). The largest users were persons aged 65 or greater (43.7%). The majority of transports occurred in urbanized regions, though rural and northern regions experienced similar paramedic transport growth rates. CONCLUSION: There was a substantial increase in the demand for paramedic transportation. Growth in paramedic demand outpaced population growth markedly and may continue to surge alongside population aging. Increases in the rate of paramedic transports per population were not bound to urbanized regions, but were province-wide. Our findings indicate a mounting need to develop innovative solutions to meet the increased demand on paramedic services and to implement long-term strategies across provincial paramedic systems.

RéSUMé: OBJECTIFS: Nous avons examiné l'évolution de l'incidence annuelle du transport paramédical au cours des dix années précédant la COVID-19 par rapport à l'augmentation de la croissance de la population et des visites à l'urgence en personne. MéTHODES: Nous avons mené une étude de cohorte au niveau de la population en utilisant le Système national d'information sur les soins ambulatoires du 1er janvier 2010 au 31 décembre 2019 en Ontario, au Canada. Nous avons inclus tous les patients triés aux urgences qui sont arrivés par transport paramédical ou sans rendez-vous. Nous avons regroupé les régions géographiques en utilisant les limites du Réseau local d'intégration des services de santé. Des statistiques descriptives, des rapports de taux (RR) et des intervalles de confiance à 95% ont été calculés pour examiner les variations des volumes de transport ajustées en fonction de la population. RéSULTATS: L'incidence globale des transports paramédicaux a augmenté de 38.3% (n = 264 134), soit quatre fois plus que la croissance démographique (9.4%) et trois fois plus que la fréquentation des urgences sans rendez-vous (13.4 %). Les taux de transport ajustés à la population ont augmenté de 26.2 % (ratio de taux 1.26, IC à 95% 1.26­1.27), contre 3.4 % pour la visite aux urgences sans rendez-vous (ratio de taux 1.03, IC à 95% 1.03­1.04). Les caractéristiques des patients et des visites sont restées constantes (âge, sexe, acuité du triage, nombre de comorbidités, disposition des urgences, visites répétées aux urgences à 30 jours) au cours des années d'étude. La majorité des transports en 2019 avaient des scores de triage non urgents (60.0 %) et ont été renvoyés chez eux directement du service d'urgence (63.7 %). Les plus grands utilisateurs étaient les personnes âgées de 65 ans ou plus (43.7 %). La majorité des transports ont eu lieu dans les régions urbanisées, bien que les régions rurales et du Nord aient connu des taux de croissance du transport paramédical similaires. CONCLUSION: Il y a eu une augmentation considérable de la demande de transport paramédical. La croissance de la demande de services paramédicaux a nettement dépassé la croissance de la population et pourrait continuer d'augmenter parallèlement au vieillissement de la population. Les augmentations du taux de transports paramédicaux par population n'étaient pas limitées aux régions urbanisées, mais s'étendaient à l'ensemble de la province. Nos constatations indiquent un besoin croissant d'élaborer des solutions novatrices pour répondre à la demande accrue de services paramédicaux et mettre en œuvre des stratégies à long terme dans l'ensemble des systèmes paramédicaux provinciaux.

Healthcare support workers' lived experiences and adaptation strategies within the care sector during the COVID-19 pandemic. A meta-ethnography review.

Support workers are an "invisible" part of the health sector often working during pandemics to support clients. This meta-ethnography screened 167 articles out of 211 results identifying 4 qualitative studies that explored the support worker's experiences during the COVID-19 pandemic. "Redundancy approach" was used to map non-essential criteria and the analysis was informed by the interpretative meta-ethnography method. Eight key themes identified from studies in UK and USA. The themes identified are: (1) job role; (2) marginalized profession; (3) impact of work; (4) concerns surrounding PPE; (5) transportation challenges; (6) level of support and guidance; (7) a higher calling and self sacrifice; (8) adaptation strategies. Adaptation strategies include purchasing their own masks, to policy and agency adaptation, cleaning, talk walks, meetings with colleagues or within the company. The adaptation strategies aim at tackling emotional distress and raise the level of appreciation that society or organizations show to the support workers.

The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment.

BACKGROUND: The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. METHODS: Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May - June 2021. RESULTS: 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient's ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. CONCLUSIONS: The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment.

An evaluation of the impact of the Coronavirus (COVID 19) pandemic on interventional radiographers' wellbeing.

BACKGROUND: Interventional radiographers have substantially contributed to patient care during the pandemic by providing imaging guidance during minimally invasive procedures. The aim of this research is to quantify the impact of the pandemic on an interventional radiographers' wellbeing during the COVID-19 pandemic. METHODS: Ethical approval was obtained at the outset of this study. An explanatory sequential mixed methods approach, using questionnaires and interviews, was used to explore and evaluate interventional radiographers' wellbeing; physical, mental and social. An electronic self-administered questionnaire was administered to interventional radiographers and a semi-structured interview was conducted on two respondents. RESULTS: Responses were received from 40 interventional radiographers. Physical, mental and social wellbeing of interventional radiographers deteriorated since the onset of COVID-19. All forms of wellbeing were negatively impacted during the pandemic with mental wellbeing (82.5%) the most impacted, closely followed by physical (75%) and social wellbeing (50%). Half of responding interventional radiographers reported being "highly stressed" while working during COVID-19. Physical activity levels decreased, caffeine consumption increased and consumption of a healthy diet decreased. Almost all interventional radiographers (95%) had anxiety about passing the virus onto family or friends and 60% of noted a deterioration in relationship with friends. Three key themes identified included the importance of teamwork, the physical demand and mental impacts of working in interventional radiology during the pandemic. CONCLUSIONS: The COVID-19 pandemic has had a negative effect on interventional radiographers' wellbeing. The implications of staff having a diminished sense of wellbeing is that productivity is likely to have been reduced and potentially related burnout can lead to illness. This research highlights the need to focus on identifying methods of addressing the shortcomings in support services and identifying the specific needs of interventional radiographers to improve their wellbeing.

A Sense of Being Needed: A Phenomenological Analysis of Hospital-Based Rehabilitation Professionals' Experiences During the COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to explore lived experiences of rehabilitation professionals working in hospitals during the COVID-19 pandemic, including the ethical issues and moral distress that these professionals might have encountered. METHODS: An interpretative phenomenological study was performed. First-person experiences of rehabilitation professionals (dieticians, occupational therapists, physical therapists, and speech-language therapists) were collected with semi-structured interviews and analyzed with interpretative phenomenological analysis. RESULTS: The data of 39 hospital-based rehabilitation professionals revealed 4 themes: a disease with great impact, personal health and safety, staying human in chaotic times, and solidarity and changing roles. Participant experiences show that the virus and COVID-19 measures had a significant impact on the in-hospital working environment due to the massive downscaling of regular care, due to infection prevention measures, and due to unknown risks to rehabilitation professionals' personal health. At the same time, participants experienced a certain freedom, which made room for authentic motives, connection, and solidarity. Participants felt welcomed and appreciated at the COVID-19 wards and intensive care units and were proud that they were able to fulfill their roles. The findings reflect a wide range of situations that were morally complex and led to moral distress. CONCLUSION: To diminish the long-lasting negative impact of the COVID-19 pandemic and moral distress, employers should empathize with the experiences of hospital-based rehabilitation professionals and create conditions for ethical reflection. Our data show that hospital-based rehabilitation professionals value professional autonomy. Creating room for professional autonomy helps them feel needed, connected, and energized. However, the needs of hospital-based rehabilitation professionals may conflict with organizational rules and structures. IMPACT: Hospital-based rehabilitation professionals were involved in situations they considered morally undesirable, and they inevitably faced moral distress during the COVID-19 crisis. This study offers rationale and guidance to employers regarding how to reduce the long-term negative impact of the COVID-19 pandemic on rehabilitation professionals.

About face: regional allied health professional early adaptation during the COVID-19 pandemic.

The coronavirus pandemic has led to significant change in allied health practice in Australia. Measures to slow virus spread have included replacing face-to-face services with telehealth services, and hands-on practice with socially distanced intervention. In the present mixed-methods, cross-sectional study, 51 allied health professionals across two public health services in regional Victoria, Australia, completed an online questionnaire with open and closed questions. The aim was to explore their experience in adapting to directed practice change during the first wave of the pandemic. The clinicians reported low levels of clinical satisfaction due to a perceived reduction in service quality and accessibility. Directed use of telehealth significantly contributed to dissatisfaction, with challenges including infrastructure, clinician and patient digital literacy and platform suitability for some patient groups and interventions. In contrast, peer support, timely and accurate communication, decision transparency, recognition and strong leadership from management supported adaptation, as did individuals' flexibility and learning. Our findings highlight the leadership qualities and support strategies conducive to workplace adaptation during a crisis period. They also support calls for further resource development to support skill translation for telehealth platform use and initiatives to increase digital literacy and infrastructure availability in regional Australia.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia.

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN: Rapid review of articles published between January 2000 and May 2020. DATA SOURCES: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN: Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing,deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

Implementation of Drive-Through Testing for COVID-19 With Community Paramedics.

OBJECTIVE: In this manuscript, we discuss the implementation and deployment of mobile integrated health and community paramedicine (MIH/CP) testing sites to provide screening, testing, and community outreach during the first months of the 2019 coronavirus disease (COVID-19) pandemic in the metropolitan region of Charlotte, North Carolina. This program addresses the need for an agile testing strategy during the current pandemic. We disclose the number of patients evaluated as "persons under investigation" and the proportion with positive severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) results from these sites. We describe how the programs were applied to patient care and include considerations on how additional staffing, scalability, and flexibility of these services may be applied to future patient and health care crises. METHODS: This is a descriptive report of the implementation of MIH/CP test sites in our health care system's early response to the COVID-19 pandemic in March 2020. Retrospective data on the number of patients and their associated demographics are reported here as raw data. No statistical analysis was performed. RESULTS: Between March 15, 2020, and April 15, 2020, our 6 MIH/CP test sites evaluated 4342 patients. Of these, 401 patients (9.2%) had positive test results, 62.8% of whom were women. The estimated duration of each patient encounter under investigation was 3 to 5 minutes. The paramedics were able to perform a brief history, specific physical examination, and screening for signs of hypoxemic respiratory failure. There were no cases of accidental exposure or failure of personal protective equipment for the MIH/CP paramedics. CONCLUSIONS: In our health care system, we pivoted the traditional MIH/CP model to rapidly initiate remote drive-through testing for COVID-19 in pre-screened individuals. This model allowed us to test patients with suspected COVID-19 patients away from traditional health care sites and mitigate exposure to health care workers and other patients.