Transitioning from a single-site pilot project to a state-wide regional telehealth service: The experience from the Victorian Stroke Telemedicine programme.

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes.

Dispelling the myths about rural consultant physician practice: the Victorian Physicians Survey.

OBJECTIVE: To quantify the barriers to practising as a rural consultant physician. DESIGN: Cross-sectional postal survey. PARTICIPANTS: All 981 practising consultant physicians in Victoria, Australia, who were Fellows of the Royal Australasian College of Physicians in 1999; 52 (100%) of rural physicians and 634 (68.2%) of metropolitan physicians completed the survey. MAIN OUTCOME MEASURES: Demographic and practice characteristics; barriers to rural practice. RESULTS: There were no rural female consultant physicians, and 35 of the 52 rural consultant physicians (67.3%) were born in a rural area. The most important perceived barriers to rural practice identified by both metropolitan and rural physicians were children's schooling (72.2%), spouse's occupation (65.7%), other issues related to children (66.7%) and difficulties getting back into metropolitan practice (45.7%). Among metropolitan physicians, barriers to rural practice differed by age, sex, place of birth and nationality. Returning to metropolitan practice, children and concern over procedures were more likely to be reported as barriers to rural practice among those aged 40 years or under, 41-50 years and 51 years and over, respectively. CONCLUSION: The major barriers to rural practice identified by physicians lie outside the health sector, and particularly concern a perceived need for wider opportunities in children's education and spouse employment.