Pregnancy and neonatal characteristics of opioid-dependent Indigenous Australians: a rural and metropolitan comparison.

AIMS: To identify maternal, obstetric and neonatal characteristics of opioid-dependent Indigenous Australians in rural and metropolitan settings. METHODS: Retrospective cohort study of 232 metropolitan and 67 rural infants born to mothers maintained on methadone throughout pregnancy for the treatment of opiate dependency, between January 2000 and December 2006. Medical records of identified mother/infant dyads were reviewed by evaluating 20 different maternal, obstetric and neonatal parameters. RESULTS: The number of infants of opiate-dependent mothers (IODMs) identified to be of Aboriginal ethnicity was 47 in the rural and 50 in the metropolitan setting. This reflected a significantly higher proportion in the rural versus metropolitan areas (70.1% vs 21.6%, P < 0.05). The effect of rurality was independent of ethnicity with significantly lower rates of neonatal withdrawal requiring treatment (P < 0.001), antenatal consultations (P < 0.01), department of community services (DoCS) involvement (P < 0.001) and shorter infant lengths of stay (P < 0.001). There was a non-significant trend towards more intrauterine growth restriction in Aboriginal infants. There were no significant differences in parameters in rural Indigenous versus rural non-Indigenous infants. CONCLUSIONS: Significant differences exist between rural and metropolitan IODMs in terms of less attendance at antenatal consultations, less neonatal withdrawal requiring treatment, shorter average length of hospital stay for the infant and less documented DoCS involvement. These differences maybe a reflection of a different diagnostic and management approach. Ethnicity had no major clinical impact in either the rural or the metropolitan settings. Future research comparing the long-term outcomes would be of interest.

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital.

OBJECTIVE: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996-2005 and assess possible correlations with basic demographic data. RESULTS: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0-10 and 71-80-year deciles and for females in 0-10, 21-30 and 71-80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically significant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary disease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. CONCLUSION: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted measures to address the problem.

Harnessing a university to address rural health workforce shortages in Australia.

OBJECTIVE: To describe the efforts of health faculties at the University of Sydney to contribute to the recruitment and retention of rural health professionals and examine for opportunities that would benefit from an institutional-led response. DESIGN: Cross-sectional survey. SETTING: The University of Sydney as a leading institution for health science education in New South Wales, which produces approximately 40% of all health science graduates in the state each year. PARTICIPANTS: Staff responsible for course coordination within the faculties of Dentistry, Medicine, Nursing and Midwifery, and Pharmacy; and eight disciplines of the Faculty of Health Sciences. RESULTS: Of the two educational strategies associated with future rural employment, more progress has been made with rural placements, which were offered by all but one of the health courses. Efforts aimed at the other key strategy of attracting and supporting rural origin students were not well developed. Dentistry, Medicine, Pharmacy and only one Faculty of Health Sciences programs had more than 0.2 full-time equivalent staff to support rural initiatives. CONCLUSION: Despite the significant government investment in rural health education, the University of Sydney experience demonstrates that this does not necessarily translate into adequate internal resources available for every course or program to optimise performance for rural health workforce outcomes. In an environment of competing priorities, benefits are likely to accrue from strategies that draw on the existing resource base and operate through greater collaborative action, coordinated at the institutional level.