Oral healthcare attendance and the effectiveness of referrals for rural antenatal women.

OBJECTIVES: To analyse the effectiveness of targeted stakeholder engagement strategies and the impact they have on antenatal referrals, oral health admission, attendance and education of pregnant women in a rural public dental clinic. METHOD: Key stakeholders (obstetric trained general practitioners [GPs] and midwives) were educated and motivated to refer pregnant women to the rural public dental clinic via priority referral pathways. A 10-month pre- and post-intervention period of oral health assessments and treatments was compared and contrasted. DESIGN: Quasi-experimental study. SETTING: A rural health service in the Loddon Mallee region, Victoria. PARTICIPANTS: Local pregnant women, 18 years of age or older, eligible for public dental care. MAIN OUTCOME MEASURES: Increased oral health admission, attendance and education of pregnant women. RESULTS: Active engagement with key stakeholders significantly increased the oral health referral, admission and attendance of eligible antenatal women. Prior to the intervention, only 15.04% of eligible antenatal women sought oral health treatment, in comparison with 40.37% post-intervention. Of the 62 women referred, 44 actively received dental care. CONCLUSION: Active engagement with key stakeholders has demonstrated a clinically effective method of increasing antenatal referrals of socially disadvantaged women to a rural public dental clinic. Further collaboration between healthcare professionals can improve the oral health admission rates, attendance and education of antenatal women and their children.

"Here Comes the Junkies," Opioid Replacement Therapy in Rural Australia.

BACKGROUND: Opioid replacement therapy (ORT) offers a harm minimization approach and is the mainstay treatment option for opioid dependence in Australia. Recovery is known to be complicated because of service access, cost, workforce availability, privacy, stigma, and discrimination. Rural living is considered to magnify each complication of recovery, yet little is understood about how opioid dependence recovery is experienced in rural Australia. This study aimed to explore the lived experience of people receiving ORT in rural Australia and describe impediments to recovery. METHODS: In this qualitative study design, all outpatients enrolled in ORT at two rural Australian sites were invited to participate. Six volunteers from each site participated in a semistructured interview (eight men, four women; mean age = 44.8 years). RESULTS: The participants had completed 3 years of secondary school education on average. Four major themes emerged: reinvention, restriction, employment, and reconnection. Small communities increased the likelihood of ORT participants knowing people both directly and indirectly, affecting their ability to reconstruct an identity. Lived distance from prescribers and dosing points dictated daily activity, including opportunities to seek and maintain employment. Rural ORT treatment seekers indicated that geographical displacement and separation from family, the people they needed to reconnect with, were challenging. CONCLUSION: Rural people engaged in ORT require positive reinforcement from service providers, enabling identity reinvention and disconnection from the drug-seeking world. Acknowledging underlying trauma and supporting reconnection with loved ones may foster positive social connectedness.

Implementation of an older person's nurse practitioner in rural aged care in Victoria, Australia: a qualitative study.

BACKGROUND: There are staff shortages nation-wide in residential aged care, which is only predicted to grow as the population ages in Australia. The aged care staff shortage is compounded in rural and remote areas where the health service workforce overall experiences difficulties in recruitment and retention. There is evidence that nurse practitioners fill important service gaps in aged care and rural health care but also evidence that barriers exist in introducing this extended practice role. METHODS: In 2018, 58 medical and direct care staff participated in interviews and focus groups about the implementation of an older person's nurse practitioner (OPNP) in aged care. All 58 interviewees had previously or currently worked in an aged care setting where the OPNP delivered services. The interviews were analysed using May's implementation theory framework to better understand staff perceptions of barriers and enablers when an OPNP was introduced to the workplace. RESULTS: The major perceived barrier to capacity of implementing the OPNP was a lack of material resources, namely funding of the role given the OPNP's limited ability to self-fund through access to the Medicare Benefits Schedule (MBS). Staff perceived that benefits included timely access to care for residents, hospital avoidance and improved resident health outcomes. CONCLUSION: Despite staff perceptions of more timely access to care for residents and improved outcomes, widespread implementation of the OPNP role may be hampered by a poor understanding of the role of an OPNP and the legislative requirement for a collaborative arrangement with a medical practitioner as well as limited access to the MBS. This study was not a registered trial.

Mind the gap: is it time to invest in embedded researchers in regional, rural and remote health services to address health outcome discrepancies for those living in rural, remote and regional areas?

Research capacity building in healthcare works to generate and apply new knowledge to improve health outcomes; it creates new career pathways, improves staff satisfaction, retention and organisational performance. While there are examples of investment and research activity in rural Australia, overall, rural research remains under-reported, undervalued and under-represented in the evidence base. This is particularly so in primary care settings. This lack of contextual knowledge generation and translation perpetuates rural-metropolitan health outcome disparities. Through greater attention to and investment in building research capacity and capability in our regional, rural and remote health services, these issues may be partially addressed. It is proposed that it is time for Australia to systematically invest in rurally focussed, sustainable, embedded research capacity building.

Preferred language regarding overweight and obesity in general practice: a survey of predominantly rural Australian adults.

Discussions regarding overweight may be infrequent in Australian general practice. General practitioners (GPs) may find these discussions difficult to initiate if they are unsure of the language to use, or if patients would find it acceptable to be weighed. Overweight and obesity are more prevalent in rural areas than in metropolitan areas, and strategies to address the health risks associated with these conditions need to be tailored to rural communities. The aims of this study were to identify the language preferred by an Australian adult sample with a range of body sizes, to assess acceptability of routine weight measurement by GPs, and to assess potential influence of gender, body size and rurality on these preferences. A questionnaire was distributed through the authors' informal networks using email and social media. Australian adults were eligible to participate. Respondents (n=771) were predominantly female, health professionals and resided in rural areas. The preferred language was weight neutral ('weight') or linked to health ('your weight may be damaging your health', 'you are above your healthy weight range'). Preferred language appeared to be influenced by gender and body size but not rurality. Most respondents (76%) would find it acceptable to be weighed regularly by their GP.