Australian Health Practitioner Regulation Agency Research Articles

Health Professional Regulation in Australia

As 2020 has progressed jurisdictions across the world and especially their health systems have been grappling with the enormous challenges posed by the COVID-19 pandemic. When the pandemic eventually subsides national and international systems of health regulation are sure to be evaluated strenuously and how health professionals are regulated will be important in these review processes. This paper discusses pre-pandemic regulatory and professional modalities of three distinct groups of health professionals in Australia: doctors; nurses and health service managers. The paper outlines the amalgam of regulatory and professional structures and actors that influence how these three professions practice and deliver health services, before reporting the results of a small qualitative study of the three groups. The study involved 19 semi-structured interviews with doctors, nurses, and health service managers to determine how they interpreted, understood, evaluated and operationalised the requirements of being a health professional, and the emphasis that they gave to professional and regulatory codes of conduct. The study provides a bottom-up perspective of how the core elements of professionalism are perceived by representatives of these groups and in turn, to offer insight into the priority that these groups give to professional association and regulatory codes of conduct. The study also included 2 additional interviews with senior personnel from the Australian Health Practitioner Regulation Agency, the meta regulator of health professionals in Australia regarding the issues raised by health professionals in the study.

A bitter pill to swallow: registered nurses and medicines regulation in remote Australia.

Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. Health workforce distribution characteristics in remote Australia implies registered nurses (RNs) may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. The regulation of health professionals and their training requirements provides essential but complex protections for the public. These protections include the National Registration and Accreditation Scheme for health practitioners and the Australian Health Practitioner Regulation Agency. Other levels of control or regulation are also exerted over health professionals via mechanisms such as salaries and funding arrangements, insurance requirements, admitting rights to healthcare facilities, and legislation controlling the use of medicines and therapeutic devices. This study aimed to examine national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas. Australian state and territory medicines legislation and regulations was interrogated for answers to the questions 'Can an RN prescribe a medication?', 'Can an RN dispense a medication?', 'Can an RN supply or issue a medication?' and 'Can an RN administer a medication?' Inconsistencies were identified nationally in the names and general structure of the legislation, the location of information relating to authorised roles with regards to medications and key terms used to describe medicines and the elements of the medication management cycle. Administrations of Schedule 4 and 8 medicine according to an order from an authorised prescriber are the only nationally consistent roles RNs are authorised to undertake with regards to medicines. Twenty-eight variations were identified with regards to additional authorisations for RNs. RNs make up more than half of the registered Australian health professional workforce and are the most consistently distributed across the nation, yet their legislated responsibilities in relation to working with medicines are inconsistent. Given the inconsistencies, RNs providing health care in remote Australia may be unable to undertake aspects of the medication management cycle that their work environment demands in the best interest of their patients and absence of other healthcare providers. The lack of legislative consistency nationally for medicines in Australia is likely to impede timely access to medications for patients. Regulatory inconsistencies may also result in RNs working well below or beyond their legal scope of practice, thereby creating clinical and workforce risks. Such risks are a significant matter for remote health service provision. Resolving these issues will require a collaborative national approach with consideration given to how the health workforce is distributed, current nursing responsibilities and relevant service delivery models for remote Australia.

Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017

BackgroundBetter understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017.MethodsData regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008–2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008–2012 and 2013–2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period.ResultsA cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013–2017 than 2008–2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013–2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017.ConclusionService provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study

BackgroundIn Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals. Purposeto explore the experiences of PPMs in Australia who have been reported to the AHPRA. MethodsA qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research. ResultsThe majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, “Caught between women and the system”, which described the participants’ feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes. ConclusionIt is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.

Sexual misconduct by health professionals in Australia, 2011-2016: a retrospective analysis of notifications to health regulators.

To assess the numbers of notifications to health regulators alleging sexual misconduct by registered health practitioners in Australia, by health care profession. Retrospective cohort study; analysis of Australian Health Practitioner Regulation Agency and NSW Health Professional Councils Authority data on notifications of sexual misconduct during 2011-2016. All registered practitioners in 15 health professions. Notification rates (per 10000 practitioner-years) and adjusted rate ratios (aRRs) by age, sex, profession, medical specialty, and practice location. Regulators received 1507 sexual misconduct notifications for 1167 of 724649 registered health practitioners (0.2%), including 208 practitioners (18%) who were the subjects of more than one report during 2011-2016; 381 notifications (25%) alleged sexual relationships, 1126 (75%) sexual harassment or assault. Notifications regarding sexual relationships were more frequent for psychiatrists (15.2 notifications per 10000 practitioner-years), psychologists (5.0 per 10000 practitioner-years), and general practitioners (6.4 per 10000 practitioner-years); the rate was higher for regional/rural than metropolitan practitioners (aRR, 1.73; 95% CI, 1.31-2.30). Notifications of sexual harassment or assault more frequently named male than female practitioners (aRR, 37.1; 95% CI, 26.7-51.5). A larger proportion of notifications of sexual misconduct than of other forms of misconduct led to regulatory sanctions (242 of 709 closed cases [34%] v 5727 of 23855 [24%]). While notifications alleging sexual misconduct by health practitioners are rare, such misconduct has serious consequences for patients, practitioners, and the community. Further efforts are needed to prevent sexual misconduct in health care and to ensure thorough investigation of alleged misconduct.

Patterns of orofacial pain practice amongst oral medicine specialists in Australia.

This study aimed to evaluate and describe the current patterns of practice pertaining to orofacial pain amongst oral medicine specialists in Australia and provide insight into the access of care available to orofacial pain patients in Australia. A survey involving questions relevant to orofacial pain, patient and practitioner demographics was designed and disseminated via an online polling platform to all Australian Health Practitioner Regulation Agency registered oral medicine specialists. Results were collated online, and simple descriptive statistics were utilised for data analysis. Twenty-six oral medicine specialists were included in this study, with a survey response rate of 81.2%. All specialists considered orofacial pain practice as part of the oral medicine specialty. 96.2% assessed and managed orofacial pain patients as part of their oral medicine practice. The greatest proportion (30.8%) of oral medicine specialists were practicing in Western Australia, a state which represents 10.3% of the Australian population. All respondents reportedly diagnose temporomandibular disorders, followed by orofacial neuropathy (96.2%) and headache or neurovascular disorders (80.8%). 92.3% of specialists managed orofacial neuropathy followed by temporomandibular disorders (84.6%) and headache or neurovascular disorders (50%). This is the first study to report on patterns of orofacial pain practice amongst oral medicine specialists in Australia. Findings demonstrate that oral medicine specialists in Australia are actively engaged in the assessment and management of the orofacial pain patient. There, however, appears to be disproportionate access to care by oral medicine specialists for patients with orofacial pain across Australia.

Gender equity within medical specialties of Australia and New Zealand: cardiology's outlier status.

Gender disparity remains a prominent medical workforce issue, extending beyond surgical specialties with low proportions of female doctors. To examine female representation within Australia and New Zealand (NZ) among physician specialties and certain comparator surgical specialties with a focus on cardiology as an outlier of workforce gender equality. Data of practising medical specialists, new consultants and trainees were sought from the Australian Health Practitioner Regulation Agency, the Medical Council of NZ and the Royal Australasian College of Surgeons (2015-2017). The stratified data pertaining to interventional cardiologists were obtained through direct contact with individual hospitals (from 2017 to 2018) and derived from state-based cardiac registries. In Australia and NZ, there were fewer female practising adult medicine physician consultants (n = 8956, 32%, P < 0.001), with gender disparities seen across most physician specialties. Cardiology (15%) was the only physician specialty with <20% representation; gastroenterology (23%), neurology (27%) and respiratory medicine (29%) had <30% female representation at the consultant level. The rates of cardiology (15%) and interventional cardiology (5%) were similar to general surgery (15%) and orthopaedics (4%). Although more than half of physician trainees are female, and most physician specialties are approaching or have equal gender ratios at the trainee level, cardiology (23%) and interventional cardiology (9%) remain significantly underrepresented. Cardiology is the only physician specialty with <20% female consultants, and this disparity is reflected throughout every stage of the cardiology training programme. Increased awareness and proactive strategies are needed to improve gender disparity within this underrepresented medical specialty.

The distribution of dentists in Australia Socio-economic profile as an indicator of access to services.

Analyse the dentist to population ratio relative to socio-economic profile to identify areas of workforce shortages and inform the policy direction of workforce recruitment strategies and public dental service planning. The suburb, state and postcode of dentists listed on the public access register of the Australian Health Practitioner Regulation Agency were geocoded by latitude and longitude and added to a map of Australia built on Australian Bureau of Statistics (ABS) Statistical Area 2 (SA2) census districts. Population data detailing the relative socio-economic disadvantage of each Statistical Area 1 (SA1) within each SA2 was superimposed on the map and used to calculate the number of dentists per 100 000 population relative to level of socio-economic disadvantage as defined by the ABS Socio-Economic Index for Areas, (SEIFA) Index of Relative Socio-economic Disadvantage (IRSD). The results were reported according to state and territory, and the Accessibility and Remoteness Index of Australia (ARIA+). The dentist to population ratio was lower in areas of disadvantage within major cities. All regions outside major cities had population cohorts with dentist to population ratios below the 65 dentists per 100 000 benchmark, conservatively estimated to be the minimum required for reasonable access to services. There is an inequity in the distribution of dentists relative to the socio-economic profile and geographic location of the Australian population. Shortages of dentists persist across many IRSD deciles in regional and rural areas. Within major cities there are fewer dentists per capita in the lower socio-economic districts.

Factors associated with rural work for nursing and allied health graduates 15-17 years after an undergraduate rural placement through the University Department of Rural Health program.

Very little is known about the long term workforce outcomes, or factors relating to these outcomes, for nursing and allied health rural placement programs. The positive evidence that does exist is based on short term (1-3 year) evaluations, which suggest that undergraduate rural placements are associated with substantial immediate rural practice of 25-30% graduates practising rurally. These positive data suggest the value of examining long term practice outcomes, since such data are necessary to providing an evidence base for future workforce strategies. The objective was to measure long term (15-17 year) rural practice outcomes for nursing and allied health graduates who had completed an undergraduate rural placement of 2-18 weeks through a university department of rural health (UDRH). This was a longitudinal cohort study, with measures taken at the end of the placement, at one year and at 15-17 years post-graduation. Participants were all nursing and allied health students who had taken part in a UDRH rural placement, who consented to be followed up, and whose practice location was able to be identified. The main outcome measure was factors associated with location of practice as being either urban (RA 1) or rural (RA 2-5). Of 776 graduates initially surveyed, 474 (61%) were able to be contacted in the year after their graduation, and 244 (31%) were identified through the Australian Health Practitioner Regulation Agency, 15-17 years later. In univariate analysis at the first graduate year, previously lived rural, weeks in placement, discipline and considering future rural practice all had significant relationships with initial rural practice. In multivariate analysis, only rural background retained significance (odds ratio (OR) 3.19, confidence interval (CI) 1.71-5.60). In univariate analysis 15-17 years later, previously lived rural and first job being rural were significantly related to current rural practice. In multivariate analysis, only first job being rural retained significance (OR 11.57, CI 2.77-48.97). The most significant long term practice factor identified in this study was initial rural practice. This suggests that funding to facilitate a rural pathway to not just train but also support careers in rural nursing and allied health rural training, similar to that already established for pharmacy and medicine, is likely to have beneficial long term workforce outcomes. This result adds to the evidence base of strategies that could be implemented for the successful development of a long term rural health workforce.

Effectiveness of the Non-Medical Surgical Assistant measured by patient outcome assessment.

To investigate effectiveness of the nurse clinician as a Non-Medical Surgical Assistant compared with the Medical Surgical Assistant. Non-Medical Surgical Assistants are clinicians who are not medical practitioners. The surgical assistant works directly with the primary surgeon intraoperatively. A pragmatic, retrospective, observational study on patients undergoing Laparoscopic Inguinal Hernia Repair or Primary Unilateral Total Hip Arthroplasty. Each patient received intraoperative care from a consultant surgeon and a Medical Surgical Assistant or Non-Medical Surgical Assistant. All surgical assistants were registered with the Australian Health Practitioner Regulation Agency. Data were collected between 01/07/2014 and 30/06/2017. The effect that surgical assistant choice had on patient outcomes was estimated using regression statistical models. Six dependent variables, including length of stay, for clinical outcome assessment were specified. The groups were equivalent in age, gender, and American Society of Anaesthesiologists scores. There were more emergency procedures in the Medical Surgical Assistant group and more hip surgery in the Non-Medical Surgical Assistant group. Patient outcome assessment showed no statistically significant differences for surgical assistant types. The nurse clinician in the role of Non-Medical Surgical Assistant was shown to be effective with equivalent patient outcomes compared with the Medical Surgical Assistant.

Facebook legal and regulatory advertising compliance by specialist orthodontic practices: a cross-sectional survey

Abstract Background Healthcare providers are increasingly using social media websites such as Facebook to advertise their services. The Australian Health Practitioner Regulation Agency guidance on the advertising of healthcare is based on the National Law in Australia and prohibits advertising that is contrary to the patient’s best interests. Aim To determine the legal and regulatory advertising compliance of the Facebook pages of specialist orthodontic practices in Australia. Methods The Facebook pages of specialist orthodontic practices were identified following a systematic search strategy. The content uploaded to each ‘eligible’ page between March 2019 and February 2020 was reviewed with regard to five specific domains of prohibited advertising. Cronbach’s Alpha Test was used to determine intra-rater agreement. Results The Facebook pages of 147 specialist orthodontist practices in Australia, representing 288 specialist orthodontists, satisfied inclusion criteria. Most Facebook pages (82.3%) breached the Law in one or more domains. The mean number (standard deviation) of domains breached was 1.65 (1.3), range 0–5. Non-compliance regarding ‘the use of testimonials’ (76.9%) and ‘information that was likely to create unrealistic expectations of orthodontic treatment’ (40.8%) were the domains most commonly contravened. All five domains were breached in 5.4% of practice Facebook pages. Intra-rater scores were strong, ranging from 0.84 to 0.94. Conclusions Compliance of the Facebook pages of specialist orthodontic practices in Australia with legal and regulatory advertisement requirements is poor. Greater awareness of the relevant obligations by specialist orthodontists responsible for their practice Facebook content is necessary to ensure that their advertising is not liable to charges of legal and/or professional misconduct.

Characteristics and predictors of regulatory immediate action imposed on registered health practitioners in Australia: a retrospective cohort study.

Objective Immediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia. Methods This was a retrospective cohort study of 11200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome. Results Of 13939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR=21.3, 95% CI 13.7-33.2; non-mandatory notifications OR=10.9, 95% CI 6.7-17.8) and by other health practitioners (mandatory notifications OR=11.6, 95% CI 7.6-17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR=11.6, 95% CI 7.6-17.8), lodged by an external agency such as the police (OR=11.8, 95% CI 7.7-18.1) or was a self-notification by the health practitioner themselves (OR=9.4, 95% CI 5.5-16.0). The odds of immediate action were higher for notifications about substance abuse (OR=9.9, 95% CI 6.9-14.2) and sexual misconduct (OR=5.3, 95% CI 3.5-8.3) than for notifications about communication and clinical care. Conclusions Health practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What is known about this topic Health practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded. What does this paper add? This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What are the implications for practitioners? Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner's career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners.

Sticking up for Victoria? - Victoria's Legislative Council inquires into the performance of the Australian Health Practitioner Regulation Agency

This article analyses the report of the Victorian Legislative Council’s Legal and Social Issues Legislation Committee (‘Committee’) from its Inquiry into the Performance of the Australian Health Practitioner Regulation Agency (AHPRA). AHPRA is a national body that provides administrative support for the National Registration and Accreditation Scheme (NRAS), under which practitioners in 14 health professions across Australia are regulated. The article considers the Committee’s fi ndings and recommendations in light of the impetuses for the creation of the NRAS, as well as the structure and implementation of the NRAS and AHPRA. It is argued that that the value of the Committee’s report is confi ned to its identifi cation of important issues concerning the NRAS and AHPRA that, in the near future, will require a more critical and comprehensive investigation than the Committee undertook.

Profile of the most common complaints for five health professions in Australia.

Objective The aims of this study were to profile the most common complaints and to examine whether any demographic factors are associated with receiving a complaint for five health professions in Australia. Methods A national cohort study was conducted for all complaints received for medicine, nursing/midwifery, dentistry, pharmacy and psychology from 1 July 2012 to 31 December 2013 (18 months). Data were collected from the Australian Health Practitioner Regulation Agency (AHPRA), the New South Wales (NSW) Health Professional Councils' Authority and the NSW Health Care Complaints Commission. The frequency and risk of complaints were summarised for the five professions and by demographic information. Results There were 545283 practitioners registered with AHPRA between 1 July 2012 and 31 December 2013, consisting of 20935 dentists, 101066 medical practitioners, 363040 nurses/midwives, 28370 pharmacists and 31872 psychologists. During the study period there were 12616 complaints, corresponding to an annual rate of 1.5 per 100 practitioners. Complaints were most common for doctors and dentists (5% per annum per practitioner) and least common for nurses/midwives (0.5% per annum per practitioner). Sex (P<0.01), age (P<0.01) and country of birth (P<0.01) were all associated with risk of complaint. The most common complaints were clinical care (44% of all complaints), medication (10%) and health impairment of the practitioner (8%). Types of complaints varied by profession, sex and age. Conclusions The risk of a complaint is low, but varies by profession and demographics. The types of complaints also vary by profession and demographics. Differences between professions is most likely driven by their different work tasks and work environments. What is already known on this subject? Although complaints are summarised annually from state and national health regulators, no overall national summary of complaints across professions exists. Thus, it is difficult to examine which complaints are most common, how professions differ from each other or what factors may be associated with risk and type of complaint. Previous studies have primarily focused on a single profession, such as medicine, where, for example, the number of prior complaints, sex, doctor speciality and age have been found to be associated with recurrent complaints. What does this paper add? This paper is the first of this kind to provide a national summary of all complaints from five of the most common health professions in Australia. We found that regardless of profession, men were at least twice as likely to have a complaint made against them than women. We also found that the types of complaint differed between men and women. There were similarities across professions for the most common types of complaints, but clear differences between professions were also noted. Not surprising, clinical care was typically the most common type of complaint for the five professions, but somewhat surprising was the inclusion of health impairment as one of the most common types of complaints. What are the implications for practitioners? Identifying the most common complaints, and the factors associated with these, may assist practitioners to understand their risk(s) of complaint and could potentially assist educators and regulators develop education programs that help reduce complaints.

Misperceptions and stereotypes in nursing care for sexually transmitted infections and domestic violence: a qualitative exploratory study

Background: Sexually transmitted infections (STI) and domestic violence (DV) are common healthcare issues experienced worldwide with DV increasing the risk of acquiring STI/s. Although nurses are well-placed to provide care for both issues, little is known about how and whether nurses perceive STI risk within the context of DV and whether this informs nursing care.Aim: To explore nurses’ perceptions of STI acquisition within the context of DV and whether this informs nursing care.Design: Qualitative exploratory descriptive design.Methods: Eight participant narratives were collected from Australian Registered Nurses (RNs), with 1–17 years of clinical practice in varied settings. Participants were required to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) and converse in English. Semi-structured interviews were undertaken via face-to-face, telephone and computer-mediated communication (CMC). Thematic analysis was guided by Braun and Clarke (2006).Results: Three themes emerged from the data: ‘Perceptions: They don’t talk about it, ‘Stereotypes: Just that stigma and ‘Provision of Care for STIs/DV: Physical and emotional. Participants held various perceptions associated with STIs and DV including the covert nature of both issues, the care of STIs within the context of DV, and how the nature of nursing care differed between STIs and DV.Conclusions: Nurses need to recognise the impact that nurse perceptions and stereotyping have on disclosures and provision of care for STIs, particularly in the context of DV. Consideration is also needed in relation to sexual and reproductive autonomy, the impact on disclosure and provision of care.

The influence of hospital location and ‘level of care’ on continuing professional development

Healthcare workers core skills are reinforced and knowledge of latest developments ensured by undertaking systematic continuing professional development. The current study explored the impact of health facility location and level of care provided on the continuing professional development offered to maternity services healthcare workers in Victoria, Australia. An online survey of middle to senior management staff of 71 public and private health services as well as 7 professional bodies was conducted, yielding 114 participants. Analysis was by location (metropolitan or regional/rural) and level of care provided. The findings revealed Australian Health Practitioner Regulation Agency registration is the predominant requirement to provide continuing professional development to staff. Dedicated education departments or educators are significantly underrepresented in Level 1&2 facilities, while Level 5&6 facilities are more likely to provide breastfeeding continuing professional development. Metropolitan locations provided more wide-ranging programmes compared with rural/regional locations. Key enablers are the capacity to share resources, have access to external courses and simulation equipment/centres, and the provision of relevant and timely continuing professional development programmes, indicating that ‘Educational hubs’ with credentialed staff working from better resourced regional facilities could deliver a complete array of CPD programmes to lower level facilities.

Australian pharmacists’ perspectives on physician-assisted suicide (PAS): thematic analysis of semistructured interviews

ObjectivesThis study aimed to investigate Australian pharmacists’ views about their role in physician-assisted suicide (PAS), their ethical and legal concerns and overall thoughts about PAS in pharmacy.DesignSemistructured interviews of pharmacists...

Attitudes towards continuing professional development: a qualitative study of Australian paramedics

BackgroundIn December 2018 Australian paramedics and the paramedicine discipline became nationally registered under the Australian Health Practitioner Regulation Agency (AHPRA). Paramedics are now required to register and satisfy registration requirements in order to work as a paramedic. One of the mandatory registration standards is continuing professional development (CPD). This study examines attitudes and perceptions held by Australian paramedics in relation to CPD. MethodsA qualitative research project was undertaken using semi-structured interviews. A purposive snowballing sampling technique was employed to invite paramedics currently working in Australia to participate in telephone-based interviews. Data were analysed using a thematic analysis approach. The transcripts were read several times to determine repeated themes and these themes were then coded by two authors. Data saturation was considered to have occurred after 18 interviews. ResultsEighteen paramedics responded and were interviewed; 16 of the respondents were male with the majority coming from Victoria. Broadly, four key themes were identified from analysis of the interviews. These included: 1) identification of CPD activities and requirements, 2) motivation, 3) factors influencing choice of activity, and 4) barriers.ConclusionThere was general acceptance of the need for paramedics to stay up-to-date with current practice. Generally, this was seen as a responsibility of the employer but some individuals made the distinction between employment requirements and professional requirements. We would encourage ongoing research in this area particularly as CPD develops over time for paramedicine in Australia.

Graduate doctors’ rural work increases over time

Background: The contribution of rural clinical school (RCS) and rural origin to developing a long-term rural medical workforce was examined.Methods: Longitudinal cohort study, after undergraduate location in either rural or urban setting, for all medical graduates 2004–2010, identified in the Australian Health Practitioner Regulation Agency, in the following groups: Urban origin/no RCS; Rural origin/no RCS; Urban origin/RCS; and Rural origin/RCS.Results: Proportions of all graduates working rurally increased from 2013 to 2018, including amongst urban origin/nonRCS graduates. Rural origin/RCS participants worked rurally at the highest rates across all time points, with an endpoint of 47%, and an odds ratio of 9.70 (5.41, 17.40) relative to the urban reference group. They had a cumulative duration of rural practice over 5 times higher than the urban reference group. RCS graduates were more likely to be working in remote areas than nonRCS graduates.Conclusion: All graduates’ contribution to rural and remote workforce is dynamic and increasing. Both RCS participation and rural student recruitment make synergistic and increasing contributions to rural work. RCS effects workforce distribution to more remote areas. Single cross-sectional studies do not capture this dynamic growth in the rural workforce.

Social network analysis of rural medical networks after medical school immersion in a rural clinical school

BackgroundThe impact of new medical graduates on the social dimensions of the rural medical workforce is yet to be examined. Social Network Analysis (SNA) is able to visualize and measure these dimensions. We apply this method to examine the workforce characteristics of graduates from a representative Australian Rural Clinical School.MethodsParticipants were medical graduates of the Rural Clinical School of Western Australia (RCSWA) from the 2001–2014 cohorts, identified as being in rural work in 2017 by the Australian Health Practitioner Regulation Agency. SNA was used to examine the relationships between site of origin and of work destination. Data were entered into UCInet 6 as tied pairs, and visualized using Netdraw. UCINet statistics relating to node centrality were obtained from the node editor.ResultsSNA measures showed that the 124 of 709 graduates in rural practice were distributed around Australia, and that their practice was strongly focused on the North, with a clear centre in the remote Western Australian town of Broome. Women were strongly recruited, and were widely distributed.ConclusionsRCSWA appears to be a “weak tie” according to SNA theory: the School attracts graduates to rural nodes where they had only passing prior contact. The multiple activities that comprise the social capital of the most attractive, remote, node demonstrate the clear workforce effects of being a “bridge, broker and boundary spanner” in SNA terms, and add new understanding about recruiting to the rural workforce.