Health Care In Remote Communities Research Articles

Examining workplace safety for remote area nurses in Australia: a cross-sectional descriptive study.

Australia's remote health sector has chronic understaffing issues and serves an isolated, culturally diverse population with a high burden of disease. Workplace health and safety (WHS) impacts the wellbeing and sustainability of the remote health workforce. Additionally, poor WHS contributes to burnout, high turnover of staff and reduced quality of care. The issue of poor WHS in Australian very remote primary health clinics was highlighted by the murder of remote area nurse (RAN) Gayle Woodford in 2016. Following her death, a national call for change led by peak bodies and Gayle's family resulted in the development of many WHS recommendations and strategies for the remote health sector. However, it is unclear whether they have been implemented. The aim of this study is to identify which WHS recommendations have been implemented, from the perspective of RANs. A cross-sectional online survey of 173 RANs was conducted during December 2020 and January 2021. The survey was open to all RANs who had worked in a very remote (MM 7 of the Modified Monash (MM) Model) primary health clinic in Australia more recently than January 2019. A convenience sampling approach was used. The survey tool was developed by the project team using a combination of validated tools and remote-specific workplace safety recommendations. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and 'never alone' policy, were broken down into specific safety criteria. These criteria were used to generate workplace safety scores to quantify how well each recommendation had been met, and clustered into the following domains: preparation of staff, safe work environment and safe work practices. Descriptive statistics were used and the safety scores between different states and territories were also compared. Overall, the average national workplace safety score was 53% (standard deviation (SD) 19.8%) of recommendations met in participants' most recent workplace, with median 38.5% (interquartile range (IQR) 15.4-61.5%) of staff preparation recommendations, median 59.4% (IQR 43.8-78.1%) of safe work environment recommendations, and median 50.0% (IQR 30.0-66.7%) of safe work practices recommendations met. Within domains, some recommendations had greater uptake than others, and the safety scores of different states/territories also varied. Significant variation was found between the Northern Territory (57.5%, SD 18.7%) and Queensland (41.7%, SD 16.7%) (p<0.01), and between South Australia (74.5%, IQR 35.9%) and Queensland (p<0.05). Last, many RANs were still expected to attend after-hours call-outs on their own, with only 64.1% (n=107/167) of participants reporting a 'never alone' policy or process in their workplace. The evidence from this study revealed that some recommended safety strategies had been implemented, but significant gaps remained around staff preparation, fatigue management and infrastructure safety. Ongoing poor WHS likely contributes to the persistently high turnover of RANs, negatively affecting the quality and continuity of health care in remote communities. Variation in safety scores between regions warns of a fragmentation of approaches to WHS within the remote health sector, despite the almost identical WHS legislation in different states/territories. These gaps highlight the need to establish and enforce a national minimum standard of workplace safety in the remote health sector.

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

The delivery of Primary Health Care in remote communities: A Grounded Theory study of the perspective of nurses

BackgroundAustralia has vast areas of desert, wilderness and offshore islands where nurses provide the majority of health care services. The residents of Australia's remote communities generally have poorer health status than their metropolitan counterparts. Despite recognition of Primary Health Care as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses employ the Primary Health Care model in practice. ObjectivesThis study described and explained from the perspective of nurses, the actions and interactions involved in the delivery of Primary Health Care in remote communities. DesignThis study was conducted from a Constructivist Grounded Theory perspective. SettingsThe setting was community health centres or Aboriginal Medical Services located in ‘remote’ or ‘very remote’ areas. Communities with inpatient health services were excluded. ParticipantsTwenty four Nurse Practitioners, Registered Nurses and nursing academics participated. Participants had worked or were working, in a variety of remote communities across Australia. Length of service ranged from three months to over 15 years nursing in remote areas. MethodsData were collected through 23 telephone interviews and an expert reference group. Theoretical sampling and constant comparative analysis were used to reach theoretical saturation. ResultsThe core issue participants faced was the inability to provide Primary Health Care. Four conditions impacted on the core issue: understanding the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process of doing the best you can with what you have, emerged as the way participants dealt with the inability to provide Primary Health Care. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home-making in a work environment. The outcome of this process was considered to be making compromises to provide Primary Health Care. ConclusionsThis study describes the substantive theory: making compromises to provide Primary Health care services in the remote Australian setting. Understanding the process of making compromises could direct employers and educators in their efforts to improve the provision of Primary Health Care in a variety of settings. Increased attention to the education, resources and support of nurses is likely to increase access to safe, quality care for remote communities.

Exploring the feasibility of eHealth solutions to decrease delays in maternal healthcare in remote communities of Ghana

BackgroundDespite the introduction of the Millennium Development Goal to reduce maternal deaths from 400 to 100 per 100,000 live births, the proportion of maternal deaths is still much higher in most developing countries like Ghana. Various interventions have been implemented in Ghana that focus on increasing skilled maternal care. These are especially needed in rural areas. EHealth has the potential to contribute to reducing the challenges in maternal healthcare (MHC) that poor areas suffer. This paper analyzes the potential of eHealth solutions to improve maternal health in rural Ghana as well as the challenges to their implementation. The work was carried out in cooperation with the local health directorate of Kpando Municipality, one of the administrative areas in the Volta Region.MethodsThe study is focused on remote peninsulas and islands in Kpando Municipality. Data was gathered through triangulated research methods. Maternal health challenges were identified using the Three Delays Model for MHC. The three delays are delay in seeking care, delay accessing health facilities, and delay receiving adequate care. Challenges to the implementation of eHealth solutions in remote communities were analyzed using the Drury’s 5C eHealth model for developing countries. The 5Cs correspond to context, community, capacity, connectivity, and content.ResultsThe results show that financial dependence of women, a decision-making process based on previous experiences and traditional beliefs, competitiveness between facilities, organizational loopholes, lack of equipment, and geographical situations directly influence MHC outcomes. EHealth solutions, thanks to the high number of health workers with basic IT skills, have high potential to reduce MHC delays. However, poverty, cultural beliefs, organizational issues, connectivity, and lack of human resources were identified as main challenges to the implementation of eHealth solutions.ConclusionIn Ghana’s rural areas the three delays proposed in the model affect the outcomes of MHC. These delays are influenced by socio-economic status, access to facilities, and quality of care. EHealth solutions show great potential to reduce the delays. Based on the 5C model, a mHealth solution aiming to improve guidance during pregnancy was outlined.

Equitable resourcing of primary health care in remote communities in Australia\u2019s Northern Territory: a pilot study

BackgroundImproved Primary Health Care (PHC) utilisation is central to reducing the unacceptable morbidity and mortality rates characterising populations living in remote communities. Despite poorer health, significant inequity characterises the funding of PHC services in Australia’s most remote areas. This pilot study sought to ascertain what funding is required to ensure equitable access to sustainable, high quality primary health care irrespective of geographical remoteness of communities.MethodsHigh performing remote Primary Health Care (PHC) services were selected using improvement measures from the Australian Primary Care Collaboratives Program and validated by health experts. Eleven PHC services provided data relating to the types of services provided, level of service utilisation, human resources, operating and capital expenses. A further four services that provide visiting PHC to remote communities provided information on the level and cost of these services. Demographic data for service catchment areas (including estimated resident population, age, Indigenous status, English spoken at home and workforce participation) were obtained from the Australian Bureau of Statistics 2011 census. Formal statistical inference (p-values) were derived in the linear regression via the nonparametric bootstrap.ResultsA direct linear relationship was observed between the total cost of resident PHC services and population, while cost per capita decreased with increasing population. Services in smaller communities had a higher number of nursing staff per 1000 residents and provided more consultations per capita than those in larger communities. The number of days of visiting services received by a community each year also increased with population. A linear regression with bootstrapped statistical inference predicted a significant regression equation where the cost of resident services per annum is equal to $1,251,893.92 + ($1698.83 x population) and the cost of resident and visiting services is equal to $1,378,870.85 + ($2600.00 x population).ConclusionsThe research findings provide empirical evidence based on real costs to guide funding for remote PHC services that takes into account the safety and equity requirements for a minimum viable service. This method can be used as a transparent, coordinated approach to ensure the equitable delivery of sustainable, high quality PHC in remote communities. This will in turn contribute to improved health outcomes.