Rural NSW Research Articles

A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals

Abstract Background Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). Methods A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Results Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38–6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53–63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as ‘good’ or ‘very good.’ No unintended harms were reported. Conclusions The VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists. Ethics number GWHREC 2019/ETH13355. Trial registration ANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities.

EP.17B.01 Timelines of Lung Cancer Pathway in Rural and Regional NSW; A Retrospective Study in Hunter New England LHD

EP.17B.01 Timelines of Lung Cancer Pathway in Rural and Regional NSW; A Retrospective Study in Hunter New England LHD

Asthma Care from Home: Study protocol for an effectiveness-implementation evaluation of a virtually enabled asthma care initiative in children in rural NSW.

Asthma is the leading source of unscheduled hospitalisation in Australian children, with a high burden placed upon children, their parents/families, and the healthcare system. In Australia, there are widening disparities in paediatric asthma care including inequitable access to comprehensive ongoing and planned asthma care for children. The Asthma Care from Home Project is a comprehensive virtually enabled asthma model of care that aims to a. supports families, communities and healthcare providers, b. flexible and locally acceptable, and c. allow for adoption of innovations such as digital technologies so that asthma care can be provided "from home", reduce potentially preventable asthma hospitalisation, and ensure satisfaction at a patient, family, and healthcare provider level. The model of care includes standardisation of discharge care through provision of an asthma discharge resource pack containing individual asthma action plan, follow-up letters for the child's general practitioner (GP) and school/child care, and access to online asthma educational sessions and resource; post-discharge care coordination through text message reminders for families for regular GP review, email correspondence with their child's GP and school/childcare; and virtual home visits to discuss home environmental triggers, provide personalised asthma education and respond to parental concerns relating to their child's asthma. This study is comprised of three components: 1) a quasi-experimental pre/post impact evaluation assessing the impact of the model on healthcare utilisation and asthma control measures; 2) a mixed-methods implementation evaluation to understand how and why our intervention was effective or ineffective in producing systems change; 3) an economic evaluation to assess the cost-effectiveness of the proposed model of care from a family and health services perspective. This study aims to improve access to asthma care for children in rural and remote areas. Implementation evaluation and economic evaluation will provide insights into the sustainability and scalability of the asthma model of care.

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

Healthy rural hearts: The feasibility of a telehealth nutrition randomised controlled trial for rural people at risk of cardiovascular disease.

Improving dietary patterns using medical nutrition therapy delivered via telehealth could make an effective contribution to reducing cardiovascular disease burden in rural Australia. However, it is important that medical nutrition therapy programmes are developed in collaboration with rural stakeholders, to increase feasibility for the rural context and the likelihood of successful implementation. The aim of this study was to evaluate the preliminary feasibility outcomes of integration (implementation), practicality, acceptability, demand, and preliminary effectiveness at the 3-month timepoint of the Healthy Rural Hearts randomised control trial. Feasibility measures were collected from participants in the Healthy Rural Hearts medical nutrition therapy trial. Study participants were patients from eligible primary care practices who had been assessed by their general practitioner as being at moderate to high risk of developing cardiovascular disease in the next five years. The sample in this analysis includes those who had completed the first 3-months of the study. Feasibility outcomes were measured over the first 3-months of the trial intervention. A process evaluation survey was used to collect measures relating to intervention implementation, practicality, acceptability, and demand. Completion rates of the Australian Eating Survey Heart version, Personalised Nutrition Questionnaire, pathology tests and telehealth medical nutrition therapy consultations delivered by Accredited Practising Dietitians were also used to measure intervention practicality. Preliminary effectiveness was evaluated by comparing the intervention group's dietary change, measured using Australian Eating Survey Heart with data from the control group. A total of 105 participants (75 intervention, 30 control participants) were eligible for inclusion in analysis. Attendance rates at the first 3-months of dietitian consultations ranged from 94.7% to 89.3% between the first and 3-month consultations, and most participants were able to complete the Australian Eating Survey Heart and Personalised Nutrition Questionnaire prior to their initial consultation [Australian Eating Survey Heart (n = 57, 76%) and Personalised Nutrition Questionnaire (n = 61, 81.3%)] and the Australian Eating Survey Heart prior to their 3-month consultation (n = 52, 69.3%). Of the participants who completed a pathology test at the 3-month time-point (n = 54, 72%), less than half were able to do so prior to their dietitian consultation (n = 35, 46.7%). Of the 75 intervention participants, 28 (37.3%) completed the process evaluation survey. Intervention participants ranked acceptability of the Healthy Rural Hearts intervention highly (mean rank out of 10 = 9.5, SD 1.9), but provided mixed responses on whether they would access the intervention outside of the study (mean rank out of 10 = 6.0, SD 3.5). There were statistically significant increases in percentage total energy intake derived from nutrient-dense core foods compared to the control group (p ≤ 0.05). The positive findings related to acceptability and implementation outcomes suggest that the Healthy Rural Hearts intervention was acceptable, practical, and able to be implemented within this population living in rural NSW. This, combined with the small to medium effect size in the proportion of total energy derived from nutrient-dense core foods compared to the control group indicates that long-term intervention effectiveness on other cardiovascular disease outcomes is important to evaluate in the future.

‘DANMM that’s good!’: evaluating the feasibility and acceptability of the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Programme across rural, regional and metropolitan NSW–a collaborative study protocol

IntroductionThis paper will describe the research protocol for the Deadly Aboriginal and Torres Strait Islander Nursing and Midwifery Mentoring (DANMM) Project, which will determine the feasibility and acceptability of a...

Building resilience among families supporting relatives with ABI in rural NSW: testing the feasibility of telephone delivery of Strength2Strength program

ABSTRACT Background Strength2Strength (S2S) is a group psychoeducational program aiming to build resilience among families supporting relatives after traumatic injury. Objective To test the feasibility, acceptability and outcomes of teleconference delivery of a 5 hour S2S program in rural New South Wales. Methods A mixed methods design investigated the (i) convenience of telephone-based delivery; and (ii) acceptability of the program material (purpose-designed survey and the Narrative Evaluation of Intervention Interview). Program efficacy was measured with the Resilience Scale (RS) and Connor-Davidson Resilience Scale (CD-RISC); the Positive and Negative Affect Scale (PANAS); Depression, Anxiety and Stress Scale – 21 (DASS-21); Carer Assessment of Managing Index (CAMI); and Caregiver Burden Scale (CBS). Participant outcome data were collected at baseline, post program and 3 months follow-up. Results 11 participants supporting adult relatives with severe brain injury completed the program. All participants and facilitators commented positively about the cost, ease of use and quality of the teleconference facility. Statistically significant gains were found between pre-program and follow-up scores on the RS, CD-RISC, PANAS-Positive, and CAMI, with statistically significant reductions found on the DASS-21 Depression Scale and CBS scores. Conclusion The study provides preliminary evidence for the efficacy of telephone–based delivery of S2S to family participants.

The lived experience of receiving services as a National Disability Insurance Scheme participant in a rural area: Challenges of choice and control.

To explore the lived experience of people with a physical disability residing in a rural area and receiving services under the NDIS. Rural areas of New South Wales classified as Modified Monash Categories 3-7. Semistructured interviews were conducted with seven purposively sampled participants who self-identified as having a physical disability, were receiving NDIS funding and lived in a rural area of NSW. Data collection and analysis were guided by hermeneutic phenomenology. We interpreted three interrelated themes; Uncertainty of Access, Battling Bureaucracy and Improving Relationships and Independence. The themes articulate the essence of this phenomenon, Challenges to choice and control. The findings of this study suggest that while people with a physical disability living in rural NSW acknowledged positive changes to their everyday lives through the NDIS, there remains a sense of confusion, frustration and disconnection with the system. Burdensome, inconsistent and untimely communication with NDIS staff caused uncertainty with the process and required negotiation to resolve issues such as delays in funding, essential services or equipment modifications. The essence of Challenges to choice and control articulates what the person had to negotiate within their lifeworld. Further guidance and clarity for people with disabilities to access the NDIS system would ensure confidence to navigate the system and receive the essential supports they need.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Does the extent of time in drought affect the rate of farm ownership change in a local government area? A sixteen-year assessment of rural land ownership change in New South Wales, Australia

Droughts are significant catalysts of financial and emotional hardship for farming communities. However, does the extent of time an area has been in drought impact upon the rate at which agricultural land changes hands? Does it encourage more land to change ownership, as stressed farmers depart at faster rates, or does its negative impacts on farm production dampen demand for rural land? This study addresses this question through a unique, longitudinal (2004–2020) dataset of property transactions in 96 rural Local Government Areas (LGAs) in New South Wales, Australia. We measure the proportion of time each LGA has been in drought during the previous 1, 2, 5 and 10 years, and correlate this against the rate of agricultural land ownership change. Results indicate that in the short-term (<5 years), the proportion of time in drought is not a major influence on the extent of agricultural land ownership change. However, over a 10-year timespan, there is a statistically significant negative correlation between the two for non-irrigated agricultural land, grazing land and land owned by individuals (as opposed to companies). These findings suggest these agricultural land markets are sensitive to the long-term effects of drought. The take-home message seems to be that the persistence of drought saps the vitality of these agricultural land markets, leaving farmers with reduced prospects to capitalise on their land assets. This finding has resonance given that climate change models suggest an intensification of the frequency and severity of drought in much of rural NSW.

Rural health workforce response to Australia's recent natural disasters and emergencies, with a focus COVID-19.

Australia has recently been heavily impacted by natural disasters and emergencies including drought, bushfire, floods and COVID-19. The New South Wales Rural Doctors Network (RDN) and partners developed and implemented strategies to support the primary health care response during this challenging time. Strategies included the establishment of an inter-sectoral working group of 35 government and non-government agencies, a stakeholder survey, a rapid literature review, and broad consultation aimed at understanding the impacts of natural disasters and emergencies on primary health care services and workforce in rural NSW. Several key initiatives were established, including the RDN COVID-19 Workforce Response Register and #RuralHealthTogether, a website to support the wellbeing of rural health practitioners. Other strategies included financial support for practices, technology enabled service support and a Natural Disaster and Emergency Learnings Report. The cooperation and coordination of 35 government and non-government agencies led to development of infrastructure to support the crisis response to COVID-19 and other natural disasters and emergencies in an integrated way. Benefits included consistency of messaging, coordination of support locally and regionally, sharing of resources and collation of localised data to inform coordination and planning. Stronger primary healthcare engagement in emergency response pre-planning is required to ensure maximum benefit and use of established resources and infrastructure. This case study shows the value and applicability of an integrated approach to support primary healthcare services and workforce when responding to natural disasters and emergencies.

Supporting students with complex needs living in rural and regional New South Wales: is wraparound the answer?

Historically, students attending school in rural and regional New South Wales have experienced poorer outcomes than their peers attending metropolitan schools. The lack of coordinated support services for students with complex support needs compounds this issue. Wraparound models of support have been successful in improving outcomes for students with complex support needs, and the New South Wales government has prioritised the establishment of strong relationships between schools and communities to overcome the limitations of geographic isolation. The aim of the current study was to explore wraparound support for students with complex support needs attending schools in rural and regional New South Wales. A qualitative research approach was employed, and semi-structured interviews were conducted with key stakeholders to gain an in-depth understanding of current successes, barriers, and needs. The findings indicated that wraparound was most effective in rural and remote schools when school staff implemented bespoke approaches to wraparound, such as restorative practices. Resourcing was a barrier found to be central to all schools. Recommendations are provided to enhance the capacity of rural and regional NSW schools to provide wraparound support for students with complex support needs.

Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study.

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.

Implementing the general capabilities in New South Wales government primary schools

This paper reports on the findings of a research project which investigated how a sample of New South Wales government primary schools understand and implement the Australian Curriculum’s general capabilities. The project sought to identify specific factors which facilitated or hindered the degree to which primary school teachers implemented the GCs in their classrooms. Data were collected and analysed in the period leading up to the current COVID-19 pandemic and as such, do not address current contextual factors at play in schools such as remote teaching and learning. The project’s mixed method approach employed an online survey which attracted responses from 185 primary teachers and included an invitation to provide brief written responses. Further data were assembled through 36 interviews undertaken with teachers in 12 primary schools in both metropolitan and rural NSW. Analysis of the interview data was undertaken by using Biesta’s (2010) three functions of education — qualification, socialisation and subjectification — as an interpretive lens. This enabled the researchers to identify, categorise and accord meaning to participant responses and consequently draw conclusions. The analysis of both the online survey and the teacher interviews revealed four main findings and shed light on individual teacher commitment to the general capabilities and associated classroom implementation issues.

Assessment of an ECG Algorithm as a Decision Support Tool For Recognition of STEMI

The Glasgow algorithm (GA) is utilised across NSW to support diagnosis of ST elevation myocardial infarction (STEMI) in combination with transmission of ECG to a specialist reading service. The GA has a reported sensitivity of specificity of 74% and 94% respectively. Whilst a high false positive rate has been previously reported in practice, up to 35% of STEMI are missed in rural NSW, and hence are not transmitted for specialist assessment.

Prehospital Thrombolysis Program Reduces the Time to Reperfusion Therapy in Patients Suffering STEMI in Rural and Regional NSW

Prehospital Thrombolysis Program Reduces the Time to Reperfusion Therapy in Patients Suffering STEMI in Rural and Regional NSW

Psychological Distress, Stressful Life Events and Social Disadvantage in Pregnant Indigenous Australian Women Residing in Rural and Remote NSW: a Longitudinal Cohort Study.

Pregnancy can be a stressful time for many women. Australian Indigenous women of childbearing age (18-44years) have been found to experience high or very high rates of psychological distress. However, few studies have examined the burden of or any associations between stressful life events, social disadvantage and psychological distress for pregnant Indigenous women in Australia. Two hundred sixty-one rural and remote women, pregnant with an Indigenous infant, from New South Wales in Australia were invited to provide data regarding social disadvantage then complete the Kessler-10 and Stressful Life Events surveys via self-report during each trimester of their pregnancy. Descriptive statistics, Pearson's correlations, Mann-Whitney U and Kruskal-Wallis tests were performed to determine the burden of and any associations between the variables of interest. High rates of psychological distress were reported by participants with 16.9% scoring severe distress levels during their pregnancy. Participants also reported high rates of stressful life events with almost 25% experiencing the death of a family member or friend, almost 14% living in overcrowded accommodation, 11% having someone close to them jailed and 8% experience separation from their partner, during their pregnancies. Distress was associated with numerous stressful life events (e.g. witnessing violence, a family member in jail and overcrowding) and one aspect of social disadvantage (smoking status). Immediate attention needs to focus on the development of interventions to address the high levels of psychological distress and provide appropriate support services during periods of major life events for pregnant Australian Indigenous women.

The success of Australia’s ‘No Jab, No Pay’ policy at a local level; retrospective clinical audit of a single medical practice assessing incidence of catch‐up vaccinations

Vaccination is a vital health care initiative to prevent individual and population infection. To increase vaccination rates the federal government implemented the 'No Jab, No Pay' policy, where eligibility for several government benefits required children to be fully vaccinated by removing 'conscientious objections' and expanding the age range of children whose families receive benefits. This study assesses the impact of this policy at a local area within a single medical practice community in NSW, Australia. A retrospective clinical audit was performed between 2012 and 2017 on a single general practice's vaccination records for children ≤19years. Catch-up vaccinations were assessed based on age at vaccination. Incidence of catch-up vaccinations was assessed for each of four years before and two years after the implementation of the 'No Jab, No Pay' policy in January 2016, along with the age of children and vaccination(s) given. Catch-up vaccinations were assessed temporally either side of implementation of 'No Jab, No Pay'. Comparing the average annual vaccination catch-up incidence rate of 6.2% pre-implementation (2012-2015), there was an increase to 9.2% in 2016 (p<.001) and 7.8% in 2017 (p=.027). Secondary outcome measurement of catch-up vaccination incidence rates before (2012-2015) and after (2016-2017) 'No Jab, No Pay' implementation showed statistically significant increases for children aged 8-11years (3.2%-5.6%, p=.038), 12-15years (7.5%-14.7%, p<.001) and 16-19years (3.3%-10.2%, p<.001) along with a statistically significant reduction in children aged 1-3years (11.4%-6.2%, p=.015). Also, catch-up rates for DTPa significantly increased after program implementation. This study demonstrates that the Australian federal government vaccination policy 'No Jab, No Pay' was coincident with an increase in catch-up vaccinations within a rural NSW community served by one medical practice, especially for older children.

Establishment of a Centralised Decision Support Service for the Management of Acute Coronary Syndrome in Rural NSW Hospitals

Rapid identification and treatment of ST elevation myocardial infarction (STEMI) is critical for survival and reduction of morbidity. Significant gains have been made utilising pre-hospital ECG transmission platforms, however one third of patients presenting to hospital with STEMI do not receive reperfusion therapy. Local research has identified that missed acute myocardial infarction is common, leads to increased mortality and morbidity, and is overrepresented in rural hospitals.

Uncovering a Climate Catastrophe? Media Coverage of Australia’s Black Summer Bushfires and the Revelatory Extent of the Climate Blame Frame

The Black Summer of 2019/2020 saw the forests of southeast Australia go up in flames. The fire season started early, in September 2019, and by March 2020 fires had burned over 12.6 million hectares (Werner and Lyons). The scale and severity of the fires was quickly confirmed by scientists to be "unprecedented globally" (Boer et al.) and attributable to climate change (Nolan et al.). The fires were also a media spectacle, generating months of apocalyptic front-page images and harrowing broadcast footage. Media coverage was particularly preoccupied by the cause of the fires. Media framing of disasters often seeks to attribute blame (Anderson et al.; Ewart and McLean) and, over the course of the fire period, blame for the fires was attributed to climate change in much media coverage. However, as the disaster unfolded, denialist discourses in some media outlets sought to veil this revelation by providing alternative explanations for the fires. Misinformation originating from social media also contributed to this obscuration. In this article, we investigate the extent to which media coverage of the 2019/2020 bushfires functioned both to precipitate a climate change epiphany and also to support refutation of the connection between catastrophic fires and the climate crisis.