Rural Tasmania Research Articles

Safety and Efficacy of Offsite Percutaneous Coronary Interventions in 1,348 Consecutive Patients in Rural Tasmania

Despite controversy, a growing body of data exists suggesting that percutaneous coronary intervention (PCI) with no surgical onsite availability is safe and efficacious. Over a period of 3 years all patients requiring PCI had their intervention performed at the Launceston General Hospital, a regional hospital serving rural Tasmania, Australia. There were no exclusion criteria uniformly adopted. Primary end points included angiographic success and major procedure-related complications. A total cohort of 1,348 consecutive patients underwent PCI during the calendar years of 2005 through 2007, including patients with ST-elevation myocardial infarction. Angiographic success for all patients was >98%. In-hospital mortality was 0.8% overall. Only 1 patient required urgent transfer to a cardiac surgical center. Bleeding rates requiring transfusion were approximately 1%. Excellent clinical outcomes have been achieved in a relatively remote PCI center in rural, northern Tasmania, where there is no emergency cardiac surgical availability. Angiographic success was high and complication rates were low, consistent with worldwide standards. In conclusion, PCI without onsite surgery appears safe and efficacious when well-trained staffing is available.

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia

Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

Youth Migration and Social Advancement: How Young People Manage Emerging Differences between Themselves and their Hometown

The phenomenon of youth out-migration from rural areas has attracted renewed governmental attention in the context of recent rural economic adjustment and decline across advanced industrial nations. While this trend is well documented in demographic and economic research, youth researchers have sought to extend this analysis beyond descriptive patterns of migration to an understanding of how rural–urban migration is positioned within a complex of youth transitions, as well as an understanding of the subjective experiences of youth migration. This paper contributes to this literature in its focus on young people's experiences of geographical out-migration and social advancement. Based on in-depth interviews with young people from rural Tasmania, this paper draws attention to the emerging differences between young people and their peers, their family and their community on leaving their hometown, and the strategies employed by young people to manage these spatial and cultural differences.

The evaluation of a model of primary mental health care in rural Tasmania

The aim of this study was to evaluate the effectiveness of a primary care mental health service. The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or 'usual' mental health service, or no treatment, over a period of 12 months. The service was evaluated in a rural primary care setting. One hundred and forty-five primary care patients. Changes in symptomatology were assessed using the SCL-90R summary scales, and changes in quality of life were assessed using the EuroQOL. Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no-treatment groups. There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.

Personal choice/social responsibility

Screening for breast cancer is a key public health policy for women. However, there is controversy about when women should commence screening because the evidence of benefit for women younger than 50 years remains unclear. In Australia women who are aged 40–49 years are allowed to participate in breast cancer screening, although government policy indicates that participation should be based on these women making an ‘informed choice’ about participation. This article reports on research investigating the idea of choice and screening. Semi-structured interviews were held with women in rural Tasmania who have participated in screening for breast cancer before turning age 50. The study finds that these ideas of choice and personal responsibility for health have social dimensions that are critical to understanding the decision to participate in screening.

Time as a source of conflict: student nurse experiences of clinical practice in a rural setting

Conducted in rural Tasmania, this study explored the experiences of undergraduate student nurse first engagements with rural clinical practice. While the purpose of the overall study was to explore how the experience of nursing practice in a rural setting influenced the way undergraduate students shaped their professional identity, this article concentrated on the way the students came to use their time during their placement. This study used a fusion of ethnography and hermeneutic philosophy using participant observation, field notes, interviews and reflective journaling to collect data. Data analysis took place concurrently with the data collection, which is consistent with the hermeneutic circle framework. Three major themes were developed and explored throughout the study: (1) navigating rural spaces; (2) time as a source of conflict; and (3) developing rural nurse identity. The theme described in this article concerns how the nursing students' assumptions regarding how time would be used during the rural placement were dislodged. This first involved a shift from regarding time as a background feature of daily life to seeing it as an explicit, foreground feature of everyday life. Second, it involved a shift away from conceptualising time as a cyclical unit of hours, instead focussing on the meaning the students came to attach to time in the rural practice setting. The findings shed light on how undergraduate student nurses used their time during clinical practice in a rural community. With no clinical experience, on the commencement of the rural placement they initially expected to spend their time caring for people, but realised they first needed to spend their time learning about rural nursing before they could then do the work of rural nursing.

Trusting technology: women aged 40-49 years participating in screening for breast cancer--an exploratory study.

This paper reports key findings from an exploratory study of factors associated with women's decision to participate in mass mammography screening in Tasmania. In particular, we explored factors that contribute to the choice to participate in screening by women who are outside the primary target group, and for whom the evidence of benefit remains contentious. Semi-structured interviews were conducted with a small sample of women aged between 40 and 49 years in rural Tasmania who had participated in mammography screening. Key ideas that appeared to shape participation included the fear of breast cancer, trust in technology, and taking responsibility for health. Information provision is also an important factor in shaping participation patterns. In order to facilitate informed consent, information provision in this area should take account of the dominant ideas that shape the decision to participate in breast cancer screening.

Rural general practitioner preceptors - how can effective undergraduate teaching be supported or improved?

General practitioners (GPs) as rural GP-Preceptors play an important role in medical student teaching within the Discipline of General Practice, University of Tasmania, Australia. As well a significant teaching role, they are responsible for apportioning 20% of the mark medical students receive in the General Practice examination at the end of the rotation. The contribution of the student-rural GP preceptor relationship to recruiting and retaining rural GPs has been acknowledged. Despite these important responsibilities, as honorary teaching staff rural GP preceptors receive no formal training in undergraduate education or assessment, nor did they receive formal peer support. To address the lack of educational preparation of GP-preceptors, and in accordance with the stringent teaching and assessment standards of the Australian Medical School Accreditation, a tripartite approach was taken to educational skills development among rural GP-preceptors. The Discipline of General Practice conducted a needs-analysis of 64 rural GP-preceptors, and an evaluation by questionnaire of the teaching efficacy of those 64 rural GP-Preceptors and 76 urban GP-preceptors by 64 final-year medical students after their 3-week rural and urban GP attachments. The second intervention, based on the assessment and evaluation findings, was devised and implemented by the University Department of Rural Health. A series of workshops comprised the interdisciplinary educational and support program for GP preceptors, entitled Preceptor Onsite Preparation Program for Information Education and Support, or POPPIES. The rural GP-preceptor needs analysis indicated that the majority of rural preceptors had no clear understanding of how what they taught fitted into the overall curriculum; they believed that their role as a clinical teacher had not been clearly defined by the program director; and also that undergraduate students had little understanding of what they needed to learn during their attachments. In contrast, preceptors believed they understood what students needed to learn; they were confident in performing the role of preceptor; and were familiar with adult learning principles, goal setting processes, effective student evaluation and the provision of appropriate performance feedback. Evaluation of feedback from students revealed that while rural GP preceptors performed well overall in regard to providing quality teaching and learning experiences, there was a significant spread of scores across all criteria, and approximately 15%-25% of students perceived various aspects of their attachment to be mediocre or poor. The combined results of the medical student questionnaire and rural GP-preceptor survey indicated both a need and a desire for educational skills development among rural GP-preceptors. On this basis, the interdisciplinary educational and support program for GP-preceptors (POPPIES) was developed and implemented as a series of workshops throughout rural Tasmania. Although no objective data are yet available about teaching outcomes as a result of POPPIES workshops, preliminary responses from attendee GP preceptors indicated that the workshops were effective in addressing educational needs, and in providing rural clinical teachers with professional teaching development.

Value of hospital-employed medical officers in rural Australia

The author reports on a unique experience of the issues relating to recruitment and retention of specialist medical staff in a regional hospital in rural Tasmania, Australia. Based on a particular time of a high specialist medical staff resignation, the author identifies the importance to sustainability of rural medical specialists, of quality hospital-employed medical officer (HMO) support staff, a factor that has not been well recognized previously. It was found that HMOs, in particular senior or specialist-in-training HMOs, considerably reduced the workload of rural specialists, especially their after-hours workload. A rating scale to assess the acceptability of after-hours workload for rural specialists, taking into account the impact of HMO support, was developed and is presented in the article. The presence of quality supporting HMOs was a vital recruitment and retention issue for rural medical specialists at that time and can be generalised to other rural situations and should be officially recognised. The observations made support increasing the number of senior or specialist-in-training-HMO positions in rural hospitals in order to retain and recruit more rural specialists.

Palliative Care in Rural Australia: Involving the Community in Multidisciplinary Coordinated Care

This paper describes the process and outcomes of a project aimed at promoting community based multidisciplinary coordinated palliative care services in rural Australia. In preliminary health service needs assessment in rural Tasmania, key health workers appealed for additional information, support and education in palliative care. They expressed a preference for this education to be delivered locally to strengthen existing knowledge in communities and to take into account contextual factors. The project aimed to enhance skills available in rural communities by involving key stakeholders including formal and informal carers, volunteers, clergy, pharmacists, community nurses and general practitioners. The project objective was to strengthen existing expertise and commitment in rural communities, enabling service providers to respond to community needs in a sustainable way. This was achieved by facilitating options for sustainable linkages and ongoing support and through outreach programs from urban Palliative Care Units. An important element in this was the Tasmanian Telehealth network, which harnesses videoconferencing, digital diagnostic equipment and image transmission technologies to offer access to healthcare services to Tasmania's rural and isolated communities. The process centred on workshops facilitated by a multidisciplinary team, which provided information about the core components of palliative care. The paper reports on the responses of health professionals and community participants to the workshops.

A geographic approach to general practice workloads: The example of rural Tasmania

Against a background of a potential oversupply of medical practitioners, this study develops a method of quantifying the hinterland and population served by each practice centre. Allowance is made for varying age and sex demands for medical service and demonstrates a seven-fold variation in workload per doctor in rural Tasmania. The need for means to correct the inertia inherent in this geographic maldistribution is emphasised.