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Rural Practice (rural + practice)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Competencies and skills for remote and rural maternity care: a review of the literature

JOURNAL OF ADVANCED NURSING, Issue 2 2007
Jillian Ireland
Abstract Title. Competencies and skills for remote and rural maternity care: a review of the literature Aim., This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. Background., There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. Methods., Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. ,remote', ,midwifery', ,obstetrics', ,nurse,midwives', education', ,hospitals', ,skills', ,competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. Findings., Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. ,Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. Conclusion., Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas. [source]

Identifying the aspects of rural exposure that influence medical students to take up rural practice

MEDICAL EDUCATION, Issue 7 2007
Geetha Ranmuthugala
No abstract is available for this article. [source]

Does a rural educational experience influence students' likelihood of rural practice?

MEDICAL EDUCATION, Issue 3 2002
Impact of student background, gender
Context The family medicine clerkship at the University of Calgary is a 4-week mandatory rotation in the final year of a 3-year programme. Students are given the opportunity to experience rural practice by training at 1 of several rural practices. Objective To determine whether exposure to a rural educational experience changes students' likelihood of doing a rural locum or rural practice and whether student background and gender are related to these practice plans. Method Clinical clerks from the Classes of 1996,2000, who trained at rural sites, responded to questionnaire items both before and after the rural educational experience. Responses to the questionnaire items and discipline of postgraduate training served as dependent variables. Student background and gender were independent variables. Results As a result of the rural educational experience all students were more likely to do a rural locum. Compared to their urban-raised peers, students from rural backgrounds reported a significantly greater likelihood of doing a rural locum and practising in a rural community, irrespective of gender or participating in a rural educational experience. There was no relationship between background and career choice. Conclusion A rural educational experience at the undergraduate level increases the stated likelihood of students participating in rural locums and helps to solidify existing rural affiliations. Students with rural backgrounds have a more favourable attitude toward rural practice. This pre-post study provides further support for the preferential admission to medical school of students with rural backgrounds to help alleviate the rural physician shortage. [source]

Comparison of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course

MEDICAL EDUCATION, Issue 3 2000
Article first published online: 25 DEC 200
Objective The experiences of rural and non-rural students undertaking a voluntary rural placement in the early years of a medical course were compared. Method Eighty percent (28) of the rural and 70% (114) of the non-rural students completed a post-placement questionnaire. Result The two groups did not differ on their overall rating of the placement, whether they felt welcome, adequacy of the time with doctors or their rating of the accommodation provided. However, 46% (13) of the rural students reported the placement had changed their feelings towards rural practice to the maximum/almost maximum extent compared with only 24% (27) of the non-rural students. [source]

Recruitment and Retention of Rural Physicians: Outcomes From the Rural Physician Associate Program of Minnesota

THE JOURNAL OF RURAL HEALTH, Issue 4 2008
Gwen Wagstrom Halaas MD
ABSTRACT:,Context: Founded in 1971 with state funding to increase the number of primary care physicians in rural Minnesota, the Rural Physician Associate Program (RPAP) has graduated 1,175 students. Third-year medical students are assigned to primary care physicians in rural communities for 9 months where they experience the realities of rural practice with hands-on participation, mentoring, and one-to-one teaching. Students complete an online curriculum, participate in online discussion with fellow students, and meet face-to-face with RPAP faculty 6 times during the 9-month rotation. Projects designed to bring value to the community, including an evidence-based practice and community health assessment, are completed. Purpose: To examine RPAP outcomes in recruiting and retaining rural primary care physicians. Methods: The RPAP database, including moves and current practice settings, was examined using descriptive statistics. Findings: On average, 82% of RPAP graduates have chosen primary care, and 68% family medicine. Of those currently in practice, 44% have practiced in a rural setting all of the time, 42% in a metropolitan setting and 14% have chosen both, with more than 50% of their time in rural practice. Rural origin has only a small association with choosing rural practice. Conclusion: RPAP data suggest that the 9-month longitudinal experience in a rural community increases the number of students choosing primary care practice, especially family medicine, in a rural setting. [source]

High School Census Tract Information Predicts Practice in Rural and Minority Communities

THE JOURNAL OF RURAL HEALTH, Issue 3 2005
Susan Hughes MS
ABSTRACT: Purpose: Identify census-derived characteristics of residency graduates' high school communities that predict practice in rural, medically underserved, and high minority-population settings. Methods: Cohort study of 214 graduates of the University of California, San Francisco-Fresno Family Practice Residency Program (UCSF-Fresno) from its establishment in 1970 through 2000. Rural-urban commuting area code; education, racial, and ethnic distribution; median income; population; and federal designation as a medically underserved area were collected for census tracts of each graduate's (1) high school address and (2) practice location. Findings: Twenty-one percent of graduates practice in rural areas, 28% practice in areas with high proportions of minority population (high minority areas), and 35% practice in federally designated medically underserved areas. Graduation from high school in a rural census tract was associated with rural practice (P <.01). Of those practicing in a rural site, 32% graduated from a rural high school, as compared with 11% of nonrural practitioners. Graduation from high school in a census tract with a higher proportion of minorities was associated with practice in a proportionally high minority community (P =.01). For those practicing in a high-minority setting, the median minority percentage of the high school census tract was 31%, compared with 16% for people not practicing in a high minority area. No characteristics of the high school census tract were predictive of practice in a medically underserved area. Conclusion: Census data from the residency graduate's high school predicted rural practice and practice in a proportionally high minority community, but not in a federally designated medically underserved area. [source]

Perceived Barriers to Nurse Practitioner Practice in Rural Settings

THE JOURNAL OF RURAL HEALTH, Issue 2 2005
Linda Lindeke PhD
ABSTRACT: Context: Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings. Purpose: This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time. Methods: A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice. Findings: Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001. Conclusions: NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities. [source]

The Rural Physician Workforce in Florida: A Survey of US- and Foreign-Born Primary Care Physicians

THE JOURNAL OF RURAL HEALTH, Issue 4 2003
Robert G. Brooks MD
Purpose: This study's goal was to assess key characteristics of primary care physicians practicing in rural, suburban, and urban communities in Florida. Methods: Surveys were mailed to all of Florida's rural primary care physicians (n = 399) and a 10% sampling (n = 1236) of urban and suburban primary care physicians. Findings: Responses from 1000 physicians (272 rural, 385 urban, 343 suburban) showed that rural physicians were more likely to have been raised in a rural area, foreign-born and trained, a National Health Service Corps member, or a J-1 visa waiver program participant. Rural physicians were more likely to have been exposed to rural medical practice or living in a rural environment during their medical school and residency training. Factors such as rural upbringing and medical school training did not predict future rural practice with foreign-born physicians. Overall, future plans for practice did not seem to differ between rural, urban, and suburban physicians. Conclusions: Recruiting and retaining doctors in rural areas can be best supported through a mission-driven selection of medical students with subsequent training in medical school and residency in rural health issues. National programs such as the National Health Service Corps and the J-1 visa waiver program also play important roles in rural physician selection and should be taken into account when planning for future rural health care needs. [source]

Using the Theory of Reasoned Action to Model Retention in Rural Primary Care Physicians

THE JOURNAL OF RURAL HEALTH, Issue 3 2003
Thomas Hugh Feeley PhD
Purpose: The current review uses Fishbein and Ajzen's Theory of Reasoned Action (TRA) to organize the literature on the predictors and correlates of retention of rural practicing physicians. TRA suggests turnover behavior is directly predicted by one's turnover intentions, which are, in turn, predicted by one's attitudes about rural practice and perceptions of salient others' (eg, spouse's) attitudes about rural practice and rural living. Methods:Narrative literature review of scholarship in predicting and understanding predictors and correlates of rural physician retention. Findings: The TRA model provides a useful conceptual model to organize the literature on rural physician retention. Physicians' subjective norms regarding rural practice are an important source of influence in the decision to remain or leave one's position, and this relation should be more fully examined in future research [source]

Outcomes of Rural Training Tracks: A Review

THE JOURNAL OF RURAL HEALTH, Issue 3 2000
Thomas C. Rosenthal M.D.
Because most programs are small (two to Jour residents), data must be aggregated to determine RTT impact on practice preparation and location. Several studies over the last decade reveal that 76 percent of RTT graduates are practicing in rural America and that graduates describe themselves as prepared for rural practice. Sixty-five percent are providing obstetrical services, and half are performing cesarean sections. From 1989 to 1999, there were a total of 107 graduates of rural training programs, making it unlikely that, without significant investment, this model could supply an adequate quantity of family physicians for rural America. [source]

Use of chronic disease management plans in rural practice

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009
Mark Morgan
No abstract is available for this article. [source]

Four years after graduation: Occupational therapists' work destinations and perceptions of preparedness for practice

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2009
Dione Brockwell
Abstract Objective:,The present study sought to identify the work destinations of graduates and ascertain their perceived preparedness for practice from a regional occupational therapy program, which had been specifically developed to support the health requirements of northern Australians by having an emphasis on rural practice. Design:,Self-report questionnaires and semistructured in-depth telephone interviews. Participants:,Graduates (n = 15) from the first cohort of occupational therapists from James Cook University, Queensland. Main outcome measure:,The study enabled comparisons to be made between rural and urban based occupational therapists, while the semistructured interviews provided a deeper understanding of participants' experiences regarding their preparation for practice. Results:,Demographic differences were noted between occupational therapists working in rural and urban settings. Rural therapists were predominantly younger and had worked in slightly more positions than their urban counterparts. The study also offered some insights into the value that therapists placed on the subjects taught during their undergraduate occupational therapy training, and had highlighted the differences in perceptions between therapists with rural experience and those with urban experience regarding the subjects that best prepared them for practice. Generally, rural therapists reported that all subjects included in the curriculum had equipped them well for practice. Conclusions:,Findings suggest the need to undertake further research to determine the actual nature of rural practice, the personal characteristics of rural graduates and the experiences of students while on rural clinical placements. [source]

Where is the evidence that rural exposure increases uptake of rural medical practice?

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2007
Geetha Ranmuthugala
Abstract Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice. This paper identifies this evidence gap, examines the concept of rural exposure, and highlights the need to identify which aspects of rural exposure contribute to a positive attitude towards rural practice, thereby influencing students to return to rural areas. The cost of rural exposure through student placements is not insignificant, and there is a need to identify which aspects are most effective in increasing the uptake of rural practice, thereby helping to address the medical workforce shortage experienced in rural Australia. [source]

Double-bundle reconstruction of the anterior cruciate ligament

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2007
Thomas Nau
Abstract Injuries of the anterior cruciate ligament often present in rural practices and rural regional hospitals. Surgical reconstruction is the treatment of choice in the young and active patient. Better biomechanical understanding has led to a further improvement of the surgical technique. The double-bundle reconstruction, which aims to address both functional bundles of the anterior cruciate ligament, represents the latest development in this field. In this review article the basic biomechanical principles as well as a new surgical technique are presented for practitioners in rural practice and rural regional hospitals. [source]

Preparing professionals from a wide range of disciplines for life and work in rural and small communities

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2006
Jennifer M. Medves
Abstract A new inter-professional subject has been offered at a Canadian university, which examines issues related to professionals' integrating into rural practice; understanding the history and geography of rural communities and important issues affecting life in rural settings. [source]

Empiric validation of the Rural Australian Medical Undergraduate Scholarship ,rural background' criterion

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2005
Gillian A. Laven
Abstract Objective:,Rural Australian Medical Undergraduate Scholarships (RAMUS) provide $10 000 per annum to selected medical students with a rural background. Eligibility criteria include having lived in a rural community for five consecutive or eight cumulative years. We sought to validate the above-specified criterion using data from the Australian National Rural Background Study. Design:,National case control study stratified by jurisdiction. Participants:,Two thousand four hundred and fourteen Australian-trained rural and urban general practitioners (GPs). Main outcome measure:,Whether the RAMUS rural background criterion was met or not. Results:,Doctors who met the RAMUS rural background criterion were more likely to be in rural practice (odds ratio = 2.50; 95% confidence interval, 1.97,3.18) than those who did not. This was true for all jurisdictions (except for the Northern Territory) and ranged from 1.95 for South Australia to 3.57 for Victoria. Conclusion:,Rural GPs are more likely to fulfil the RAMUS rural background criterion, supporting the existence of the RAMUS scheme. [source]

Application of mobile-phone cameras to home health care and welfare in the elderly: Experience in a rural practice

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2005
Kazuhiko Kotani
No abstract is available for this article. [source]

Preparedness for rural community leadership and its impact on practice location of family medicine graduates

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 1 2005
Wayne Woloschuk
Abstract Objective:,To identify non-clinical dimensions of preparedness for rural practice and to determine whether preparedness for rural practice is predictive of rural practice location. Design:,Cross-sectional postal survey mailed in 2001. Setting:,Communities across Canada where graduates were practising. Subjects:,,Graduates (n = 369) of the family medicine residency program at the universities of Alberta (U of A) and Calgary (U of C) between 1996 and 2000, inclusive. Interventions:,Using a 4-point scale, graduates rated the extent to which the residency program prepared them for eight dimensions of rural practice: clinical demands of rural practice, understanding rural culture, small community living, balancing work and personal life, establishing personal/professional boundaries, becoming a community leader, handling a ,fish bowl' lifestyle, and choosing a suitable community. Main outcome measure:,Identification of non-clinical dimensions of preparedness for rural practice and whether scores on preparedness scales are predictive of rural practice location. Results:,The overall response rate was 76.4%. Factor analysis of the eight preparedness items produced two factors, ,rural culture' and ,rural community leader' which explained 72% of the variance. The alpha coefficient for each factor was 0.87. Odds ratios revealed that family medicine graduates prepared for rural community leadership roles were 1.92 (CI = 1.03,3.61) times more likely to be in rural practice. Rural physicians were also 2.14 (CI = 1.13,4.03) times as likely to have a rural background. Conclusions:,Preparedness to be a rural community leader and having a rural background were predictive of rural practice. Educators should consider this in both family medicine residency admissions policy and practice and when designing and implementing family medicine residency curricula. [source]

High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 5 2004
Masatoshi Matsumoto
Abstract Context:,Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. Objectives:,To show the technology status of rural practice and compare it to the national level. Design:,Nationwide postal survey. Setting, Subjects & Interventions:,Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as ,rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. Results:,A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. Conclusions:,Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject:,As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?:,In Japan, rural medical facilities are technologically better equipped than urban facilities. [source]

RURAL DOCTORS, SATISFACTION IN JAPAN: A NATIONWIDE SURVEY

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2004
Masatoshi Matsumoto
Objectives: The purpose of this paper was to discover to what degree Japanese rural doctors are satisfied with various aspects of their jobs and lives, and to find out whether they intend to continue their rural careers. Design: Nationwide postal survey Setting: Public clinics or hospitals in municipalities that are authorised as ,rural' by the national government. Subjects: A total of 4896 doctors working for public clinics or hospitals. Interventions: Self-evaluation questionnaires were mailed. The rural doctors were asked to evaluate their satisfaction with 19 items related to their job conditions and 10 items concerning life conditions, using a four-point scale. They also were asked to evaluate their intent to stay in rural practice until retirement. Results: The response rate was 64%. Overall, rural doctors were satisfied with both their work and life conditions. However, only 27% of respondents hoped to continue rural practice beyond the usual age of retirement. Among job-related items, continuing medical education and interactions with municipal governments were rated as least satisfactory. Among lifestyle-related items, duration of holidays and workload were unsatisfactory. Subgroup analysis revealed male doctors showed greater intent to stay in rural practice. Doctors aged > 50 years were more satisfied with most aspects of their job and lifestyle than younger doctors. A strong correlation was found between the degree of intent to stay and several items such as interactions with municipal government, human interactions salary and job fulfilment. Conclusions: Strategies, based on the results of this survey, should be implemented. Particularly in Japan, positive interaction between doctors and municipal governments is crucial. [source]

WORK OF FEMALE RURAL DOCTORS

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2004
Jo Wainer
Objectives: To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. Design: Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. Setting: General and specialist practice. Subjects: Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3,7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Main outcome measure: Interaction of hours and type of work with family responsibilities. Results: Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for oncall and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. [source]

GETTING THE BALANCE RIGHT?

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2003
GPS WHO CHOSE TO STAY IN RURAL PRACTICE
ABSTRACT Background: Despite major challenges to the retention of rural GPs in Australia, little is known about why some rural GPs stay long-term within their communities. Method: A group of rural GPs interviewed as part of another study about 10 years ago were re-interviewed to explore their attitudes to their reasons for staying. Results: Eighteen of the original group of 23 could be contacted and 13 were interviewed. Factors that appeared to promote staying in rural practice were: strong attachment to the community; and practice arrangements that allow for adequate time off-call and for holidays. However, several GPs were stressed and some had considered leaving. The stressors were similar to those identified in earlier research, including overwork and having to send children to boarding school. Conclusion: Personal and professional support arrangements within the community appear to be associated with decisions by rural GPs to remain in practice for substantial periods of time. Retention strategies should focus on facilitation of local integration. [source]

MEN'S HEALTH PROMOTION BY GENERAL PRACTITIONERS IN A WORKPLACE SETTING

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2002
Samar Aoun
ABSTRACT:A project to promote men's health through diabetes education and screening was undertaken throughout rural industries in 1999/2000 in the south-west of Western Australia. Five hundred and twenty-five men aged 40,65 years participated from 27 industries. Sixty-four per cent of these men were identified at high-risk of developing diabetes and were referred to their general practitioner (GP) for follow-up. Seventy-six per cent of those at-risk visited their GP and hence the strategy adopted has been appropriate in engaging men in the preventive concept of seeking care, that is, getting them to attend their GP when they only have the risk factors but not the disease. However, men were left short of knowing how to achieve a change in their lifestyle behaviour and take appropriate action. Given the constraints of rural practice and the need to prioritise those with disease and gaps in service provision for both health services and GPs, there are two challenges: identifying those at-risk and modifying their behaviour. [source]

GENERAL PRACTITIONERS LEAVING RURAL PRACTICE IN WESTERN VICTORIA

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 2 2000
Peter MacIsaac
ABSTRACT The West Vic Division of General Practice, working with the Department of General Practice, The University of Queensland conducted a qualitative study of GPs who had left western Victoria over the previous 10 years to examine issues relating to the decision to leave rural practice. This study was conducted as part of a project to explore the role of rural Divisions in assisting with general practitioner recruitment and retention. The study supported the conclusions of a similar study in North Queensland and proposed a model that regards rural retention as an interplay of influences both positive and negative with acute trigger factors that can precipitate the decision to leave. Conflict and dissatisfaction with aspects of rural GP hospital work appeared to be a relatively frequent trigger factor that is immediately amenable to intervention from Divisions of general practice and through improvement in negotiation and conflict resolution skills for rural general practitioners. [source]

Retention: An unresolved workforce issue affecting rural occupational therapy services

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 4 2002
Anna Mills
Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has been focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. This was the focus of this study. Ethnographic interviews were used to explore the experiences of 10 occupational therapists who had left rural practice. Six themes emerged from the participants' experiences, from when they first considered rural practice to reflections following their departure from it. These themes were initial appeal, facing the challenge, rural practice issues, the social sphere, reasons for leaving and the value of rural experience. These factors gave rise to a proposed Model of Retention Equilibrium, which suggests that retention can be improved by addressing the imbalance between incentives to leave and incentives to stay. The model provides a useful framework for occupational therapists contemplating rural practice, as well as for health services managers responsible for service delivery in rural areas. [source]

Does a rural educational experience influence students' likelihood of rural practice?

The Visiting Specialist Model of Rural Health Care Delivery: A Survey in Massachusetts

THE JOURNAL OF RURAL HEALTH, Issue 4 2006
Jacob Drew BA
ABSTRACT:,Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Methods: Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Findings: Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =,0.573, P = .032); study hospitals ranged in bed size from 15 to 129. Conclusions: The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability. [source]

Identifying and addressing barriers to the use of enhanced primary care plans for chronic disease in rural practices

AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2009
David Pierce
No abstract is available for this article. [source]

Double-bundle reconstruction of the anterior cruciate ligament

Prostate-specific antigen testing: uncovering primary care influences

BJU INTERNATIONAL, Issue 5 2006
Gerard J. Gormley
OBJECTIVES To examine influences on the behaviour of General Practitioner (GP) in relation to prostate-specific antigen (PSA) testing. SUBJECTS AND METHODS In Northern Ireland in 2003,2004, all GPs (1067) were invited to complete a self-administered postal questionnaire survey that was then matched with a regional PSA-testing database. The main outcome measures were individual GP responses for demographic, practice and training characteristics, PSA testing behaviour and perceived influences, matched against GP-initiated first PSA tests performed in 2003 and 2004 (22 207 tests). RESULTS In all, 704 GPs (66%) responded and 49% of these reported awareness of the national guidelines, which was highest among those attending postgraduate meetings. PSA tests were more likely to be ordered by full-time male GPs who had attended a local postgraduate urology meeting; ran a ,well-man' clinic; tested men with unrelated complaints; and were not in a training practice. Testing levels were highest among GPs who had been practising for 21,30 years and those in rural practices. Awareness of national guidelines or having had a postgraduate post in urology did not affect testing behaviour. After adjusting for gender, working hours, duration in practice and urban/rural setting, independent influences increasing testing behaviour were: testing men with a positive family history or unrelated complaints; testing any man who requests it; and previous experience of prostate cancer being detected in an asymptomatic patient by PSA testing. Working in an accredited training practice was associated with lower testing levels. CONCLUSION There are complex influences on the PSA testing behaviour of GPs; addressing these influences could contribute to the rationalization of testing. A low awareness of national guidelines indicates a need for new strategies to disseminate and implement guidelines. The influence of local educational meetings on PSA testing is an unharnessed force. [source]