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Community participation in organising rural general practice : Is it sustainable?

Author/Creator: Taylor, Judith, Wilkinson, David, Cheers, Brian
Resource type: journal article
Date: 2006
Subject: community development, community participation, rural general practice
Record contributed by: University of South Australia

Full Record and related resources:
http://arrow.unisa.edu.au:8081/1959.8/45249
http://arrow.unisa.edu.au/vital/access/manager/Repository/unisa:32798
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http://arrow.unisa.edu.au:8081/1959.8/45249
http://arrow.unisa.edu.au/vital/access/manager/Repository/unisa:32798

Description
None Available

Publisher: Blackwell Publishing Asia
Relation: ;

Format: 4
Other identifier: RM:0000026909; unisa:32798
Coverage: ; ARROW@UNISA
Language: en-aus
Source: Australian journal of rural health vol. 14, no. 4, pp. 144-147 1
Rights: Copyright status unknown
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Expectations and experiences associated with rural GP placements

Author/Creator: Elliott, Taryn Elizabeth, Bromley, Timothy Alan, Chur-Hansen, Anna, Laurence, Caroline Olivia Mary
Resource type: journal article
Date: 2009, 2010
Subject: expectations; experiences; qualitative; rural general practice placement; South Australia.
Record contributed by: The University of Adelaide

Full Record and related resources:
http://hdl.handle.net/2440/57013
http://link.library.adelaide.edu.au/?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.issn=14456354&rft.pub=Deakin+University&rft.volume=2009&rft.atitle=Expectations+and+experiences+associated+with+rural+GP+placements&rft.aulast=Elliott&rft.spage=1&rft.jtitle=Rural+and+Remote+Health&rft.epage=12&rft.pages=1-12
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http://hdl.handle.net/2440/57013
http://link.library.adelaide.edu.au/?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.issn=14456354&rft.pub=Deakin+University&rft.volume=2009&rft.atitle=Expectations+and+experiences+associated+with+rural+GP+placements&rft.aulast=Elliott&rft.spage=1&rft.jtitle=Rural+and+Remote+Health&rft.epage=12&rft.pages=1-12

Description
Introduction: Evidence indicates a need to recruit more GPs to a career in rural general practice (GP). Research has indicated that placement experiences have the potential to impact on medical career decision-making. Research also suggests that rural placements can raise both professional and psychosocial concerns, but there is no existing evidence about whether pre-placement expectations translate into actual placement experiences. This study aimed to explore both the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. Method: A qualitative research design was used where 11 pre-rural placement and 19 post-rural placement GP registrars associated with the Adelaide to Outback GP Training Program (AOGP) were interviewed until no new information emerged. An even distribution of gender and training pathway was achieved. Transcripts were subjected to thematic analysis, which explored the pre-placement expectations and the post-placement experiences of GP registrars undertaking a rural placement. Rater consensus was achieved for the themes extracted. Results: Analysis resulted in positive and negative pre-placement expectation and post-placement experience themes. One-third of pre-placement expectations were positive. The overall trend was for negative expectation themes to be viewed positively by registrars interviewed post-placement. Five positive post-placement experience themes, relating to support received, were not identified at pre-placement. This demonstrates that there are positive rural placement experiences that are not understood by registrars before their placement (‘being known to all’, ‘support from AOGP’, ‘support from Division’, ‘support from family and friends’ and ‘self-initiated support’). The only negative expectations that were also discussed by registrars post-placement as negative experiences were ‘separation from family’, ‘busy workload’ and ‘driving’. The negative expectations that were also viewed as negative experiences were ‘separation from family’, ‘busy workload’ and ‘driving’, which are difficult to change but should be discussed and planned for pre-placement. Conclusions: Based on these results it is important for GP supervisors, regional training providers, Divisions and rural workforce agencies to work together to ensure that registrars are provided with information and support pre-placement to alleviate their unwarranted negative expectations, while confirming warranted positive expectations. Warranted negative expectations should also be discussed beforehand to plan strategies for managing them during the placement. If the findings are used in this way, an improvement in overall rural placement experience could be expected.

T Elliot, T Bromley, A Chur-Hansen and C Laurence

Publisher: Deakin University
Contributor: School of Psychiatry

Other identifier: Rural and Remote Health 9 [serial online], 2009:www1-12; 1445-6354; 0020094693
Language: en
Source: http://rrh.deakin.edu.au
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Introduction: Evidence indicates a need to recruit more GPs to a career in rural general practice (GP). Research has indicated that placement experiences have the potential to impact on medical career decision-making. Research also suggests that rural placements ...
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An examination of the structural and political barriers preventing permanent resident overseas-trained doctors from working as general practitioners in rural New South Wales

Author/Creator: McFayden, Lisa
Date: 2008
Subject: overseas-trained doctors, rural general practice, medical workforce shortages
Record contributed by: Australasian Digital Theses Program, The University of Newcastle

Full Record and related resources:
http://hdl.handle.net/1959.13/29762
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http://hdl.handle.net/1959.13/29762

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Research Doctorate - Doctor of Philosophy

This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.


Language: eng
Rights: Copyright 2008 Lisa McFayden
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This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking ...
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Overseas trained doctors in rural and remote Australia: do they practise differently from Australian trained doctors?.

Author/Creator: Laurence, Caroline Olivia Mary
Date: 2008
Subject: Overseas trained doctor; Rural; General practice; Practice pattern, Physicians, Foreign Australia. Medicine, Rural Practice Australia. Rural health services Australia.
Record contributed by: Australasian Digital Theses Program, The University of Adelaide

Full Record and related resources:
http://hdl.handle.net/2440/49903
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http://hdl.handle.net/2440/49903

Description
Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.

http://proxy.library.adelaide.edu.au/login?url=http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385

Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008


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Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia ...
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Rural medical education: five medical students spend a year in rural Port Lincoln Australia

Author/Creator: Baillie, Susan Kaye, Matena, Jennifer, Yerxa, John Dwight, Newbury, Jonathan William
Resource type: journal article
Date: 2007, 2008
Subject: Australia, general practice; Rural medical education, undergraduate
Record contributed by: The University of Adelaide

Full Record and related resources:
http://hdl.handle.net/2440/46021
http://link.library.adelaide.edu.au/?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.volume=7&rft.atitle=Rural+medical+education:+five+medical+students+spend+a+year+in+rural+Port+Lincoln++Australia&rft.aulast=Baillie&rft.place=http://rrh.deakin.edu.au&rft.spage=www1&rft.issn=14456354&rft.jtitle=Rural+and+Remote+Health&rft.issue=2&rft.epage=www6&rft.pub=Deakin+University&rft.pages=www1-www6
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http://hdl.handle.net/2440/46021
http://link.library.adelaide.edu.au/?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.volume=7&rft.atitle=Rural+medical+education:+five+medical+students+spend+a+year+in+rural+Port+Lincoln++Australia&rft.aulast=Baillie&rft.place=http://rrh.deakin.edu.au&rft.spage=www1&rft.issn=14456354&rft.jtitle=Rural+and+Remote+Health&rft.issue=2&rft.epage=www6&rft.pub=Deakin+University&rft.pages=www1-www6

Description
(c) Rural and Remote Health

Context: The University of Adelaide and the University of South Australia established the Spencer Gulf Rural Health School (SGRHS) as a joint venture to facilitate rural health professional education and research. Annually a cohort of medical students from the University of Adelaide volunteer and are placed in various SGRHS ‘learning centres’ throughout rural South Australia for the 5th year of their medical training. Issues: This article addresses the issues encountered in one of these ‘learning centres’ in Port Lincoln, rural South Australia. The challenge was to integrate five students into a general medical practice and the local hospital and to provide high quality medical education for the academic year. Lessons learned: Medical practice, student and university requirements were identified and a range of strategies implemented to address these. To date, four groups of medical students have successfully completed their rural academic year in Port Lincoln since 2003. The local systems have evolved to allow five students to integrate into the practice and hospital using a range of teaching and learning methods and resources.

Publisher: Deakin University
Contributor: School of Population Health and Clinical Practice : General Practice

Other identifier: Rural and Remote Health, 2007; 7 (2):www1-www6; 1445-6354; 0020077112
Language: en
Source: http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=586
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Context: The University of Adelaide and the University of South Australia established the Spencer Gulf Rural Health School (SGRHS) as a joint venture to facilitate rural health professional education and research. Annually a cohort of medical students from ...
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An audit of structured diabetes care in a rural general practice

Author/Creator: Ackermann, EW, Mitchell, GK
Resource type:
Date: 2006
Subject: Endocrine organs and diseases (incl. diabetes) (730105), Rural health (730209), Medicine, General & Internal, Multifactorial Intervention, Risk Engine, Type-2, Improve, Disease
Record contributed by: The University of Queensland

Full Record and related resources:
http://espace.library.uq.edu.au/view/UQ:82785
isMemberOf School of Medicine Publications http://espace.library.uq.edu.au/list/UQ:3831
isMemberOf Excellence in Research Australia (ERA) - Collection http://espace.library.uq.edu.au/list/UQ:152266
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http://espace.library.uq.edu.au/view/UQ:82785
isMemberOf School of Medicine Publications http://espace.library.uq.edu.au/list/UQ:3831
isMemberOf Excellence in Research Australia (ERA) - Collection http://espace.library.uq.edu.au/list/UQ:152266

Description
Objective: To assess the impact of structured diabetes care in a rural general practice. Design and setting: A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized Australian rural town. Medical care followed each doctor's usual practice. Participants: The first 404 consecutive patients with type 2 diabetes who consented to take part in the program were evaluated 24 months after enrolment in July 2002 to December 2003. Main outcome measures: Change in cardiovascular disease risk factors (waist circumference, body mass index, serum lipid levels, blood pressure); change in indicators of risks associated with poorly controlled diabetes (glycated haemoglobin [HbA1(c]) concentration, foot lesions, clinically significant hypoglycaemia); change in 5-year cardiovascular disease risk. Results: Women had a lower 5-year risk of a cardiovascular event at enrolment than men. Structured care was associated with statistically significant reductions in mean cardiovascular disease risk factors (waist circumference, -2.6 cm; blood pressure [systolic, -3 mmHg; diastolic -7 mmHg]; and serum lipid levels [total cholesterol, -0.5 mmol/L; HDL cholesterol, 0.02 mmol/L; LDL cholesterol, -0.4 mmol/L; triglycerides, -0.3 mmol/L]); and improvements in indicators of diabetic control (proportion with severe hypoglycaemic events, -2.2%; proportion with foot lesions, -14%). The greatest improvements in risk factors occurred in patients with the highest calculated cardiovascular risk. There was a statistically significant increase in the proportion of patients with ideal blood pressure (systolic, <130 mmHg; diastolic, <80 mmHg) and LDL cholesterol level (<2.5 mmol/L) of 6.4% and 20.5%, respectively. Conclusions: Implementing structured care in this rural general practice coincided with improved risk factor management, and may have contributed to the improvement. The greatest benefits were in patients with high cardiovascular risk.

Publisher: Australasian Medical Publishing Co
Contributor: www.mja.com.au

Coverage: 2006-01-01T00:00:00Z
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Objective: To assess the impact of structured diabetes care in a rural general practice. Design and setting: A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized ...
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The changing face of rural general practice: an ethnographic study of general practitioners and their spouses

Author/Creator: DUREY, Angela
Date: 2006
Subject: rural GPs, partners, gender, politcal economy, structure and social practice
Record contributed by: Australasian Digital Theses Program

Full Record and related resources:
http://adt.ecu.edu.au/adt-public/adt-ECU2006.0015.html
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http://adt.ecu.edu.au/adt-public/adt-ECU2006.0015.html

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Rural general practice is general practice at its best: a comment by one GP interviewed for this study was echoed by colleagues who viewed their work in a rural setting as challenging, diverse, rewarding and satisfying. Despite reported difficulties associated with rural general practice, many GPs argued that the benefits outweigh the disadvantages. Few wanted to leave. Nonetheless, too few Australian trained GPs are willing to move from cities to work in the country. Consequently, overseas trained doctors have been recruited to fill vacancies or nurses provide health services in communities unable to attract a GP.

Publisher: Edith Cowan University. Education And Arts: School Of Community Services And Social Sciences

Language: en
Rights: http://www.ecu.edu.au/corporate/disclaimer.html; Copyright DUREY Angela
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Rural general practice is general practice at its best: a comment by one GP interviewed for this study was echoed by colleagues who viewed their work in a rural setting as challenging, diverse, rewarding and satisfying. Despite reported difficulties associated ...
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Keeping women doctors in the country

Author/Creator: Ozolins, I. Z., Greenwood, G., Beilby, Justin John
Resource type: journal article
Date: 2004, 2006
Subject: General practice; retention; rural health services; women doctors
Record contributed by: The University of Adelaide

Full Record and related resources:
http://hdl.handle.net/2440/6260
http://link.library.adelaide.edu.au/?atitle=Keeping%20women%20doctors%20in%20the%20country&aulast=Ozolins&issn=1445-6354&title=Rural%20and%20Remote%20Health&volume=2004&date=2004&pages=www1-www9&spage=www1&epage=www9
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http://hdl.handle.net/2440/6260
http://link.library.adelaide.edu.au/?atitle=Keeping%20women%20doctors%20in%20the%20country&aulast=Ozolins&issn=1445-6354&title=Rural%20and%20Remote%20Health&volume=2004&date=2004&pages=www1-www9&spage=www1&epage=www9

Description
© Ieva Ozolins, Gay Greenwood, Justin Beilby 2004 A licence to publish this material has been given to ARHEN, http://www.rrh.org.au

Women are disproportionately poorly represented in the rural Australian medical workforce and appropriate retention policies should recognise the factors contributing to a positive rural experience for female doctors. This study describes the professional, social and family experiences of 10 female general practitioners (GPs) working in rural South Australia. Variety of work, the opportunity to provide continuity of care and being valued by the community were important factors in rural recruitment and retention. Successful retention of a female rural medical workforce also required flexible on-call and after-hours arrangements, provision of additional support and employment opportunities for non-medical spouses and partners; and provision of appropriate child care services to rural medical families. To date, there have been few initiatives specifically addressing the concerns of female rural medical practitioners. An advisory body of rural women doctors and community representatives can provide practical guidance regarding the opportunities available for rural communities to effectively support their women doctors.

IZ Ozolins, G Greenwood and J Beilby

Publisher: Deakin University
Contributor: School of Population Health and Clinical Practice : Public Health

Other identifier: Rural and Remote Health, 2004; 4 (2)1-9; 1445-6354; 0020042515
Language: en_US
Source: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=268
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Women are disproportionately poorly represented in the rural Australian medical workforce and appropriate retention policies should recognise the factors contributing to a positive rural experience for female doctors. This study describes the professional, ...
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Population Health And Public Health In Australian Rural General Practice: A Case Series Of Research, Clinical Applications And Educational Strategies

Author/Creator: Fraser, John
Date: 2006
Subject: population health, public health, general practice, rural health
Record contributed by: Australasian Digital Theses Program, The University of Newcastle

Full Record and related resources:
http://hdl.handle.net/1959.13/24740
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http://hdl.handle.net/1959.13/24740

Description
Background General practice’s population health and public health role is being promoted internationally to improve health outcomes. 1-6 This Thesis aims to: • Describe and evaluate projects which are relevant to exploring the interface of population health and public health with Australian rural general practice; and • Describe and evaluate projects which can increase population health and public health expertise and capacity amongst our future rural general practice workforce. Methods This Thesis uses a descriptive design. A series of research papers published in the peer reviewed literature are presented in each chapter. These papers are used as case studies to explore the aims of this Thesis. A variety of quantitative and qualitative methods have been used to conduct research in remote communities of the Northern Territory, rural South Australia and New South Wales from 1992 to 2005. Results Public health and population health can interface with Australian rural general practice in sustainable models described in case studies within this Thesis. There is a continuum of roles in this interface from population health in practice, public health, ‘new’ public health and leadership. Population health activities include screening and promotion of lifestyle factors to patients.7 Public health activities can be developed to extend the reach of health programs to the broader community. This may include participation in population based surveillance systems and health promotion projects. Promoters of ‘new’ public health 8,9 support an expansion of public health’s scope to include advocating social development through community participation and empowerment. Leadership can extend to policy development and liaison with general practice, population health and public health practitioners to promote collaborative models of health care. A sustainable model of increasing rural workforce recruitment via developing workforce capacity in public health and population health has been developed and evaluated as part of this Thesis. Conclusions This Thesis presents rural Australian case studies demonstrating integration of population health and public health roles with general practice. Vertically integrated workforce models have been developed, as part of this Thesis, which can facilitate recruitment to the rural health workforce. In the long term, educational models have been developed and evaluated as part of this Thesis. These models can increase the population health and public health expertise and capacity of this workforce.

MD Doctorate


Language: eng
Rights: http://www.newcastle.edu.au/copyright.html; Copyright 2006 John Fraser
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Background General practice’s population health and public health role is being promoted internationally to improve health outcomes. 1-6 This Thesis aims to: • Describe and evaluate projects which are relevant to exploring the interface ...
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A participant-observer case study of research in isolated Australian rural general practice / Richard W. Watts.

Author/Creator: Watts, Richard Walter
Date: 2003
Subject: No Subjects
Record contributed by: Australasian Digital Theses Program, The University of Adelaide

Full Record and related resources:
http://hdl.handle.net/2440/38454
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http://hdl.handle.net/2440/38454

Description
Author's previously published works appended.

Bibliography: p. 291-326.

xxii, 329 p., [80 leaves] :

Title page, contents and abstract only. The complete thesis in print form is available from the University Library.

The subject of this thesis is a single participant-observer case study which demonstrates the feasibility of integrating research activity within the daily routine of patient care in a busy rural general practice. Case studies were conducted over a period of 10 years in the town of Port Lincoln, South Australia. The research questions were generated by cues or uncertainties arising in routine clinical practice and included the disciplines of epidemiology, clinical audit, randomised drug trials and meta-analysis. The author concludes that research can be an integral part of routine patient care and should be promoted as part of a strategy to improve the research culture of general practice.

Thesis (MD)--University of Adelaide, Dept. of General Practice, 2003


Language: en_US
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The subject of this thesis is a single participant-observer case study which demonstrates the feasibility of integrating research activity within the daily routine of patient care in a busy rural general practice. Case studies were conducted over a period of ...
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