Influence of rurality on general practitioner registrars' participation in their practice's after-hours roster: A cross-sectional study.

OBJECTIVE: To investigate whether practice rurality and rural training pathway are associated with general practitioner registrars' participation in their practice's after-hours care roster. DESIGN: A cross-sectional analysis of data (2017-2019) from the Registrar Clinical Encounters in Training study, an ongoing inception cohort study of Australian general practitioner registrars. The principal analyses used logistic regression. SETTING: Three national general practitioner regional training organisations across 3 Australian states. PARTICIPANTS: General practitioner registrars in training within regional training organisations. MAIN OUTCOME MEASURE: Involvement in practice after-hours care was indicated by a dichotomous response on a 6-monthly Registrar Clinical Encounters in Training study questionnaire item. RESULTS: 1576 registrars provided 3158 observations (response rate 90.3%). Of these, 1574 (48.6% [95% confidence interval: 46.8-50.3]) involved registrars contributing to their practice's after-hours roster. In major cities, 40% of registrar terms involved contribution to their practice's after-hours roster; in regional and remote practices, 62% contributed to the after-hours roster. On multivariable analysis, both level of rurality of practice (odds ratio(OR) 1.75, P = .007; and OR 1.74, P = .026 for inner regional and outer regional/remote locations, respectively, versus major city) and rural training pathway of registrar (OR 1.65, P = .008) were significantly associated with more after-hours roster contribution. Other associations were registrars' later training stage, larger practices and practices not routinely bulk billing. Significant regional variability in after-hours care was identified (after adjusting for rurality). CONCLUSION: These findings suggest that registrars working rurally and those training on the rural pathway are more often participating in practice after-hours rosters. This has workforce implications, and implications for the educational richness of registrars' training environment.

Vaccine provider views on the impact of COVID-19 on immunisation in general practice: a qualitative study.

BACKGROUND: General practitioners and general practice nurses are the most trusted and experienced sources of vaccine information for Australians and are the principal providers of routine immunisation in New South Wales, Australia. This study explored perceived barriers and challenges to the rollout of the COVID-19 immunisation program and continued provision of routine immunisation through general practice. METHODS: Structured in-depth interviews were conducted between 29 April and 8 July 2021 with general practitionerss and general practice nurses working in accredited general practices in the Greater Sydney area. Interviews were transcribed verbatim and analysed thematically. RESULTS: Fifteen participants (12 general practitioners and three general practice nurses) were interviewed. Participants considered the COVID-19 vaccine rollout to significantly burden general practice at the cost of delivery of routine preventative care. Patient fear and anxiety and vaccine hesitancy were perceived as major challenges to the provision of all immunisations, exacerbated by media coverage of shifting recommendations related to COVID-19 vaccine adverse events. Inadequate communication from government bodies contributed to a perceived erosion of patient trust in general practice. Participants considered routine immunisation to be minimally disrupted owing to robust practice-based recall and reminder systems and legislated immunisation requirements for children. CONCLUSION: The role of general practitioners and general practice nurses in the COVID-19 vaccine rollout was seen to be one of great burden and complexity. As the primary providers of immunisation in New South Wales, continued communication with and support for general practice, both financially and informationally, is pivotal to the sustained successful provision of routine and COVID-19 immunisation.