Should I stay or should I go? Exploring the job preferences of allied health professionals working with people with disability in rural Australia.

INTRODUCTION: The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services. OBJECTIVE: This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists - "therapists") living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention. METHODS: A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs' current job, and their workforce preferences were explored using a best-worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs' relative preferences for six different job attributes. RESULTS: One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, "high autonomy of practice" is the most valued attribute level, followed by "travel BWSDCE arrangements: one or less nights away per month", "travel arrangements: two or three nights away per month" and "adequate access to professional development". On the other hand, the least valued attribute levels were "travel arrangements: four or more nights per month", "limited autonomy of practice" and "minimal access to professional development". Except for "some job flexibility", all other attributes had a statistical influence on AHPs' job preference. Preferences differed according to age, marital status and having dependent children. CONCLUSIONS: This study allowed the identification of factors that contribute to AHPs' employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention.

Factors affecting retention of allied health professionals working with people with disability in rural New South Wales, Australia: discrete choice experiment questionnaire development.

OBJECTIVE: This paper describes the development of a discrete choice experiment (DCE) questionnaire to identify the factors (attributes) that allied health professionals (AHPs) working with people with disability identify as important to encouraging them to remain practising in rural areas. METHODS: Focus groups and semi-structured interviews were conducted with 97 purposively selected service providers working with people with disability in rural New South Wales, Australia. Focus groups and interviews were digitally recorded, transcribed, and analysed using a modified grounded theory approach involving thematic analysis and constant comparison. RESULTS: Six attributes that may influence AHPs working with people with disability in rural areas to continue to do so were inductively identified: travel arrangements, work flexibility, professional support, professional development, remuneration, and autonomy of practice. The qualitative research information was combined with a policy review to define these retention factors and ensure that they are amenable to policy changes. CONCLUSION: The use of various qualitative research methods allowed the development of a policy-relevant DCE questionnaire that was grounded in the experience of the target population (AHPs).

Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales.

OBJECTIVE: To explore the characteristics of allied health professionals (AHPs) working with people with disabilities in western New South Wales (NSW). DESIGN: A cross-sectional survey was conducted using an online questionnaire. SETTING: Rural western NSW. PARTICIPANTS: AHPs including physiotherapists, speech pathologists, occupational therapists and psychologists ('therapists') working with people with disabilities. MAIN OUTCOME MEASURE: AHPs characteristics. RESULTS: The majority of respondents were women (94%), with a mean age of 39 years; average time since qualification was 14 years; mean years in current position was 6. Most worked with people with a lifelong disability. Two thirds reported that family ties kept them in rural areas; 71% grew up in a rural/remote area. Most participants (94%) enjoyed the rural lifestyle, and 84% reported opportunities for social interaction as good or very good. Participants with dependent children were less likely to cease working in western NSW within 5 years than those without dependent children (P < 0.05). CONCLUSIONS: The characteristics of therapists working with people with disabilities in rural NSW were identified. Overall working, but also social conditions and community attachment were important for this group. Understanding the workforce will contribute to policy development to meet increasing demands for therapy services.

Climate adversity and resilience: the voice of rural Australia.

INTRODUCTION: Over the past decade, Australia has experienced prolonged drought and extensive flooding. It is argued that such events impact more significantly on rural communities than urban. Although there is a body of research investigating the effects of drought on mental and physical health in rural Australia, little research has examined the effects of flood and drought on wellbeing. This article explores the influence of drought and flood on the wellbeing of rural residents in New South Wales (NSW), Australia. METHODS: Forty-six individuals living in four rural communities in NSW were recruited and asked their experience of flood and drought using in-depth semi-structured face to face interviews or focus groups. The study used a grounded hermeneutic approach to contextualise participants' experiences within a rural social and cultural construct. RESULTS: Weather was found to be at the core of rural life, with flood and drought contributing to decreased wellbeing from stress, anxiety, loss and fear. Social connectedness was found to promote resilience in rural communities buffering the effects of flood and drought. CONCLUSIONS: Flood and drought have negative impacts on an individual's wellbeing. Although these negative effects were seen to be buffered by individual and community resilience, the long term emotional impact of flood and drought on rural communities needs to be further considered.

Patients' experiences of referral for colorectal cancer.

BACKGROUND: Outcomes for colorectal cancer patients vary significantly. Compared to other countries, Australia has a good record with patient outcomes, yet there is little information available on the referral pathway. This paper explores the views of Australian patients and their experiences of referral for colorectal cancer treatment following diagnosis; the aim was to improve our understanding of the referral pathway and guide the development of future interventions. METHODS: A purposive sampling strategy was used, recruiting 29 patients representing urban and rural areas from 3 Australian states who participated in 4 focus groups. Seven patients provided individual interviews to supplement the data. Recordings were transcribed verbatim, data was coded with NVivo software and analysed thematically before deductive analysis. RESULTS: Four aspects of the referral process were identified by patients, namely detection/diagnosis, referral for initial treatment/specialist care, the roles of the GP/specialist, and the patient's perceived involvement in the process. The referral process was characterised by a lack of patient involvement, with few examples of shared decision-making and few examples of limited choice. However, patients did not always feel they had the knowledge to make informed decisions. Information exchange was highly valued by patients when it occurred, and it increased their satisfaction with the process. Other factors mediating care included the use of the public versus private health system, the quality of information exchange (GP to specialist and GP to patient), continuity of care between GP and specialist, and the extent of information provision when patients moved between specialist and GP care. CONCLUSIONS: Patients described poor GP continuity, ad hoc organisational systems and limited information exchange, at both interpersonal and inter-organisational levels, all leading to sub-optimal care. Implementation of a system of information feedback to GPs and engagement with them might improve information exchange for patients, enabling them to be more involved in improved referral outcomes.

A national study into the rural and remote pharmacist workforce.

INTRODUCTION: As for many health professionals, distance presents an enormous challenge to pharmacists working in rural and remote Australia. Previous studies have identified issues relating to the size of the rural and remote pharmacist workforce, and a number of national initiatives have been implemented to promote the recruitment and retention of pharmacists in rural and remote locations. The aim of this study was to explore and describe the current rural and remote pharmacy workforce, and to identify barriers and drivers influencing rural and remote pharmacy practice. METHODS: A mixed-methods approach was used, which comprised a qualitative national consultation and a quantitative rural and remote pharmacist workforce survey. Semi-structured interviews (n=83) and focus groups (n=15, 143 participants) were conducted throughout Australia in 2009 with stakeholders with an interest in rural and remote pharmacy, practising rural/remote pharmacists and pharmacy educators, and as well as with peak pharmacy organizations, to explore the issues associated with rural/remote practice. Based on the findings of the qualitative work a 45-item survey was developed to further explore the relevance of the issues identified in the qualitative consultation. All registered Australian pharmacists practising in non-urban locations (RRMA 3-7, n=3,300) were identified and invited to participate in the study, with a response rate of 23.4%. RESULTS: The main themes identified from the qualitative consultation were the impact of national increases in the pharmacist workforce on rural/remote practice; the role of the regional pharmacy schools in contributing to the rural/remote workforce; and the perceptions of differences in pharmacist roles in rural/remote practice. The survey indicated that pharmacists practising in rural and remote locations were older than the national average (55.8 years versus 40 years). Differences in their professional role were seen in different pharmacy sectors, with hospital pharmacists spending significantly more time on the delivery of professional services and education and teaching, but less time on medication supply than community pharmacists. Rural/remote pharmacists were generally found to be satisfied with their current role. The main 'satisfiers' reported were task variety, customer appreciation, use of advanced skills, appropriate remuneration, happiness in their work location, sound relationships with other pharmacists, a happy team and relationships with other health professionals. CONCLUSION: This study described the distribution, roles and factors affecting rural and remote pharmacy practice. While the results presented provide an extensive overview of the rural/remote workforce, a comparable national study comparing rural/remote and urban pharmacists would further contribute to this discussion. Knowledge on why pharmacists chose to work in a particular geographical location, or why pharmacists chose to leave a location would further enrich our knowledge on what drives and sustains the rural/remote pharmacist workforce.

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia.

BACKGROUND/AIM: This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study's purpose was to identify the impact of Information and Communication Technology on the workforce practices of occupational therapists' working in a rural area of New South Wales. METHODS: Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison, was used to analyse the interview transcripts. RESULTS: This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients' acceptance. CONCLUSION: The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently.

Integrating evidence into policy and sustainable disability services delivery in western New South Wales, Australia: the 'wobbly hub and double spokes' project.

BACKGROUND: Policy that supports rural allied health service delivery is important given the shortage of services outside of Australian metropolitan centres. The shortage of allied health professionals means that rural clinicians work long hours and have little peer or service support. Service delivery to rural and remote communities is further complicated because relatively small numbers of clients are dispersed over large geographic areas. The aim of this five-year multi-stage project is to generate evidence to confirm and develop evidence-based policies and to evaluate their implementation in procedures that allow a regional allied health workforce to more expeditiously respond to disability service need in regional New South Wales, Australia. METHODS/DESIGN: The project consists of four inter-related stages that together constitute a full policy cycle. It uses mixed quantitative and qualitative methods, guided by key policy concerns such as: access, complexity, cost, distribution of benefits, timeliness, effectiveness, equity, policy consistency, and community and political acceptability. Stage 1 adopts a policy analysis approach in which existing relevant policies and related documentation will be collected and reviewed. Policy-makers and senior managers within the region and in central offices will be interviewed about issues that influence policy development and implementation. Stage 2 uses a mixed methods approach to collecting information from allied health professionals, clients, and carers. Focus groups and interviews will explore issues related to providing and receiving allied health services. Discrete Choice Experiments will elicit staff and client/carer preferences. Stage 3 synthesises Stage 1 and 2 findings with reference to the key policy issues to develop and implement policies and procedures to establish several innovative regional workforce and service provision projects. Stage 4 uses mixed methods to monitor and evaluate the implementation and impact of new or adapted policies that arise from the preceding stages. DISCUSSION: The project will provide policy makers with research evidence to support consideration of the complex balance between: (i) the equitable allocation of scarce resources; (ii) the intent of current eligibility and prioritisation policies; (iii) workforce constraints (and strengths); and (iv) the most effective, evidence-based clinical practice.

Patients with colorectal cancer - a qualitative study of referral pathways and continuing care.

BACKGROUND: This article explores the views of general practitioners on their referral of colorectal cancer patients following diagnosis to specialist surgeons. METHODS: Sampling was purposive. Nineteen GPs representing urban and rural areas participated in four focus groups. RESULTS: General practitioners viewed their relationship with surgeons to be of prime importance in the decision about whom to refer. This relationship allowed faster referrals and improved feedback from the specialist to the GP. General practitioners preferred referral to the private health services because they perceived delays in the public system and that referral and communication was easier with private specialists. Neither the volume of colorectal cancer work nor the availability of a multidisciplinary team influenced their decision making. DISCUSSION: The relationship and communication between GP and surgeon are important in facilitating the referral pathway and the continuing role that many GPs would like to have in the care of their patients.

Issues affecting therapist workforce and service delivery in the disability sector in rural and remote New South Wales, Australia: perspectives of policy-makers, managers and senior therapists.

INTRODUCTION: The disability sector encompasses a broad range of conditions and needs, including children and adults with intellectual and developmental disabilities, people with acquired disabilities, and irreversible physical injuries. Allied health professionals (therapists), in the disability sector, work within government and funded or charitable non-government agencies, schools, communities, and private practice. This article reports the findings of a qualitative study of therapist workforce and service delivery in the disability sector in rural and remote New South Wales (NSW), Australia. The aim was to investigate issues of importance to policy-makers, managers and therapists providing services to people with disabilities in rural and remote areas. METHODS: The project gathered information via semi-structured interviews with individuals and small groups. Head office and regional office policy-makers, along with managers and senior therapists in western NSW were invited to participate. Participants included 12 policy-makers, 28 managers and 10 senior therapists from NSW government agencies and non-government organisations (NGOs) involved in providing services and support to people with disabilities in the region. Information was synthesised prior to using constant comparative analysis within and across data sets to identify issues. RESULTS: Five broad themes resonated across participants' roles, locations and service settings: (1) challenges to implementing policy in rural and remote NSW; (2) the impact of geographic distribution of workforce and clients; (3) workforce issues - recruitment, support, workloads, retention; (4) equity and access issues for rural clients; and (5) the important role of the NGO sector in rural service delivery and support. CONCLUSIONS: Although commitment to providing best practice services was universal, policy-related information transfer between organisations and employees was inconsistent. Participants raised some workforce and service delivery issues that are similar to those reported in the rural health literature but rarely in the context of allied health and disability services. Relatively recent innovations such as therapy assistants, information technology, and trans-disciplinary approaches, were raised as important service delivery considerations within the region. These and other innovations were expected to extend the coverage provided by therapists. Non-government organisations played a significant role in service delivery and support in the region. Participants recognised the need for therapists working for different organisations, in rural areas, to collaborate both in terms of peer support and service delivery to clients.

Systematic review of prognostic factors related to overall survival in patients with stage IV colorectal cancer and unresectable metastases.

BACKGROUND: With the improvements in newer chemotherapeutic agents, the role of primary tumour resection in patients with stage IV colorectal cancer is controversial. In many cases primary tumour resection is still favoured as first-line management. However, a detailed understanding of independent prognostic factors related to survival is necessary before making this decision. METHOD: A literature search was conducted using Medline and Embase. Studies that performed multivariate analysis on overall survival of patients with incurable stage IV colorectal cancer were included in this review. RESULTS: Fourteen retrospective studies involving 3209 patients were included. Clinical variables analysed to consistently have independent prognostic significance for long-term survival included the patients' performance status (<2), volume of liver metastases (<50%), nodal stage (N0), disease-free resection margins, and treatment with chemotherapy and/or primary tumour resection. Cancer antigen (CA) 19-9, low albumin, elevated ALP levels, apical lymph node involvement, presence of ascites, and postoperative transfusion were each assessed by only one study and found to be independently associated with survival. Factors inconsistently reported to have independent prognostic significance were age, ASA score, preoperative CEA levels, primary tumour location, tumour size and differentiation, peritoneal dissemination, and extrahepatic metastases. CONCLUSION: Each patient should be reviewed individually on the basis of the above independent prognostic factors before deciding to resect the primary tumour. Patients with a poor performance status, extensive hepatic metastases, and extensive nodal disease detected preoperatively are less likely to have a survival benefit. Nonsurgical approaches to manage these patients should be given careful consideration.

Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa.

OBJECTIVE: Access barriers to health care for minority populations has been a feature of medical, health and social science literature for over a decade. Considerations of cultural barriers have featured in this literature, but definitions of what constitutes a cultural barrier have varied. In this paper, data from recent interviews with Aboriginal and Torres Strait Islander people, Aboriginal Health Workers and other non-Indigenous health professionals in north-west Queensland assist to refine the meaning of this term and uncovered other issues disguised as 'cultural' difference. DESIGN: Semistructured interviews with community and health professionals. SETTING: Mount Isa, Queensland, Australia. PARTICIPANTS: Aboriginal and Torres Strait Islanders, Aboriginal Health Workers and other health professionals in Mount Isa between 2007 and 2009. RESULTS: Cultural barriers were considered differently by Aboriginal patients and health practitioners. While Aboriginal patients focused heavily on social relationships and issues of respect and trust, most practitioners seemed more focused on making Aboriginal people feel comfortable with changes to physical environments and systems, with less emphasis on creating strong interpersonal relationships. CONCLUSIONS: For Aboriginal patients the focus on interpersonal relationships between themselves and health practitioners is paramount. Creating comforting physical environments and systems that are easier to navigate do assist in overcoming cultural barriers, but are often seen as little more than token gestures if trusting interpersonal relationships are not formed between patient and practitioner.

Rural maternity care and health policy: parents' experiences.

OBJECTIVE: To explore rural residents' experiences of access to maternity care with consideration of the policy context. DESIGN: This paper describes findings from focus groups with parents which formed part of case study data from a larger study. SETTING: Four north Queensland rural towns. PARTICIPANTS: Thirty-three parents living in one of the four rural towns. MAIN OUTCOME MEASURES: Identifying prevalent themes in case studies regarding rural parents' expectations and experiences in accessing maternity care. RESULTS: Parents desired a local, safe and consistent maternity service. Removing or downgrading rural services introduced new barriers to care for rural residents: (i) increased financial costs; (ii) family issues; and (iii) safety concerns. CONCLUSIONS: Although concerns about rural residents' health status and health care access have received significant policy attention for over a decade, many of the problems which prompted these policy initiatives remain today. Current policy approaches should be re-evaluated in order to improve rural Australians' access to vital health services such as maternity care.

Heatwaves and the elderly - The role of the GP in reducing morbidity.

BACKGROUND Heatwaves are increasing in frequency, intensity and duration, and are associated with an increase in mortality and morbidity, particularly in the very young and the very old. Concurrently, the Australian population is aging, with the prediction that by 2036 approximately 27% of Australians will be aged over 65 years. OBJECTIVE This article reviews the evidence on heat related health risk and discusses the role of the general practitioner in reducing morbidity in older people as a result of heatwaves. DISCUSSION Heatwaves are associated with increased mortality and morbidity in people aged over 65 years, and more so in those aged over 75 years. Older people are more vulnerable to the effects of extreme heat through a range of physiological and physical factors. As key providers of healthcare to older people, GPs play a crucial role in identifying those at risk and implementing strategies to minimise the risks of mortality and morbidity during periods of extreme heat.

Impact of rurality on environmental determinants and hazards.

The original of this paper was prepared as invited pre-reading for the Inaugural Rural Health Symposium held in Brisbane in July 2008 under the theme "The impact of 'rurality'", sub-theme (a) Environmental determinants. The natural environment shapes human activity, both economically and socially. It also directly and indirectly influences health and well-being. People in rural and remote areas are more directly exposed to the natural environment than their urban counterparts. The built environment is largely a product of economic activity; thus, the built environment in rural areas tends to reflect the predominant primary industry/ies. The rural built environment presents many potential hazards and risks to health and well-being, particularly for those involved in the primary industries, which are either not present in urban areas, or are present on smaller or more contained scales. The natural and built environments also influence individuals' attitudes and behaviours, both positively and negatively. The environmental determinants of rural health, therefore, can be considered in terms of the natural environment, the built environment and individuals' responses to environmental influences. This paper raises some of the common environmental determinants of rural health and well-being and briefly touches on what these mean for rural health service delivery.

At work or play: a comparison of private property vehicle crashes with those occurring on public roads in north Queensland.

OBJECTIVE: To define characteristics of vehicle crashes occurring on rural private property in north Queensland with an exploration of associated risk factors. DESIGN: Descriptive analysis of private property crash data collected by the Rural and Remote Road Safety Study. SETTING: Rural and remote north Queensland. PARTICIPANTS: A total of 305 vehicle controllers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash. MAIN OUTCOME MEASURE: A structured questionnaire completed by participants covering crash details, lifestyle and demographic characteristics, driving history, medical history, alcohol and drug use and attitudes to road use. RESULTS: Overall, 27.9% of interviewees crashed on private property, with the highest proportion of private road crashes occurring in the North West Statistical Division (45%). Risk factors shown to be associated with private property crashes included male sex, riding off-road motorcycle or all-terrain vehicle, first-time driving at that site, lack of licence for vehicle type, recreational use and not wearing a helmet or seatbelt. CONCLUSIONS: Considerable trauma results from vehicle crashes on rural private property. These crashes are not included in most crash data sets, which are limited to public road crashes. Legislation and regulations applicable to private property vehicle use are largely focused on workplace health and safety, yet work-related crashes represent a minority of private property crashes in north Queensland.

Young driver restrictions: does the evidence support them?

OBJECTIVE: To assess the suitability of Queensland's graduated licensing system in the context of rural and remote Queensland. DESIGN: Age-based comparison of crash data collected by the Rural and Remote Road Safety Study (RRRSS). SETTING: Rural and remote North Queensland. PARTICIPANTS: A total of 367 vehicle controllers aged 16 years or over hospitalised at Townsville, Cairns or Mount Isa for at least 24 hours, or killed, as a result of a vehicle crash. MEASUREMENTS: Specific RRRSS variables are assessed in relation to Queensland's graduated licensing program, including rates of unlicensed driving/riding, late night crashes, crashes with multiple passengers, contributing factors in crashes and vehicle types involved. RESULTS: While people between 16 and 24 years of age comprise 16% of the target population, 25% of crashes meeting RRRSS criteria involved a vehicle controller in that age group. 12.8% of all cases involved an unlicensed driver/rider, within which 66% were below 25 years of age. Young drivers/riders were represented in 50% of crashes occurring between 11:00 p.m. and 5:00 a.m., and 33% of crashes in vehicles with multiple passengers. Motorcyclists represented about 40% of cases in both age groups. There were no significant differences between age groups in vehicle types used, or circumstances that contributed to crashes. CONCLUSIONS: The general overrepresentation of young drivers/riders in rural and remote North Queensland supports tailored interventions, such as graduated licensing. However, while some measures in the legislation are well supported, problems surrounding unlicensed driving/riding might be exacerbated.

Practice based research - lessons from the field.

BACKGROUND: The authors sought to describe the process of conducting a successful randomised controlled trial in a primary care setting and identify enabling factors and barriers. METHODS: Descriptive report of methods used to conduct a randomised controlled trial investigating the effect of allowing sutures to be wet and uncovered in the first 48 hours following minor excisions. RESULTS: The trial identified several enabling factors and barriers to conducting research in a primary care setting. The project described in this article was successful because a group of general practitioners sought to answer an interesting question which was relevant to their clinical practice and which had not been answered by current evidence. DISCUSSION: The findings are likely to assist groups seeking to conduct practice based research in the primary care setting.

Colorectal cancer management - the role of the GP.

BACKGROUND: Colorectal cancer (CRC) contributes significantly to the morbidity and mortality of Australians. The introduction of the National Bowel Cancer Screening Program has focussed attention on the role of the general practitioner in CRC screening. However, their increasing role across the management spectrum of CRC remains poorly researched. OBJECTIVE: This article examines the published literature on the existing and potential roles of the GP in the detection and management of CRC. Evidence about the existing and potential role of the GP was found through a literature search on Medline, PubMed, epidemiological evidence and recent guidelines. DISCUSSION: The role of the GP in CRC management varies. Some GPs play many roles such as advocate, facilitator, supporter, educator and counsellor. The role of the GP is influenced by GP-specialist communication, practice location, and patient and GP factors. There is a potential to increase this role, especially in providing psychosocial support and counselling for both the patient and their family.

Groups or teams in health care: finding the best fit.

RATIONALE: In the evolution of the team concept, clear distinctions between 'groups' and 'teams' were made. In this paper we argue that these distinctions were not made explicit in the translation of team structures to health care. Even though teams are appropriate for many health care settings, this paper explores the notion that when teams may not be working, it is the concept of team that may not be appropriate, not the functioning of the team itself. METHODS: This paper reviews the differences between teams and groups, and identifies how these differences are expressed in health care settings using urban and rural examples from the UK and Australia. RESULTS: Some suggestions about matching structures to suit the unique nature of health care provision, particularly in community health settings, are made. DISCUSSION: Instead of concentrating on improving the process of teams, the focus could be better directed to ensure that whatever structure is utilized best facilitates the necessary outcomes in the most effective way. The team approach may not always be the best approach, and sometimes referring to a number of people working together as a group is sufficient.