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1.
J Prim Health Care ; 16(2): 170-179, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38941251

RESUMO

Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Maori and Pasifika communities. Methods Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakeha focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion In providing rural health provider perspectives from rural areas serving Maori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Pesquisa Qualitativa , Serviços de Saúde Rural , Adulto , Feminino , Humanos , Masculino , Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , COVID-19/etnologia , Vacinas contra COVID-19/administração & dosagem , Grupos Focais , Pessoal de Saúde , Serviços de Saúde do Indígena , Disparidades em Assistência à Saúde/etnologia , Entrevistas como Assunto , Povo Maori , Nova Zelândia , População das Ilhas do Pacífico , Pandemias , Serviços de Saúde Rural/organização & administração , População Rural
2.
Aust J Rural Health ; 32(1): 53-66, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37964677

RESUMO

OBJECTIVE: Building health services and workforce that are both well supported and fit for purpose is a key consideration for improving health outcomes in rural populations. Achieving this requires an understanding of the roles and practice characteristic of each professional group, including allied health professionals. This study explores what it means to be an allied health professional practicing in rural Aotearoa New Zealand. DESIGN: A qualitative study design was used, involving individual semi-structured interviews with 13 rural allied health professionals in the Otago and Northland regions. The interviews explored participants journey into rural practice, their experiences working rurally, and their views on rural practice. FINDINGS: Four main themes were derived: Identity; Connectedness; Expectations; and Providing Care. DISCUSSION: Proud of being rural, these allied health professionals are immersed within their community, intertwining their professional and personal identities. The unique nature of this dual identity while empowering for some, can also isolate rural allied health professionals from their professional bodies and urban peers. This leads to a sense of vulnerability and feeling undervalued and invisible. In response, rural allied health professionals choose to form strong connections to their local interprofessional team and their community. The connections they forge, and the breadth of their skills cumulate to enable allied health professionals to provide dynamic and responsive health services for their rural communities. CONCLUSION: This study provides the first insight into experiences and perspectives of allied health professionals within rural Aotearoa New Zealand. Despite the challenges, a sense of pride is associated with practicing rurally for allied health professionals.


Assuntos
Serviços de Saúde Rural , População Rural , Humanos , Nova Zelândia , Pessoal Técnico de Saúde , Pesquisa Qualitativa
3.
J Prim Health Care ; 15(4): 343-349, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38112704

RESUMO

Introduction Due to COVID-19 pandemic restrictions in Aotearoa New Zealand, an established remote community marae-based workshop (a component of a postgraduate rural medical programme) was converted into a virtual platform. Aim The aim of this study was to explore student and teacher experiences of this virtual adaptation with focus on cultural aspects. Methods A qualitative exploratory study was undertaken that involved document review and qualitative interviews. Students and teachers were invited to participate. Semi-structured interviews were conducted. Thematic analysis was undertaken using a framework-guided rapid analysis method. The two participant groups' data were analysed concurrently but separately. Results Students found the virtual workshop valuable in furthering their knowledge of Maori culture, cross-cultural communication skills and health inequities in rural clinical practice. Through the innovative efforts of their teachers, they felt some sense of connection with the remote locality and its people. Teachers were able to impart knowledge, connect and keep everyone culturally safe through their commitment and adaptability. However, moving to a virtual platform meant compromise to the cultural experience for students and loss of sharing the learning and experience with their place and their people. Discussion In the event of a further pandemic or other emergency situation, where strong established relationships exist, replacing an in-person remote marae-based workshop with a virtual workshop, while limited, is achievable and has value. When urban tertiary institutions partner with remote Maori communities to deliver virtual teaching, caution is needed in ensuring sustained transparency in priorities and expectations to avoid further exacerbations of power imbalance and resulting loss of value.


Assuntos
Assistência à Saúde Culturalmente Competente , Povo Maori , Pandemias , Humanos , Nova Zelândia , Pesquisa Qualitativa , Estudantes , Serviços de Saúde Rural
4.
Aust J Rural Health ; 31(5): 921-931, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37491762

RESUMO

OBJECTIVE: The aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital. METHODS: A retrospective observational study. DESIGN: Patients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals. SETTING: Six New Zealand (NZ) rural hospitals were included. PARTICIPANTS: Patients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included. MAIN OUTCOME MEASURES: The primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital. RESULTS: There were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery. CONCLUSIONS: Most patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.


Assuntos
Medicina Geral , Transferência de Pacientes , Humanos , Hospitais Rurais , Nova Zelândia , Estudos Retrospectivos
5.
Rural Remote Health ; 23(2): 7583, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-37054731

RESUMO

INTRODUCTION: In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Maori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system. METHODS: A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants' views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method. RESULTS: Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, 'Our place and our people', reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital's response. Local services were provided by small, adaptable teams across broad scopes and blurred primary-secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, 'Our positioning in the wider health system', related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being 'at the end of the dripline'. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them. CONCLUSION: This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Maori.


Assuntos
Serviços de Saúde Rural , Humanos , Hospitais Rurais , Nova Zelândia , Atenção à Saúde , Programas Governamentais , Pesquisa Qualitativa
6.
J Prim Health Care ; 15(1): 14-23, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-37000550

RESUMO

Introduction There is considerable variation in the structure and resources of New Zealand (NZ) rural hospitals; however, these have not been recently quantified and their effects on healthcare outcomes are poorly understood. Importantly, there is no standardised description of each rural hospital's catchment boundary and the characteristics of the population living within this area. Aim To define and describe a catchment population for each of New Zealand's rural hospitals. Methods An exploratory approach to developing catchments was employed. Geographic Information Systems were used to develop drive-time-based geographic catchments, and administrative health data (National Minimum Data Set and Primary Health Organisation Data Set) informed service utilisation-based catchments. Catchments were defined at both the Statistical Area 2 (SA2) and domicile levels, and linked to census-based population data, the Geographic Classification for Health, and the area-level New Zealand Index of Socioeconomic Deprivation (NZDep2018). Results Our results highlight considerable heterogeneity in the size (max: 57 564, min: 5226) and characteristics of populations served by rural hospitals. Substantial differences in the age structure, ethnic composition, socio-economic profile, 'remoteness' and projected future populations, are noted. Discussion In providing a standardised description of each rural hospital's catchment boundary and its population characteristics, the considerable heterogeneity of the communities served by rural hospitals, both in size, rurality and socio-demographic characteristics, is highlighted. The findings provide a platform on which to build further research regarding NZ's rural hospitals and inform the delivery of high-quality, cost-effective and equitable health care for people living in rural NZ.


Assuntos
Hospitais Rurais , Características de Residência , Humanos , Nova Zelândia , População Rural
7.
J Prim Health Care ; 14(3): 259-267, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36178831

RESUMO

Introduction The allied health workforce is a crucial, if at times poorly visible, component of modern healthcare systems. The services provided by allied health professionals may be particularly important for underserved populations, including rural and remote communities. Aim To determine what is currently known through research about the allied health workforce in rural Aotearoa New Zealand. Method A scoping review of diverse sources of literature from Aotearoa New Zealand was obtained from seven databases (July 2011-July 2021). Results Eighty-nine articles were identified, of which 10 met the inclusion criteria; nine empirical studies and one narrative review. The included research fell into two main categories: geographic workforce distribution (n = 8), and the role of the rural allied health workforce (n = 2). Discussion The paucity of research that meets the criteria for inclusion makes it difficult to draw conclusions about the allied health workforce in rural Aotearoa New Zealand. There is a focus in both the international rural allied health literature and the Aotearoa New Zealand rural medical and nursing literature on: measuring geographic workforce distribution; and rural-specific training. This suggests that these issues are important to the rural workforce. Similar research is needed in Aotearoa New Zealand to inform policy and ensure the rural allied health workforce reaches its full potential in improving health outcomes for rural New Zealanders.


Assuntos
Serviços de Saúde Rural , Pessoal Técnico de Saúde , Mão de Obra em Saúde , Humanos , Nova Zelândia , População Rural
8.
J Prim Health Care ; 14(3): 254-258, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36178847

RESUMO

Introduction There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim To explore rural hospital leader perspectives of the role of rural hospitals. Methods An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. 'Rural Hospital' was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about 'range of services' (median 7, IQR 6, 8), 'accessibility' (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and 'local governance and control' were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital's future. Discussion By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.


Assuntos
Hospitais Rurais , Serviços de Saúde Rural , Humanos , Nova Zelândia , População Rural , Inquéritos e Questionários
9.
J Prim Health Care ; 14(1): 74-79, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35417324

RESUMO

Introduction New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand's University of Otago distance-taught Rural Postgraduate programme. Methods Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion The University of Otago's Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery.


Assuntos
Medicina Geral , Clínicos Gerais , Serviços de Saúde Rural , Medicina Geral/educação , Humanos , Nova Zelândia , Ilhas do Pacífico
10.
Educ Prim Care ; 33(2): 77-84, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34990304

RESUMO

AIM: Rural-targeted postgraduate medical training is a key factor associated with entering rural practice. Rural health professionals often experience geographical and professional isolation, which can impact their training and education. In New Zealand, during the 2020 COVID-19 pandemic, an established distance postgraduate rural medical programme replaced its in-person residentials with virtual workshops. This study aimed to gain insights into the student experience of the virtual workshops, with emphasis on exploring the effects of the absence of an in-person component. METHOD: Qualitative exploratory design. All students who had completed a semester one 2020 University of Otago rural postgraduate module were invited by email to participate. Fifteen semi-structured interviews were conducted by video-conference. A thematic analysis was conducted using a general inductive approach. RESULTS: Three themes captured the main issues. 1. Making sure everyone is in the same boat: the key roles of an in-person component were identified as consolidation of learning, benchmarking and connectedness. 2. Learning but not connecting: virtual workshops were well facilitated, allowed continuation of study and the convenience of staying home, however connectedness faded. 3. We've got to keep a human touch in a digital age: looking beyond the pandemic, opportunities for streamlining virtual content were identified, however there was concern around diminished communication and cultural aspects of learning and the absent connection with rural health services and communities. CONCLUSION: A virtual workshop is valuable in the COVID-19 environment but does not replace an in-person component of a distance postgraduate training programme for rural medicine.


Assuntos
COVID-19 , Serviços de Saúde Rural , Humanos , Nova Zelândia , Pandemias , Estudantes
11.
N Z Med J ; 134(1545): 11-21, 2021 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-34788268

RESUMO

AIM: The COVID-19 pandemic stress-tested health systems globally and accentuated pre-existing health inequities. There is little understanding of the impact that the 2020 pandemic preparations had on New Zealand's rural hospitals. This study explores rural hospital doctors' experiences of the COVID-19 pandemic, with an emphasis on the rural hospital-base hospital interface. METHODS: Seventeen semi-structured interviews were conducted with rural hospital doctors across New Zealand. A thematic analysis using a framework-guided rapid analysis method was undertaken. RESULTS: The regular communication channels and processes linking rural hospitals to their urban base hospitals were disrupted as the pandemic began. Established local leadership facilitated a rural hospital's ability to make an effective local response. District health board (DHB) support for their rural hospitals varied widely and largely reflected the status of the pre-pandemic relationship. DHB understanding of rural hospital facilities and processes was considered to be poor. Ongoing uncertainty around managing and transferring acutely unwell patients with COVID-19 remained. Equity concerns centred on access to advanced care. CONCLUSION: The experience of the COVID-19 pandemic has highlighted the resilience of rural hospitals as well as the challenges they face in operating at the margins of the healthcare system.


Assuntos
COVID-19/terapia , Hospitais Rurais , Serviços de Saúde Rural , Atitude do Pessoal de Saúde , Humanos , Entrevistas como Assunto , Nova Zelândia , Médicos
12.
J Prim Health Care ; 13(1): 84-90, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33785115

RESUMO

BACKGROUND AND CONTEXT Rural health services without an onsite laboratory lack timely access to haematology results. Set in New Zealand's far north, this paper provides a rural nursing perspective on how a health service remote from a laboratory introduced a haematology analyser suitable for point-of-care use and established the associated quality assurance programme. ASSESSMENT OF PROBLEM Five broad areas were identified that could impact on successful implementation of the haematology analyser: quality control, staff training, physical resources, costs, and human resource requirements. RESULTS Quality control testing, staff training and operating the haematology analyser was more time intensive than anticipated. Finding adequate physical space for placement and operation of the analyser was challenging and costs per patient tests were higher than predicted due to low volumes of testing. STRATEGIES FOR IMPROVEMENT Through a collaborative team approach, a modified quality assurance programme was agreed on with the supplier and regional point-of-care testing co-ordinator, resulting in a reduced cost per test. The supplier provided dedicated hours of staff training. Allocated time was assigned to run point-of-care testing quality assurance. LESSONS Having access to laboratory tests can reduce inequalities for rural patients, but natural enthusiasm to introduce new point-of-care technologies and devices needs to be tempered by a thorough consideration of the realities on the ground. Quality assurance programmes need to fit the locality while being overseen and supported by laboratory staff knowledgeable in point-of-care testing requirements. Associated costs need to be sustainable in both human and physical resources.


Assuntos
Hematologia , Serviços de Saúde Rural , Enfermagem Rural , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , População Rural
13.
N Z Med J ; 134(1529): 57-68, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33582708

RESUMO

AIMS: The Rural Hospital Medicine Training Programme (RHMTP) was established in 2008 to develop New Zealand's rural hospital medical workforce. This study evaluates the RHMTP's first 10-year outcomes. METHODS: A mixed-methods descriptive study. Database interrogation of: the Royal New Zealand College of General Practitioners records; University of Otago's e-Vision; the Medical Council of New Zealand's register of doctors. A survey of trainees who had graduated or withdrew from the programme. Survey questions included: current scope and place of employment; undergraduate rural experience; and trainee experiences. RESULTS: From 2009-2018, 98 doctors entered the RHMTP: 29 graduated, 20 withdrew and 49 are active registrars. Of the graduates, more than half (17/29) also completed GP training. Overall survey response rate: 80% (39/49). Graduate response rate: 97% (28/29). 92% (24/26) of currently practising graduates are working in rural New Zealand, mostly (22/24) in rural hospitals. Trainees value the RHMTP's flexibility and breadth of clinical exposure. The main challenges relate to a lack of alignment of training requirements and funding. CONCLUSIONS: In its first decade, the RHMTP has been successful in generating a rural hospital workforce and the programme is steadily growing. Attention to existing barriers is needed to ensure the RHMTP can reach its potential to benefit all of New Zealand's rural communities.


Assuntos
Atitude do Pessoal de Saúde , Medicina Geral/educação , Clínicos Gerais/provisão & distribuição , Hospitais Rurais , Adulto , Escolha da Profissão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Avaliação de Programas e Projetos de Saúde , Saúde da População Rural , Inquéritos e Questionários , Recursos Humanos
16.
N Z Med J ; 133(1509): 39-46, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32027637

RESUMO

AIM: Hokianga Health in New Zealand's far north is an established health service with a small rural hospital, serving a largely Maori community. The aim of this study was to gain insights into the wider roles of one rural hospital from the perspective of its staff. METHOD: Eleven face-to-face semi-structured interviews were conducted with employees of Hokianga Health, eight with past and current medical practitioners, three with senior non-medical staff. Interviews were recorded and transcribed. Thematic analysis of the interviews was undertaken using the Framework Method. RESULTS: Four main themes were identified: 'Our Context', emphasising geographical isolation; 'Continuity of Care', illustrating the role of the hospital across the primary-secondary interface; 'Navigation' of health services within and beyond Hokianga; and the concept of hospital as 'Home'. CONCLUSION: Findings highlight the importance of geographically appropriate, as well as culturally appropriate, health services. A hospital as part of a rural health service can enhance comprehensive and continuous care for a rural community. Study findings suggest rural hospitals should be viewed and valued as their own distinct entity rather than small-scale versions of larger urban hospitals.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Rurais , Serviços de Saúde Rural , Continuidade da Assistência ao Paciente , Atenção à Saúde , Acessibilidade aos Serviços de Saúde , Hospitais Comunitários , Humanos , Nova Zelândia , Navegação de Pacientes , População Rural
17.
Rural Remote Health ; 19(4): 5442, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31782988

RESUMO

INTRODUCTION: In 2008, the Medical Council of New Zealand recognised rural hospital medicine as a vocational scope of practice. The aim was to provide training and professional development standards for medical practitioners working in New Zealand's rural hospitals and to encourage quality systems to become established in rural hospitals. Hokianga Health in New Zealand's far north is an established integrated health service that includes a rural hospital and serves a largely Māori community. The aim of this study was to explore how the new scope had affected health practitioners and the health service at Hokianga Health. METHODS: A case study design was used, employing qualitative methods. Documentary analysis was undertaken tracking change and development at Hokianga Health. Twenty-six documents (10 from within and 16 from outside Hokianga Health) were included in the analysis. Eleven face-to-face semi-structured interviews were conducted with employees of Hokianga Health. The interviews explored participants' views of the rural hospital medicine scope. Interviews were recorded and transcribed. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately. RESULTS: Four themes capturing the main issues were identified: (1) 'What I do': articulating the scope of medical practice at Hokianga, (2) 'What we do': the role of the hospital at Hokianga, (3) 'On the fringes', and (4) Survival. With changing regulatory policy an established part of Hokianga Health practice, the hospital aspect was outside the scope of general practice. This mismatch created a vulnerability for individual doctors and threatened the hospital service. The new scope filled the gap, rural hospital medicine together with general practice now covering the whole practice scope at Hokianga Health. With the introduction of the rural hospital medicine scope and the accompanying national definition of a rural hospital came a sense of belonging and increased connectedness, Hokianga Health and its practitioners realigning with the new scope, its policies, processes and language. The new scope brought for the first time a specific focus on the inpatient and emergency care aspects of practice at Hokianga and with this validation of the hospital aspect of the medical practitioners work. The critical importance of a fit-for-purpose scope and rural-specific postgraduate training programs in minimising inequity of care and opportunity for rural communities was emphasised. The importance of benchmarking with its associated costs was also highlighted. The main challenges identified related to the real (as well as potential) increased regulatory requirements of two separate scopes of practice for practitioners and a small rural health service working across primary and secondary care. CONCLUSION: In better equipping medical practitioners for rural hospital work and strengthening hospital systems and standards, the rural hospital medicine scope has met its intentions at Hokianga Health. The rural hospital medicine pathway is a necessary partial solution to rural medical practitioners maintaining a broad skill set. Continued flexibility is required in training programs in order to meet a range of different practitioner and rural health service needs.


Assuntos
Medicina Geral/economia , Medicina Geral/normas , Hospitais Comunitários/normas , Estudos de Casos Organizacionais/estatística & dados numéricos , Atenção Primária à Saúde/normas , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Humanos , Nova Zelândia , Guias de Prática Clínica como Assunto
18.
Can J Rural Med ; 24(4): 109-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31552867

RESUMO

INTRODUCTION: Measuring the diameter of the inferior vena cava (IVC) or the height of the jugular venous pressure (JVP) with point-of-care ultrasound (POCUS) is a practical alternative method for estimating a patient's intravascular volume in the rural setting. This study aims to determine whether or not POCUS of the IVC or JVP generates additional useful clinical information over and above routine physical examination in this context. METHODS: Twenty generalist physicians, working in five New Zealand rural hospitals, recorded their estimation of a patient's intravascular volume based on physical examination and then again after performing POCUS of the IVC or JVP, using a visual scale from 1 to 11. RESULTS: Data were available for 150 assessments. There was an only moderate agreement between the pre- and post-test findings (Spearman's correlation coefficient = 0.46). In 28% (42/150) of cases, the difference was four or more points on the scale, and therefore, had the potential to be clinically significant. CONCLUSION: In the rural context, POCUS provides new information that frequently alters the clinician's estimation of a patient's intravascular volume.


Résumé Introduction: La mesure du diamètre de la veine cave inférieure ou de la hauteur de la pression veineuse jugulaire à l'aide de l'échographie au point de service est une méthode pratique pour estimer le volume intravasculaire d'un patient en région rurale. Cette étude vise à déterminer si oui ou non l'échographie au point de service de la veine cave inférieure ou de la pression veineuse jugulaire génère un surcroît d'information clinique utile par rapport à l'examen physique de routine dans ce contexte. Méthodologie: Vingt médecins généralistes de 5 hôpitaux des régions rurales de la Nouvelle-Zélande ont noté sur une échelle visuelle de 1 à 11 leur estimation du volume intravasculaire des patients basée sur l'examen physique, puis après une échographie au point de service de la veine cave inférieure ou de la pression veineuse jugulaire. Résultats: Des données se rapportant à 150 évaluations étaient disponibles. La concordance entre les résultats d'avant le test et d'après le test n'était que modérée (coefficient de corrélation de Spearman = 0,46). Dans 28 % (42/150) des cas, la différence était de quatre points ou plus sur l'échelle et avait donc le potentiel d'être cliniquement significative. Conclusion: En contexte rural, l'échographie au point de service fournit de nouveaux renseignements qui altèrent fréquemment l'estimation du volume intravasculaire par le clinicien. Mots-clés: Échographie, évaluation du volume, point de service, rural, veine cave inférieure.


Assuntos
Volume Sanguíneo , Veias Jugulares/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desidratação/diagnóstico por imagem , Feminino , Clínicos Gerais , Insuficiência Cardíaca/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hospitais Rurais , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Sepse/diagnóstico por imagem , Adulto Jovem
19.
Rural Remote Health ; 19(3): 5027, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31401838

RESUMO

INTRODUCTION: Point-of-care ultrasound (POCUS) has the potential to improve access to diagnostic imaging for rural communities. This article evaluates the sensitivity and specificity, impact on patient care, quality and safety of two common POCUS examinations - focused assessment with sonography in trauma (FAST) and aortic aneurysm (AAA) - in the rural context. METHODS: This study is a subgroup analysis of a larger study into POCUS in rural New Zealand. Twenty-eight physicians in six New Zealand rural hospitals, with limited access to formal diagnostic imaging, completed a questionnaire before and after POCUS scans to assess the extent to which it altered diagnostic certainty and patient disposition (discharge v admission to rural hospital v transfer to urban hospital). The investigators and a specialist panel reviewed images for technical quality and accuracy of interpretation, and patient clinical records, to determine accuracy of the POCUS findings and their impact on patient care. RESULTS: For FAST and AAA scans respectively, sensitivities were 75% and 100%, and specificities 100% and 93%; rural doctors correctly interpreted their POCUS images for 97% and 91% of scans. The proportions of scans that had either a 'significant' or 'major' impact on patient care were 17% and 31%. POCUS resulted in the disposition being de-escalated for 15% and 10% of patients and escalated for 5% and 3% of patients. CONCLUSIONS: In the rural context, POCUS AAA is a reliable 'rule out' test for ruptured abdominal aortic aneurysm and FAST scan has a role as a 'rule in' test for solid organ injury. These findings are consistent with larger studies in the emergency medicine literature.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Serviço Hospitalar de Emergência/organização & administração , Avaliação Sonográfica Focada no Trauma/métodos , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Avaliação Sonográfica Focada no Trauma/estatística & dados numéricos , Humanos , Masculino , Nova Zelândia , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural
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