Nasal high flow therapy in remote hospitals: guideline development using a modified Delphi technique.

INTRODUCTION: In remote Australian hospitals there are no onsite paediatric intensive care units (PICUs), increasing the reliance on aeromedical retrieval to access tertiary care. Nasal high flow (NHF) therapy is an oxygen therapy used in tertiary hospitals to treat paediatric patients with respiratory conditions. In rural and remote Queensland, Australia, the use of NHF therapy is inconsistent and there are no guidelines on how this therapy should be implemented in practice. Therefore, three remote hospitals within the Torres Strait and Cape York commenced a project to improve consistent and equitable access to NHF therapy. Implementing NHF therapy in remote hospitals may improve health and social outcomes for children with acute respiratory distress. A clinical guideline for the use of NHF therapy in the three participating remote hospitals was published on 28 October 2021. This study aimed to develop a clinical guideline for the use of NHF therapy in three remote hospitals. METHODS: A modified Delphi technique was used to develop the guideline. Remote medicine and nursing clinicians at the three study sites, retrieval experts, a receiving tertiary-based paediatrician, PICU specialists and NHF therapy experts made up the expert panel of participants. These experts participated in an iterative round table discussion to develop remote-specific guidelines for the use of NHF therapy. Prior to the meeting, panellists were provided with an executive summary of the current literature on NHF therapy implementation with key questions for consideration. Participants were able to add relevant issues ad hoc. A final guideline representing the panellists' recommendations was submitted to the Torres and Cape Health Service for ratification. RESULTS: Remote-specific decisions on the following topics were produced: environment of care, nasogastric tube usage, timings of chest X-ray, automatic approvals to arrange courier services for pathology, medication use, staff training; staff ratios, observations regimes, both tertiary and local medical consultation frequency and the experience level of the medical officer required to attend to these consultations, location of the on-call medical officer, documentation, escalation of care considerations and disposition of the patient in relation to retrievals. DISCUSSION: Decisions were made to mitigate two highly representative remote factors: delays in the workplace practices, such as time to arrange treatment locally and delays in retrievals; and burden of the lack of access to services, such as lack of access to trained staff, staffing levels on-shift, adequate oxygen and equipment/consumable supplies. CONCLUSION: The aim was to develop a clinical guideline that was contextualised to the remote hospital. This outcome was achieved by using a modified Delphi technique, with a panel of experts providing the decision-making for the guideline. Consistency and safety were addressed by reducing delays in workplace practices; examples were time to arrange treatment locally and mitigate delays in an unknown time to retrievals, access to trained staff, staffing levels, and communication between remote and tertiary teams.

Healthy ageing in remote Cape York: a co-designed Integrated Allied Health Service Model.

Allied health services in rural and remote hospitals often work in siloed and solo discipline-specific positions. They are often part of general multi-disciplinary teams without a clearly articulated service model that integrates care for individuals and addresses broader community health needs. Integrated care service models for clients with complex disabilities or chronic health needs have demonstrated improved outcomes, but feasible service models are rarely described in the context of rural, remote and Aboriginal and Torres Strait Islander communities. Integration can support primary health care in remote communities where resources are thin, and the breadth of multidisciplinary service providers is not available. A remote health service, in collaboration with a University Department of Rural Health and community partners, developed a community rehabilitation and lifestyle service for adults who experience chronic disease, disability or were at risk of functional decline due to frailty. Using an integrated approach, this model of care improves access to specialist and primary healthcare services, delivers targeted group-based rehabilitation and preventative activities, and addresses community and workforce capacity to meet the needs of the remote community. This paper describes a remote primary health care, Integrated Allied Health Service Model, developed with a focus on the co-ordination and integration of care and resources between the health service, education and community.

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review.

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

Pharmacy practice and First Peoples health equity: a scoping review protocol.

OBJECTIVE: The objective of this review is to examine and describe global pharmacy practice strategies and interventions designed to achieve health equity for First Peoples. INTRODUCTION: Access to medicines and quality use of medicines is critical to achieving health equity for First Peoples. Pharmacists are uniquely placed to lead the charge in transforming current health systems, reducing health disparities, and bolstering the movement toward health equity. INCLUSION CRITERIA: Global studies describing pharmacy practice strategies and interventions designed to achieve health equity for First Peoples will be considered for inclusion in the review. Studies relating to all areas of pharmacy practice, including community and clinical pharmacy, social, administrative, pharmaceutical sciences, practice, teaching, research, advocacy, or service relevant to the review's objective will also be considered for inclusion. The types of studies to be included are qualitative, quantitative, and mixed methods systematic reviews, scoping reviews, literature reviews, and gray literature. METHODS: This review will be conducted in accordance with JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, CINAHL, and gray literature sources will be searched from 1998 to the present. Titles, abstracts, and full texts will be screened against the inclusion criteria. Strategies and interventions identified in the included reviews will be mapped to a published framework, outlining actionable strategies for pharmacy practice inclusion in sustainable efforts to achieve health equity. Qualitative content analysis and descriptive statistics will be utilized with data presented in tables, accompanied by a narrative. REVIEW REGISTRATION: Open Science Framework osf.io/qa64b.

Pharmacist-Led Interventions for Medication Adherence in Patients with Chronic Kidney Disease: A Scoping Review.

BACKGROUND: Patients with chronic kidney disease (CKD) are routinely prescribed complex medication regimes. Medication reconciliation, medicine reviews, patient counselling and disease state and medication education are all key pharmacist-led interventions, which can improve medication adherence in patients with CKD. AIM: To characterize peer reviewed literature on the role of pharmacists in supporting medication adherence of patients with chronic kidney disease and highlight the impact they might have in the health outcomes for patients. METHOD: This review was performed in accordance with the Scoping Review Framework outlined in the Joanna Briggs Institute Reviewer's Guide. Four electronic databases were searched (Medline (Ovid), Emcare, Scopus and Web of Science) for all relevant literature published up until November 2022. A total of 32 studies were reviewed against an exclusion and inclusion criteria, with findings from each study categorized into barriers, interventions, perceptions, financial implications and outcomes. RESULTS: Eight eligible studies were identified, where pharmacists' interventions including medication reconciliation, medicine reviews, patient counselling and disease state and medication education, were all reported to have a positive effect on medication adherence. Although pharmacy services in chronic kidney disease were acceptable to patients and pharmacists, these services were under-utilized and limited by logistical constraints, including staffing shortages and time limitations. Patient education supplemented with education tools describing disease states and medications was reported to increase patient adherence to medication regimes. CONCLUSIONS: Pharmacist-led interventions play an integral role in improving medication adherence in patients with chronic kidney disease, with their inclusion in renal care settings having the potential to improve outcomes for patients.

Cape York Kidney Care: service description and baseline characteristics of a client-centred multidisciplinary specialist kidney health service in remote Australia.

BACKGROUND: Chronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures. METHODS: The model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1-5. This data has been de-identified and aggregated. RESULTS: CYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities. CONCLUSION: The CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.

Impact of the COVID-19 pandemic on primary care delivery in a remote Aboriginal community.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the delivery of primary health care internationally, particularly for the most marginalised groups. This project investigated the impact of the initial response to the COVID-19 pandemic on the delivery of primary health care in a remote First Nations community in Far North Queensland with a high chronic disease burden. There were no confirmed cases of COVID-19 circulating in the community at the time of the study. A comparison was conducted of patient numbers presenting to a local primary healthcare centre (PHCC) in the periods before, during and after the initial peak of Australian COVID-19 restrictions in 2020, compared to the same period in 2019. A significant proportional decrease was observed in the number of patients that presented from the target community during the initial restrictions. A sub-analysis of preventative services delivered to a defined high-risk group found that services delivered did not decrease to this particular group during the periods of interest. This study has highlighted that there is a risk of underutilisation of primary healthcare services during a health pandemic in remote settings. Strengthening the primary care system to adequately provide ongoing services during natural disasters requires further consideration to reduce the risk of long-term impacts of service disengagement.

Different meanings what we want in our lives a qualitative exploration of the experience of Aboriginal and/or Torres Strait Islander peoples in a co-designed community rehabilitation service.

PURPOSE: Promoting positive psychological, social and functional health outcomes for Aboriginal and Torres Strait Islander people requires health services to be culturally safe, respecting culture as central to the individuals and their communities. This study explored the experience of Aboriginal and Torres Strait Islander people, participating in a co-designed student-assisted community rehabilitation service in a remote Aboriginal community in Far North Queensland. MATERIALS AND METHODS: Observation, informal yarning and semi-structured interviews with older Aboriginal and Torres Strait Islander people (n = 6) engaged in the service was conducted over a 7 week period. Interpretive phenomenological analysis was applied through inductive thematic analysis. RESULTS: Four themes illustrated that experiences within the program promoted: A connection to people, both within the program and those significant in people's lives; a connection to past experiences, roles and events; a connection to the future of cultural knowledge; and a sense of achievement and fun. Participants shared their unique stories on their positive experience of the culturally responsive approach in the activities. CONCLUSIONS: These results suggest that knowledge translation and reciprocity provide a strong foundation for rehabilitation programs that support healthy ageing for Aboriginal and Torres Strait Islander people and encourage active and ongoing individual and community involvement.

Listening to and following the needs and wishes of Aboriginal and Torres Strait Islander rehabilitation participants, promotes the delivery of a service that is culturally and personally meaningful.Promoting two-way learning between participants and the people delivering the service promotes engagement with the service, reduces traditional power dynamics and increases the importance and meaning of the service for participants.Elevating cultural respect as an essential element of a rehabilitation service promotes service delivery that supports cultural relevance and safety.

Feasibility, accessibility and acceptability a pharmacist-led ear health intervention at rural community pharmacies (LISTEN UP): a mixed-methods study in Queensland, Australia.

OBJECTIVE: Ear disease in rural and remote communities is occurring at high rates, with limited access to health services and health providers contributing to the problem. Community pharmacists are well-placed to provide expanded services to improve ear health in rural communities. We aimed to evaluate the feasibility, accessibility and acceptability of a pharmacist-led intervention for ear disease in consumers presenting to community pharmacy. DESIGN: Prospective preintervention and postintervention mixed-methods study. An ethnographic lens of rural culture was applied to the descriptive qualitative component of the study. SETTING: Two rural community pharmacies in Queensland, Australia. PARTICIPANTS: People aged 6 months or older, who present with an ear complaint to a participating community pharmacy. INTERVENTION: LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme) is a community pharmacy-based intervention to improve the management of ear health. Trained pharmacists conducted ear examinations using otoscopy and tympanometry on consumers following a LISTEN UP protocol. They made recommendations including no treatment, pharmacy only products or general practitioner (GP) referral. Consumers were contacted 7 days later for follow-up. RESULTS: 55 rural consumers participated in the study. The most commonly reported complaints were 'blocked ear' and 'ear pain'. Pharmacists recommended over-the-counter products to two-thirds of the participants and referred one quarter to a GP. 90% (50/55) of the consumers were highly satisfied with the service and would recommend the service. All consumers described the service positively with particular reference to convenience, improved confidence and appreciation of the knowledge gained about their ear complaint. Pharmacists were motivated to upskill and manage workflow to incorporate the service and expected both consumers and GPs to be more accepting of future expanded services as a result of LISTEN UP. However, without funding to provide the service, during the study other remunerated pharmacy tasks took priority over providing LISTEN UP. CONCLUSION: Rural community pharmacists can provide an acceptable and accessible ear health service; however, it is not feasible without a clear funding structure to provide resources including additional pharmacists, equipment and training. TRIAL REGISTRATION NUMBER: ACTRN12620001297910.

Expanded Pharmacy Practice Implementation: Lessons from Remote Practice.

AIM: The aim of this study is to explore pharmacist perspectives of the implementation of a community pharmacy-based ear health service in rural communities. METHOD: A community pharmacy-based health service model was designed and developed to provide an accessible ear care service (LISTEN UP-Locally Integrated Screening and Testing Ear aNd aUral Program) and pharmacist's perspectives of the implementation of LISTEN UP were explored. Thematic analysis was conducted and data coded according to the Consolidated Framework for Implementation Research. RESULTS: A total of 20 interviews were conducted with 10 pharmacists, averaging 30 min. Visualistion of the ear canal was reported as the greatest advantage of the service, whilst the time required for documentation reported as a complexity. The number of pharmacists working at one time and the availability of a private consultation room were identified as the two limiting factors for execution. On reflection, the need for government funding for service viability and sustainability was highlighted. DISCUSSION/CONCLUSION: Expanded pharmacy practice is emerging for the Australian pharmacy profession. Rural community pharmacists are recognised as integral members of healthcare teams, providing accessible medication supply and health advice to seven million people in Australia who call rural and remote regions home. However, there are no structured models supporting them to provide expanded services to improve health outcomes in their communities. This study provides lessons learnt to guide future design and development of expanded models of pharmacy practice.

Developing a community rehabilitation and lifestyle service for a remote indigenous community.

PURPOSE: Community rehabilitation is an essential health service that is often not available to remote Australians. This paper describes the first cycle of a collaborative project, between local community members, allied health professionals and a university, to co-design a community rehabilitation and lifestyle service to support adults and older people to stay strong and age well in place. METHODS: An action research framework was used to develop the service for adults in two remote communities, one being a discrete Aboriginal community. The first cycle involved planning for, and trialling of a service, with observations, reflections and feedback from clients, community members, university students and health service providers, to inform the subsequent service. RESULTS: Over two years, stakeholders worked collaboratively to plan, trial, reflect and replan an allied health student-assisted community rehabilitation service. The trial identified the need for dedicated clinical and cultural supervision. During replanning, three key elements for culturally responsive care were embedded into the service: reciprocity and yarning; holistic community-wide service; and Aboriginal and Torres Strait Islander mentorship. CONCLUSIONS: An action-research approach to co-design has led to the establishment of a unique community rehabilitation service to address disability and rehabilitation needs in two remote Australian communities.Implications for rehabilitationCo-design of community rehabilitation services between Aboriginal and Torres Strait Islander community members and the local allied health professionals can lead to development of an innovative service model for remote Aboriginal communities.Culturally responsive community rehabilitation services in Aboriginal and Torres Strait Islander communities requires holistic and community-wide perspectives of wellbeing.Incorporating Aboriginal and Torres Strait Islander ways of engaging and communicating, and leadership and mentorship for non-Indigenous allied health professionals and students are essential components for students-assisted culturally responsive services.

Expanded practice for rural community pharmacy: what are we waiting for?

OBJECTIVE: To synthesise stakeholder (consumer, pharmacist and health professional) perspectives of expanded pharmacy practice in rural and remote community pharmacy. METHODS: Comparison of perspectives of stakeholder groups identified by four studies has highlighted the expected outcomes and anticipated barriers to expanded pharmacy practice. Aligning the studies has identified priority areas of health for which pharmacists may be able to provide expanded service delivery. KEY FINDINGS: Expanded pharmacy services are supported by consumers, pharmacists and health professionals and are expected to improve health outcomes for rural and remote populations. Barriers will need to be overcome for expanded services to be sustainable in the future. CONCLUSION: The pharmacy profession will need to undertake a paradigm shift to professional practice and work towards this should begin to reduce the health inequality for rural populations.

Community pharmacist interventions in ear health: a scoping review.

BACKGROUND: In Australia, around 3.6 million people suffer from hearing loss, more than 1.3 million with preventable hearing conditions. Ear diseases are prevalent in Indigenous populations, particularly children and are associated with poor educational outcomes and subsequent high rates of unemployment and incarceration. In Australia, rural and remote communities have rates of middle ear perforations five times the rate that the World Health Organisation regards to be a significant public health problem.Barriers to accessing ear health services have been identified including gaps in testing during the 'early years' and difficulty in accessing these services. Reducing the risk of hearing loss through improved ear health care can directly impact the ability to learn and develop. Collaboration between community, health providers and government is crucial to ensure necessary support for change. An opportunity presents for rural community pharmacists, who are both qualified and accessible to provide an ear health programme and thus improve health outcomes for both Indigenous and non-Indigenous Australians in their communities. AIM: The aim of this study was to identify published evidence of pharmacists' involvement in ear health care interventions to inform the development of ear health services able to be delivered in rural community pharmacy in Australia. DATA SOURCES: The search strategy was applied to the following electronic databases: MEDLINE, Scopus, CINAHL, Emcare, Cochrane, Google Scholar and Google.Study selection articles were included if they described an ear health intervention in a community pharmacy setting. The interventions reported in the articles were evaluated for their inclusion of effectiveness, whether the service was sustainable, and the inclusion of enablers and barriers to the provision of ear care. The articles were also thematically analysed using the Deadly Ears Deadly Kids Deadly Communities Framework. A total 8427 articles were identified and evaluated against inclusion and exclusion criteria, with eleven eligible articles suitable for inclusion in the review. The articles included were conducted in Australia (n = 4), England (n = 4), United States of America (n = 2) and Brazil (n = 1). The ear health interventions identified included hearing screening (n = 3), otoscopy pilot studies (n = 2), audiometry services (n = 1), specific education for undergraduate pharmacy students (n = 2) and a pharmacy-based clinic (n = 3). Effectiveness and sustainability were not formally reported in any of the included articles. Positive outcomes, funding availability, consumer access to community pharmacy, cost savings for consumers and improved connection to health providers were identified as enablers. Difficulty in attracting funding was the most commonly reported barrier. CONCLUSIONS: Improving ear health of both Indigenous and non-Indigenous peoples through services provided in community pharmacy presents as an important opportunity for rural pharmacists. Pharmacists are accessible and thus well placed to improve ear healthcare and resultant quality of life for these vulnerable populations. This review has identified factors required to effectively develop ear health models of care in community pharmacy including a pharmacist training program, continuous funding to ensure sustainability and support from pharmacy stakeholders and the community.

Developing an Ear Health Intervention for Rural Community Pharmacy: Application of the PRECEDE-PROCEED Model.

Unaddressed hearing loss affects an estimated 466 million people worldwide, costing over $750 billion globally, with rural communities being particularly disadvantaged, due to the greater inequity in access to healthcare services. This mixed-methods study aimed to use the PRECEDE-PROCEED model to develop and pilot a rural community pharmacy-based ear health service, LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Program). The PRECEDE process involved an assessment of the predisposing, reinforcing and enabling constructs to support practice change through a scoping review, stakeholder surveys and interviews and consultation with governing bodies and regulatory authorities. The PROCEED segment structured the evaluation of the service pilot and informed planned implementation, process, impact and outcome evaluation. The pilot study conducted in February 2021 included 20 participants, with the most common ear complaints presented being pain, pressure or blockage. All these participants reported high levels of satisfaction with the service, would recommend the service to others and would attend the pharmacy first before seeing a GP for future ear complaints. The PRECEDE-PROCEED model provides a comprehensive model to guide the design of the LISTEN UP program, an innovative model, expanding services offered by rural community pharmacies, with preliminary results demonstrating high consumer satisfaction.

Expanded practice in rural community pharmacy: a macro-, meso and micro-level perspective.

INTRODUCTION: Expanding community pharmacists' scope of practice, in rural and remote locations has the potential to improve access to health care and health outcomes. Internationally, a lack of support from other health professionals (HPs) has presented a barrier to the uptake of expanded pharmacy models. Rural allied health workers, including pharmacists, however, already work across an extended scope using generalist and specialist skills to meet unique community needs with limited infrastructure for support. Limited data on expanded practice from Australia prompted this study to explore Australian rural and remote doctor, nurse and allied health perspectives of expanded pharmacy services in non-metropolitan settings. METHODS: An ethnographic lens of rural culture was applied to this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with HPs working in rural and remote locations in Australia. Inductive and deductive thematic analysis was guided by a multi-level lens of macro- (policy level), meso- (HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided strategies to align to the theoretical framework for the analysis. RESULTS: Twenty-three rural and remote HPs (doctors (8), nurses (4), allied HPs (11)) participated. Key themes identified included supportive government and funding provisions (macro); collaboration with other health providers (meso); ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place (meso); pharmacists' capacity, including time and space (meso); and opportunity to empower and engage consumers through rural community pharmacies (micro). CONCLUSION: As pharmacists internationally continue to develop their expanded scope of practice, these results provide the first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators for pharmacists' expanded practice are highlighted. Engagement of both government and rural health providers is seen as crucial for expanded models of pharmacy practice to evolve to deliver improved health outcomes for rural and remote communities.

LISTEN UP (Locally Integrated Screening and Testing Ear aNd aUral Programme): a feasibility study protocol for a community pharmacy-based ear health intervention.

BACKGROUND: Ear disease is a major cause of preventable hearing loss and is very common in rural communities, estimated to affect 1.3 million Australians. Rural community pharmacists are well placed to provide improved ear health care to people who are unable to easily access a general practitioner (GP). The purpose of this study is to apply an ear health intervention to the rural community-pharmacy setting in Queensland, Australia, to improve the management of ear disease. The aims are the following: (1) to evaluate the feasibility, potential effectiveness and acceptability of a community pharmacy-based intervention for ear health, (2) to evaluate the use of otoscopy and tympanometry by pharmacists in managing ear complaints in community pharmacy and (3) to evaluate the extended role of rural pharmacists in managing ear complaints, with the potential to expand nationally to improve minor ailment management in rural communities. METHODS/DESIGN: This is a longitudinal pre- and post-test study of a community-pharmacy-based intervention with a single cohort of up to 200 patients from two rural community pharmacies. Usual care practices pertaining to the management of ear complaints will be recorded prior to the intervention for 8 weeks. The intervention will then be piloted for 6 weeks, followed by a 12 month impact study. Patients aged > 13 years presenting to the pharmacies with an ear complaint will be invited to participate. Trained pharmacists will conduct an examination including a brief history, hearing screening, otoscopy and tympanometry assessments. Patients will be referred to a general practitioner (GP) if required, according to the study protocol. Patients will complete a satisfaction survey and receive a follow-up phone call at 7 days to explore outcomes including prescribed medications and referrals. Pharmacists and GPs will complete pre- and post- intervention interviews. Patient, pharmacist and GP data will be analysed using descriptive statistics and thematic analysis for the qualitative data. DISCUSSION: This study will demonstrate the implementation of a screening and referring ear health intervention in rural community pharmacy. Feasibility, potential effectiveness and acceptability of the intervention will be assessed. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry Number: ACTRN12620001297910 .

Rural pharmacists and stakeholders perspectives of expanded pharmacy practice: A descriptive study.

OBJECTIVE: To explore pharmacist and stakeholder perspectives of pharmacists providing expanded services in rural community pharmacies. DESIGN: A descriptive qualitative study with an ethnographic lens of rural culture collected data via in-depth semi-structured interviews with stakeholder representatives and rural and remote pharmacists. SETTING: Regional, rural and remote practice settings as defined by the Modified Monash Model MM3-MM7. PARTICIPANTS: Twelve rural or remote pharmacists and eight stakeholder representatives from various government and professional organisations participated in the study. MAIN OUTCOME MEASURE: Macro-, meso- and micro-level perspectives of pharmacists providing expanded pharmacy services in rural community pharmacies. RESULT: At the macro-level, both pharmacists and stakeholders agreed that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. The meso-level revealed that pharmacist participants expected expanded practice to improve rural pharmacist recruitment and retention through improved professional satisfaction. The importance of effective collaboration and coordination with other health care providers in a community was described by pharmacists and stakeholders to ensure success of expanded services. All participants agreed that sustainability of these services relied on appropriate remuneration. At the micro-level, expanded pharmacy services are expected to save consumers' time and money as patients are redirected into appropriate health care settings. CONCLUSION: Enablers and barriers across policy, health professional, consumer and community levels need to be addressed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

Consumer perspectives of expanded practice in rural community pharmacy.

BACKGROUND: People living in rural and remote regions have mortality and morbidity rates worse than their counterparts in metropolitan cities. Distance to access healthcare and limited access to health professionals highlights the need for expanded pharmacy services to address the health disparity facing rural and remote Australia. OBJECTIVES: Examining consumers' perspective of expanded pharmacy services with a view to improving the health of their local community is a focus of the study. METHODS: A questionnaire was provided to 20 rural and remote community pharmacies across Australia, to be administered to pharmacy consumers during July-September 2019. The questionnaire involved consumers choosing expanded services that they would like to see provided by their local pharmacy. The data were manually entered, exported into IBM SPSS Statistic 25 and summarised using descriptive statistics. RESULTS: 406 consumers from rural and remote locations completed the questionnaire. Vaccinations, chronic disease management and mental health services represented eight out of the ten most frequently chosen services. Over 95% of respondents agreed or strongly agreed that they would support the expanded services and that pharmacists have the required skills and knowledge to deliver these services. Findings indicated that the remote and very remote participants chose all of the 26 services more frequently than those in large and medium towns. Age also significantly influenced the frequency of choosing particular services, including osteoporosis testing, vision and eye checks, counselling services, swallowing checks, diet checks and breastfeeding advice and support. CONCLUSION: This study demonstrates that consumers believe that the health of the people in their community will improve with the provision of expanded services. These preliminary findings provide useful baseline information suggesting the development of expanded pharmacy services in rural and remote communities is likely to be well accepted by consumers.