Understanding rural pharmacists' perspectives: lived experiences and insights associated with rural recruitment and retention.

INTRODUCTION: Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities. METHODS: The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention. RESULTS: The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns. DISCUSSION: The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities also require innovative approaches to address concerns among potential candidates. Lastly, efforts to enable and support social connections such as schooling and spousal employment, while building community connection and a sense of rural community belonging, remain essential to recruit and retain pharmacists. CONCLUSION: Rural pharmacist recruitment and retention is complex, requiring a multi-pronged approach to implement practical solutions. Given this complexity and the unique features of each rural community, solutions require whole-of-community ownership to create innovative solutions. Recognition of specific advantages and challenges can address key driving factors for pharmacist recruitment and retention in rural communities.

Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review.

Objectives: Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods: A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results: Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions: Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.

'Growing your own' a case study of a collaborative training program in medical radiation science.

INTRODUCTION: Two universities run a collaborative Medical Radiation Science program where students undertake study in Tasmania before transferring to a partner university in another state to complete their program. This study assessed rates and predictors of graduate radiographers, radiation therapists and nuclear medicine technologists (collectively classified as medical radiation practitioners according to AHPRA [https://www.medicalradiationpracticeboard.gov.au/About.aspx; ahpra.gov.au/registration/registers] contemporary classification) returning to Tasmania and rural locations to practice. METHODS: A cross-sectional 22-item online survey including open-ended questions was administered via Facebook. Rates of graduates working in Tasmania and rural locations, work satisfaction, and program efficacy were assessed. Logistic regression was used to assess predictors of working in Tasmania and rural locations. RESULTS: 58 Facebook members from a total of 87 program graduates were invited to participate. Of these, 21 responded. Thirteen (62.0%) were currently working in Tasmania, of which the majority practised in regional (MMM2) areas. Most (90.5%) reported that they were happy at work, with all participants reporting the course prepared them well or very well for their first professional jobs. 71.4% stated that the provision of the first 2 years of the course in their home state influenced their decision to study medical radiation science. Being born in a rural region (MMM > 2) was a predictor for working in Tasmania (OR = 3.5) and rural locations (OR = 1.77). Males were twice as likely to work in Tasmania (OR = 2.3) and more rural locations (OR = 2.0). CONCLUSIONS: Collaboration is beneficial in producing professionals in regions with smaller enrolments limit the ability to grow their own graduates independently. Interuniversity collaborative models are recommended for other rural regions to meet local health workforce needs.

COPD in Africa: risk factors, hospitalisation, readmission and associated outcomes-a systematic review and meta-analysis.

BACKGROUND: This review aims to synthesise available evidence on the prevalence of chronic obstructive pulmonary disease (COPD), associated risk factors, hospitalisations and COPD readmissions in Africa. METHOD: Using the Met-Analyses and Systematic Reviews of Observational Studies guideline, electronic databases were searched from inception to 1 October 2021. The quality of studies was assessed using the Newcastle-Ottawa Scale. Evidence from retrieved articles was synthesised, and a random-effect model meta-analysis was conducted. The protocol was registered on PROSPERO. RESULTS: Thirty-nine studies met the inclusion criteria, with 13 included in the meta-analysis. The prevalence of COPD varied between the Global Initiative for Chronic Obstructive Lung Disease (2%-24%), American Thoracic Society/European Respiratory Society (1%-17%) and Medical Research Council chronic bronchitis (2%-11%) criteria, respectively. Increasing age, wheezing and asthma were consistent risk factors for COPD from studies included in the narrative synthesis. Our meta-analysis indicated that prior tuberculosis ((OR 5.98, 95% CI 4.18 to 8.56), smoking (OR 2.80, 95% CI: 2.19 to 3.59) and use of biomass fuel (OR 1.52, 95% CI: 1.39 to 1.67)) were significant risk factors for COPD. Long-term oxygen therapy (HR 4.97, 95% CI (1.04 to 23.74)) and frequent hospitalisation (≥3 per year) (HR 11.48, 95% CI (1.31 to 100.79)) were risk factors associated with 30-day COPD readmission. CONCLUSION: This study not only highlights specific risk factors for COPD risk in Africa but also demonstrates the paucity and absence of research in several countries in a continent with substantial COPD-related mortality. Our findings contribute towards the development of evidence-based clinical guidelines for COPD in Africa.PROSPERO registration numberCRD42020210581.

Sustaining rural pharmacy workforce understanding key attributes for enhanced retention and recruitment.

OBJECTIVE: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. DESIGN: Cross-sectional design involving face-to-face, telephone or video conferencing interviews. SETTING: Twelve rural communities across Tasmania and Western Victoria, Australia. PARTICIPANTS: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. MAIN OUTCOME MEASURES: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. RESULTS: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high- and low-performing communities. Overall, the highest-rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. CONCLUSIONS: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community.

Workplace violence against pharmacists: A systematic review and meta-analysis.

BACKGROUND: The rate of violence against health care workers is increasing worldwide. Pharmacists are the most accessible and frequently visited health care team members and are potentially more susceptible to violence than other health care workers. OBJECTIVE(S): This systematic review and meta-analysis aimed to estimate the magnitude of workplace violence toward pharmacists. METHODS: We comprehensively searched PubMed, Scopus, and Embase from their inception till December 2021 for pertinent studies that reported workplace violence incidents against pharmacists. Rates of workplace violence against pharmacists were calculated in a meta-analysis using a random-effects model. RESULTS: Overall, 624 articles were found, and 6 studies comprising 1896 pharmacists met the criteria for meta-analysis. The pooled estimate of workplace violence was 45% (95% confidence interval [CI]: 30-60%), and 39% (95% CI: 24-55%) experienced violent events over preceding 12 months. Considerable proportion of pharmacists experienced some form of violence (65%, 95% CI: 41-88%), verbal abuse (50%, 95% CI: 36-65%), threats (42%, 95% CI: 26-59%) or assaults (27%, 95% CI: 9-46%). Moreover, 56% (95% CI: 23-89%) of pharmacists reported experiencing physical and/or verbal violence over the previous 12 months. CONCLUSION: The analysis reveals the high rate of workplace violence in the pharmacy environment, with nearly half of pharmacists affected. While more studies are required, the limited evidence suggests the need to ensure safe workspaces in pharmacy environments through implementation of appropriate policies and legislation.

The Pharmacy Community Apgar Questionnaire: a modified Delphi technique to develop a rural pharmacist recruitment and retention tool.

INTRODUCTION: An adequate healthcare workforce remains essential for the health of rural communities. Strategies to address rural health workforce challenges have often centred on the medical and nursing workforce; however, addressing the rural pharmacist workforce also remains critical as they are often the first point of contact for health advice. Initiatives have increased pharmacist supply; however, key issues such as poor attraction, recruitment, and retention to rural areas remain. The aim of this study was to support the recruitment and retention of pharmacists in rural areas of Australia through the development of the Pharmacy Community Apgar Questionnaire (PharmCAQ). METHODS: A modified Delphi technique was employed to develop the PharmCAQ. A panel of experts were purposively selected. Eight representatives were from organisations with rural experience relevant to the study including the Society of Hospital Pharmacists of Australia, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Pharmacy Board of Australia, and a representative of a government health agency, who also leads a hospital pharmacy. Three additional participants included local and international academics with health policy and rural health workforce expertise. All participants participated in three separate focus groups of 45-60 minutes duration, where the review and refinement of factors that drive recruitment and retention of pharmacist were discussed. Face and content validity was achieved through the representatives, while internal consistency was achieved when the tool was piloted among 10 rural pharmacists in rural Victoria. RESULTS: Fifty key factors that impact the recruitment and retention of pharmacists were identified, developed and succinctly described. All factors were grouped into five classifications: (1) geographic, (2) economic and resources, (3) practice and scope of practice, (4) practice environment and (5) community practice support. After final consensus, the factors and their definitions formed the final questionnaire. Lastly, the reliability of PharmCAQ was determined, with a Cronbach's alpha coefficient of 0.852. CONCLUSION: While the development and use of the Apgar questionnaire for the recruitment and retention of health professionals is not a novel idea, seeking to specifically focus on pharmacists is unique. However, 10 factors were similar to factors associated with rural recruitment and retention of both physicians and nurses; they encompassed geographic, community support, and economic and resource factors. Regardless of similarities or differences between health professions in terms of recruitment and retention, as a mechanism for addressing the worsening health professional shortage currently experienced in rural areas, the PharmCAQ was developed to support the recruitment and retention of the pharmacist workforce in rural areas.

Factors that influence pharmacists' efforts in addressing substance use in Nigeria: An exploratory study.

Introduction: Substance use is a major global public health problem. Over the years, the burden of substance use has increased worldwide, with Nigeria having a prevalence that is substantially above the global average. Tackling this challenge requires a collaborative effort between different health professionals. Despite the critical roles pharmacists could play in substance use prevention and management, exploration of pharmacists' role in mitigating substance use in society has received limited attention in most sub-Saharan countries. In this study, we explored the experiences of pharmacists in substance use prevention and management. Methods: We conducted semi-structured interviews to explore pharmacists' perceptions of their roles in the prevention and management of substance use in Nigeria. Following data transcription, we conducted a thematic content analysis. Results: The four major themes that emerged included 1) the extent of pharmacists' involvement in the decision-making process for addressing substance use, 2) factors that influence pharmacists efforts in addressing substance use in Nigeria, 3) how to improve rational prescribing practices and, 4) capacity building to enhance pharmacists participation in addressing substance use. Conclusion: Pharmacists have the opportunity to play critical roles in the prevention and management of substance use, but several individual and systemic challenges limit their full potential. Addressing these challenges is crucial in increasing pharmacists' participation in preventing and managing substance use.

Considerations for Training and Workforce Development to Enhance Rural and Remote Ophthalmology Practise in Australia: A Scoping Review.

Australia has one of the lowest per capita numbers of ophthalmologists among OECD countries, and they predominantly practise in metropolitan centres of the country. Increasing the size and distribution of the ophthalmology workforce is of critical importance. The objective of this review was to investigate the context of rural ophthalmology training and practise in Australia and how they relate to future ophthalmology workforce development. This scoping review was informed by Arksey and O'Malley's framework and the methodology described by Coloqhuon et al. The search yielded 428 articles, of which 261 were screened for eligibility. Following the screening, a total of 75 articles were included in the study. Themes identified relating to rural ophthalmology training and practise included: Indigenous eye health; access and utilisation of ophthalmology-related services; service delivery models for ophthalmic care; ophthalmology workforce demographics; and ophthalmology workforce education and training for rural and remote practise. With an anticipated undersupply and maldistribution of ophthalmologists in the coming decade, efforts to improve training must focus on how to build a sizeable, fit-for-purpose workforce to address eye health needs across Australia. More research focusing on ophthalmology workforce distribution is needed to help identify evidence-based solutions for workforce maldistribution. Several strategies to better prepare the future ophthalmology workforce for rural practise were identified, including incorporating telehealth into ophthalmology training settings; collaborating with other health workers, especially optometrists and specialist nurses in eyecare delivery; and exposing trainees to more patients of Indigenous background.

The Australian pharmacist workforce: distribution and predictors of practising outside of metropolitan and regional areas in 2019.

OBJECTIVE: This study describes the distribution of the Australian pharmacists' workforce using a range of indicators and identifies predictors of practising outside of metropolitan and regional areas. METHODS: A cross-sectional description of the 2019 pharmacy workforce. Pharmacists who completed the 2019 workforce survey as reported in the Australian National Health Workforce Dataset (NHWDS). The main outcome measures were the number of pharmacists per 100 000, the proportion working less than 35 h a week, the proportion with primary qualification from overseas (outside of Australia and New Zealand) and the proportion aged 65 years or older. Additionally, predictors of practising outside of metropolitan and regional areas were also identified. KEY FINDINGS: Nationally, there were 102 pharmacists/100 000 with one-third working less than 35 h a week. About 10% of pharmacists obtained their primary qualification from overseas and 4% were 65 years old or older. Males were more likely to practise outside of metropolitan and regional areas [OR, 1.40 (1.30-1.50); P < 0.001], while younger people were less likely to practise outside of these locations [OR, 0.71 (0.66-0.76); P < 0.001]. Those who had obtained their primary qualification overseas were also more likely to practise outside of metropolitan and regional areas. CONCLUSIONS: Analysis of the 2019 NHWDS suggests an uneven distribution of the pharmacist workforce. Also, three predictors of practising outside of major cities and regional centres were identified.

'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19.

INTRODUCTION: As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE: To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN: Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS: 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION: Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION: Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.

Impact of COVID-19 on rural and remote student placements in Australia: A national study.

OBJECTIVE: To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN: A mixed-method design comprising an online survey and semi-structured interviews. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION: A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES: Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS: While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS: The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.

Public Awareness of Bowel Cancer Risk Factors, Symptoms and Screening in Tasmania, Australia: A Cross-Sectional Study.

Tasmania has one of the highest bowel cancer incidence and death rates in the world. Public awareness of risk factors, symptoms, and early detection of bowel cancer is important for minimising the burden of disease. This study measured awareness levels of bowel cancer risk factors, symptoms and screening in Tasmania. An online survey of 3703 participants aged 18 years and older found that alcohol consumption, low physical activity levels, and having diabetes were the least known risk factors for bowel cancer. Over half of all participants were unaware the risk of bowel cancer increased with age, and 53 percent were not confident they would notice a bowel cancer symptom. Over a third of survey respondents did not know that screening commenced at the age of 50. The results indicate that a targeted campaign to increase bowel cancer awareness in Tasmania may help reduce the high rates of morbidity and mortality from the disease.

Assessment of COVID-19 Information Overload Among the General Public.

BACKGROUND: A relentless flood of information accompanied the novel coronavirus 2019 (COVID-19) pandemic. False news, conspiracy theories, and magical cures were shared with the general public at an alarming rate, which may lead to increased anxiety and stress levels and associated debilitating consequences. OBJECTIVES: To measure the level of COVID-19 information overload (COVIO) and assess the association between COVIO and sociodemographic characteristics among the general public. METHODS: A cross-sectional online survey was conducted between April and May 2020 using a modified Cancer Information Overload scale. The survey was developed and posted on four social media platforms. The data were only collected from those who consented to participate. COVIO score was classified into high vs. low using the asymmetrical distribution as a guide and conducted a binary logistic regression to examine the factors associated with COVIO. RESULTS: A total number of 584 respondents participated in this study. The mean COVIO score of the respondents was 19.4 (± 4.0). Sources and frequency of receiving COVID-19 information were found to be significant predictors of COVIO. Participants who received information via the broadcast media were more likely to have high COVIO than those who received information via the social media (adjusted odds ratio ([aOR],14.599; 95% confidence interval [CI], 1.608-132.559; p = 0.017). Also, participants who received COVID-19 information every minute (aOR, 3.892; 95% CI, 1.124-13.480; p = 0.032) were more likely to have high COVIO than those who received information every week. CONCLUSION: The source of information and the frequency of receiving COVID-19 information were significantly associated with COVIO. The COVID-19 information is often conflicting, leading to confusion and overload of information in the general population. This can have unfavorable effects on the measures taken to control the transmission and management of COVID-19 infection.

Distribution and Location Stability of the Australian Ophthalmology Workforce: 2014-2019.

OBJECTIVE: To investigate the ophthalmology workforce distribution and location stability using Modified Monash Model category of remoteness. METHODS: Whole of ophthalmologist workforce analysis using Australian Health Practitioner Registration Agency (AHPRA) data. Modified Monash Model (MMM) category was mapped to postcode of primary work location over a six-year period (2014 to 2019). MMM stability was investigated using survival analysis and competing risks regression. DESIGN: Retrospective cohort study. SETTING: Australia. PARTICIPANTS: Ophthalmologists registered with AHPRA. MAIN OUTCOME MEASURES: Retention within MMM category of primary work location. RESULTS: A total of 948 ophthalmologists were identified (767 males, 181 females). Survival estimates indicate 84% of ophthalmologists remained working in MMM1, while 79% of ophthalmologists working in MMM2-MMM7remained in these regions during the six-year period. CONCLUSION: The Australian ophthalmology workforce shows a high level of location stability and is concentrated in metropolitan areas of Australia. Investment in policy initiatives designed to train, recruit and retain ophthalmologists in regional, rural and remote areas is needed to improve workforce distribution outside of metropolitan areas.

Factors contributing to the recruitment and retention of rural pharmacist workforce: a systematic review.

BACKGROUND: Recruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists' retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages. METHODS: A systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists. RESULTS: The final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors. CONCLUSIONS: The results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.

Rural employment: A get-go for recent nursing and allied health graduates?

OBJECTIVE: To explore the pathways recent nursing and allied health graduates have used to gain initial employment in regional and rural Tasmania. DESIGN: A mixed-methods design comprising an online survey and semi-structured interviews. SETTING: Tasmania, Australia. PARTICIPANTS: Eighty-four recent nursing and allied health graduates from 18 disciplines. MAIN OUTCOME MEASURES: Location and pathway to initial employment, job search strategies, number of job applications and length of time taken to gain employment. RESULTS: Participants obtained their qualification from Tasmania or mainland Australia. Rural-origin graduates were more likely to work in rural locations after graduating. Graduates sought initial regional or rural employment to be close to family; to avail themselves of more job opportunities and less competition from other graduates; and for adventure. An inability to secure metropolitan jobs led others to seek opportunities in regional and rural Tasmania. Graduates that used multiple job search strategies and who were more flexible regarding location and field of initial employment experienced fewer challenges gaining employment. CONCLUSION: For recent nursing and allied health graduates, securing initial employment can be time-consuming and labour-intensive. Being flexible, persistent and willing to adjust expectations about work location will help. Rural employment might provide the right get-go for a professional career. Understanding the pathways recent graduates have used to gain initial rural employment can help better connect graduates and prospective employers.

Review of the Health, Welfare and Care Workforce in Tasmania, Australia: 2011-2016.

BACKGROUND: On a per capita basis, rural communities are underserviced by health professionals when compared to metropolitan areas of Australia. However, most studies evaluating health workforce focus on discrete professional groups rather than the collective contribution of the range of health, care and welfare workers within communities. The objective of this study was therefore to illustrate a novel approach for evaluating the broader composition of the health, welfare and care (HWC) workforce in Tasmania, Australia, and its potential to inform the delivery of healthcare services within rural communities. METHODS: Census data (2011 and 2016) were obtained for all workers involved in health, welfare and care service provision in Tasmania and in each statistical level 4 area (SA4) of the state. Workers were grouped into seven categories: medicine, nursing, allied health, dentistry and oral health, health-other, welfare and carers. Data were aggregated for each category to obtain total headcount, total full time equivalent (FTE) positions and total annual hours of service per capita, with changes observed over the five-year period. RESULTS: All categories of the Tasmanian HWC workforce except welfare grew between 2011 and 2016. While this growth occurred in all SA4 regions across the state, the HWC workforce remained maldistributed, with more annual hours of service per capita provided in the Hobart area. Although the HWC workforce remained highly feminised, a move toward gender balance was observed in some categories, including medicine, dentistry and oral health, and carers. The HWC workforce also saw an increase in part-time workers across all categories. CONCLUSIONS: Adopting a broad approach to health workforce planning can better reflect the reality of healthcare service delivery. For underserviced rural communities, recognising the diverse range of workers who can contribute to the provision of health, welfare and care services offers the opportunity to realise existing workforce capacity and explore how 'total care' may be delivered by different combinations of health, welfare and care workers.

General practitioner perspectives on barriers and enablers to bowel cancer screening in rural Tasmania: A thematic analysis of face-to-face interviews.

BACKGROUND AND OBJECTIVES: When detected early, nine in 10 Australians with bowel cancer can be successfully treated, yet participation in the National Bowel Cancer Screening Program (NBCSP) remains low. The aim of this study was to identify enablers and barriers to bowel cancer screening in rural Tasmanian communities from the perspective of general practitioners (GPs). METHOD: Qualitative analysis of face-to-face interviews with eight GPs was used to determine factors that influence NBCSP uptake in four rural Tasmanian Local Government Areas. RESULTS: High workloads, competing priorities and not knowing when a patient received an NBCSP kit were identified as barriers to supporting the program, while practice reminder systems were seen to improve the likelihood of GPs recommending the program to patients. DISCUSSION: GPs are important for improving participation in the NBCSP. Incorporating GPs' views of barriers and enablers for screening is key to improving NBCSP participation in rural Tasmania and Australia more broadly.