Impact of sleep on educational outcome of Indigenous Australian children: A systematic review.

INTRODUCTION: The association between quality sleep and improved cognition is well reported in literature. However, very few studies have been undertaken to evaluate the impact of poor sleep on educational outcomes in Indigenous Australian children. OBJECTIVES: The objective of this review was to explore the association between sleep and educational outcomes of Indigenous children. METHODS: For this systematic review, a literature search covering research articles in academic databases and grey literature sources was conducted to retrieve studies published until March 2022. Eight online e-databases (PubMed, Ovid MEDLINE, CINAHL, SCOPUS, HealthinfoNet, PsycINFO, Cochrane and Google Scholar) were searched for data extraction and two appraisal tools (NIH and CREATE) were used for quality assessment. Studies that explored any aspect of sleep health in relation to educational/academic outcomes in school going Indigenous Australian children aged 5-18 were included in this study. All review articles and studies that focused on physical/ mental disabilities or parent perceptions of sleep and educational outcomes were excluded. A convergent integrated approach was used to collate and synthesize information. RESULTS: Only three studies (two cross-sectional and one longitudinal) met the eligibility criteria out of 574 articles. The sample size ranged from 21-50 of 6 to 13 year old children. A strong relationship was indicated between sleep quantity and educational outcomes, in two of the three studies. One study related the sleep fragmentation/shorter sleep schedules of short sleep class and early risers with poorer reading (B = -30.81 to -37.28, p = 0.006 to 0.023), grammar (B = -39.79 to -47.89, p = 0.012-0.013) and numeracy (B = -37.93 to -50.15, p = 0.003 to 0.022) skills compared with long sleep and normative sleep class whereas another reported no significant relation between sleep and educational outcomes. CONCLUSION: The review highlights the need for more research to provide evidence of potentially modifiable factors such as sleep and the impact these may have on academic performance.

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.

Discharge against medical advice in rural and remote emergency departments: views of healthcare providers.

INTRODUCTION: The aim of the study was to explore, in one remote hospital, emergency department healthcare providers' experience and perceptions of the factors surrounding a patient's decision to discharge against medical advice (DAMA). The secondary objective was to gain insight into staff experiences of the current protocols for managing DAMA cases and explore their recommendations for reducing DAMA incidence. METHODS: This was a cross-sectional study involving a survey and semi-structured interviews exploring healthcare providers' (n=19) perceptions of factors perceived to be influencing DAMA, current practice for managing DAMA and recommendations for practice improvements. Health professionals (doctors, nurses, Aboriginal Health Workers) all worked in the emergency department of a remote community hospital, Queensland, Australia. Responses relating to influencing factors for DAMA were provided on a three-point rating scale from 'no influence/little influence' to 'very strong influence'. DAMA management protocol responses were a three-point rating scale from 'rarely/never' to 'always'. Semi-structured interviews were conducted after the survey and explored participants' perceptions in greater detail and current DAMA management protocol. RESULTS: Feedback from the total of 19 participants across the professions presented four prominent yet interconnected themes: patient, culture, health service and health provider, and health literacy and education-related factors. Factors that were perceived to have a strong influence on DAMA events included alcohol and drug abuse (100%), a lack of culturally sensitive healthcare services (94.7%), and family commitments or obligations (89.5%). Healthcare provider recommendations for preventing DAMA presented themes of right communication, culturally safe care (right place, right time) and the right staff to support DAMA prevention. The healthcare providers described the pivotal role the Indigenous Liaison Officer (ILO) plays and the importance of this position being filled. CONCLUSION: DAMA is a multifaceted issue, influenced by both personal and hospital system-related factors. Participants agreed that the presence of ILO and/or Aboriginal Health Workers in the emergency department may reduce DAMA occurrences for Indigenous Australians who are disproportionately represented in DAMA rates, particularly in rural and remote regions of Australia.

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.

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.

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.

Exploring how to sustain 'place-based' rural health academic research for informing rural health systems: a qualitative investigation.

BACKGROUND: The field of rural health research is critical for informing health improvement in rural places but it involves researching in small teams and distributed sites that may have specific sustainability challenges. We aimed to evaluate this to inform how to sustain the field of rural health research. METHODS: We conducted In-depth semi-structured interviews of 50-70 minutes with 17 rural early career researchers who were from different research sites across rural Australia. Data were thematically coded. RESULTS: Seven sustainability challenges were noted, namely recognition, workload, networks, funding and strategic grants, organisational culture, job security, and career progression options. Rural researchers were poorly recognised for their work and researchers were not extended the same opportunities enjoyed by staff at main campuses. Unpredictable and high workloads stemmed from community demand and limited staff. Strategic grant opportunities failed to target the generalist, complex research in this field and the limited time researchers had for grant writing due to their demands within small academic teams. Limited collaboration with other sites increased dissatisfaction. In the face of strong commitment to rural 'places' and their enthusiasm for improving rural health, fixed-term contracts and limited career progression options were problematic for researchers and their families in continuing in these roles. CONCLUSION: A comprehensive set of strategies is needed to address the sustainability of this field, recognising its value for rural self-determination and health equity. Hubs and networks could enable more cohesively planned, collaborative research, skills sharing, senior academic supervision and career development. Targeted funding, fit to the context and purpose of this field, is urgent. Inaction may fuel regular turnover, starting after a researcher's first years, losing rich academic theoretical and contextual knowledge that is essential to address the health of rural populations.

Understanding the field of rural health academic research: a national qualitative, interview-based study.

INTRODUCTION: Rural areas depend on a specific evidence base that directly informs their unique health systems and population health context. Developing this evidence base and its translation depends on a trained rural health academic workforce. However, to date, there is limited description of this workforce and the field of rural health research. This study aimed to characterise this field to inform how it can be fostered. METHODS: Qualitative semi-structured interviews of 50-70 minutes duration were conducted with 17 early career rural health researchers based in Australian rural and remote communities, to explore their professional background, training and research experiences. RESULTS: Six key themes emerged: becoming a rural health researcher; place-based research that has meaning; generalist breadth; trusted partnerships; small, multidisciplinary research teams; and distance and travel. The field mostly attracted researchers already living in rural areas. Researchers were strongly inspired by doing research that effected local change and addressed inequalities. Their research required a generalist skill set, applying diverse academic and local contextual knowledge that was broader than their doctoral training. Research problems were complex, diverse and required novel methods. Research occurred within trusted community partnerships spanning wide geographic catchments, stakeholders and organisations. This involved extensive leadership, travel and time for engagement and research co-production. Responding to the community was related to researchers doing multiple projects of limited funding. The field was also depicted by research occurring in small collegial, multidisciplinary teams focused on 'people' and 'place' although researchers experienced geographic and professional isolation with respect to their field and main university campuses. Researchers were required to operationalise all aspects of research processes with limited help. They took available opportunities to build capacity in the face of limited staff and high community demand. CONCLUSION: The findings suggest that rural health research is highly rewarding, distinguished by a generalist scope and basis of 'rural' socially accountable research that is done in small, isolated teams of limited resources. Strategies are needed to grow capacity to a level fit to address the level of community demand but these must embrace development of the rural academic entry pathway, the generalist breadth and social accountability of this field, which underpins the perceived value of rural health research for rural communities.

Supporting holistic care for patients with tuberculosis in a remote Indigenous community: a case report.

CONTEXT: Tuberculosis (TB) is a serious infectious disease with high rates of morbidity and mortality if left untreated. In Australia, TB has been virtually eradicated in non-Indigenous Australian-born populations but in remote Aboriginal and/or Torres Strait Islander communities TB presents a rare but significant public health issue. Remote health services are most likely to encounter patients with suspected and confirmed TB diagnosis but may be unprepared for supporting someone with this disease and the complexities of balancing public health risk with patient autonomy. ISSUE: This case study will outline the process for diagnosis and treatment of a TB patient in a remote Cape York community. This case involved significant delay in diagnosis and required several strategies to achieve successful disease eradication. The process of treatment, however, had a significant effect on the patient's physical health, and social and emotional wellbeing. LESSONS LEARNED: This case highlights the importance of early collaboration between medical, nursing, Indigenous health worker and allied health services and the importance of technology such as electronic information records to support opportunistic access to diagnostic services and treatment. The enactment of the TB protocol should include discussions about the consequences of any restrictions of movement, employment or social/community roles. Identifying alternative opportunities to engage in meaningful roles may reduce the impact the disease has on a patient's quality of life.

Implementing cognitive remediation therapy (CRT) in a mental health service: staff training.

OBJECTIVE: This paper describes the establishment of training in cognitive remediation for psychosis within a community mental health service. METHODS: Clinical staff working in the community of a mental health service were surveyed to ascertain their interest in cognitive aspects of psychosis and skills training in cognitive remediation (CR). Based on the results of the survey a tiered training programme was established with attendance figures reported for each level of training. Fidelity assessment was conducted on the five CR programmes operating. RESULTS: Of 106 clinical staff working in the community with people diagnosed with a psychotic illness 51 completed the survey (48% response rate). The training needs varied with all 106 staff receiving the fundamental (mandatory) training and 51 staff receiving CR facilitator training. Thirty three percent of staff trained as facilitators were delivering CR. CONCLUSIONS: Up skilling the mental health workforce to incorporate an understanding of the cognitive aspects of psychosis into care delivery can be facilitated by a tiered training structure. Fundamental training on the psychosocial aspects of psychosis can act as a platform for focussed CR skills based training. There is also a need for accessible therapy based supervision for staff wishing to develop competencies as CR therapists.

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.

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.

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.

Implementing cognitive remediation therapy: lessons from two public mental health services.

OBJECTIVE: Neurocognitive deficits are a core symptom domain of schizophrenia, occurring in 75-90% of people with this diagnosis and influencing long term functional outcomes. This article aims to describe the pilot implementation of cognitive remediation therapy in two large public mental health services and detail changes made to the delivery of this therapy after this trial. CONCLUSIONS: Cognitive remediation therapy provides an evidence-based approach to targeting cognitive deficits but the translation of this therapy from a research setting to clinical practice has not been well evaluated.

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.

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.

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.

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.