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Special Issue "Rural and Remote Health Workforce"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 May 2021).

Special Issue Editors

Dr. Kathleen Tori
E-Mail Website
Guest Editor
School of Nursing, College of Health and Medicine, Newnham campus, University of Tasmania, Launceston 7250, Australia
Interests: advanced practice nursing; higher education; impact evaluation; multidisciplinary; nurse practitioners; nurse led models of care; policy; professionalism; rural and remote nursing; research translation; sustainability
Special Issues and Collections in MDPI journals
Dr. Carey Mather
E-Mail Website
Guest Editor
School of Nursing, College of Health and Medicine, Newnham Campus, University of Tasmania, Launceston 7250, Australia
Interests: evaluation; digital professionalism; health literacy; higher education; human computer interaction; nursing; mobile learning; mobile technology; nursing informatics; participatory health; primary health; social media
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Rural and remote areas experience unique challenges, and as such, healthcare services require strategic planning or redesign in order to be responsive and sustainable. Documented poorer health outcomes for rural communities are compounded by chronicity of disease; ageing populations; lack of sustainable infrastructure; the tyranny of distance to definitive, specialised health care; and workforce issues related to the recruitment and retention of health practitioners. The delivery of various healthcare systems approaches, including tertiary and targeted primary care models, to meet the evolving needs of the rural communities should be a priority. In recent years, many alternate models of healthcare delivery have been proposed, trialed and evaluated; however, many have had limited success from a sustainability perspective.

This Special Issue of IJERPH provides an opportunity to explore the reality of healthcare options and outcomes for rural and remote communities. Papers that explore successful integration of innovative healthcare models demonstrating improved accessibility and health outcomes are encouraged, as are papers that focus on plausible solutions to the identified health workforce issues in these communities. Research from all healthcare disciplines and settings addressing impact and economic evaluations of rural and remote health initiatives are welcome.

Dr. Kathleen Tori
Dr. Carey Mather
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Rural and remote
  • Health
  • Workforce
  • Recruitment and retention
  • Multidisciplinary
  • Models of practice
  • Access
  • Equity
  • Sustainability
  • Primary care
  • Care systems

Published Papers (8 papers)

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Research

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Article
Lessons for Workforce Disaster Planning from the First Nosocomial Outbreak of COVID-19 in Rural Tasmania, Australia: A Case Study
Int. J. Environ. Res. Public Health 2021, 18(15), 7982; https://doi.org/10.3390/ijerph18157982 - 28 Jul 2021
Viewed by 549
Abstract
The identification and announcement of the COVID-19 pandemic has been a global issue. Disaster preparedness for internal and external threats is inherent within health care environments and requires agile thinking and swift remediation. Nosocomial infection is a risk for recipients of care, especially [...] Read more.
The identification and announcement of the COVID-19 pandemic has been a global issue. Disaster preparedness for internal and external threats is inherent within health care environments and requires agile thinking and swift remediation. Nosocomial infection is a risk for recipients of care, especially in hospital settings, which has implications for workforce planning. The aim of this case study was to examine the community response to the internal disaster of the first nosocomial COVID-19 outbreak within an Australian rural health care environment. A critical discourse analysis method was adopted to generate and analyse data collected from three different media platforms during a six-week period. Four main themes were distilled: actions and intent, loss, well-being and recognising choice, and community action. Phase two of the study interrogated these themes to expose the power positioning of speakers and their relationships to the audiences. Strengthening communication with local communities within health care environments must be a priority in any future rural workforce disaster preparedness planning. Maintenance of trust with health service provision and delivery in rural communities is imperative. The inclusion of a robust communication plan within any risk management strategy that meets the needs of the local users of health services is mandatory. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
Article
Whole of Community Facilitators: An Exemplar for Supporting Rural Health Workforce Recruitment through Students’ Professional Experience Placements
Int. J. Environ. Res. Public Health 2021, 18(14), 7675; https://doi.org/10.3390/ijerph18147675 - 19 Jul 2021
Viewed by 472
Abstract
The Whole of Community Facilitator model provides support for healthcare students’ professional experience placements (PEP) in rural regions in Tasmania. In Tasmania, rural PEP is challenged as healthcare facilities are often small and have limited capacity for staff to devote considerable time to [...] Read more.
The Whole of Community Facilitator model provides support for healthcare students’ professional experience placements (PEP) in rural regions in Tasmania. In Tasmania, rural PEP is challenged as healthcare facilities are often small and have limited capacity for staff to devote considerable time to supervising students during PEP. Recruitment and retention of the rural health workforce in Tasmania is sometimes difficult because the island State is geographically distant from mainland Australia, and predominantly classified as a regional, rural, or remote area. The University of Tasmania, College of Health and Medicine (the College) explored various initiatives to support rural workforce sustainability, and the project discussed addresses this issue by promoting rural healthcare facilities as potential employment destinations for students upon completion of their course. The model supports the delivery of high-quality supervision to students whilst undertaking rural PEP, to foster positive experiences and potentially influence their future career choices. A successful exemplar was trialled in 2012 and implemented statewide in 2017 using a Whole of Community Facilitation (WOCF) model. The initiative supports host facilities, supervisors, host staff, and students and promotes positive placement experiences. The initiative was designed in consideration of Tasmania’s rurality, and uses a flexible and responsive framework. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
Article
Review of the Health, Welfare and Care Workforce in Tasmania, Australia: 2011–2016
Int. J. Environ. Res. Public Health 2021, 18(13), 7014; https://doi.org/10.3390/ijerph18137014 - 30 Jun 2021
Viewed by 548
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
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Article
Promoting Interprofessional Education and Collaborative Practice in Rural Health Settings: Learnings from a State-Wide Multi-Methods Study
Int. J. Environ. Res. Public Health 2021, 18(10), 5162; https://doi.org/10.3390/ijerph18105162 - 13 May 2021
Viewed by 621
Abstract
Evidence is mounting regarding the positive effects of Interprofessional Education and Collaborative Practice (IPECP) on healthcare outcomes. Despite this, IPECP is only in its infancy in several Australian rural healthcare settings. Whilst some rural healthcare teams have successfully adopted an interprofessional model of [...] Read more.
Evidence is mounting regarding the positive effects of Interprofessional Education and Collaborative Practice (IPECP) on healthcare outcomes. Despite this, IPECP is only in its infancy in several Australian rural healthcare settings. Whilst some rural healthcare teams have successfully adopted an interprofessional model of service delivery, information is scarce on the factors that have enabled or hindered such a transition. Using a combination of team surveys and individual semi-structured team member interviews, data were collected on the enablers of and barriers to IPECP implementation in rural health settings in one Australian state. Using thematic analysis, three themes were developed from the interview data: IPECP remains a black box; drivers at the system level; and the power of an individual to make or break IPECP. Several recommendations have been provided to inform teams transitioning from multi-disciplinary to interprofessional models of service delivery. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
Article
The Integral Role of Organisational Governance in Promoting Interprofessional Education in Rural Settings
Int. J. Environ. Res. Public Health 2021, 18(6), 3041; https://doi.org/10.3390/ijerph18063041 - 16 Mar 2021
Viewed by 797
Abstract
One of the key challenges with implementing and sustaining interprofessional education initiatives is the lack of governance structures and processes to guide them. This case study presents a process evaluation of an intersectoral advisory group that facilitated a novel interprofessional clinical education model [...] Read more.
One of the key challenges with implementing and sustaining interprofessional education initiatives is the lack of governance structures and processes to guide them. This case study presents a process evaluation of an intersectoral advisory group that facilitated a novel interprofessional clinical education model in rural health settings in the state of Queensland, Australia. The group consisted of health and academic partners to guide the implementation and promote sustainability of this new model. The advisory group process was evaluated mid-way and at conclusion of the group functions, using focus group discussions. The focus group audio recordings were transcribed verbatim and subjected to inductive content analysis. Categories were developed for reporting. Three broad categories were identified: Characteristics of the group, functions of the group and multifaceted communication within the group and between sectors. By identifying and mapping the processes used by a strategic, high-level intersectoral advisory group consisting of members from the health and academic fields, key recommendations have been formulated to guide similar work in the future. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
Article
Characteristics of Confidence and Preparedness in Paramedics in Metropolitan, Regional, and Rural Australia to Manage Mental-Health-Related Presentations: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2021, 18(4), 1882; https://doi.org/10.3390/ijerph18041882 - 15 Feb 2021
Viewed by 1303
Abstract
Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson [...] Read more.
Mental-health-related presentations account for a considerable proportion of the paramedic’s workload in prehospital care. This cross-sectional study aimed to examine the perceived confidence and preparedness of paramedics in Australian metropolitan and rural areas to manage mental-health-related presentations. Overall, 1140 paramedics were surveyed. Pearson chi-square and Fisher exact tests were used to compare categorical variables by sex and location of practice; continuous variables were compared using the non-parametric Mann–Whitney and Kruskal–Wallis tests. Perceived confidence and preparedness were each modelled in multivariable ordinal regressions. Female paramedics were younger with higher qualifications but were less experienced than their male counterparts. Compared to paramedics working in metropolitan regions, those working in rural and regional areas were generally older with fewer qualifications and were significantly less confident and less prepared to manage mental health presentations (p = 0.001). Compared to male paramedics, females were less confident (p = 0.003), although equally prepared (p = 0.1) to manage mental health presentations. These results suggest that higher qualifications from the tertiary sector may not be adequately preparing paramedics to manage mental health presentations, which signifies a disparity between education provided and workforce preparedness. Further work is required to address the education and training requirements of paramedics in regional and rural areas to increase confidence and preparedness in managing mental health presentations. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
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Review

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Review
Increasing Rural Recruitment and Retention through Rural Exposure during Undergraduate Training: An Integrative Review
Int. J. Environ. Res. Public Health 2020, 17(17), 6423; https://doi.org/10.3390/ijerph17176423 - 03 Sep 2020
Cited by 3 | Viewed by 1084
Abstract
Objectives: Ensuring nationwide access to medical care challenges health systems worldwide. Rural exposure during undergraduate medical training is promising as a means for overcoming the shortage of physicians outside urban areas, but the effectiveness is widely unknown. This integrative review assesses the effects [...] Read more.
Objectives: Ensuring nationwide access to medical care challenges health systems worldwide. Rural exposure during undergraduate medical training is promising as a means for overcoming the shortage of physicians outside urban areas, but the effectiveness is widely unknown. This integrative review assesses the effects of rural placements during undergraduate medical training on graduates’ likelihood to take up rural practice. Methods: The paper presents the results of a longitudinal review of the literature published in PubMed, Embase, Google Scholar and elsewhere on the measurable effects of rural placements and internships during medical training on the number of graduates in rural practice. Results: The combined database and hand search identified 38 suitable primary studies with rather heterogeneous interventions, endpoints and results, mostly cross-sectional and control studies. The analysis of the existing evidence exhibited predominantly positive but rather weak correlations between rural placements during undergraduate medical training and later rural practice. Beyond the initial scope, the review underpinned rural upbringing to be the strongest predictor for rural practice. Conclusions: This review confirms that rural exposure during undergraduate medical training to contributes to recruitment and retention in nonurban settings. It can play a role within a broader strategy for overcoming the shortage of rural practitioners. Rural placements during medical education turned out to be particularly effective for rural-entry students. Given the increasing funding being directed towards medical schools to produce graduates that will work rurally, more robust high-quality research is needed. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
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Other

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Case Report
Healthcare Professional Presenteeism during a COVID-19 Outbreak in an Australian Rural Healthcare Environment: A Case Analysis
by , and
Int. J. Environ. Res. Public Health 2021, 18(16), 8336; https://doi.org/10.3390/ijerph18168336 - 06 Aug 2021
Viewed by 545
Abstract
The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the [...] Read more.
The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach. Full article
(This article belongs to the Special Issue Rural and Remote Health Workforce)
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