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

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 29530

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Special Issue Editors

Dr. Belinda O’Sullivan

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Leading Guest Editor

Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD 4350, Australia
Interests: rural workforce training and development; workforce support; rural health systems; rural health outcomes; rural communities

Dr. Matthew McGrail

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Assistant Guest Editor

Rural Clinical School, University of Queensland, Rockhampton, QLD 4700, Australia
Interests: rural health workforce; access to health care; health services research; GIS methodologies in health; health workforce policy/incentives; recruitment, retention and mobility
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Special Issue Information

Dear Colleagues,

Rural communities remain challenging environments in which to address healthcare needs, particularly across secondary (‘specialty’) levels of care. Lower population density, size, staffing, and infrastructure often make the delivery of specialty care to rural populations more difficult. Moreover, rural people often have more extreme health needs, sometimes due to later presentations or poorer primary care access. Improving access to specialist-level healthcare in rural settings involves consideration of the workforce and their scope of skills (including primary care health workers being trained and supported to deliver additional specialty services independently or under supervision) and methods for delivering services (such as outreach, telehealth, and face-to-face models). It also involves the development of regional service hubs, which support the delivery of care to wider geographic catchments.

With this background in mind, we make a special call for papers about rural specialty care. We encourage articles about specialty-level services by various health worker types, countries, rural contexts, and clinical settings. These may include literature reviews, articles describing or evaluating workforce and service interventions, and insights that can inform the development and maintenance of specialist service capacity in rural areas. Articles will need to define the rural location and its characteristics, be clear about the context of the population’s need for the form of specialty care (what the rural problem is), define any specialist providers and their qualifications, and ensure that it is clear as to how the specialist care is accessed, for example, through referral or first point of contact, and any telehealth modalities or outreach parameters are clear. We encourage the use of globally standard terminology to allow for generalizability. We thank you in advance for your contributions. With your assistance, we can shed some light on this critical issue in order to improve the health of regional, rural, and remote people.

Dr. Belinda O’Sullivan
Dr. Matthew McGrail
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 submissions that pass pre-check are 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 monthly 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 2500 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 specialists
scope of practice
extended primary healthcare
models of care
regional hubs
specialist services
specialist telehealth
specialist outreach
rural health workforce

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Published Papers (6 papers)

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Research

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9 pages, 2489 KiB

Open AccessArticle

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

by Penny Allen, Belinda Jessup, Santosh Khanal, Victoria Baker-Smith, Kehinde Obamiro and Tony Barnett

Int. J. Environ. Res. Public Health 2021, 18(23), 12574; https://doi.org/10.3390/ijerph182312574 - 29 Nov 2021

Cited by 6 | Viewed by 2416

Abstract

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. Full article

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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13 pages, 1901 KiB

Open AccessArticle

Exploring Doctors’ Emerging Commitment to Rural and General Practice Roles over Their Early Career

by Matthew McGrail, Belinda O’Sullivan, Tiana Gurney, Diann Eley and Srinivas Kondalsamy-Chennakesavan

Int. J. Environ. Res. Public Health 2021, 18(22), 11835; https://doi.org/10.3390/ijerph182211835 - 11 Nov 2021

Cited by 8 | Viewed by 2540

Abstract

Producing enough doctors working in general practice or rural locations, or both, remains a key global policy focus. However, there is a lack of evidence about doctors’ emerging commitment to these decisions. This study aimed to explore changes in the level of certainty about career interest in working in general practice and working rurally, as doctors pass through various early career stages. The participants were 775 eligible respondents to a 2019 survey of medical graduates of The University of Queensland from 2002–2018. Certainty levels of specialty choice were similar between GPs and specialists up until the beginning of registrar training. At that point, 65% of GPs compared with 80% of other specialists had strong certainty of their specialty field. Consistently (and significantly) less of those working rurally had strong certainty of the location where they wanted to practice medicine at each career time point. At the start of registrar training, a similar gap remained (strong certainty: 51% rural versus 63% metropolitan). This study provides new evidence that career intent certainty is more delayed for the cohort choosing general practice and rural practice than the other options. The low level of certainty in early career highlights the importance of regular positive experiences that help to promote the uptake of general practice and rural practice. Full article

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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13 pages, 1435 KiB

Open AccessArticle

Uganda Mountain Community Health System—Perspectives and Capacities towards Emerging Infectious Disease Surveillance

by Aggrey Siya, Richardson Mafigiri, Richard Migisha and Rebekah C. Kading

Int. J. Environ. Res. Public Health 2021, 18(16), 8562; https://doi.org/10.3390/ijerph18168562 - 13 Aug 2021

Cited by 3 | Viewed by 4052

Abstract

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs’ perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts. Full article

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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14 pages, 984 KiB

Open AccessArticle

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

by Selina Taylor, Alice Cairns and Beverley Glass

Int. J. Environ. Res. Public Health 2021, 18(12), 6456; https://doi.org/10.3390/ijerph18126456 - 15 Jun 2021

Cited by 5 | Viewed by 8944

Abstract

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

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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14 pages, 729 KiB

Open AccessArticle

A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

by Belinda O'Sullivan, Helen Hickson, Rebecca Kippen, Donna Cohen, Phil Cohen and Glen Wallace

Int. J. Environ. Res. Public Health 2021, 18(4), 1482; https://doi.org/10.3390/ijerph18041482 - 4 Feb 2021

Cited by 3 | Viewed by 5148

Abstract

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice. Full article

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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Review

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15 pages, 659 KiB

Open AccessReview

Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review

by Hannah Beks, Sandra Walsh, Laura Alston, Martin Jones, Tony Smith, Darryl Maybery, Keith Sutton and Vincent L Versace

Int. J. Environ. Res. Public Health 2022, 19(3), 1438; https://doi.org/10.3390/ijerph19031438 - 27 Jan 2022

Cited by 19 | Viewed by 5366

Abstract

Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy. Full article

(This article belongs to the Special Issue Rural Health Workforce (2nd Edition))

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