Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia

Background/aim: This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study’s purpose was to identify the impact of information and Communication Technology on the workforce practices of occupational therapists’ working in a rural area of New South Wales. Methods: Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison,was used to analyse the interview transcripts. Results: This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients’ acceptance.Conclusion: The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently

Health policy: understanding outcomes for rural maternity care

Aims and rationale: Despite government commitments to improve rural residents' access to health services, 42% of rural maternity units throughout Queensland have closed over the last 10 years. Such closures raise concerns about equity of access and quality of maternity care for rural communities. There is little literature available which discusses the impact of health policies on rural residents' experiences of accessing maternity care, or the experiences of the health professionals who provide these services. The aims of this study are twofold: (a) critically review government health policies relevant to rural maternity care; and (b) investigate the correlation between health policy discourse and the lived experiences of rural communities in providing and accessing maternity services. Approaches: Relevant Commonwealth and Queensland health policies were identified and critically reviewed. A case study approach was then used to explore the lived experiences of both providers (midwives, GP proceduralists, hospital administrators) and users (community members) of maternity care in four rural, north Queensland towns. Data comprised documentary evidence, interviews with service providers and focus groups with community members. Findings: The reduction of rural maternity services was found to have profound, multifaceted effects on local communities. Lived experiences and policy-related outcomes are discussed within four topic areas: workforce; community engagement; quality and safety of care. Benefits to the community: Understanding policy outcomes for rural maternity units should inform the development of future health policies. Recommendations are aimed at enhancing maternity care provision and access in rural communities

Engaging rural communities health policy

Aims & Rationale: The Alma-Ata Declaration espouses participation as a right for all citizens and important in the provision of primary health care. Australian health policy discourse encourages citizen engagement, but the extent to which this actually occurs remains unclear. Citizen engagement potentially offers considerable benefits for rural communities – a population with known health disadvantages. Drawing on results of a research project exploring the health policy implications for rural maternity care, this paper aims to (a) discuss the extent of community participation found in four rural north Queensland towns; and (b)consider how policy discourse around citizen engagement may be applied to rural health policies. Methods: Case studies of four rural north Queensland towns were completed. Observational, interview and documentary data were collected and qualitatively analysed via an inductive thematic technique. Findings: The case studies provided little indication of formal mechanisms through which community members could provide input to local health service delivery. Two communities demonstrated rapid mobilisation to rally and apply political pressure when their health services were threatened, but a distinction must be made between community action and true engagement processes. While mindful of the benefits, interviewees at all sites were particularly concerned about the barriers to successful community engagement, including: (i) overcoming community scepticism; (ii) concerns about representativeness; and (iii) community capacity. Benefits to the community: For rural communities, citizen engagement may have particular advantages in enhancing the appropriateness and responsiveness of local health services. Recommendations are made for improving rural communities' input to health policies which affect them

Health policy and rural health services: using qualitative methodologies in policy analysis

Background: Equity, access, safety and quality are prominent themes in rural health policies at a national level. These policies often contain objectives around improving rural health services and the health status of rural Australians. It is important to consider whether these objectives are being met for rural populations to discern the appropriateness of current policies and the potential need for changes in policy approach. Objective: To understand the influence of policy on provision of, and access to, rural maternity care. Design: Analysis of policy and case studies. Setting: Four north Queensland rural towns. Participants: (a) Rural residents who recently accessed maternity care; and (b) health care professionals involved in the provision of maternity services including midwives, procedural medical practitioners and GPs. Main outcome measures: Identification of predominant themes in government policies that relate to rural maternity care and identification of outcomes for local maternity services. These findings were supplemented by insights to rural citizens’ experiences in accessing maternity care and rural clinicians’ experience in providing care. Results: The findings indicate a dearth of specific policies to support the development and continuation of rural maternity care services. Conclusions: Without detailed policy support for rural maternity care, services at each of the four case study towns appeared more vulnerable to the effects of other non-specific policies and negative environmental factors

Health policy: outcomes for rural residents’ access to maternity care

Regular health care during pregnancy, birthing and the postnatal period is recommended for improving maternal and neonatal outcomes and accessing such care has become a common expectation for Australian families. Studies have highlighted the relative safety of birthing in rural hospitals even though these units are typically associated with low volumes of deliveries. Yet, in Queensland, the location and number of public maternity units shows a clear trend towards centralisation of services. During 1995- 2005, 43% of Queensland public maternity units closed, with the remaining units predominantly located in coastal and more populated locations. The closure of rural maternity units is not restricted to Queensland: the National Rural Health Alliance estimated 130 rural maternity units had closed across Australia throughout the decade 1996-20065. Growing numbers of closed rural maternity units raises considerable questions regarding the care accessed by rural residents. This paper presents findings from research conducted in north Queensland which examined the impact of health policy on an issue that is of central importance to rural communities—access to birthing services. A multi-dimensional understanding of access to maternity services was adopted in this study, a view which goes beyond measuring access only in terms of geographic distance. Gulliford et al have provided a constructive discussion of the multifaceted nature of access, particularly the differentiation between ‘having access’ and ‘gaining access’ to health care. Having access implies that a person has the opportunity to use a health service if they need or want it. This type of access is often measured in terms of doctors or hospital beds per capita and is dependent on the provision, and geographical allocation of resources, as well as the actual configuration of the network of health services. The authors draw attention to Mooney’s proposition that equal costs in using a service (eg costs of care, costs of travel, lost work) indicates equal access to services. On the other hand, gaining access to health care can be complicated by a variety of barriers including those of a personal nature (eg patients recognising their need to access health care); financial (that is, costs to be borne by the potential patient) or organisational (eg waiting lists)

Who are they and what do they do? Profile of allied health professionals working with people with disabilities in rural and remote New South Wales

Objective: To explore the characteristics of allied health professionals (AHPs) working with people with disabilities in western New South Wales. Design: A cross-sectional survey was conducted using an online questionnaire. Setting: Rural western NSW. Participants: AHPs including physiotherapists, speech pathologists, occupational therapists and psychologists (“therapists”) working with people with disabilities. Main outcome measure: Questionnaire Results: The majority of respondents were female (94%), with a mean age of 39 years; average time since qualification was 14 years; mean years in current position was 6. Most worked with people with a lifelong disability. Two-thirds reported family ties kept them in rural areas; 71% grew up in a rural/remote area. Most participants (94%) enjoyed the rural lifestyle and 84% reported opportunities for social interaction as good or very good. Participants with dependent children were less likely to cease working in western NSW within 5 years than those without dependent children (p<0.05). Conclusions: The characteristics of therapists working with people with disabilities in rural NSW were identified. Overall working, but also social, conditions and community attachment were important for this group. Understanding the workforce will contribute to policy development to meet increasing demands for therapy services.The project is jointly funded through the National Health and Medical Research Council ‘Partnerships for Better Health’ scheme, by the National Health and Medical Research Council (ID 571446) and NSW Government Family and Community Services – Ageing, Disability and Home Care (Western Region)

Recruitment and retention of allied health professionals in the disability sector in rural and remote New South Wales, Australia

Background: People with disability living in rural areas are vulnerable to the loss of access to allied health services due to a critical shortage of allied health professionals (AHPs). This study aimed to investigate recruitment and retention issues of importance to AHPs providing services to people with disability in rural New South Wales, Australia. Method: Focus groups and semi-structured interviews were conducted with 97 purposively sampled service providers in the disability sector. Interviews and focus groups were digitally recorded and transcribed. A modified grounded theory approach using thematic analysis and constant comparison was used to analyse the data. Results: Three major themes relating to recruitment and retention were identified: (a) flexible recruitment, (b) retention strategies that work, and (c) challenges to retention. Conclusions: AHPs in the disability sector identified some of the same issues influencing recruitment and retention as AHPs in the health, education, and private sectors. Several unique issues were also identified that will assist policymakers to improve recruitment and retention of AHPs employed in the disability sector in rural areas

Conference report:Improving outcomes for gastrointestinal cancer in the UK

Substantial steps are being made towards early diagnosis. A range of tools are available to help GPs appropriately categorise early symptoms during routine consultations. Various promising new tests and devices are being explored, especially for cancers that frequently present at late stages. The continuing increase in demand on endoscopy services is a major concern, not least because of the shortage of trained practitioners and other healthcare staff. However, screening and collaborative streamlining initiatives might help to improve the relevance of referrals. The question posed in the title of the conference was rhetorical, but a positive answer seems potentially achievable, even in austere times, through facilitating uptake of screening, working to develop the primary-secondary care interface, educating the public and by protecting funds for research