International Journal of Environmental Research and Public Health

Research

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17 pages, 364 KiB

Open AccessArticle

Health Service Implementation and Antifragile Characteristics in Rural Communities: A Dirt Research Approach

by Samuel Petrie and Paul Peters

Int. J. Environ. Res. Public Health 2023, 20(14), 6418; https://doi.org/10.3390/ijerph20146418 - 20 Jul 2023

Viewed by 1184

Abstract

The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities [...] Read more.

The implementation of health and care services within rural communities requires necessary sensitivity to the unique facets of rural places. Often, rural service implementation is executed with inappropriate frameworks based on assumptions derived from urban centres. To understand the characteristics of rural communities that can facilitate successful program implementation better, ethnographic accounts of rural health and care services were compiled in rural communities within Canada, Australia, and Iceland. Ethnographic accounts are presented in the first and third person, with an accompanying reflexive analysis immediately following these accounts. Antifragility was the guiding concept of interest when investigating rural implementation environments, a concept that posits that a system can gain stability from uncertainty rather than lose integrity. These ethnographic accounts provide evidence of antifragile operators such as optionality, hybrid leadership, starting small, nonlinear evaluation, and avoiding suboptimisation. It is shown that the integration of these antifragile operators allows programs to function better in complex rural systems. Further, the presence of capable individuals with sufficient knowledge in several disciplines and with depth in a single discipline allows for innovative local thinking initiatives. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

9 pages, 305 KiB

Open AccessArticle

Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia

by Annie C. Arnold, Richard Fleet and David Lim

Int. J. Environ. Res. Public Health 2023, 20(10), 5821; https://doi.org/10.3390/ijerph20105821 - 14 May 2023

Cited by 1 | Viewed by 1378

Abstract

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and [...] Read more.

This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

10 pages, 304 KiB

Open AccessArticle

A Qualitative Study of Rural and Remote Australian General Practitioners’ Involvement in High-Acuity Patients

by Sinead Turner, Vivian Isaac and David Lim

Int. J. Environ. Res. Public Health 2023, 20(5), 4548; https://doi.org/10.3390/ijerph20054548 - 03 Mar 2023

Cited by 2 | Viewed by 1638

Abstract

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic [...] Read more.

This study aimed to understand the experiences, barriers, and facilitators of rural general practitioners’ involvement with high-acuity patients. Semi-structured interviews with rural general practitioners in South Australia who had experience delivering high-acuity care were audio-recorded, transcribed verbatim, and analyzed through content and thematic approaches incorporating Potter and Brough’s capacity-building framework. Eighteen interviews were conducted. Barriers identified include the inability to avoid high-acuity work in rural and remote areas, pressure to handle complex presentations, lack of appropriate resources, lack of mental health support for clinicians, and impacts on social life. Enablers included a commitment to community, comradery in rural medicine, training, and experience. We concluded that general practitioners are a vital pillar of rural health service delivery and are inevitably involved in disaster and emergency response. While the involvement of rural general practitioners with high-acuity patients is complex, this study suggested that with the appropriate system, structure and role supports, rural general practitioners could be better empowered to manage high-acuity caseloads locally. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

16 pages, 659 KiB

Open AccessArticle

Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers’ Perspective

by David Lim, Emily Phillips, Clare Bradley and James Ward

Int. J. Environ. Res. Public Health 2023, 20(5), 4415; https://doi.org/10.3390/ijerph20054415 - 01 Mar 2023

Cited by 2 | Viewed by 1875

Abstract

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a [...] Read more.

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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18 pages, 571 KiB

Open AccessArticle

Understanding Unmet Care Needs of Rural Older Adults with Chronic Health Conditions: A Qualitative Study

by Dennis Asante, Craig S. McLachlan, David Pickles and Vivian Isaac

Int. J. Environ. Res. Public Health 2023, 20(4), 3298; https://doi.org/10.3390/ijerph20043298 - 13 Feb 2023

Cited by 2 | Viewed by 2088

Abstract

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better [...] Read more.

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better understanding of healthcare access and their specific unmet needs. This qualitative study sought the views of both rural-centric older people and healthcare professionals to understand health needs, barriers, and enablers of accessing health services, with a focus on chronic health condition(s). Methods: Between April and July 2022, separate in-depth interviews were conducted with 20 older people (≥60 years) in a rural South Australian community. Additionally, focus group interviews were conducted with 15 healthcare professionals involved in providing health services to older adults. Transcripts were coded using the NVivo software and data were thematically analysed. Results: Participants described a range of unmet care needs including chronic disease management, specialist care, psychological distress, and the need for formal care services. Four barriers to meeting care needs were identified: Workforce shortages, a lack of continuity of care, self-transportation, and long waiting times for appointments. Self-efficacy, social support, and positive provider attitudes emerged as crucial enabling factors of service use among rural ageing populations. Discussion: Older adults confront four broad ranges of unmet needs: Chronic disease management care, specialist care, psychological care, and formal care. There are potential facilitators, such as self-efficacy, provider positive attitudes, and social support, that could be leveraged to improve healthcare services access for older adults. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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8 pages, 1154 KiB

Open AccessArticle

The Dermatologic Care Needs of a Rural Community in South Florida

by Sara M. Asbeck, Brenda U. Imo, Okelue E. Okobi and Jennifer Dorcé-Medard

Int. J. Environ. Res. Public Health 2023, 20(4), 3071; https://doi.org/10.3390/ijerph20043071 - 09 Feb 2023

Cited by 2 | Viewed by 1753

Abstract

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of [...] Read more.

For patients in rural areas, primary care is often their only access to healthcare services, and skin concerns are among the most common diseases seen in these settings. This study aims to investigate the most common skin conditions, management trends and patterns of referral to dermatology in a rural and underserved community in South Florida. A retrospective chart review was conducted using medical records from the C.L. Brumback Primary Care Clinic in Belle Glade, FL. The most common skin conditions were fungal infections, unspecified dermatitis, pruritus, skin cancer concern, alopecia, and autoimmune skin disorders. The most frequent management strategy was medication prescription followed by specialist referral. Of the 21 percent of patients referred to a specialist, 55 percent of these were to dermatology. The most common diagnoses referred to dermatology were atopic dermatitis and alopecia. Only 20 percent of these patients reported attending their follow-up appointment, and the average distance to referral was 21 miles. Belle Glade is unique in its need for and access to dermatologic care. The lack of access to specialists in rural communities is a public health issue that more studies and outreach initiatives should address. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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19 pages, 4596 KiB

Open AccessArticle

Research on Co-Opetition Mechanism between Pharmaceutical Enterprises and Third-Party Logistics in Drug Distribution of Medical Community

by Zhao Li, Tie Xia, Wanzhi Shen and Sheng Chen

Int. J. Environ. Res. Public Health 2023, 20(1), 609; https://doi.org/10.3390/ijerph20010609 - 29 Dec 2022

Viewed by 1236

Abstract

Third-party logistics (3PL) has a relatively perfect distribution system in solving the drug distribution of the medical community and optimizing the distribution efficiency of pharmaceutical enterprises, and it has gradually become an indispensable component of drug distribution. By constructing the co-opetition model of [...] Read more.

Third-party logistics (3PL) has a relatively perfect distribution system in solving the drug distribution of the medical community and optimizing the distribution efficiency of pharmaceutical enterprises, and it has gradually become an indispensable component of drug distribution. By constructing the co-opetition model of “Pharmaceutical Enterprises—3PL”, this paper explores the game strategy choice between pharmaceutical enterprises and 3PL for the solution of drug distribution under the condition of information asymmetry, and it puts forward some suggestions to improve the competition and cooperation mechanism between pharmaceutical enterprises and 3PL in drug distribution in the medical community. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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14 pages, 619 KiB

Open AccessArticle

Fundamental Aspects of the Development of a Model of an Integrated Health Care System for the Prevention of Iron Deficiency Anemia among Adolescent Girls: A Qualitative Study

by Puspa Sari, Dewi Marhaeni Diah Herawati, Meita Dhamayanti and Dany Hilmanto

Int. J. Environ. Res. Public Health 2022, 19(21), 13811; https://doi.org/10.3390/ijerph192113811 - 24 Oct 2022

Cited by 1 | Viewed by 2504

Abstract

Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This [...] Read more.

Iron deficiency anemia (IDA) in adolescent girls is a problem that has not been resolved. This study aimed to explore the critical aspects of an integrated health care system model for preventing IDA in adolescent girls in a rural area of Indonesia. This qualitative research employed a grounded theory approach in order to build a substantive theory. This study used in-depth interviews with adolescents, parents, teachers, health workers, and persons in charge of adolescent programs at the health office, education office, and ministry of religion. Purposive sampling was performed until data saturation was achieved. Codes, categories, and themes were generated through thematic data analysis to develop a substantive theory. Data analysis was performed using MAXQDA 2022 software. A total of 41 people participated in this study. This investigation generated twenty-two categories and seven themes. These themes relate to policymaker commitments, stakeholder governance, quality, adolescents’ lifestyles, adolescents’ self-factors, adolescents’ access to health services, and social support. The themes identified become fundamental aspects of the integrated health care system model for preventing IDA in adolescent girls. The model of the integrated health care system consists of several essential points, which include awareness and efforts from policymakers and adolescent girls, supported by parents, teachers, and the community. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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Review

Jump to: Research

29 pages, 690 KiB

Open AccessReview

Exploring Allied Health Models of Care for Children with Developmental Health Concerns, Delays, and Disabilities in Rural and Remote Areas: A Systematic Scoping Review

by Georgia Gosse, Saravana Kumar, Helen Banwell and Anna Moran

Int. J. Environ. Res. Public Health 2024, 21(4), 507; https://doi.org/10.3390/ijerph21040507 - 19 Apr 2024

Viewed by 817

Abstract

Background: Access to appropriate healthcare is essential for children’s healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models [...] Read more.

Background: Access to appropriate healthcare is essential for children’s healthy development. This is lacking in rural and remote areas, impacting health outcomes. Despite efforts to improve access for these communities, to date, no review has systematically mapped the literature on allied health models of care for children with developmental needs. This scoping review seeks to address this knowledge gap. Methods: Adhering to the PRISMA-ScR and Joanna Briggs Institute guidelines, a systematic search was conducted. A total of 8 databases (from inception to May 2023) and 106 grey literature sources were searched. Two reviewers independently undertook a two-stage screening process. Data were extracted using customised tools and narratively synthesised utilising the Institute of Medicine’s quality domains. This review is registered a priori via Open Science Framework. Results: Twenty-five citations were identified within the literature. Varied models of care were reported from five mostly Western countries. Models of care identified in these areas were classified as screening services, role substitution, consultative services, or online-based services. Positive impacts on quality of healthcare were reported across all quality domains (apart from safety) with the domain of effectiveness being the most commonly reported. Conclusions: Multiple models of care are currently in operation for children with developmental needs in rural and remote areas and appear to improve the quality of care. Due to complexities within, and limitations of, the evidence base, it is unclear if one model of care is superior to another. This review provides a basis for further research to explore why some models may be more effective than others. Full article

(This article belongs to the Special Issue Public Health: Rural Health Services Research)

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