Dissertations / Theses on the topic 'Medicine, Rural Practice Australia'
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Cutts, Christopher. "Identification of influences on the quality use of medicines in general practice in rural Australia /." [St. Lucia, Qld.], 2002. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16591.pdf.
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Murphy, Angela University of Ballarat. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12747.
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"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."Doctor of Philosophy
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Murphy, Angela. "When urban policy meets regional practice : Evidence based practice from the perspective of multi-disciplinary teams working in rural and remote health service provision." University of Ballarat, 2004. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14586.
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"In the main, contemporary research on Evidence Based Practice (EBP) has taken place within metropolitan locations, and has offered urbocentric solutions and insights. However the transferability of these developments to rural services is untested empirically. In addition, evidence development and studies on the implementation of this evidence have tended to be discipline-stream-specific; there has been very little research into either the development of multi-disciplinary evidence guidelines or the implementation of EBP from the perspective of individual practitioners working within multi-disciplinary teams. This research shortfall has provided the rationale for this study...."Doctor of Philosophy
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McGrath, Alicia University of Ballarat. "Changing rural general practitioner practice : evaluating health assessment uptake." University of Ballarat, 2003. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12770.
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The Enhanced Primary Care Package aimed to improve health and quality of life through enhancing primary health care for those over 75 years, Aboriginal and Torres Strait Islanders over 55 years and those with chronic conditions and multidisciplinary needs. A multi-level approach was implemented to promote the package. West Vic Division of General Practice conducted the General Practice Education Support and Community Linkages implementation program for the package in Western Victoria and focused on health assessments for those over 75 years. This research investigated what factors affected change in rural general practitioner practice through surveying general practitioners and collecting Health Insurance Commission data prior to and following the program. Patients were also interviewed to determine acceptance of health assessments and nurse involvement. The program increased awareness, but had little effect on increasing uptake, as only 53% of general practitioners began undertaking health assessments. However the general practitioners indicated an increased frequency of health assessment prescription. Health Insurance Commission data suggested an immediate increase in the use of the assessments, however the rate fluctuated and then declined. Lack of sustained uptake of the program was not associated with remuneration, as 77% of general practitioners did not regard finance as a barrier. Respondents’ major barrier was time (40% pre-education, 73% post-education). This data reflected a rural environment where general practitioners face competing priorities, time constraints, workforce shortage and long consultation lists. A notable change did however occur from practice nurse employment as the involvement of a practice nurse generally resulted in patient satisfaction with the assessment. It was apparent that a complex multifaceted and longer-term view is needed to address factors which limit rural general practitioners’ ability to change. This needs to be addressed at the Commonwealth level and not in isolation in order to produce an integrated framework to enhance and promote, rather than demand change.Master of Applied Science
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McGrath, Alicia. "Changing rural general practitioner practice : evaluating health assessment uptake." University of Ballarat, 2003. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/14607.
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The Enhanced Primary Care Package aimed to improve health and quality of life through enhancing primary health care for those over 75 years, Aboriginal and Torres Strait Islanders over 55 years and those with chronic conditions and multidisciplinary needs. A multi-level approach was implemented to promote the package. West Vic Division of General Practice conducted the General Practice Education Support and Community Linkages implementation program for the package in Western Victoria and focused on health assessments for those over 75 years. This research investigated what factors affected change in rural general practitioner practice through surveying general practitioners and collecting Health Insurance Commission data prior to and following the program. Patients were also interviewed to determine acceptance of health assessments and nurse involvement. The program increased awareness, but had little effect on increasing uptake, as only 53% of general practitioners began undertaking health assessments. However the general practitioners indicated an increased frequency of health assessment prescription. Health Insurance Commission data suggested an immediate increase in the use of the assessments, however the rate fluctuated and then declined. Lack of sustained uptake of the program was not associated with remuneration, as 77% of general practitioners did not regard finance as a barrier. Respondents’ major barrier was time (40% pre-education, 73% post-education). This data reflected a rural environment where general practitioners face competing priorities, time constraints, workforce shortage and long consultation lists. A notable change did however occur from practice nurse employment as the involvement of a practice nurse generally resulted in patient satisfaction with the assessment. It was apparent that a complex multifaceted and longer-term view is needed to address factors which limit rural general practitioners’ ability to change. This needs to be addressed at the Commonwealth level and not in isolation in order to produce an integrated framework to enhance and promote, rather than demand change.Master of Applied Science
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au, jmaxwell@katel net, and John Alexander Loftus Maxwell. "Rural veterinary practice in Western Australia 1964 to 2007." Murdoch University, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20081113.142241.
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Concern for the plight of rural veterinary practice in Australia existed throughout the 20th century. During the 1970s, the profession highlighted the problems faced by rural practitioners and in 2003, the Frawley Review examined current rural veterinary services. However, neither influenced the course of rural practice in Australia.
The present thesis examined the status of rural practice in Western Australia from the 1960s to the present day. It did this by investigating the historical changes in agriculture during this period and their effect on rural practice. The practice at Katanning, in rural Western Australia, was used as a case study a study of the changes and adaptions made by that practice to remain viable.
In 2006, surveys of both rural practitioners and government veterinary officers were conducted to obtain information of the veterinary services being provided to rural Western Australia. In addition, oral history interviews with a number of respondents to the surveys were carried out.
Rapid expansion of Western Australian agriculture took place during the 1960s and was matched by growth in rural veterinary services. A government subsidy scheme recruited a number of veterinarians to the state. A Preventive Medicine/Animal Production service with sheep was established at Katanning in 1967. The reasons for developing such a service, its promotion, the results achieved and its subsequent failure are documented in the thesis.
The 1970s was a troubled decade for agriculture and for those servicing it. The collapse of the beef-cattle boom was accompanied by a 20% reduction in veterinary staff in rural practice Australia-wide and a number of changes were implemented at Katanning to meet these circumstances.
The 1980s saw a reduction in the economic significance of agriculture in Western Australia. At the same time, students from the Veterinary School at Murdoch University began graduating and, for the first time in the professions history, an overproduction of veterinarians existed.
The 1990s was a period of relative stability, but was accompanied by major changes for the profession and rural practice. Many practices adopted merchandising and the sale of pet foods to supplement dwindling income. Previously, a male dominated profession, during this decade, it rapidly changed to one dominated by female graduates. Accompanying this gender change there was an increase in the demand for part-time work, whereas previously the profession had been predominantly a full-time vocation.
The present decade opened with a questioning of the direction being taken by the profession and its undergraduate education. The current study revealed that the government veterinary services in Western Australia have contracted in size and scope, whilst at the same time, most rural practitioners attend companion animals at the expense of economic livestock. As a result, veterinary services to economic livestock have reduced and are likely to continue to do so and suggestions are made to counter this trend.
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Maxwell, John Alexander Loftus. "Rural veterinary practice in Western Australia 1964 to 2007." Thesis, Maxwell, John Alexander Loftus (2008) Rural veterinary practice in Western Australia 1964 to 2007. PhD thesis, Murdoch University, 2008. https://researchrepository.murdoch.edu.au/id/eprint/428/.
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Concern for the plight of rural veterinary practice in Australia existed throughout the 20th century. During the 1970s, the profession highlighted the problems faced by rural practitioners and in 2003, the Frawley Review examined current rural veterinary services. However, neither influenced the course of rural practice in Australia.
The present thesis examined the status of rural practice in Western Australia from the 1960s to the present day. It did this by investigating the historical changes in agriculture during this period and their effect on rural practice. The practice at Katanning, in rural Western Australia, was used as a case study - a study of the changes and adaptions made by that practice to remain viable.
In 2006, surveys of both rural practitioners and government veterinary officers were conducted to obtain information of the veterinary services being provided to rural Western Australia. In addition, oral history interviews with a number of respondents to the surveys were carried out.
Rapid expansion of Western Australian agriculture took place during the 1960s and was matched by growth in rural veterinary services. A government subsidy scheme recruited a number of veterinarians to the state. A Preventive Medicine/Animal Production service with sheep was established at Katanning in 1967. The reasons for developing such a service, its promotion, the results achieved and its subsequent failure are documented in the thesis.
The 1970s was a troubled decade for agriculture and for those servicing it. The collapse of the beef-cattle boom was accompanied by a 20% reduction in veterinary staff in rural practice Australia-wide and a number of changes were implemented at Katanning to meet these circumstances.
The 1980s saw a reduction in the economic significance of agriculture in Western Australia. At the same time, students from the Veterinary School at Murdoch University began graduating and, for the first time in the profession's history, an overproduction of veterinarians existed.
The 1990s was a period of relative stability, but was accompanied by major changes for the profession and rural practice. Many practices adopted merchandising and the sale of pet foods to supplement dwindling income. Previously, a male dominated profession, during this decade, it rapidly changed to one dominated by female graduates. Accompanying this gender change there was an increase in the demand for part-time work, whereas previously the profession had been predominantly a full-time vocation.
The present decade opened with a questioning of the direction being taken by the profession and its undergraduate education. The current study revealed that the government veterinary services in Western Australia have contracted in size and scope, whilst at the same time, most rural practitioners attend companion animals at the expense of economic livestock. As a result, veterinary services to economic livestock have reduced and are likely to continue to do so and suggestions are made to counter this trend.
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Maxwell, John Alexander Loftus. "Rural veterinary practice in Western Australia 1964 to 2007." Access via Murdoch University Digital Theses Project, 2008. http://wwwlib.murdoch.edu.au/adt/browse/view/adt-MU20081113.142241.
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Jeyaretnam, Joseph S. "Occupational hazards and radiation safety in veterinary practice including zoo veterinary practice in Australia." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1306.
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This thesis contains reviews and research on the occupational hazards of zoo veterinary practitioners in Australia. Although occupational hazards have long been recognised in the veterinary profession, little information is available on the number and magnitude of injuries to veterinarians in Australia, the United Kingdom or the United States. Apart from anecdotal accounts and some limited data, most of the available information is on occupational zoonoses, generally well recognized by veterinarians. Other occupational hazards to which veterinarians are exposed have received scant attention. The veterinary practitioner in a zoo environment has to treat a range of captive wild species which are much more unpredictable and dangerous than domesticated animals. A comprehensive study on occupational hazards sustained by veterinarians in zoological gardens has not been undertaken in Australia. Only one study had been undertaken in the US amongst zoo veterinarians, while comprehensive may not be able to be transposed to zoos in Australia as the species held in Australian zoos differ from those in the US. Personal communication with some senior veterinarians in the zoological gardens in Australia, have elicited further information on the prevalence of occupational hazards sustained by the zoo and wildlife park veterinarians. The prevalence of physical hazards including radiation, chemical and biological hazards reported by veterinary practitioners and the author's own experience as a veterinary practitioner, chairman of the safety committee, member of the animal ethics committee and manager, research In the zoological gardens in Perth, Western Australia have demonstrated a need for a comprehensive study on occupational hazards prevalent among zoo veterinarians. To investigate the occupational hazards including radiological hazards amongst zoo veterinarians in Australia, a self-administered 14-page comprehensive questionnaire comprising 58 questions was mailed to 27 practising zoo veterinarians in Australia. The questionnaire focused on physical injuries, chemical exposures, allergic and irritant reactions, biological exposures, radiological hazards including problems encountered with x-ray machines, use of protective gear and ancillary equipment for radiography, personnel involved in x-ray procedures and in restraining animals, compliance with the Australian National Health and Medical Research Council (NHMRC) Code of Practice (1982), Radiation Safety Regulations (1988) and National Standard for Limiting Occupational Exposure to Ionising Radiation (1995) The result of the study revealed that 60% of the participants sustained physical injuries such as crushes, bites and scratches inflicted by a range of species with some Injuries requiring medical treatment. Also, 50% of the participants suffered from back injuries while 15% reported fractures, kicks, bites necessitating hospitalization. Ninety percent of the participants sustained needlestick injuries ranging from one to 16+ times. Other significant findings include: necropsy injuries, animal allergies, formaldehyde exposure, musculoskeletal Injuries and zoonotic infections. The survey also identified that veterinary practitioners and their staff were exposed to radiation by not complying with the National Health and Medical Research Council (NHMRC) Australian Code of Practice for the Safe Use of Ionising Radiation (1982) which has been framed to minimize exposure to ionising radiation. The majority of the veterinarians in the study group indicated that radiation exposure Is a major occupational hazard to the veterinary profession. Subsequent to the review and research, discussions were held with few senior zoo veterinarians, the Registrar of the Veterinary Surgeons Board and a number of practising senior veterinarians In Australia to collect information on occupational hazards. Additional information was obtained on occupational injuries sustained by the zoo veterinarians through formal discussions with the Director and the two senior veterinarians In the zoological gardens in Sri Lanka. The discussions with the veterinary practitioners in government and private practice revealed that veterinarians experienced a range of occupational hazards including exposure to rabies. Discussions with the dean and the professor of the animal science department focused on the nature of injuries and preventive strategies. In order to obtain information on occupational hazards in the health care industry, the professor of anatomy of the faculty of medicine and a senior surgeon in Sri Lanka were interviewed. This study identified that the zoo veterinarians are routinely exposed to a wide range of occupational hazards. The literature review among veterinary practitioners In US, UK, Australia and Canada have also identified numerous occupational hazards sustained by the veterinarians. The discussions held in Sri Lanka with the professionals in veterinary and health care industry showed that occupational injuries have been common amongst them and they do not have appropriate preventive guidelines in place. This thesis has incorporated recommendations in the form of preventive strategies for minimizing occupational hazards among veterinary practitioners both in zoological gardens and veterinary practices In Australia and in the developed and developing countries.
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Duffield, Patricia. "A Pilgrim's Tale : Travelling the landscape of rural and regional practice nursing." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2007. https://ro.ecu.edu.au/theses/271.
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This thesis is based on a model of critical feminist ethnography, designed to explore how practice nurses experience their daily work life in rural and regional general practice. Here, rural and regional practice includes small and large organisations based outside the metroploitan area that employ practice nurses, some in large regional centres and others in small regional communities. Ownership of the general practicioners, local government, regional health services, Aboriginal medical services, universities and private-for-profit businesses.
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Hagemeier, Nicholas E., Sarah Blevins, Kyle Hagen, Emily Sorah, Richa Shah, and Kelly Ferris. "Integration of Rural Community Pharmacies into a Rural Family Medicine Practice-Based Research Network: A Descriptive Analysis." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1476.
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Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation.
Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions.
Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation.
Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas.
Type: Original Research
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Hesterman, Sandra. "Inclusive educational practice in rural Western Australia: A case study of a student with special needs." Thesis, Hesterman, Sandra ORCID: 0000-0001-7491-5527 (1998) Inclusive educational practice in rural Western Australia: A case study of a student with special needs. Masters by Research thesis, Curtin University, 1998. https://researchrepository.murdoch.edu.au/id/eprint/66430/.
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Maphis, L. E., C. Smith, K. Hicks, Jodi Polaha, P. Cronin, and W. T. III Dalton. "Improving Behavioral Health Consultation Skills for Serving Rural Populations: An Advanced Trainee’s Experience in Pedagogy and Practice." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6586.
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Click, Ivy A., Reid B. Blackwelder, and Donald W. Good. "Practice Predictors of Graduates of a College of Medicine with a Rural Primary Care Mission." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/248.
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The purpose of this study was to examine the practicing characteristics of graduates of a college of medicine with a rural primary care mission, including influences on graduates' specialty choices and practice locations. Secondary data analyses were conducted on student records and AMA Physician Masterfile data. Fewer graduates were practicing primary care than had entered primary care training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended other primary care programs. Women and rural track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Primary care physicians (PCPs) were practicing in more rural locales than non-PCPs. Family physicians tended to practice in the most rural locales. FMDRL_ID: 4822
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McCarter, K., Jodi Polaha, and N. Gouge. "Rural Pediatric Primary Care Practice Patterns as a Result of an On-Site Behavioral Health Consultant: A Retrospective Analysis." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6631.
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Blue, Ian A. "The professional working relationship of rural nurses and doctors : four South Australian case studies." Title page, table of contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phb6582.pdf.
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Elliott, Jayne. "Endormez-moi!, an early twentieth-century obstetrical practice in the Gatineau Valley, Quebec." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ26915.pdf.
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Durey, Angela. "The changing face of rural general practice: an ethnographic study of general practitioners and their spouses." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2005. https://ro.ecu.edu.au/theses/61.
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Rural general practice is general practice at its best: a comment by one GP interviewed for this study was echoed by colleagues who viewed their work in a rural setting as challenging, diverse, rewarding and satisfying. Despite reported difficulties associated with rural general practice, many GPs argued that the benefits outweigh the disadvantages. Few wanted to leave. Nonetheless, too few Australian trained GPs are willing to move from cities to work in the country. Consequently, overseas trained doctors have been recruited to fill vacancies or nurses provide health services in communities unable to attract a GP.
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Bellinger, Nathan. "Predictors of Primary Care Physicians Practicing in Medically Underserved and Rural Areas of Indiana." Thesis, Connect to resource online, 2009. http://hdl.handle.net/1805/1954.
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Thesis (M.S.)--Indiana University, 2009.Department of Geography, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Jeffrey Wilson, James J. Brokaw, Owen Dwyer, Terrell W. Zollinger. Includes vitae. Includes bibliographical references (leaves 41-45).
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O'Meara, Peter Francis Public Health & Community Medicine Faculty of Medicine UNSW. "Models of ambulance service delivery for rural Victoria." Awarded by:University of New South Wales. Public Health and Community Medicine, 2002. http://handle.unsw.edu.au/1959.4/18771.
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The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and discussion about possible changes to the way pre-hospital services are delivered in rural Victoria.
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Somers, George Theodore 1951. "An approach to the understanding and measurement of medical students' attitudes toward a rural career." Monash University, School of Rural Health, 2004. http://arrow.monash.edu.au/hdl/1959.1/5190.
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Harris, Evan, McKenzie L. Calhoun, and Jesse Gilbreath. "Establishing an Interprofessional Transitional Care Clinic in a Rural Federally Qualified Health Center (FQHC) Setting." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6896.
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Mills, David. "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia /." Title page, table of contents and abstract only, 2005. http://web4.library.adelaide.edu.au/theses/09MD/09mdm6571.pdf.
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Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005.Includes publications published as a result of ideas developed in this thesis, inserted at end. "April 2005" Includes bibliographical references (leaves 210-242).
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Farmer, Cortney, Havya Dave, Zachary Sumpter, Patricia Conner, and Amanda Stoltz. "OUTPATIENT EVALUATION & MANAGEMENT BILLING AND CODING: DEVELOPMENT OF ENDURING CURRICULUM FOR PGY1 RESIDENT EDUCATION IN A RURAL FAMILY MEDICINE PRACTICE." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/162.
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Accurate Evaluation and Management (E&M) billing and coding is an essential skill for medical clinicians. Consequences of incorrect E&M billing and coding include delayed patient treatment, delayed reimbursements from third party payers, and even charges of insurance fraud. The accuracy of billing and coding is especially salient in practices whose patient population is covered primarily by Medicare/Medicaid, as is the case in many Northeast Tennessee clinics. Despite the importance of accurate E&M billing and coding, recently graduated physicians moving into their first year of residency are often under-informed regarding proper billing and coding. Much of their knowledge about the process is picked up piecemeal over the course of their residency. The purpose of this study is to educate incoming post-graduate year one (PGY1) medical residents on the E&M billing and coding system for a rural Family Medicine clinic. During their first month as PGY1 resident physicians, participants were given a survey to assess their knowledge of E&M billing and coding for outpatient encounters. Participants then attended an educational session on this topic and received handouts that they could reference in the future. The participants were then surveyed again. Data analysis is currently underway. A repeated measure t-test will be utilized to determine if the educational session and informational handouts led to a statistically significant increase in PGY1 resident knowledge of E&M billing and coding. It is expected that participants will show significant knowledge gains as a result of the educational training. This research has important implications for medical resident training, particularly in rural practices that treat large populations covered by Medicare/Medicaid.
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Snyder, Jennifer A. "Investigation of Physician Assistants' Choice of Rural or Underserved Practice and Framing Methods of Recruitment and Retention." Thesis, Nova Southeastern University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3644022.
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Objective: This dissertation analyzed one state's physician assistant (PA) workforce focusing on recruitment and retention. The goal was to identify factors associated with Indiana PAs working in medically underserved, rural, and primary-care medicine. The study evaluated characteristics of PAs who chose initially to work in rural versus urban areas and who have continued to do so. From the literature and as a result of study outcomes, a framework was developed, upon which recommendations were made for effective methods of increasing and retaining the number of PAs in primary care within rural areas. Subjects: Data were obtained from applications for PA licensure submitted to the Indiana Professional Licensing Agency between the years 2000 and 2010. Additionally, PAs working in Indiana who graduated during this period were surveyed. Methods: Descriptive statistics quantitatively defined the Indiana PA workforce. Survey questions to this population focused on provider upbringing, education, and specialization interest, as well as recruitment and retention to rural, primary-care, or underserved areas. Chi Square tests and logistic regression were used, where appropriate, to examine the influence of independent variables on the choice of practicing in rural, primary-care, and medically underserved areas. Based on these responses, recommendations were developed for strategies to increase the supply of physician assistants in rural areas. Findings: Among applicants for PA licensure in Indiana from 2000 to 2010, there were more females (70%) than males (30%), and the median age of applicants was 35 years. Respondent PAs predominantly worked in counties that were designated by the United States Department of Agriculture as metropolitan (91.3%) and largely in areas designated as Code 1 according to Rural-Urban Continuum Codes, the highest level of urbanicity. Additionally, more PAs worked in a specialty area (79%) than in primary care (21%). Chi Square analyses revealed significant relationships (p < .05) between primary care and gender; educated outside of Indiana and working in an underserved area; and being born in a rural area and choosing to practice in a rural area. Binary logistic regression identified that female gender was predictive of the decision to practice in primary care, and birth in a rural area was predictive of current rural practice. In reflecting upon their first employment following training, 70 percent of respondents believed that the job offer was neither directly nor indirectly a result of having completed a clinical rotation at that particular site, or having worked with a particular preceptor, during their experiential training. A relationship was found between the respondents' initial job location being urban and living in a metro location at the time of high school graduation. Finally, educational debt influenced males' initial practice location and specialty but did not similarly affect choice of practice among females. Conclusions: There were several important characteristics of recently licensed PAs in Indiana that were identified in this study. Educational institutions, policymakers, and communities may increase recruitment and retention of PAs to rural and primary-care practice by actively identifying PAs who possess selected characteristics for the area of interest and providing incentives to reduce educational debt.
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Click, Ivy A. "Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etd/1112.
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The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included all living graduates with Doctor of Medicine (MD) degrees who graduated from 1998 through 2009 (n=678). Statistical procedures included Pearson Chi-square, logistic regression, independent t tests, ANOVA, and multiple linear regression. Data analyses revealed that the majority of graduates were between 24 and 29 years of age, male, white, non-Hispanic, and from metropolitan hometowns. Most had completed the generalist track and initially entered a primary care residency training program. The majority passed USMLE Step 1 and Step 2 on the first attempt. The USMLE Step 2-CK average was 212.50. The average cumulative GPA was 3.44. Graduates were nearly evenly divided between primary care and nonprimary care practice, with the majority practicing in metropolitan areas. Graduates who initially entered primary care residency training were more likely to practice primary care medicine than those who entered nonprimary care programs; however, fewer graduates were practicing primary care than had entered primary care residency training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended family medicine, pediatrics, or OB/GYN programs. Women and Rural Primary Care Track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Nonprimary care physicians had significantly higher USMLE Step 2-CK scores than did primary care physicians (PCPs). PCPs practiced in more rural locales than non-PCPs. Family physician graduates tended to practice in more rural locales than OB/GYNs or pediatricians. Hometown location predicted practice location over and above medical school track.
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Brusk, Amy M. "Survey of business management factors associated with mixed animal veterinary practice size and growth." Thesis, Manhattan, Kan. : Kansas State University, 2009. http://hdl.handle.net/2097/1431.
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Clark, R. A. "Chronic Heart Failure Beyond City Limits: An Analysis of the Distribution, Management and Information Technology Solutions for People with Chronic Heart Failure in Rural and Remote Australia." Thesis, University of South Australia, 2007.
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Loh, Poh Kooi. "Innovations in health for older people in Western Australia." University of Western Australia. School of Medicine and Pharmacology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0051.
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Australia and many other developed communities are ageing rapidly, placing a strain on the delivery of health services. This thesis examines the use of innovative health services management coupled with information and communication technology (ICT) to more efficiently deliver services to disabled older people in the hospital, community and residential care. The hypothesis explored is that ICT can provide clinical services to older people in poorly serviced communities and groups, thus extending the influence and capabilities of specialist health care professionals. The relevance of these studies is predominantly for those people who live outside the metropolitan regions, particularly in remote and rural communities, and also for those frail older people, who because of disability, are unable to travel to specialist health services. There are a series of studies presented in this thesis which have all been published. They have demonstrated that in a community and rural setting, ICT use in the assessment and management of geriatric syndromes such as dementia is valid and practical. This included the validation of commonly used assessment tools via Telehealth. A Telehealth protocol for assessment of Alzheimer's Dementia (AD) was developed and published. The use of ICT to link health services clinical and administrative data for determining stroke outcomes and disability has been evaluated and a resource utilization prediction model developed. Finally, in residential care a survey and a qualitative study of poor uptake of ICT services in hostels and nursing homes revealed insights into ICT perception by the older people in care facilities and their professional staff. The implications and future development of these studies have been discussed, especially barriers to increased uptake of ICT, cost comparisons and the potential of future technologies such as video conferencing mobile phones.
30
Mamudu, Hadii M., Pooja Subedi, Timir Paul, Ali E. Alamin, Arsham Alamian, Liang Wang, David Stewart, et al. "The Associated Risk Factors for Coronary Artery Calcium in Asymptomatic Individuals with and Without Diabetes in Rural Central Appalachia." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5561.
Full textAbstract:
Aim To examine the risk factor of coronary artery calcium (CAC) in individuals with diabetes and those without diabetes in Central Appalachia. Methods Study population included 2479 asymptomatic participants who underwent CAC screening between August 2012 and November 2016. CAC score was classified into four categories [0 (no plaque), 1–99 (mild plaque), 100–399 (moderate plaque), and ≥400 (severe plaque)]. Multinomial logistic regression analyses were conducted to test the association between CAC and cardiovascular disease (CVD) risk factors among participants with diabetes, age and gender matched controls, and randomly selected controls. Results 13.6% of total participants had diabetes. Around 69%, 59.8%, and 57.7% of the participants with diabetes, matched controls, and randomly selected controls had CAC score ≥1, respectively. Participants with diabetes had higher prevalence of all CVD risk factors than controls. Among participants with diabetes, hypertension and physical inactivity increased the odds of CAC = 100–399, while among those without diabetes, hypertension and hypercholesteremia increased the odds of having CAC = 1–99 and CAC ≥ 400. Conclusion Half of study participants had subclinical atherosclerosis (i.e., CAC), and individuals with diabetes had higher CAC scores. This study suggests that individuals with diabetes in Central Appalachia might benefit from screening for CAC.
31
Williams, J. Gary. "Supervised autonomy : medical specialties and structured conflict in an Australian General Hospital /." Title page, contents and abstract only, 1991. http://web4.library.adelaide.edu.au/theses/09PH/09phw7242.pdf.
Full text
32
Fitzpatrick, Lesley Maria Gerard. "Inventing cultural heroes : a critical exploration of the discursive role of culture, nationalism and hegemony in the Australian rural and remote health sector." Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/16371/1/Lesley_Fitzpatrick_Thesis.pdf.
Full textAbstract:
Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point.
Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony.
The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts.
The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector.
In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce.
The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.
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Fitzpatrick, Lesley Maria Gerard. "Inventing cultural heroes : a critical exploration of the discursive role of culture, nationalism and hegemony in the Australian rural and remote health sector." Queensland University of Technology, 2006. http://eprints.qut.edu.au/16371/.
Full textAbstract:
Rural and remote areas of Australia remain the last bastion of health disadvantage in a developed nation with an enviable health score-card. During the last ten years, rural and remote health has emerged as a significant issue in the media and the political arena. This thesis examines print media, policy documents and interviews from selected informants to ascertain how they represent medical practitioners and health services in rural and remote areas of Australia, why they do so, and the consequences of such positions. In many of these representations, rural and remote medical practitioners are aligned with national and cultural mythologies, while health services are characterised as dysfunctional and at crisis point. Ostensibly, the representations and identity formulations are aimed at redressing the health inequities in remote rural and Australia. They define and elaborate debates and contestations about needs and claims and how they should be addressed; a process that is crucial in the development of professional identity and power (Fraser; 1989). The research involves an analysis and critical reading of the entwined discourses of culture, power, and the politics of need. Following Wodak and others (1999), these dynamics are explored by examining documents that are part of the discursive constitution of the field. In particular, the research examines how prevailing cultural concepts are used to configure the Australian rural and remote medical practitioner in ways that reflect and advance socio-cultural hegemony. The conceptual tools used to explore these dynamics are drawn from critical and post-structural theory, and draw upon the work of Nancy Fraser (1989; 1997) and Ruth Wodak (1999). Both theorists developed approaches that enable investigation into the effects of language use in order to understand how the cultural framing of particular work can influence power relations in a professional field. The research follows a cultural studies approach, focussing on texts as objects of research and acknowledging the importance of discourse in the development of cultural meaning (Nightingale, 1993). The methodological approach employs Critical Discourse Analysis, specifically the Discourse Historical Method (Wodak, 1999). It is used to explore the linguistic hallmarks of social and cultural processes and structures, and to identify the ways in which political control and dominance are advanced through language-based strategies. An analytical tool developed by Ruth Wodak, Rudolf de Cillia, Martin Reisigl and Karin Leibhart (1999) was adapted and used to identify nationalistic identity formulations and related linguistic manoeuvres in the texts. The dissertation argues that the textual linguistic manoeuvres and identity formulations produce and privilege a particular identity for rural and remote medical practitioners, and that cultural myth is used to popularise, shore up and advance the goals of rural doctors during a period of crisis and change. Important in this process is the differentiation of rural and remote medicine from other disciplines in order to define and advance its political needs and claims (Fraser, 1989). This activity has unexpected legacies for the rural and remote health sector. In developing a strong identity for rural doctors, discursive rules have been established by the discipline regarding roles, personal and professional characteristics, and practice style; rules which hold confounding factors for the sustainability of remote and rural medical practice and health care generally. These factors include: the professional fragmentation of the discipline of primary medical care into general practice and rural medicine; and identity formulations that do not accommodate an ageing workforce characterised by cultural diversity, decreasing engagement in full time work, and a higher proportion of women participants. Both of these factors have repercussions for the recruitment and retention of rural and remote health professionals and the maintenance of a sustainable health workforce. The dissertation argues that the formulated identities of rural and remote medical practitioners in the texts maintain and reproduce relationships of cultural, political and social power. They have also influenced the ways in which rural and remote health services have been developed and funded. They selectively represent and value particular roles and approaches to health care. In doing so, they misrepresent the breadth and complexities of rural and remote health issues, and reinforce a reputational economy built on differential professional and cultural respect, and political and economic advantage. This disadvantages the community, professions and interest groups of lower value and esteem, and other groups whose voices are often not heard. Thus, regardless of their altruistic motivations, the politics of identity and differentiation employed in the formulated identities in the texts are based on an approach that undermines the redistributive goals of justice and equity (Fraser 1997), and works primarily to develop and advantage the discipline of rural medicine.
34
Clements, Andrea D., Jodi Polaha, Wallace E. Jr Dixon, and Jan Brownlee. "The Assessment and Treatment of Attention-Deficit Hyperactivity Disorder in Primary Care: A Comparison of Pediatricians and Family Practice Physicians." Digital Commons @ East Tennessee State University, 2008. https://doi.org/10.1037/h0095954.
Full textAbstract:
The adherence to published guidelines for diagnosis and treatment of Attention-Deficit Hyperactivity Disorder (ADHD) by primary care pediatricians (PDs) and family practice physicians (FPs), particularly those in rural areas, has not been well documented. This study examined survey responses from PDs and FPs who serve southern Appalachia (northeast Tennessee, southwest Virginia and Kentucky, and western North Carolina) regarding key practice parameters in line with the current American Academy of Pediatrics guidelines. Results showed that both PDs and FPs reported adhering to most of the diagnosis and treatment guidelines. PDs were more likely than FPs to report using both parent and teacher input in diagnosis and reported prescribing different medications for ADHD to some degree. Both practice areas reported ongoing access to continuing medical education, which is a means to enhancing care of ADHD patients. Implications for primary care are given with attention to the limited availability of PDs in rural areas and future areas of research in rural mental healthcare are suggested.
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Dowling, Karilynn, Taylor Riedley, MacKenzie Broome, and Nicholas E. Hagemeier. "Stopping the Spread by Using Sterile Needles Instead: A Rural Community Pharmacy Hepatitis C/HIV Prevention Feasibility Study." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5432.
Full textAbstract:
Purpose: Prescription and illicit opioid abuse have disproportionately impacted the Central Appalachian Region. Centers for Disease Control and Prevention (CDC) data indicate the region is home to many of the 220 counties most vulnerable to rapid dissemination of Hepatitis C Virus (HCV) and HIV related to injection drug use. Growing evidence supports the role of community pharmacies in HCV/HIV prevention by providing access to non-prescription sterile syringes; however, research has largely been confined to major metropolitan areas. The objective of this study is to evaluate the feasibility of community pharmacies in Central Appalachia serving as access points for sterile syringes. Methods: This study was approved by the Institutional Review Board. Using state directories of health professionals, community pharmacists from Northeast Tennessee, Western North Carolina, and Southwest Virginia were randomly selected to participate in key informant interviews to inform understanding of the impact of attitudes, beliefs, and state-level policies on pharmacists’ syringe dispensing behaviors (N=15). Informed consent was obtained prior to initiating the interviews and participants were provided modest compensation for their time. The semi-structured interviews were guided by Theory of Planned Behavior constructs to focus the interview on evidence-based predictors of behaviors. Interviews were audio-recorded, de-identified, transcribed, and are currently being thematically analyzed by the research team with NVivo software. The results of this study are expected to inform development of a survey instrument for a larger quantitative evaluation of pharmacists' perceptions on syringe dispensing in the region. Results: Not applicableConclusion: Not applicable
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Loury, Sharon, Mchael Bradfield, Joseph Florence, Kenneth Silver, Karin Hoffman, and Alexis Andino. "Addressing the Health of Hispanic Migrant Farmworkers in Rural East Tennessee Through Interprofessional Education, Experiential Learning, and a University/Community Partnership." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/ijhse/vol1/iss1/3.
Full textAbstract:
The concept of interprofessional practice and education is not new but has recently gained attention as the result of a paradigm shift in the future of healthcare and how it is delivered and financed. Universities are now addressing ways to incorporate interprofessional education and learning experiences into the curriculum to ensure graduating healthcare professionals are competent to collaborate as a team and deliver quality effective healthcare.
A regional research university in East Tennessee with health programs across five Health Science colleges (Clinical and Rehabilitative Health Sciences, Medicine, Nursing, Pharmacy, and Public Health), Psychology, and Social Work has offered an interprofessional rural course for more than six years. The two-semester course is focused on vulnerable or underserved populations and rural communities in the south central Appalachian region. Each course section comprised of 8 to 10 students is led by a team of two or more faculty who represent a cross section of healthcare disciplines and focuses on a specific population or community. The student groups develop interprofessional working relationships among each other and faculty while partnering with rural communities. Using a community-based participatory research approach they prioritize health needs, and develop and implement evidence-based strategies to address the identified needs. Interprofessional education, cross cultural learning, and a university/community partnership within the context of the Hispanic migrant farmworker population are addressed in this paper. The course process, target population, cultural learning, and student outcomes are specifically discussed.
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D'Arrietta, Louisa, and n/a. "An investigation of the information needs and information-seeking behaviour of general practitioners in their delivery of patient care to the elderly on the Gold Coast." University of Canberra. Information, Language & Culture, 1994. http://erl.canberra.edu.au./public/adt-AUC20060426.164122.
Full textAbstract:
The study investigated the self-reported information needs and
information-seeking behaviour of 143 general practitioners in their delivery
of patient care to the elderly on the Gold Coast.
The study sought to obtain an information profile in order to begin
discussion on the need for possible infrastructures that may need to be
considered in any planning strategies concerned with access to and
provision of relevant, accurate and timely information to general
practitioners which affects their delivery of patient care to the growing
number of elderly patients.
A ten-page questionnaire utilising both structured and unstructured
questions was returned by 61.9 percent of the survey population.
Demographic characteristics indicated that respondents were representative
of general practitioners in Australia.
Respondents frequently needed information with 40 percent requiring it '1 -
4 times a week' and 78 percent 'once a month or more often'. Information
on medical fact was required most frequently, 29 percent, medical opinion
27 percent, and non-medical information 23 percent.
The study found support for the proposition that computerised information
systems need to be enhanced and made widely known and available to
general practitioners to assist them in obtaining information that they need
in delivery of patient care to the elderly. There is a great need by these
general practitioners for non-medical information as well as medical
information. Therefore, the development of a database of non-medical
information containing information on local agencies and services is of high
priority.
Library information delivery services should also be de-institutionalised in
terms of lifting restrictions to services provided to enable general
practitioners greater access to information. Library services should aim to
provide remote access to information via telephone, fax and modem with
emphasis on value added services aimed at solving a particular specific
information need as well as straight-out bibliographic search services and
document delivery services.
Continuing medical education in the form of CME courses, conferences and
meetings should focus on specific information needs of general practitioners
in this area of patient care to the elderly. The need for information on
cardiology, orthopaedics, dermatology, physiotherapy, podiatry,
pharmaceutical benefits, home help, Meals-on-Wheels and nursing home
placement were areas of particular interest identified by respondents in this
study.
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Carman, Rebecca Anne. "The impact of immunisation service delivery in general practice on Aboriginal children living in the Perth metropolitan area: An opportunity to reduce the gap?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2019. https://ro.ecu.edu.au/theses/2176.
Full text
39
Laurence, Caroline Olivia Mary. "Overseas trained doctors in rural and remote Australia: do they practise differently from Australian trained doctors?" 2008. http://hdl.handle.net/2440/49903.
Full textAbstract:
Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a significant part of Australia’s policy to address the medical workforce issue of geographic maldistribution to ensure that communities in rural and remote Australia have access to adequate general practice (GP) services. This policy has not been without problems, particularly in the areas of assessment of skills and qualifications, appropriate orientation and integration into Australian communities, and retention of these doctors within rural and remote communities. To date there has been little evidence-based research on the role of OTDs in the medical workforce in Australia. This study explores the service provision and quality of care provided by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the adequacy of this strategy and discusses the implications for future workforce policies and programs. A mixed method design was used in the study. The quantitative component involved secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote Australia in the same year. A log Poisson regression model was used to assess the interactive effect of the various GP characteristics, such as age, sex, experience and practice location with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient age and sex. The qualitative component involved two focus groups with OTDs which were used to help explain the relationships between variables found in the quantitative component of the study. Template analysis was used to identify themes from the focus group. Significantly different rates per patient between OTDs and ATDS were found across most service items and GP characteristics examined. The greatest variation was found among items relating to in-surgery consultations and non-surgery consultations such as nursing home visits. Fewer differences were found between groups relating to pathology, imaging or procedural services. Analysis of surrogate quality items identified few differences between OTDs and ATDs. The focus group identified a number of other factors that influenced their patterns of service and accounted for some of the differences identified in the quantitative analysis. These factors included knowledge of the health care system in Australia, cultural and communication influences, health conditions of patients, patient and community attitudes, remuneration influences and training influences. These had varying degrees of influence on their patterns of service. The reasons for the differences found between OTDs and ATDs are partially explained by the characteristics of the GPs examined and partially explained by other external influences that relate to the particular circumstances of the OTDs, such as knowledge of the Australian health care system and cultural and communication issues. Understanding the nature of practice is central to ensuring appropriate professional support measures. The study findings highlight the need for a targeted training program for OTDs that address the areas that have the greatest influence on patterns of service to ensure that rural and remote communities receive the same quality of service from OTDs as provided by ATDs.http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1320385
Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008
40
Laurence, Caroline Olivia Mary. "Overseas trained doctors in rural and remote Australia: do they practise differently from Australian trained doctors?" Thesis, 2008. http://hdl.handle.net/2440/49903.
Full textAbstract:
Over the last seven years the recruitment of overseas trained doctors (OTDs) has formed a
significant part of Australia’s policy to address the medical workforce issue of geographic
maldistribution to ensure that communities in rural and remote Australia have access to
adequate general practice (GP) services. This policy has not been without problems,
particularly in the areas of assessment of skills and qualifications, appropriate orientation and
integration into Australian communities, and retention of these doctors within rural and
remote communities.
To date there has been little evidence-based research on the role of OTDs in the medical
workforce in Australia. This study explores the service provision and quality of care provided
by OTDs using the 5 Year OTD Scheme as the case study. In doing so, it assesses the
adequacy of this strategy and discusses the implications for future workforce policies and
programs.
A mixed method design was used in the study. The quantitative component involved
secondary analysis of Medicare Australia data for all OTDs participating in the 5 Year OTD
Scheme in 2002 and all Australian trained doctors (ATDs) practising in rural and remote
Australia in the same year. A log Poisson regression model was used to assess the interactive
effect of the various GP characteristics, such as age, sex, experience and practice location
with OTD/ATD status on the rate of a particular service item per patient, adjusted for patient
age and sex.
The qualitative component involved two focus groups with OTDs which were used to help
explain the relationships between variables found in the quantitative component of the study.
Template analysis was used to identify themes from the focus group.
Significantly different rates per patient between OTDs and ATDS were found across most
service items and GP characteristics examined. The greatest variation was found among
items relating to in-surgery consultations and non-surgery consultations such as nursing home
visits. Fewer differences were found between groups relating to pathology, imaging or
procedural services. Analysis of surrogate quality items identified few differences between
OTDs and ATDs.
The focus group identified a number of other factors that influenced their patterns of service
and accounted for some of the differences identified in the quantitative analysis. These
factors included knowledge of the health care system in Australia, cultural and
communication influences, health conditions of patients, patient and community attitudes,
remuneration influences and training influences. These had varying degrees of influence on
their patterns of service.
The reasons for the differences found between OTDs and ATDs are partially explained by the
characteristics of the GPs examined and partially explained by other external influences that
relate to the particular circumstances of the OTDs, such as knowledge of the Australian health
care system and cultural and communication issues. Understanding the nature of practice is
central to ensuring appropriate professional support measures. The study findings highlight
the need for a targeted training program for OTDs that address the areas that have the greatest
influence on patterns of service to ensure that rural and remote communities receive the same
quality of service from OTDs as provided by ATDs.Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008
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Taylor, Selina Maree. "Expanded pharmacy practice in rural Australia." Thesis, 2021. https://researchonline.jcu.edu.au/74283/1/JCU_74283_Taylor_2021_thesis.pdf.
Full textAbstract:
Selina Taylor studied pharmacists, consumers, health professionals and stakeholders perspectives of expanded pharmacy practice and integrated her findings to develop and pilot an ear health intervention for rural community pharmacy. This study highlights the challenges and enablers of expanded services for rural and remote community pharmacy in Australia.
42
Casey, Mavourneen. "The practice of Western Herbal Medicine in Australia." Thesis, 2009. http://hdl.handle.net/1959.13/39546.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)In recent decades, complementary and alternative medicine (CAM) has gradually assumed a growing popularity and economic importance in the health care systems of Western nations including Australia. Personal expenditure on CAM now represents a significant investment by the Australian general population. During this period, various CAM professions have steadily emerged as popular, if unofficial, healthcare providers. Despite the growing popularity of CAM, little is known outside of special interest groups about most CAM practices or about the professionals who provide them. In Australia one of the most well known and popular forms of CAM is herbal medicine. The focus of this thesis is on the professional practice of herbal medicine in Australia, specifically Western Herbal Medicine (WHM). It is estimated that practitioners of WHM conduct almost two million consultations a year representing an investment of $AUS 85 million (excluding the cost of medicines)in the Australian health economy. Typically described as a complete system of medicine, WHM boasts a comprehensive philosophy and claims to offer a unique approach to treatment, diagnosis and prescription. WHM practitioners reputedly operate within a broad range of autonomy, including some acting as primary health care professionals. Nevertheless, little is known about the Australian WHM profession: their approach to clinical practice; their use of herbal medicines; the patients and problems seen in WHM practice; or the nature of the WHM profession’s relationship with the mainstream healthcare sector. This thesis presents a pragmatic health services inquiry that aims to provide empirical data for the purpose of stimulating reflective practice within the WHM profession and seeks to inform discussion about the role of WHM in the Australian healthcare system. The analysis employs the concept of 'mainstreaming' (the increasing popularity, acceptance and legitimacy of CAM within the dominant healthcare structures) to explore the response of WHM to the changing role of CAM within mainstream healthcare. Mainstreaming is interpreted as an active social process in which the boundaries between CAM and mainstream healthcare are shifting, and is a concept that implies the dominance of the mainstream medical paradigm. The investigation triangulates quantitative and qualitative methods to provide an in-depth account of WHM practice from the perspective of the WHM practitioner. The study population is the membership of the National Herbalists’ Association of Australia (NHAA), and the unit of analysis is the individual WHM practitioner. The research describes the clinical practice of WHM and explores the WHM profession’s developing relationship with the mainstream – including the Australian public and the mainstream healthcare professions, particularly medical practice. A social theoretical framework is employed to examine WHM practice within its social context. The conceptual framework directs the examination of the evolving relationship between WHM and mainstreaming towards three core areas of intersection: (1) the inter-professional; (2) the intra-professional; and (3) the professional/non-professional. The inquiry consists of a mixed methods design in which an initial survey study is followed by a qualitative in-depth interview study. The rationale of adopting a mixed methods approach was threefold: firstly, to increase the scope of inquiry by selecting methods most appropriate for each inquiry component; secondly, to better understand the research problem by converging both types of data; and finally, to increase the validity of constructs and inquiry results by triangulation of data sources. The survey study consisted of a postal questionnaire that was distributed to the membership of the NHAA. The survey was specifically designed for this study in consultation with the NHAA. A preliminary pilot study of the draft questionnaire was conducted consisting of both a formal and informal stage of testing. The questionnaire was distributed with the association’s quarterly professional journal (The Australian Journal of Medical Herbalism) in December 2003 and again in March 2004. Achieving a response rate of 58% (n=378), the survey data described key aspects of the WHM profession; its approach to clinical practice, herbal prescribing and aspects of its professional relationships. The survey results demonstrated an increased influence of medical science on WHM principles and practices including the incorporation of medical concepts,clinical procedures, technologies and language into clinical practice. Although the survey provided strong evidence of a trend towards the rationalisation of WHM clinical practice, the results showed how the prescription of herbal medicines remains a predominantly traditional practice. In terms of the WHM profession, the survey results indicate that WHM practitioners are not assuming a primary healthcare role in Australia but are predominantly providing treatments for chronic conditions. The data indicated high levels of concurrent patient care, including concurrent use of pharmaceutical and herbal medicines;thus, suggesting that WHM clientele consider WHM a complementary rather than an alternative form of medicine. The survey also showed that WHM practitioners would welcome improved inter-professional and intra-professional relationships. The second phase of the mixed methods study consisted of a series of qualitative in-depth interviews with a sub-sample of survey respondents (n=18)resident in NSW, Australia. The objectives of the in-depth interview study were twofold: firstly, to add depth and meaning to survey data; and secondly, to understand the practice of WHM from the perspective of the WHM practitioner.To ensure flexibility and to uncover novel data from the participants the in-depth interviews were carried out on a semi-structured basis. Building upon the survey findings, the qualitative study explored the WHM practitioners' conceptualisations, explanations and rationalisations of their approach to WHM practice. The interview participants represented a broad range of WHM practitioners who commonly shared a holistic worldview, but who also offered a range of interpretations of the philosophical and theoretical basis of WHM. The investigation described how mainstream conceptualisations of healthcare have impacted upon the traditional model of WHM practice. The analysis identifies a number of competing sub-groups within WHM who each advocate particular approaches to WHM practice. In particular, the analysis highlights a significant degree of internal tension operating within WHM about the salience of medical science within WHM. The analysis also revealed how the perceived subordination to, and thus distinction from, mainstream medicine is a dominant issue within the WHM practitioner’s discourse. The explanation for this emerged from the perception amongst the in-depth interview participants of the widespread appropriation of herbal medicine by the mainstream, as well as systematic discrimination towards the WHM profession. Furthermore, there was evidence of not only poor intra-professional cohesion but significant intra-professional differences regarding the apposite location of WHM in relation to mainstream healthcare. This research provides new understandings about the clinical practice of WHM practice, but also about the role of the WHM practitioner in Australian healthcare. The thesis reveals a story of irony. Despite the increasing popularity of herbal medicines and significant concessions within WHM to the medicalparadigm, the WHM profession is struggling to achieve legitimate participation within the mainstream and continues to operate on the fringe of Australian healthcare. The thesis concludes that the process of mainstreaming is challenging the authenticity of WHM herbal tradition and challenging the future viability of the WHM profession, the implications of which suggest that the WHM practitioner will continue to experience financial insecurity unless the WHM profession can collectively move to demarcate its scope of practice and legitimate its professional role.
43
Casey, Mavourneen. "The practice of Western Herbal Medicine in Australia." 2009. http://hdl.handle.net/1959.13/39546.
Full textAbstract:
Research Doctorate - Doctor of Philosophy (PhD)In recent decades, complementary and alternative medicine (CAM) has gradually assumed a growing popularity and economic importance in the health care systems of Western nations including Australia. Personal expenditure on CAM now represents a significant investment by the Australian general population. During this period, various CAM professions have steadily emerged as popular, if unofficial, healthcare providers. Despite the growing popularity of CAM, little is known outside of special interest groups about most CAM practices or about the professionals who provide them. In Australia one of the most well known and popular forms of CAM is herbal medicine. The focus of this thesis is on the professional practice of herbal medicine in Australia, specifically Western Herbal Medicine (WHM). It is estimated that practitioners of WHM conduct almost two million consultations a year representing an investment of $AUS 85 million (excluding the cost of medicines)in the Australian health economy. Typically described as a complete system of medicine, WHM boasts a comprehensive philosophy and claims to offer a unique approach to treatment, diagnosis and prescription. WHM practitioners reputedly operate within a broad range of autonomy, including some acting as primary health care professionals. Nevertheless, little is known about the Australian WHM profession: their approach to clinical practice; their use of herbal medicines; the patients and problems seen in WHM practice; or the nature of the WHM profession’s relationship with the mainstream healthcare sector. This thesis presents a pragmatic health services inquiry that aims to provide empirical data for the purpose of stimulating reflective practice within the WHM profession and seeks to inform discussion about the role of WHM in the Australian healthcare system. The analysis employs the concept of 'mainstreaming' (the increasing popularity, acceptance and legitimacy of CAM within the dominant healthcare structures) to explore the response of WHM to the changing role of CAM within mainstream healthcare. Mainstreaming is interpreted as an active social process in which the boundaries between CAM and mainstream healthcare are shifting, and is a concept that implies the dominance of the mainstream medical paradigm. The investigation triangulates quantitative and qualitative methods to provide an in-depth account of WHM practice from the perspective of the WHM practitioner. The study population is the membership of the National Herbalists’ Association of Australia (NHAA), and the unit of analysis is the individual WHM practitioner. The research describes the clinical practice of WHM and explores the WHM profession’s developing relationship with the mainstream – including the Australian public and the mainstream healthcare professions, particularly medical practice. A social theoretical framework is employed to examine WHM practice within its social context. The conceptual framework directs the examination of the evolving relationship between WHM and mainstreaming towards three core areas of intersection: (1) the inter-professional; (2) the intra-professional; and (3) the professional/non-professional. The inquiry consists of a mixed methods design in which an initial survey study is followed by a qualitative in-depth interview study. The rationale of adopting a mixed methods approach was threefold: firstly, to increase the scope of inquiry by selecting methods most appropriate for each inquiry component; secondly, to better understand the research problem by converging both types of data; and finally, to increase the validity of constructs and inquiry results by triangulation of data sources. The survey study consisted of a postal questionnaire that was distributed to the membership of the NHAA. The survey was specifically designed for this study in consultation with the NHAA. A preliminary pilot study of the draft questionnaire was conducted consisting of both a formal and informal stage of testing. The questionnaire was distributed with the association’s quarterly professional journal (The Australian Journal of Medical Herbalism) in December 2003 and again in March 2004. Achieving a response rate of 58% (n=378), the survey data described key aspects of the WHM profession; its approach to clinical practice, herbal prescribing and aspects of its professional relationships. The survey results demonstrated an increased influence of medical science on WHM principles and practices including the incorporation of medical concepts,clinical procedures, technologies and language into clinical practice. Although the survey provided strong evidence of a trend towards the rationalisation of WHM clinical practice, the results showed how the prescription of herbal medicines remains a predominantly traditional practice. In terms of the WHM profession, the survey results indicate that WHM practitioners are not assuming a primary healthcare role in Australia but are predominantly providing treatments for chronic conditions. The data indicated high levels of concurrent patient care, including concurrent use of pharmaceutical and herbal medicines;thus, suggesting that WHM clientele consider WHM a complementary rather than an alternative form of medicine. The survey also showed that WHM practitioners would welcome improved inter-professional and intra-professional relationships. The second phase of the mixed methods study consisted of a series of qualitative in-depth interviews with a sub-sample of survey respondents (n=18)resident in NSW, Australia. The objectives of the in-depth interview study were twofold: firstly, to add depth and meaning to survey data; and secondly, to understand the practice of WHM from the perspective of the WHM practitioner.To ensure flexibility and to uncover novel data from the participants the in-depth interviews were carried out on a semi-structured basis. Building upon the survey findings, the qualitative study explored the WHM practitioners���� conceptualisations, explanations and rationalisations of their approach to WHM practice. The interview participants represented a broad range of WHM practitioners who commonly shared a holistic worldview, but who also offered a range of interpretations of the philosophical and theoretical basis of WHM. The investigation described how mainstream conceptualisations of healthcare have impacted upon the traditional model of WHM practice. The analysis identifies a number of competing sub-groups within WHM who each advocate particular approaches to WHM practice. In particular, the analysis highlights a significant degree of internal tension operating within WHM about the salience of medical science within WHM. The analysis also revealed how the perceived subordination to, and thus distinction from, mainstream medicine is a dominant issue within the WHM practitioner’s discourse. The explanation for this emerged from the perception amongst the in-depth interview participants of the widespread appropriation of herbal medicine by the mainstream, as well as systematic discrimination towards the WHM profession. Furthermore, there was evidence of not only poor intra-professional cohesion but significant intra-professional differences regarding the apposite location of WHM in relation to mainstream healthcare. This research provides new understandings about the clinical practice of WHM practice, but also about the role of the WHM practitioner in Australian healthcare. The thesis reveals a story of irony. Despite the increasing popularity of herbal medicines and significant concessions within WHM to the medicalparadigm, the WHM profession is struggling to achieve legitimate participation within the mainstream and continues to operate on the fringe of Australian healthcare. The thesis concludes that the process of mainstreaming is challenging the authenticity of WHM herbal tradition and challenging the future viability of the WHM profession, the implications of which suggest that the WHM practitioner will continue to experience financial insecurity unless the WHM profession can collectively move to demarcate its scope of practice and legitimate its professional role.
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Reid, Stephen John Young. "Education for rural medical practice." Thesis, 2010. http://hdl.handle.net/10413/3951.
Full textAbstract:
In the context of a country and a continent that is largely rural, education for rural medical practice in Africa is relatively undocumented and poorly conceptualized. The arena of medical education in South Africa has been largely unchanged by the transition to democracy, despite intentions of reform. The literature reveals a lack of empirical evidence as well as theory in education for rural health, particularly in developing countries.
This report presents twelve original papers on a range of key issues that represent the author’s contribution to filling this gap in South Africa. It aims to contribute to the development of a discourse in education for rural medical practice in an African context, and culminates in a theoretical paper regarding pedagogy for rural health. A conceptual framework is utilized that is based on the standard chronological steps in the initial career path of medical doctors in South Africa.
Beginning with the literature that is focused around the need to recruit and retain health professionals in rural and underserved areas around the world, the report then addresses the policy context for medical education in South Africa, examining the obstacles to true reform of a transformatory nature. The selection of students of rural origin, and the curricular elements necessary to prepare graduates for rural practice are then investigated, including the actual career choices that medical graduates make in South Africa. Out in the workplace, the educational components of the year of compulsory community service are described, including organizational learning and apprenticeship as novice practitioners, placed under severe pressure in rural hospitals in the South African public health service. A community-oriented type of medical practice is described amongst exemplary individuals, indicating the aspiration towards a different kind of educational outcome.
Finally the thesis as such is presented in the final paper regarding a theoretical basis for education for rural health, consisting of the combined notions of placed-based and critical pedagogy. It is argued that while the geographic elements of rural practice require a pedagogy that is situated in a particular rural context, the developmental imperatives of South Africa demand a critical analysis of health and the health care system, and the conceptual basis of this position is explained.Thesis (Ph.D.) - University of KwaZulu-Natal, Durban, 2010.
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Martin, Carmel. "The care of chronic illness in general practice." Phd thesis, 1998. http://hdl.handle.net/1885/147963.
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Taylor, Judy. "Community participation in organising rural general medical practice three case studies in South Australia." 2004. http://arrow.unisa.edu.au:8081/1959.8/24996.
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It is well documented that rural and remote Australian residents have poorer access to medical services than their counterparts in capital cities. According to the Australian Institute of Health and Welfare in 1998 there were 75.3 vocationally registered general practitioners per 100,000 population in rural and remote areas, compared with 103.0 per 100,000 in metropolitan areas. In 1998 28.7% of the Australian population lived in rural and remote areas, so a substantial proportion of the Australian population is adversely affected by the unequal distribution of general practitioners. Australian country communities highly regard the services of general practitioners and they continue to demand residential medical services. Demand is driven by need for access to health services, but also by the intimate inter-relationships between the general practice and community sustainability. For example, the general practice contributes to the viability of the local hospital which is often a major employer in the district. Consequently, many country communities strive to keep their general practice by contributing to practice infrastructure, providing governance, raising funds for medical equipment, and actively helping recruitment.thesis (PhDHealthSciences)--University of South Australia, 2004.
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Arviers, Peter. "The Training and Education Needs of Emergency Medicine Doctors working in Rural and Regional Australia." 2007. http://eprints.utas.edu.au/7761.
Full textAbstract:
For professional and lifestyle reasons, most specialist doctors (including emergency medicine specialists) choose to live and work in major metropolitan centres. In rural and regional hospitals, emergency presentations are generally dealt with by ‘non-specialist’ doctors, often with limited peer support and minimal specialist backup. Recruitment of suitably trained medical staff for rural and regional hospitals is increasingly difficult. The doctors working in the emergency departments of these smaller hospitals are a mix of junior medical staff, Career Medical Officers, short term locums, and part time General Practitioners - with a high reliance on overseas trained doctors from widely varying backgrounds.
While undergraduate and general practice training in rural areas has been extensively studied, there has been relatively little attention given to postgraduate specialty training and few studies on adverse events and health outcomes in rural areas.
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Halcomb, Elizabeth, University of Western Sydney, College of Social and Health Sciences, and of Nursing Family and Community Health School. "Carving a niche for Australian practice nurses in chronic heart failure management." 2005. http://handle.uws.edu.au:8081/1959.7/20689.
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Chronic and complex conditions are a significant concern within contemporary health care systems. The ageing population and improvements in survival from acute cardiac illness have seen an increasing incidence of heart failure (HF). Heart failure represents a significant burden on both the individual and the wider community. Despite effective pharmacotherapy and established evidence-based management guidelines, the overall prognosis from HR is poor. The complexity of the disease process and the highly developed evidence-base makes HR an excellent exemplar for the management of a range of chronic conditions. Studies undertaken as part of the ‘Carving a niche for Australian practice nurses’ project have led to the development of a model of care that integrates the role of the practice nurse with those of other health care providers to improve outcomes for people with chronic and complex conditions. Whilst the model of care developed from these studies requires empirical testing to validate its utility, it is currently being incorporated in clinical planning and ongoing pragmatic research. The systematic, sequential derivation of data from this ‘Carving a niche for Australian practice nurses’ project will inform the development of primary care and provide a conceptual framework for future intervention studies in Australian general practice.Doctor of Philosophy (PhD)
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." 2004. http://hdl.handle.net/2440/22153.
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"October 2004"Includes bibliographical references (leaves 313-337)
x, 337 leaves : ill. (col.), maps (col.) ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2004
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Grech, Carol Margaret. "Coronial inquiries into fatal adverse events in South Australian hospitals : from inquest to practice / Carol Grech." Thesis, 2004. http://hdl.handle.net/2440/22153.
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