Dissertations / Theses: 'Rural general practice'

1

Hays, Richard B. "Improving standards in rural general practice /." St. Lucia, Qld, 2003. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe17837.pdf.

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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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3

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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4

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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5

Watts, Richard Walter. "A participant-observer case study of research in isolated Australian rural general practice." Title page, table of contents and abstract only, 2003. http://web4.library.adelaide.edu.au/theses/09MD/09mdw352.pdf.

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Author's previously published works appended. Bibliography: p. 291-326. The subject of this thesis is a single participant-observer case study which demonstrates the feasibility of integrating research activity within the daily routine of patient care in a busy rural general practice. Case studies were conducted over a period of 10 years in the town of Port Lincoln, South Australia. The research questions were generated by cues or uncertainties arising in routine clinical practice and included the disciplines of epidemiology, clinical audit, randomised drug trials and meta-analysis. The author concludes that research can be an integral part of routine patient care and should be promoted as part of a strategy to improve the research culture of general practice.

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6

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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7

Schwarz, Imogen University of Ballarat. "(Re)creating spaces within rural general practice : women as agents of change at the organisational and practitioner levels." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/12764.

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This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice.
Doctor of Philosophy

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8

Schwarz, Imogen. "(Re)creating spaces within rural general practice : women as agents of change at the organisational and practitioner levels." University of Ballarat, 2005. http://archimedes.ballarat.edu.au:8080/vital/access/HandleResolver/1959.17/15386.

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This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice.
Doctor of Philosophy

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9

James, Marie-Eva. "The practice of local partnership in rural development : the cases of Newent (UK) and Sault (France)." Thesis, University of Gloucestershire, 2001. http://eprints.glos.ac.uk/3020/.

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This research is concerned with the practice of local partnerships in the promotion of rural development with particular reference to two case study areas, Newent in the UK and Sault in France. In recent years, local partnership working has become increasingly common in the promotion of rural development. It is presented by academics, politicians, policy makers and practitioners as 'inherent' and 'imperative' to the preparation and implementation of rural development programmes today. However, there still exists limited understanding and knowledge about local partnership working in practice and the validity and importance of such statements. To advance this understanding the present research had four main objectives organised around the identification and the exploration of four main issues: the reasons, the processes, the outcomes and the implications of the local partnership practice in rural development. The author has sought to elucidate the subject by means of a detailed exploratory study involving the longitudinal observation of two particular examples of local partnerships. Two case study areas were selected, both with an active history of rural development initiatives and partnership working at parish or commune level. Newent is a small town in the Forest of Dean, which has sought to address growing socio-economic decline in recent years by preparing and implementing a regeneration strategy through local partnership working. Sault is a village in Provence, which has had to respond to depopulation and various economic difficulties as well as the closure in 1996-98 of the military base of Albion. Qualitative data on local partnership evolution and operation, collected in both areas between 1998 and 2001, was assembled from documentary research, semi structured interviews and direct observation at meetings. This investigation has allowed the identification of various explanations for the recent increase in the practice of local partnership in rural development, explanations which are mainly associated with the underlying context of the rural development process today and with the meaning of the partnership concept itself. From this investigation local partnership working in rural development has emerged as a long-term, progressive, comprehensive and pragmatic process that is organised over time. Its existence and longevity depend primarily on the local context, the existence of opportunities, the issues to be addressed, a broad mobilisation of local/rural actors, a flexible local space, some local re-organisation as well as regular and concrete achievements. In this respect, the most commonly reported outcomes of local partnership working pertain to the process of partnership working more than to the tangible outputs that may have resulted from it. These meet the initial expected benefits from such a practice as for example broader participation, greater reciprocity between rural development actors and territories, and an increase in local capacity for development action.

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Hunt, Rachel. "Huts, bothies and buildings out-of-doors : an exploration of the practice, heritage and culture of 'out-dwellings' in rural Scotland." Thesis, University of Glasgow, 2016. http://theses.gla.ac.uk/8057/.

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This project provides an insight into the culture and practice of what has been termed ‘out-dwelling’, a cumulative term for huts and bothies. In doing so it draws attention to Scottish rural leisure and seeks to explore the materialities, experiences and practices of the ‘out-dwelling’ scene. As such, it focuses upon both the buildings and their users, speaking to the intimate geographies of this culture, as well as to its broader cultural significance. Part of this task involves an exploration of landscape, and of the means by which out-dwellings facilitate an engagement with physical surrounds beyond their built form. Just as this thesis seeks to situate the intimate interior of being in buildings, it also displays the ‘out-dwelling’ world through a broader lens, viewing these buildings and their users as part of a broader cultural movement, informed by the social history of land-use and ownership in rural Scotland. Inspired by an interest in hutting as a political act, this thesis also explores the critical edge to this potentially radical culture and situates ‘out-dwelling’ within a broader international hutting history. In doing so, this thesis enables a fuller understanding of the past, present and, to a certain extent, the future of such practice within rural Scotland.

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11

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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Henderson, Andrea. "An exploration of the impact of consultation on educational psychology service users, namely teachers, parents and pupils in a large rural local authority." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4622/.

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Research and recent policy developments in the education of children with special educational needs highlight the need for both greater involvement of parents and pupils in determining how pupil needs are met, and increased accountability of educational psychology services, particularly in demonstrating the impact interventions have on clients, namely children and young people. The research aimed to explore the impact of consultation in relation to four areas, namely teachers’ perceptions of their ability to make a difference with regard to progress of the pupils about whom they are concerned; parental perceptions of whether consultation had made a difference to their child’s subsequent progress; pupil perceptions of whether/how actions undertaken following EPs’ consultation with school staff and/or their parents had made a difference to their progress; and what educational psychologists considered to be the key factors enabling consultation to contribute to pupil progress. The educational psychologists used consultation in school with teachers, using Target Monitoring and Evaluation (TME) in order to set targets and monitor progress. Semi-structured interviews were carried out in order to ascertain perceptions regarding the consultation process. Findings suggest that although consultation is perceived as a helpful approach by EPs and those to whom they offered consultation, review and further development of the Service approach to consultation is needed to ensure the greater involvement of parents and pupils in determining and monitoring targets set.

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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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14

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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15

Baines, Darrin Lloyd. "An economic analysis of the effects of the fundholding and indicative prescribing schemes on drug usage and costs in English general practice : a study of one rural health authority." Thesis, University of Nottingham, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.297744.

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16

Abernathy, Sean W. "Practices and experiences of fundraising leadership in large rural associate's colleges in a southeastern state." Thesis, The University of Alabama, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3620045.

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Due to changes in economic and social climate, including a decrease in state and federal funding, Associate's Colleges began to supplement their search for funds by fund raising. Associate's Colleges' fund raising has evolved and the purpose of this research was to scrutinize philosophies, perspectives, practices, relationships, and experiences of collegiate staff involved in institutional fund raising in large rural Associate's Colleges in a southeastern state in order to promote prosperity in resource development. The researcher's objective was to endeavor to document the roles of institutional actors in the fundraising process, their training, background, organization, and how their tactics differ when approaching corporations and individuals. In addition, the study looked at governance of foundations and fundraising staff specifics (job descriptions, student use, size related to funds generated). This included the roles of governance, philosophies, resources, methods of procuring funds, and reporting. This study displayed differences and similarities in fund raising practices at large rural Associate's Colleges in a southeastern state and described the setting in which these events took place. The participants in this study were ten fund raisers connected with Associate's Colleges of varying ages, educational backgrounds, and fund raising experience. Data for the study were derived from semi-structured interviews with each fund raiser, a foundation meeting observation, and a review of fund raising related documents. Using basic qualitative methods, the researcher conducted a thematic analysis of the data which enabled him to organize that data into manageable segments where he coded it. This process enabled the researcher to establish connections between the collected data and the research questions. Three major themes emerged from data analysis: (a) Relationship Management is Fund Raising; (b) Relationship Management is a Product of Resources and Communication; (c) Profitable Fund Raising Involves Maximizing the Potential of Four Factors: Participants, Environment, Experiences, Philosophy. Moreover, the study answered how large rural Associate's Colleges in a southeastern state developed fiscal resources in a climate of reduced state and federal funding.

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Lohn, Christina 1962. "Women's medical knowledge and health care practices concerning the most common respiratory illnesses. A case study of a rural community in northern Germany." Thesis, The University of Arizona, 1991. http://hdl.handle.net/10150/277875.

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In order to stop rising health care expenditures, 81 villagers and their health professionals were interviewed about their medical knowledge (aeteology, symptoms, treatment, illness length, necessity to consult a doctor, etc.) and health care practices concerning common respiratory illnesses. According to informants, sniffles, cough, flu, common cold, sore throat/tonsillitis, bronchitis and sinusitis are the most common respiratory illnesses. All of them are regarded to be caused by several mechanisms of getting cold and/or wet. Despite the general disbelief in the germ theory and the prevention of contagion among household members, informants have an extensive knowledge about effective treatments and consult health professionals when home-remedies fail or a doctor's excuse is needed. Due to the effectiveness of home-treatments and self-containment of most common respiratory infections, this study concludes that health insurance companies should restrict the reimbursement of prescriptions for Bagatellmedizin, inhalation apparatus and home-remedies.

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18

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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19

Watts, Richard Walter. "A participant-observer case study of research in isolated Australian rural general practice / Richard W. Watts." Thesis, 2003. http://hdl.handle.net/2440/38454.

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Author's previously published works appended.
Bibliography: p. 291-326.
xxii, 329 p., [80 leaves] :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
The subject of this thesis is a single participant-observer case study which demonstrates the feasibility of integrating research activity within the daily routine of patient care in a busy rural general practice. Case studies were conducted over a period of 10 years in the town of Port Lincoln, South Australia. The research questions were generated by cues or uncertainties arising in routine clinical practice and included the disciplines of epidemiology, clinical audit, randomised drug trials and meta-analysis. The author concludes that research can be an integral part of routine patient care and should be promoted as part of a strategy to improve the research culture of general practice.
Thesis (MD)--University of Adelaide, Dept. of General Practice, 2003

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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.

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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

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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.

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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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Fraser, John. "Population Health And Public Health In Australian Rural General Practice: A Case Series Of Research, Clinical Applications And Educational Strategies." Thesis, 2006. http://hdl.handle.net/1959.13/24740.

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Background General practice’s population health and public health role is being promoted internationally to improve health outcomes. 1-6 This Thesis aims to: • Describe and evaluate projects which are relevant to exploring the interface of population health and public health with Australian rural general practice; and • Describe and evaluate projects which can increase population health and public health expertise and capacity amongst our future rural general practice workforce. Methods This Thesis uses a descriptive design. A series of research papers published in the peer reviewed literature are presented in each chapter. These papers are used as case studies to explore the aims of this Thesis. A variety of quantitative and qualitative methods have been used to conduct research in remote communities of the Northern Territory, rural South Australia and New South Wales from 1992 to 2005. Results Public health and population health can interface with Australian rural general practice in sustainable models described in case studies within this Thesis. There is a continuum of roles in this interface from population health in practice, public health, ‘new’ public health and leadership. Population health activities include screening and promotion of lifestyle factors to patients.7 Public health activities can be developed to extend the reach of health programs to the broader community. This may include participation in population based surveillance systems and health promotion projects. Promoters of ‘new’ public health 8,9 support an expansion of public health’s scope to include advocating social development through community participation and empowerment. Leadership can extend to policy development and liaison with general practice, population health and public health practitioners to promote collaborative models of health care. A sustainable model of increasing rural workforce recruitment via developing workforce capacity in public health and population health has been developed and evaluated as part of this Thesis. Conclusions This Thesis presents rural Australian case studies demonstrating integration of population health and public health roles with general practice. Vertically integrated workforce models have been developed, as part of this Thesis, which can facilitate recruitment to the rural health workforce. In the long term, educational models have been developed and evaluated as part of this Thesis. These models can increase the population health and public health expertise and capacity of this workforce.
MD Doctorate

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Fraser, John. "Population Health And Public Health In Australian Rural General Practice: A Case Series Of Research, Clinical Applications And Educational Strategies." 2006. http://hdl.handle.net/1959.13/24740.

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Background General practice’s population health and public health role is being promoted internationally to improve health outcomes. 1-6 This Thesis aims to: • Describe and evaluate projects which are relevant to exploring the interface of population health and public health with Australian rural general practice; and • Describe and evaluate projects which can increase population health and public health expertise and capacity amongst our future rural general practice workforce. Methods This Thesis uses a descriptive design. A series of research papers published in the peer reviewed literature are presented in each chapter. These papers are used as case studies to explore the aims of this Thesis. A variety of quantitative and qualitative methods have been used to conduct research in remote communities of the Northern Territory, rural South Australia and New South Wales from 1992 to 2005. Results Public health and population health can interface with Australian rural general practice in sustainable models described in case studies within this Thesis. There is a continuum of roles in this interface from population health in practice, public health, ‘new’ public health and leadership. Population health activities include screening and promotion of lifestyle factors to patients.7 Public health activities can be developed to extend the reach of health programs to the broader community. This may include participation in population based surveillance systems and health promotion projects. Promoters of ‘new’ public health 8,9 support an expansion of public health’s scope to include advocating social development through community participation and empowerment. Leadership can extend to policy development and liaison with general practice, population health and public health practitioners to promote collaborative models of health care. A sustainable model of increasing rural workforce recruitment via developing workforce capacity in public health and population health has been developed and evaluated as part of this Thesis. Conclusions This Thesis presents rural Australian case studies demonstrating integration of population health and public health roles with general practice. Vertically integrated workforce models have been developed, as part of this Thesis, which can facilitate recruitment to the rural health workforce. In the long term, educational models have been developed and evaluated as part of this Thesis. These models can increase the population health and public health expertise and capacity of this workforce.
MD Doctorate

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McFayden, Lisa. "An examination of the structural and political barriers preventing permanent resident overseas-trained doctors from working as general practitioners in rural New South Wales." Thesis, 2008. http://hdl.handle.net/1959.13/29762.

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Research Doctorate - Doctor of Philosophy
This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

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McFayden, Lisa. "An examination of the structural and political barriers preventing permanent resident overseas-trained doctors from working as general practitioners in rural New South Wales." 2008. http://hdl.handle.net/1959.13/29762.

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Abstract:

Research Doctorate - Doctor of Philosophy
This thesis explores the barriers that are preventing large numbers of permanent resident overseas-trained doctors (PROTDs) from working as general practitioners (GPs) in rural New South Wales (NSW). It focuses specifically on doctors from non-English speaking backgrounds who are permanent residents of Australia or Australian citizens, and who migrated to Australia for reasons other than employment. This thesis explores the views and perceptions of PROTDs and does not specifically consider the views of other stakeholders. Archival, qualitative and quantitative research techniques have been used to determine the suitability of the policies and practices governing the appointment and registration of PROTDs in NSW, and to identify any policy changes required. This research demonstrates that the policies governing medical registration in NSW have frequently been driven by political factors, and have, at times, been used to control the size of the medical workforce. As a consequence of these policies, many PROTDs have been prevented from working as a doctor in NSW. Of particular concern is the lack of training or clinical experience available to PROTDs and their difficulties preparing for, and passing, the Australian Medical Council (AMC) examinations. The lack of accurate information regarding the requirements and opportunities for medical practice in NSW is also a major problem. PROTDs in NSW are unable to get the training and support they need to meet the requirements for medical registration in NSW and are rapidly losing their confidence, and their clinical skills. Not all PROTDs are going to have, or be able to acquire, the skills and knowledge required for general practice in rural NSW. However the need for additional doctors is sufficiently great to warrant a proactive approach from governments and relevant agencies. In the seven years it has taken to complete this research, most of the discriminatory aspects of the assessment and registration of PROTDs in NSW have been removed. However the legacy of previous policies and practices remains and a large number of PROTDs remain out of the medical workforce.

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Everitt-Deering, Patricia. "The adoption of information and communication technologies by rural general practitioners a socio technical analysis /." 2008. http://eprints.vu.edu.au/1412/1/everittdeering.pdf.

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This thesis has been supported by an ARC Industry Linkage grant and sought to explain the process of adoption of information technologies by comparing two main theories that have been developed to explain adoption of innovations, that of innovation diffusion and that of actor network theory. In the process of analysis for this thesis I decided very early on that the better way of explaining the pattern of adoption was by using the framework of actor network theory supported by qualitative methodology. A major contribution of this thesis could be seen as an ANT analysis of IT/IM in general practice. It appears that the multi partner, multi discipline research approach was a success for it created the opportunity to draw on diverse backgrounds. More importantly this research indicates that the qualitative research methodology of Actor Network Analysis has delivered an insight that is richer in data than the quantitative research that is usually undertaken in this field. This process assisted with enlightening the barriers and enablers to the adoption of information technology/information management (IT/IM) in general practice in a particular study area and to explain why, in the study area the pattern is fragmented and unclear. This study found it is important to note the difference between the adoption of IT/IM by general practice and adoption and use by general practitioners. The adoption process has been complex and many stakeholders have grappled with issues such as the cost of computerization, the rapid changes in technology, the lack of agreed standards and the problems of introducing technology information solutions in to the daily work place of general practice. Through comparison via case studies, extended interviews and implementing several study phases to develop a longitudinal aspect for the research, the teasing out of such issues as decision making in general practice and general practice as small business was undertaken. Through review of models that seek to explain adoption I will finalise by formalizing which theory of adoption better suits explanation of adoption of innovation within this study area. This thesis reports that while there are generally pockets of high uptake and use of IT/IM, this is not the complete picture across the study area and this reflects the situation in Australia. There are differences in adoption from one practice to another and even within practices; there are differences in adoption in terms of acceptance of an idea versus doing; in the study area there is only one practice which can reasonably claim to be paperless. Throughout this thesis a series of vignettes will be developed which set out to provide a whole play. Each vignette presents an aspect in the total picture of computerization. This thesis does not set out to provide the whole picture as that is still a work in progress, as such this thesis has no definite border, and the vignettes will sometimes show only the head and shoulders of the story with the background fading off. Other vignettes are very clear but as with all vignettes there are questions about the shaded areas. It is in these areas that questions arise to demonstrate there is greater depth in the story of the adoption of IT/IM in general practice in the study area, and, that adoption of IT/IM in general practice is complex and a continuing developmental story.

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Everitt-Deering, Patricia. "The adoption of information and communication technologies by rural general practitioners: a socio technical analysis." Thesis, 2008. https://vuir.vu.edu.au/1412/.

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This thesis has been supported by an ARC Industry Linkage grant and sought to explain the process of adoption of information technologies by comparing two main theories that have been developed to explain adoption of innovations, that of innovation diffusion and that of actor network theory. In the process of analysis for this thesis I decided very early on that the better way of explaining the pattern of adoption was by using the framework of actor network theory supported by qualitative methodology. A major contribution of this thesis could be seen as an ANT analysis of IT/IM in general practice. It appears that the multi partner, multi discipline research approach was a success for it created the opportunity to draw on diverse backgrounds. More importantly this research indicates that the qualitative research methodology of Actor Network Analysis has delivered an insight that is richer in data than the quantitative research that is usually undertaken in this field. This process assisted with enlightening the barriers and enablers to the adoption of information technology/information management (IT/IM) in general practice in a particular study area and to explain why, in the study area the pattern is fragmented and unclear. This study found it is important to note the difference between the adoption of IT/IM by general practice and adoption and use by general practitioners. The adoption process has been complex and many stakeholders have grappled with issues such as the cost of computerization, the rapid changes in technology, the lack of agreed standards and the problems of introducing technology information solutions in to the daily work place of general practice. Through comparison via case studies, extended interviews and implementing several study phases to develop a longitudinal aspect for the research, the teasing out of such issues as decision making in general practice and general practice as small business was undertaken. Through review of models that seek to explain adoption I will finalise by formalizing which theory of adoption better suits explanation of adoption of innovation within this study area. This thesis reports that while there are generally pockets of high uptake and use of IT/IM, this is not the complete picture across the study area and this reflects the situation in Australia. There are differences in adoption from one practice to another and even within practices; there are differences in adoption in terms of acceptance of an idea versus doing; in the study area there is only one practice which can reasonably claim to be paperless. Throughout this thesis a series of vignettes will be developed which set out to provide a whole play. Each vignette presents an aspect in the total picture of computerization. This thesis does not set out to provide the whole picture as that is still a work in progress, as such this thesis has no definite border, and the vignettes will sometimes show only the head and shoulders of the story with the background fading off. Other vignettes are very clear but as with all vignettes there are questions about the shaded areas. It is in these areas that questions arise to demonstrate there is greater depth in the story of the adoption of IT/IM in general practice in the study area, and, that adoption of IT/IM in general practice is complex and a continuing developmental story.

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Mills, David (Peter David Duncombe). "The role of goal setting in the diabetes case management of aboriginal and non-aboriginal populations in rural South Australia / David Mills." 2005. http://hdl.handle.net/2440/38374.

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Includes publications published as a result of ideas developed in this thesis, inserted at end.
"April 2005"
Includes bibliographical references (leaves 210-242)
242 leaves :
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.)--University of Adelaide, Dept. of General Practice, 2005

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Mills, David (Peter David Duncombe). "The role of goal setting in the diabetes case management of Aboriginal and non-Aboriginal populations in rural South Australia / David Mills." Thesis, 2005. http://hdl.handle.net/2440/38374.

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Includes publications published as a result of ideas developed in this thesis, inserted at end.
Includes bibliographical references (leaves 210-242)
242 leaves
Examines goal setting in people with diabetes as part of chronic disease management in a rural setting. The studies were performed in Eyre Peninsula with a significant (10-20%) Aboriginal population.
Thesis (M.D.) -- University of Adelaide, Dept. of General Practice, 2005

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Lartigue, Benoît. "Un festival de jazz en monde rural : analyse sociologique d’un conflit qui dure : le cas français d'Uzeste Musical et de ses relations conflictuelles avec la localité qui l'accueille." Thèse, 2014. http://hdl.handle.net/1866/11539.

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L’étude de cas qui compose ce mémoire de maîtrise cherche à expliquer sous l’optique sociologique la pérennité des relations conflictuelles qu’entretiennent le festival permanent Uzeste Musical et le village du même nom, peuplé de 450 habitants et dans lequel il se déroule depuis plus de 35 ans. Fondée sur une enquête de terrain mêlant approche ethnographique et entretiens semi-dirigés au sein de ce village du sud ouest de la France, l’analyse combine in vivo une description ethnographique du conflit à différents éléments théoriques susceptibles d’en rendre raison. Principalement, le recours à la théorie des champs et des sens pratiques de Bourdieu et à celle, pragmatique, de Boltanski et Thévenot, permet de saisir dans le discours des différents acteurs du conflit les raisons pour lesquelles un festival de jazz comme celui-ci se révèle être à bien trop d’égards étranger aux structures et à la culture d’un tel village pour s’y faire pleinement accepter. Il permet également de rendre compte de la manière par laquelle ces mêmes acteurs tendent à redéfinir un conflit – dont la longévité pourrait a priori sembler insoutenable – en des termes qui leur sont familiers, posture qui leur permet alors de relativiser une conflictualité qu’ils assimilent à l’histoire ordinaire de leur village et avec laquelle ils sont ainsi en mesure de composer.
This master’s thesis is a case study that uses a sociological perspective to seek the reasons of the persistent conflict between the Uzeste Musical festival and a village of 450 inhabitants going by the same name, and last for the past 35 years. Based on a fieldwork, it combines an ethnographical approach and semi-structured interviews within this southwest village of France. The analysis mixes in vivo an ethnographical description of the conflict to different theoretical elements. The field and the practical sense theory of Bourdieu, in addition to the Boltanski & Thévenot’s pragmatic theory will help us understand the true implication of this problematic cohabitation. Through discussions with the different actors of the conflict rise the very reasons why this jazz festival seems foreign to the structures and the culture of the village, thus not being accepted by its inhabitants. Furthermore, it demonstrates the way the actors will try to redefine the conflict itself with familiar terms, even thought the latter seems unsustainable. This position allows them to put the conflict into perspective like it was always a part of the village’s history, thus redefining a way to cope with this problematic cohabitation.

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Van, Biljon Marilene. "Clarifying fair value accounting challenges in the reporting of biological assets in the public sector by referring to ASGISA-EC." Diss., 2013. http://hdl.handle.net/10500/8771.

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Fair value accounting of biological assets in the public sector was introduced with the adoption of the public sector specific accounting standard, Generally Recognised Accounting Practice (GRAP) 101. The public sector currently uses different bases of accounting: public entities and municipalities must use accrual accounting and apply the principles of GRAP, while government departments report on the modified cash basis. Furthermore, public entities do not consistently apply the requirements of GRAP 101. This lack of a uniform basis of accounting has a negative effect on the comparability of financial information. This study identified the challenges facing the public sector in the application of GRAP 101, specifically regarding the fair value accounting of biological assets. The successful implementation of GRAP 101 by a public entity, AsgiSA-EC, was used as a case study to clarify the fair value accounting challenges in the reporting of biological assets in the sector.
Business Management
M. Accounting Science

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Dissertations / Theses on the topic 'Rural general practice'

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