Academic literature on the topic 'Rural health services Victoria Yea'

IntroductionOver 310 000 women gave birth in Australia in 2016, with approximately 80 000 births in the state of Victoria. While most of these births occur in metropolitan Melbourne and other large regional centres, a significant proportion of Victorian women birth in local rural health services. The Victorian state government recently mandated the provision of a maternal and neonatal emergency training programme, called Maternal and Newborn Emergencies (MANE), to rural and regional maternity service providers across the state. MANE aims to educate maternity and newborn care clinicians about recognising and responding to clinical deterioration in an effort to improve clinical outcomes. This paper describes the protocol for an evaluation of the MANE programme.Methods and analysisThis study will evaluate the effectiveness of MANE in relation to: clinician confidence, skills and knowledge; changes in teamwork and collaboration; and consumer experience and satisfaction, and will explore and describe any governance changes within the organisations after MANE implementation. The Kirkpatrick Evaluation Model will provide a framework for the evaluation. The participants of MANE, 27 rural and regional Victorian health services ranging in size from approximately 20 to 1000 births per year, will be invited to participate. Baseline data will be collected from maternity service staff and consumers at each health service before MANE delivery, and at four time-points post-MANE delivery. There will be four components to data collection: a survey of maternity services staff; follow-up interviews with Maternity Managers at health services 4 months after MANE delivery; consumer feedback from all health services collected through the Victorian Healthcare Experience Survey; case studies with five regional or rural health service providers.Ethics and disseminationThis evaluation has been approved by the La Trobe University Science, Health and Engineering College Human Ethics Sub-Committee. Findings will be presented to project stakeholders in a deidentified report, and disseminated through peer-reviewed publications and conference presentations.

Outpatient and emergency services in rural hospitals have rarely been studied. This paper analyses routinely collecteddata, together with data from a survey of hospitals, to provide a picture of these services in Victorian public hospitals.The larger rural hospitals provide the bulk of rural outpatients and emergency services, particularly so for medicaloutpatients. Cost per service varies with the size of the hospital, possibly reflecting differences in complexity. Fundingpolicies for rural hospital outpatient and emergency services should be sufficiently flexible to take into account thedifferences between rural hospitals.

Objective: The objective was to describe and evaluate a community mental health service developed during 1991–1992 in an attempt to meet the mental illness needs of an isolated rural community. The setting was the Grampians health region in Western Victoria: this region has an area of 45,000 square kilo-metres and a population of 182,000. Method: The method involved firstly describing the evolution of the service delivery model. This comprised a team of travelling psychiatrists and community psychiatric nurses which succeeded in providing a combined inpatient and outpatient service which was integrated with general practitioners. Secondly, diagnostic and case load descriptions of patients receiving service were compared for both the inpatient and outpatient settings. Results: The results were that reduced reliance on inpatient beds and increased consumer satisfaction were achieved. Conclusion: It was concluded that on initial evaluation of the service it was seen to be meeting its objective of treating the seriously mentally ill in an isolated rural community based setting.

The objective of the study was to describe and explain variations in rates of hospital admissions for long-term complications of diabetes mellitus in rural and urban Victoria as an indicator of the adequacy of ambulatory care services. The Victorian Inpatient Minimum Database (VIMD), Health Insurance Commission data for 1998, Medical Labour Force Annual Survey 1998, Socioeconomic Indexes for Areas 1996 (SEIFA) and Accessibility/Remoteness Index of Australia (ARIA) were merged to determine the extent to which hospitalisation for complications of diabetes can be predicted from accessibility and utilisation of general practitioner services. The rural and urban differentials for long-term diabetic complications and their strong relationship with GP services, the degree of remoteness, lack of insurance, and Aboriginality reflect issues related to equity and access, patient and GP education, and inclination to seek care, all of which have implications for planning of primary health services in rural areas. This study describes a model for the analysis of ambulatory care sensitive conditions, and illustrates the important use of routine databases combined with other sources of information in quantifying the impact of factors related to primary care services.

In April 1995 the Royal Children's Hospital Mental Health Service in Melbourne piloted the use of videoconferencing in providing access for rural service providers and their clients to specialist child and adolescent psychiatric input. What began as a pilot project has in two years become integrated into the service-delivery system for rural Victoria. The experience of the service in piloting and integrating the use of videoconferencing to rural Victoria has been an important development for child and adolescent mental health services in Australia.

In June 1994, the Renfrew Victoria Hospital was selected as the first-ever recipient of the Health Care Quality Team Award in the “Small and Rural Provider” category. This award, offered by the Canadian College of Health Service Executives and 3M Health Care, was established to recognize health care organizations that have sustained measurable improvements in their network of services, and have done so through the use of a team. Renfrew Victoria Hospital's entry focused on the establishment of a hemodialysis unit for the residents of Renfrew County. This article summarizes the parameters of this award, as presented in our submission.

The study reported in this paper compared data from 20 separate focus groups,representing providers and consumers of health services in the Grampians region,Victoria, on their perceptions of the allied health service issues in that region. Theresults of the study indicated that providers and consumers raised many similar issuesin regard to allied health services ? access to allied health services, service delivery,social and rural issues ? but discussed the issues from different perspectives. Theprovider discussion was concerned with service delivery issues and the consumerdiscussion was focused on broader social issues which affect health.

Objective: To investigate the reasons for complaint or non-complaint by rural consumers of health services. Design: Qualitative study using focus group discussion of hypothetical scenarios. Setting: Selected rural communities in the Loddon- Mallee region of north-western Victoria. Participants: Sixty volunteer participants in eight focus groups recruited through advertising. Main outcome measure: Issues and themes concerning circumstances leading to, and factors inhibiting, complaints about a health service and awareness of complaints mechanisms. Results: Compared with residents of larger towns, those of small communities were more likely to report they would complain to the local provider, whereas those in larger towns were more likely to mention Hospital Boards or the Commissioner. Deterrents to making complaints included the lack of services, scepticism about the role of complaints in bringing about change and an attitude that it was more appropriate to try to fix the problem than complain about it. Lack of awareness of appropriate complaint mechanisms which feed into quality assurance processes was also identified.

Research has indicated that people with a dual diagnosis of mental illness and substance abuse are more difficult to manage than any other group of mentally ill clients. For young people with a dual diagnosis, particularly in rural and regional areas, there are significant barriers to the provision of optimal care. Currently, a lack of communication between mental health, drug and alcohol services and consumers results in the inadequate provision of treatment for young people, with a resultant significant service gap. Dual diagnosis programs that focus on both substance abuse and mental health issues demonstrate greatly improved client outcomes. Developing a peer education program provides one constructive way of involving dual diagnosis consumers in developing more responsive health services. It provides a highly structured and supported way of involving consumers who ordinarily find mental health services bewildering and inaccessible. By drawing on the knowledge and skills of young people with dual diagnosis, and involving them as peer educators, the notion of expertise in lived experience is captured and harnessed to provide the establishment of a consumer-focused service that better meets the needs of this complex, often neglected, client group.

Introduction. There is a higher prevalence of Parkinson’s disease (PD) in rural Australia and a poorer perceived quality of life of rural Australians with PD. Coordinated multidisciplinary teams specialised and experienced in the treatment of PD are recommended as the preferred model of care best able to manage the complexities of this disorder. There remains a lack of team-based specialised PD services in rural Australia available to people living with PD. This study aims to explore how the lack of specialised PD services impacts on the person’s experiences of the health care they receive in rural Victoria. This study compared the health-care experiences of two different cohorts of people with PD living in rural Victoria; one cohort living in East Gippsland have had an established comprehensive care model implemented with local trained teams and supported by a metropolitan PD centre, and the other cohort was recruited from the remainder of Victoria who had received standard rural care. Methods. This descriptive study used a survey to explore health-care experiences. Questionnaires were mailed to participants living in rural Victoria. Eligibility criteria included having a diagnosis of PD or Parkinsonism and sufficient English to respond to the survey. The validated Patient-Centred Questionnaire for PD was used to measure health-care experiences. The questions are grouped accordingly under one of the 6 subscales or domains. Outcomes from the questionnaire included summary experience scores (SES) for 6 subscales; overall patient-centeredness score (OPS); and quality improvement scores (QIS). Secondary outcomes included health-related quality of life using the disease-specific questionnaire PDQ39; disease severity using the Hoehn and Yahr staging tool; and disability using the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part II. Results. Thirty-nine surveys were returned from the East Gippsland group and 68 from the rural group. The East Gippsland group rated significantly more positive the subscales “empathy and PD expertise,” P=0.02, and “continuity and collaboration of professionals,” P=0.01. The groups did not differ significantly for the remaining 4 subscales (P>0.05) nor for the OPS (P=0.17). The QIS showed both groups prioritised the health-care aspect “provision of tailored information” for improvement. Quality of life was greater (P<0.05) and impairment (P=0.012) and disability were less (P=0.002) in the East Gippsland group. Conclusion. Participants who received health care from the East Gippsland program had better key health-care experiences along with better QOL and less impairment and disability. Participants prioritised provision of information as needing further improvement.

The objective of this study was to give voice to women experiencing psychiatric rehabilitation services in rural Victoria. A critical analysis of the literature revealed a landscape of marginalisation and alienation for women experiencing a mental illness in a rural area. This study used a phenomenological method to explore the meanings of women's experiences. The understanding of meaning was developed through a dual perspective with women experiencing rural psychiatric rehabilitation and workers who delivered these services. The research centred on the voices of the women but encouraged a personal and collective reflective approach with workers. As the researcher I also took a reflexive approach which highlighted the methodology as an evolving and ongoing process and demonstrated the integral nature of the researcher in the research process. A chapter on locating the researcher was included as part this reflective process. The analysis of the collective stories produced a rich diversity of material was drawn together thematically to include: • Reflections of struggle; • Long way from anywhere: • The rural dimension; • Construction of a caring relationship, and, • Interlinking care. Through this thesis I argue that women are marginalised and alienated by social cultural conditions of their lives which impacts on their mental illness and rural experiences. However, women are not a homogenous group and a diversity of experiences exists which demonstrates women's active capacity to mediate their environment. As active participants in their psychiatric rehabilitation care the women were able to shift their identity from one of powerlessness and lack of control towards regaining control and managing their illness and environment. The thesis is a story of transformation as the women progressively moved forward in their journey.

The study explored, described and explained the current models of voluntary counselling and testing services delivery and analysed the extent to which a given VCT model had influenced uptake of VCT services in the fishing communities along the shores of Lake Victoria, in Wakiso District, with an aim of designing optimal VCT service delivery strategies. The study was therefore exploratory, descriptive and explanatory, and collected both qualitative and quantitative data in a three-phased approach. Phase I involved the Kasenyi fishing community respondents, while phases II and III involved VCT managers and VCT counsellors at the Entebbe and Kisubi Hospitals. The findings indicated that VCT services are generally available onsite at health facilities, and in the field through mobile VCT outreach or home-based VCT services provided at clients’ homes. Both client-initiated and health provider-initiated VCT services are available and services are integrated with other health services. Despite the availability of VCT, only about half of the respondents in phase I had accessed VCT services although almost all indicated a willingness to undergo HIV testing in the near future. The main challenges to service delivery and utilisation included limited funding and staffing as well as limited awareness in target communities. The strategies drawn are based on the need to increase availability, accessibility, acceptability and utilisation of VCT services.
Health Studies
D. Litt. et Phil. (Health Studies)

Statistics show that Australia has an ageing population which will experience radical changes over the next 50 years due to the progression into retirement of generations born in the ‘baby boom’ years (1945-1965). Statistics also show that the proportion of Australian people over 65 is increasing and, as the majority of deaths occur in this age group the demand for palliative care, or care of the dying, is also likely to increase. Many retiring baby boomers looking for a sea change, gravitate towards coastal and rural areas may well be contributing to Foskey’s (1998) notion of ‘Aged Care Ghettos’ where these areas may not have the desired infrastructure to deal with an increased demand for health services including palliative care services. An increasing focus on, and public interest in palliative care research will likely emerge in keeping with the changing needs of an ageing population. It will become particularly important that relevant research undertakings are initiated to establish a clearer understanding of the issues and problems surrounding palliative care. At the present time there exists a limited research base in relation to palliative care and related services in Australia. While there has been a concentration of palliative support services in urban settings this has not been the case in rural based settings. Palliative Care Australia (2000) reported that half of the people receiving palliative care in Victoria in 1997 died in rural and regional areas, which may be attributed to harsher living environments, poor access to health services, specialists, and health professionals, lower socio-economic status and employment levels, and exposure to occupational hazards. This thesis is concerned with examining palliative care services and related needs in a selected rural area within the Australian state of Victoria. The overall aim of this research was to investigate the availability of palliative care services, trends in ageing and to examine the relationship between the two. Methodology used in this research incorporated a sequential mixed methods approach of quantitative and then qualitative methodology to determine the relationship between the needs of an ageing population and rural palliative care service delivery in Australia. The data collection included demographic statistics from the Australian Bureau of Census and Statistics and Palliative Care Australia, and were used for descriptive purposes to inform and support this research. Other ordinal data were obtained using a questionnaire. These data were analysed in the context of the research. Qualitative data were obtained through interviews with focus groups. The Gippsland area provided an excellent area for this research and the findings of this research would appear to be consistent with the literature relating to access and equity issues faced in rural areas. Other rural areas may replicate the data gathering used in this research. A number of conclusions are able to be drawn from this research based on the review of literature and examination of the emerging issues, results and findings. Statistical projections into ageing indicate that the health of all Australians will have significant consequences for our society as we generally live longer and healthier lives. Health and ageing predictions and projections should prompt key stakeholders including baby boomers, the aged cohorts of the future, to plan and prepare, perhaps redefining ageing in the attempt. Findings further show that planning should include preparations for the expected rise of dementia related diseases and the implications of gender on health which will have ramifications for an ageing population, and in particular for women as carers in our society. As a result of this research recommendations are made for a model for the delivery of palliative care services in rural areas, which is specific to the needs of an ageing population. These recommendations are made in acknowledgement and with respect and consideration for the concerns of the rural community where feedback from focus group participants suggests that rather than another ‘model’, a hospice is what is needed to meet the current and future needs of rural communities. “Another ‘Model’ is the last thing we need, it’s not the how we are doing things, it’s the where – we desperately need a hospice down here” and, “It’s bricks and mortar we want down here, not more theories”. Evidence collected from this research also suggests that a ‘rural attitude’ to death and dying may prevail. In its simplest form, this attitude emerges in statements such as: ‘it’s the country you expect to get less’ and ‘we just look after our own when we can’. It is also apparent that while people in rural areas have the same medical and palliative care needs as those in metropolitan areas, this research shows that they are differentially disadvantaged when it comes to accessing palliative care services. This research has found that a negative relationship exists between ageing trends in a selected rural area of Australia chosen for this study and the availability of palliative care services.

Abstract The Mallee Climate Oral History Collection is the product of a four-year research partnership with Museum Victoria. From 2004 to 2007, a series of annual recordings were conducted on the experience of drought with people in wheat-belt communities dotted across the semiarid Mallee. The timing of the project during the millennium drought coincided with a momentous shift in Australian public awareness of climate change, prompting reflexive discussion of the meaning of drought. Interviewees wore several “hats” in life—farming to health work, public service to parenting, local business to education, government science to community advocacy for rural social and environmental sustainability. These stories bear the mark of rural endurance: as the drought wore on, just one interviewee left the Mallee; the rest were determined to continue making a living here, at the inland edge of the Australian cropping zone.

Information communications technology (ICT) has been identified as a key enabler in the achievement of regional and rural success, particularly in terms of economic and business development. The potential of achieving equity of service through improved communications infrastructure and enhanced access to government, health, education, and other services has been identified. ICT has also been linked to the aspiration of community empowerment, where dimensions include revitalizing a sense of community, building regional capacity, enhancing democracy, and increasing social capital. In Australia, there has been a vision for online services to be used to open up regional communities to the rest of the world. Government support has been seen “as enhancing the competence levels of local economies and communities so they become strong enough to deal equitably in an increasingly open marketplace” (McGrath & More, 2002, p. 40). In a regional and rural context, the availability of practical assistance is often limited. Identification of the most appropriate online services for a particular community is sometimes difficult (Ashford, 1999; Papandrea & Wade, 2000; Pattulock & Albury Wodonga Area Consultative Committee, 2000). Calls, however, continue for regional communities to join the globalized, online world. These are supported by the view that success today is based less and less on natural resource wealth, labor costs, and relative exchange rates, and more and more on individual knowledge, skills, and innovation. But how can regional communities “grab their share of this wealth” and use it to strengthen local communities (Simpson 1999, p. 6)? Should communities be moving, as Porter (2001, p. 18) recommends (for business), away from the rhetoric about “Internet industries,” “e-business strategies,” and the “new economy,” to see the Internet as “an enabling technology—a powerful set of tools that can be used, wisely or unwisely, in almost any industry and as part of almost any strategy?” Recent Australian literature (particularly government literature) does indeed demonstrate somewhat of a shift in terms of the expectations of ICT and e-commerce (National Office for the Information Economy, 2001; Multimedia Victoria, 2002; National Office for the Information Economy, 2002). Consistent with reflections on international industry experience, there is now a greater emphasis on identifying locally appropriate initiatives, exploring opportunities for improving existing communication and service quality, and for using the Internet and ICT to support more efficient community processes and relationships (Hunter, 1999; Municipal Association of Victoria and ETC Electronic Trading Concepts Pty Ltd., 2000; National Office for the Information Economy, 2002). The objective of this article is to explore whether welldeveloped and well-implemented online services can make a positive contribution to the future of regional and rural communities. This will be achieved by disseminating some of the learning from the implementation of the MainStreet Regional Portal project (www.mainstreet.net.au). To provide a context for this case study, the next section introduces some theory relevant to virtual communities and portals. The concept of online communities is introduced and then literature is reviewed to identify factors that have been acknowledged as important in the success of online community and portal initiatives.