Welcome to the rural research blog – brought to you by the Section of Rural Health.
The postcards from the edge series has come to an end. However, if you have something to contribute then please be in touch.
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A case for mandatory ultrasound training for rural general practitioners: a commentary
Arnold AC, Fleet R, Lim D. A case for mandatory ultrasound training for rural general practitioners: a commentary . Rural and Remote Health 2021; 21:6328. Full text is open access:: https://doi.org/10.22605/RRH6328
Don’t disagree. Increasing access to cheaper devices (e.g. Butterfly) and multiple training opportunities including Postgraduate Certificate in Clinician-Performed Ultrasound (PGCertCPU) will hopefully open up this diagnostic modality to more clinicians and patients. Multiple GPs and rural hospital docs have now done PGCertCPU.
Adequate peer-review and credentialing for clinicians, especially those in isolated practices/facilities, remains an issue.
Context: Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient’s bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients’ lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five.
Issues: Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling and quality assurance programs prevent physicians from feeling confident when utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use.
Lessons learned: Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance.
Australia, diagnostic imaging, paediatric diagnostic imaging, patient transfers, point-of-care ultrasound, rural medicine, telemedicine, training protocol.
Thanks to Fiona Doolan-Noble for forwarding this paper.
Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa
Whitehead J, Atatoa P, Scott N, Lawrenson R. Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa. Preprint on medRxiv. https://doi.org/10.1101/2021.08.26.21262647
This is a pre-print version. It has not been peer reviewed but is open access. The final publication (after peer review/editorial process) maybe (slightly) different and we will link to that when it is available.
From Jesse the lead author:
We examined the spatial accessibility of Covid-19 vaccination services across NZ at the start of the latest Covid-19 delta outbreak. We estimated access by looking at the number of vaccination services available to communities within a 30 minute drive, relative to the size of the local population. The locations of Covid-19 vaccinations services on the 18th August 2021 were distributed unevenly, and resulted in better spatial access for urban, wealthy, and European populations. Access was significantly worse for rural areas, Māori, older people, and areas of high socioeconomic deprivation. We also found significant variation in levels of access by DHB region. Furthermore, high access to Covid-19 vaccination services at the DHB level was associated with more equitable vaccination uptake for Māori. DHBs that provided the best access to vaccination services had the highest vaccination rate ratios for Māori.
Are we surprised?
Aim This research examines the spatial equity, and associated health equity implications, of the geographic distribution of Covid-19 vaccination services in Aotearoa New Zealand.
Method We mapped the distribution of Aotearoa’s population and used the enhanced-two-step-floating-catchment-method (E2SFCA) to estimate spatial access to vaccination services, taking into account service supply, population demand, and distance between populations and services. We used the Gini coefficient and both global and local measures of spatial autocorrelation to assess the spatial equity of vaccination services across Aotearoa. Additional statistics included an analysis of spatial accessibility for priority populations, including Māori (Indigenous people of Aotearoa), Pacific, over 65-year-olds, and people living in areas of high socioeconomic deprivation. We also examined vaccination service access according to rurality, and by District Health Board region.
Results Spatially accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Māori, older people, and residents of areas with socioeconomic constraint have, on average, statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services, also varies significantly by District Health Board (DHB) region as does equality of access, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Māori vaccination rate ratio of DHBs.
Conclusion Covid-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive Covid-19 vaccinations, have the worst access to vaccination services.
Congratulations to the three members of the Section received wards at the RNZCGP conference. Kati Blattner who was awarded the Eric Elder medal, Branko Sijnja was awarded a Distinguished Fellowship, Jill Muirhead and Wendy Finnie were awarded Honorary Fellowships.
For those of you who are in leadership roles can you please fill in the below survey (it’s QUICK!). For those who are not – can you please forward within your workplaces!
You can cash in your chocolate fish in a time when we can talk again.
The place of Rural Hospitals in New Zealand’s Health System: an exploratory study
University of Otago Research Grant 2021; PI Kati Blattner, RF Lynne Clay,
CI’s Tim Stokes, Garry Nixon, Rory Miller, Sue Crengle, Lauralie Richard & Ray Anton
Aims: To identify current and future priorities for NZ rural hospitals and gain a national picture of NZ rural hospital provision to provide a platform for further research through:stakeholder interviews, a national online survey & identification of key service characteristics.
Progress to date:
Interviews: Thank you to rural hospital leaders and key stakeholders who have participated
representing 18 RH (with 2 more IV scheduled), and 4 national stakeholder groups.
National Survey: For people in leadership roles (clinical & non-clinical), we have now launched our short survey. Please access today!
Service Characteristics: A worksheet of key service provision information populated from RH websites. We will be emailing these to RH leaders for assistance to verify and add missing details.
Podcast version (audio only) coming soon.