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Doctors’ experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study
Back in 2018 the Department of General Practice and Rural Health hosted Dr Mante Hedman – rural GP from northern Sweden – for his PhD research on rural health care in Sweden and NZ. His NZ research has now been published and is OPEN ACCESS: https://bmjopen.bmj.com/content/12/12/e062968
Objective To explore rural hospital doctors’ experiences of providing care in New Zealand rural hospitals. Design The study had a qualitative design, using qualitative content analysis. Setting The study was conducted in South Island, New Zealand, and included nine different rural hospitals. Respondents Semistructured interviews were conducted with 16 rural hospital doctors. Results Three themes were identified: ‘Applying a holistic perspective in the care’, ‘striving to maintain patient safety in sparsely populated areas’ and ‘cooperating in different teams around the patient’. Rural hospital care more than general hospital care was seen as offering a holistic perspective on patient care based on closeness to their home and family, the generalist perspective of care and personal continuity. The presentation of acute life-threatening low-frequency conditions at rural hospitals were associated with feelings of concern due to limited access to ambulance transportation and lack of experience. Overall, however, patient safety in rural hospitals was considered equal or better than in general hospitals. Doctors emphasised the central role of rural hospitals in the healthcare pathways of rural patients, and the advantages and disadvantages with small non-hierarchical multidisciplinary teams caring for patients. Collaboration with hospital specialists was generally perceived as good, although there was a sense that urban colleagues do not understand the additional medical and practical assessments needed in rural compared with the urban context. Conclusions This study provides an understanding of how rural hospital doctors value the holistic generalist perspective of rural hospital care, and of how they perceive the quality and safety of that care. The long distances to general hospital care for acute cases were considered concerning.
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The Department of General Practice and Rural Health, Dunedin School of Medicine, invites applications for the part time (0.3 FTE) position of Southland/Central Otago Regional Convenor (Senior Professional Practice Fellow) to join their Rural Medical Immersion Programme (RMIP) team.
We also welcome applications from suitably qualified candidates seeking a more formal academic role at Senior Lecturer level (teaching, research and programme development). This is part time position (0.5 FTE) with additional duties including a leadership role in the RMIP programme, contributing to research as well as community and university service.
Closing date is Sunday 18 December 2022
For further details & application click here
Cormack D, Masters-Awatere B, Lee A, Rata A, Boulton A. Understanding the context of hospital transfers and away-from-home hospitalisations for Māori. The New Zealand Medical Journal. 2022 Nov 11;135(1565):41-50.
In this paper, 10% of acute hospital admissions, transfers and arranged admissions for Māori are to hospitals outside of their home domicile which increases with higher levels of deprivation. With around 25% of Māori living rurally the burden of travel is even greater. Let’s hope Te Whatu Ora & Te Aka Whai Ora make this a priority in addressing health disparities.
In Aotearoa New Zealand, people regularly travel away from their home to receive hospital care. While the role of whānau support for patients in hospital is critical for Māori, there is little information about away-from-home hospitalisations. This paper describes the frequency and patterning of away-from-home hospitalisations and inter-hospital transfers for Māori. Data from the National Minimum Dataset (NMDS), for the 6-year period of 1 January 2009–31 December 2014, were analysed. Basic frequencies, means and descriptive statistics were produced using SAS software. We found that more than 10% of all routine hospitalisations constituted an away-from-home hospitalisation for Māori; that is, a hospitalisation that was in a district health board (DHB) other than the DHB of usual residence for the patient. One quarter (25.19%) of transfer hospitalisations were to a DHB other than the patient’s DHB of domicile. Away-from-home hospital admissions increase for Māori as deprivation increases for both routine and transfer admissions, with over half of Māori hospital admissions among people who live in areas of high deprivation. This analysis aids in understanding away-from-home hospitalisations for Māori whānau, the characteristics associated with these types of hospitalisations and supports the development and implementation of policies which better meet whānau Māori needs. The cumulative impact of the need to travel to hospital for care, levels of poverty and a primarily reimbursement-based travel assistance system all perpetuate an unequal cost burden placed upon Māori whānau.
OPEN ACCESS NOW AVAILABLE
Jesse Whitehead, Gabrielle Davie, Brandon de Graaf, Sue Crengle, David Fearnley, MicHelle Smith, Ross Lawrenson & Garry Nixon
NZMJ, Vol135, No 1559. Published August 5, 2022: https://journal.nzma.org.nz/journal-articles/defining-rural-in-aotearoa-new-zealand-a-novel-geographic-classification-for-health-purposes
You’ve heard about it! Now read in detail on how the Geographic Classification for Health in Aotearoa NZ was developed. A game-changer for rural health policy and delivery.
Aim: Describe the first specifically designed and validated five-level rurality classification for health purposes in New Zealand that is both data-driven and incorporates heuristic understandings of rurality. Method: Our approach involved: (1) defining the purpose and parameters of a proposed five-level Geographic Classification for Health (GCH); (2) developing a quantitative framework; (3) undertaking co-design with the National Rural Health Advisory Group (NRHAG), and extensive consultation with key stakeholders; (4) testing the validity of the five-level GCH and comparing it to previous Statistics New Zealand (Stats NZ) rurality classifications; and (5) describing rural populations and identifying differences in all-cause mortality using the GCH and previous Stats NZ rurality classifications. Results: The GCH is a technically robust and heuristically valid rurality classification for health purposes. It identifies a rural population that is different to the population defined by generic Stats NZ classifications. When applied to New Zealand’s Mortality Collection, the GCH estimates a rural mortality rate 21% higher than for residents of urban areas. These rural–urban disparities are masked by the generic Stats NZ classifications. Conclusion: The development of the five-level GCH embraces both the technical and heuristic aspects of rurality. The GCH offers the opportunity to develop a body of New Zealand rural health literature founded on a robust conceptualisation of rurality.