What does it mean to be an allied health professional working in rural Aotearoa New Zealand?

Friday, November 24th, 2023 | claly44p | No Comments

Walker, SM, Blattner, K, Nixon, G, Koroheke Rogers, M, Kennedy, E. What does it mean to be an allied health professional working in rural Aotearoa New Zealand? A qualitative study. Aust J Rural Health. 2023; 00: 1–14.

OPEN ACCESS https://doi-org.ezproxy.otago.ac.nz/10.1111/ajr.13061

Great to feature home grown allied health research on this blog, as our medical colleagues usually predominant in this rural space!  Sarah’s paper, part of her PhD, resonated loudly with me as a physiotherapist who has worked in both urban and rural practice. This research is the building block for growing the rural allied health workforce and it’s fantastic to have someone with Sarah’s passion to champion the cause of allied rural health professions in Aotearoa NZ.  I look forward to seeing where this leads. (Lynne Clay)


Objective: Building health services and workforce that are both well supported and fit for purpose is a key consideration for improving health outcomes in rural populations. Achieving this requires an understanding of the roles and practice characteristic of each professional group, including allied health professionals. This study explores what it means to be an allied health professional practicing in rural Aotearoa New Zealand.

Design: A qualitative study design was used, involving individual semi-structured interviews with 13 rural allied health professionals in the Otago and Northland regions. The interviews explored participants journey into rural practice, their experiences working rurally, and their views on rural practice.

Findings: Four main themes were derived: Identity; Connectedness; Expectations; and Providing Care.

Discussion: Proud of being rural, these allied health professionals are immersed within their community, intertwining their professional and personal identities. The unique nature of this dual identity while empowering for some, can also isolate rural allied health professionals from their professional bodies and urban peers. This leads to a sense of vulnerability and feeling undervalued and invisible. In response, rural allied health professionals choose to form strong connections to their local interprofessional team and their community. The connections they forge, and the breadth of their skills cumulate to enable allied health professionals to provide dynamic and responsive health services for their rural communities.

Conclusion: This study provides the first insight into experiences and perspectives of allied health professionals within rural Aotearoa New Zealand. Despite the challenges, a sense of pride is associated with practicing rurally for allied health professionals.

Treatment of heart attacks at rural and urban hospitals

Wednesday, November 15th, 2023 | claly44p | No Comments

Investigations and treatment after non-ST segment elevation acute coronary syndrome for patients presenting to rural or urban hospitals in Aotearoa New Zealand: ANZACS-QI 75. Rory Miller, Garry Nixon, Robin M Turner, Tim Stokes, Rawiri Keenan, Corina Grey, Yannan Jiang, Susan Wells, Wil Harrison, Andrew J Kerr. New Zealand Medical Journal (Friday 10 November 2023 edition)

Congratulations Rory and the team – the full article can be found here if you are a NZMJ subscriber.  Or, for an overview of the study check out the University of Otago Media Release https://www.otago.ac.nz/news/news/treatment-of-heart-attacks-at-rural-and-urban-hospitals 

There’s also an interview with Rory c/o RNZ Midday Rural News here


Aims: Compare the care patients with non-ST segment elevation acute coronary syndrome (NSTEACS) received in Aotearoa New Zealand depending on the rural–urban category of the hospital they are first admitted to. 

Methods: Patients with NSTEACS investigated with invasive coronary angiogram between 1 January 2014 and 31 December 2019 were included. There were three hospital categories (routine access to percutaneous coronary intervention [urban interventional], other urban [urban non-interventional] and rural) and three ethnicity categories (Māori, Pacific and non-Māori/non-Pacific). Clinical performance measures included: angiography ≤3 days, assessment of left ventricular ejection fraction (LVEF) and prescription of secondary prevention medication. 

Results: Of 26,779 patients, 66.2% presented to urban-interventional, 25.6% to urban non-interventional and 8.2% to rural hospitals. A smaller percentage of patients presenting to urban interventional than urban non-interventional and rural hospitals were Māori (8.1%, 17.0% and 13.0%). Patients presenting to urban interventional hospitals were more likely to receive timely angiography than urban non-interventional or rural hospitals (78.5%, 60.8% and 63.1%). They were also more likely to have a LVEF assessment (78.5%, 65.4% and 66.3%). In contrast, the use of secondary prevention medications at discharge was similar between hospital categories. 

Māori and Pacific patients presenting to urban interventional hospitals were less likely than non-Māori/non-Pacific to receive timely angiography but more likely to have LVEF assessed. However, LVEF assessment and timely angiography in urban non-interventional and rural hospitals were lower than in urban interventional hospitals for both Māori and non-Māori/non-Pacific. 

Conclusions: Patients presenting to urban hospitals without routine interventional access and rural hospitals were less likely to receive LVEF assessment or timely angiography. This disproportionately impacts Māori, who are more likely to live in these hospital catchments. 

Regional Rural Health Commissioning role vacancy

Tuesday, November 14th, 2023 | claly44p | No Comments

Te Whatu Ora is currently advertising for a Principal Service Development Manager in the Rural Health Commissioning team, for Te Waipounamu
Find the job listing here with more information and job description. https://jobs.tewhatuora.govt.nz/jobs/19739/KHJ-1761039
Note, applicants can be based anywhere in Te Waipounamu.

The use of neonatal bubble Continuous Positive Airway Pressure in a rural hospital setting

Tuesday, October 24th, 2023 | claly44p | No Comments

Great work from Tāupo Hospital published this week in the NZMJ showing how a bubble CPAP protocol for neonates can be successfully introduced into a rural setting with positive impacts

Glenn A. Barker: The use of neonatal bubble Continuous Positive Airway Pressure in a rural hospital setting. NZMJ Oct 20; 136(1584). ISSN 1175-8716 https://journal.nzma.org.nz/journal-articles/the-use-of-neonatal-bubble-continuous-positive-airway-pressure-in-a-rural-hospital-setting


Aim: This retrospective review examined the introduction of bubble Continuous Positive Airway Pressure (bCPAP) in resuscitating neonates in a rural hospital environment. 

Methods: A retrospective audit of all emergent neonatal presentations to a rural emergency department (ED) over a 5-year period prior to (pre) and a 3.5-year period following the introduction of bCPAP (post). 

Results: Sixty-seven neonatal resuscitations (31 pre- and 36 post-introduction of bCPAP) were reviewed, having an average gestation of 37.4 weeks and birth weight of 3,110g, with no significant difference in characteristics between groups. Time in the ED was significantly longer post-bCPAP (202±93 vs 156±70 mins), but time applying T-piece assisted ventilation was significantly reduced (55±40 vs 94 ± 84 mins). There was an 11% reduction in the use of aeromedical retrieval and an 18% reduction in admissions to the regional level III neonatal intensive care unit (NICU) with a corresponding increase in admissions to local level II NICU. 

Conclusion: The introduction of bCPAP into a rural hospital setting is technically feasible and results in less time spent on technically demanding hand ventilation, fewer admissions to level III neonatal intensive care units and a reduction in the use of aeromedical retrieval assets. 

Te Paatu o Te Ao Hurihuri – pandemic-related virtual adaptation of an established marae-based workshop for rural doctors: a qualitative study

Wednesday, October 18th, 2023 | claly44p | No Comments

Blattner Katharina, Rogers-Koroheke Marara, Clay Lynne (2023) Te Paatu o Te Ao Hurihuri – pandemic-related virtual adaptation of an established marae-based workshop for rural doctors: a qualitative study. Journal of Primary Health Care , -.

OPEN ACCESS: https://doi.org/10.1071/HC23089

The main message that should be emphasised for this paper is the commitment we have as rural health educators to genuine sustained community partnership and engagement.

Thanks to everyone involved across all health professional disciplines, especially those at Hauora Hokianga for your ongoing contribution to the education of rural health professionals, both under and postgraduate in Aotearoa New Zealand.

Kati Blattner



Due to COVID-19 pandemic restrictions in Aotearoa New Zealand, an established remote community marae-based workshop (a component of a postgraduate rural medical programme) was converted into a virtual platform.


The aim of this study was to explore student and teacher experiences of this virtual adaptation with focus on cultural aspects.


A qualitative exploratory study was undertaken that involved document review and qualitative interviews. Students and teachers were invited to participate. Semi-structured interviews were conducted. Thematic analysis was undertaken using a framework-guided rapid analysis method. The two participant groups’ data were analysed concurrently but separately.


Students found the virtual workshop valuable in furthering their knowledge of Māori culture, cross-cultural communication skills and health inequities in rural clinical practice. Through the innovative efforts of their teachers, they felt some sense of connection with the remote locality and its people. Teachers were able to impart knowledge, connect and keep everyone culturally safe through their commitment and adaptability. However, moving to a virtual platform meant compromise to the cultural experience for students and loss of sharing the learning and experience with their place and their people.


In the event of a further pandemic or other emergency situation, where strong established relationships exist, replacing an in-person remote marae-based workshop with a virtual workshop, while limited, is achievable and has value. When urban tertiary institutions partner with remote Māori communities to deliver virtual teaching, caution is needed in ensuring sustained transparency in priorities and expectations to avoid further exacerbations of power imbalance and resulting loss of value.

Do rural students face greater barriers to medical school admission?

Thursday, October 12th, 2023 | claly44p | No Comments

Media release

Rural students face educational barriers to medical training

Students applying to enter medical programmes in Aotearoa New Zealand, after attending rural and regional schools, are disadvantaged by lower exam marks at those schools.

A new study, published in the Journal of the Royal Society of New Zealand, compared NCEA and UE attainment rates across secondary schools from 2012 to 2021, finding rural high schools have lower pass rates and marks than urban ones.

“The lower UE attainment levels for rural schools means it is likely that rural students will have greater difficulty in entering medical programmes and this inequity is worse for rural Māori students,” says lead author Dr Kyle Eggleton, Associate Dean Rural at Waipapa Taumata Rau, University of Auckland.

Rural schools are more likely to be in socioeconomically deprived areas, have a greater proportion of Māori students and be poorly resourced compared with urban schools.

Māori students attending schools which had a Māori world view, such as kura kaupapa and Māori boarding schools had higher pass rates than those attending mainstream schools.

The authors emphasised the study’s findings were based on aggregate data, and did not necessarily reflect the experiences of all rural students. However, the research provides evidence of a systemic problem.

The findings are relevant to the Otago and Auckland medical schools’ rural and regional admission schemes, which currently earmark a number of places for rural and regional students.

The admission schemes have been established among many measures aimed at addressing a rural medical workforce crisis in New Zealand. Medical students from rural backgrounds are more likely to return and work rurally.

“The study’s findings have important implications for the future of medical education in Aotearoa New Zealand,” Dr Eggleton says.

Recommendations from the research include:

  • Rural entry pathways need to have an equity focus, so students have additional support once entering medical programmes.
  • Rural Māori students should be targeted in Māori admission pathways and additional support given to address educational disadvantage.
  • There should be pre-programme preparatory courses and interventions in rural high schools.
  • Importantly, rural high schools should have increased funding and resources.

Importantly, rural high schools should have increased funding and resources.

“It is clear that more needs to be done to address the educational attainment inequities faced by rural students, particularly rural Māori students,” Dr Eggleton says.

“This will require a fundamental shift in the way that medical programmes are designed and delivered, with a focus on equity as well as workforce needs,” he says.

Waipapa Taumata Rau, University of Auckland

Article details:

Lucy Mason, Hana Turner-Adams, Garry Nixon & Kyle Eggleton (2023) Rural secondary school leaver attainment inequities for students entering medical programmes in Aotearoa New Zealand, Journal of the Royal Society of New Zealand

Open Access DOI 10.1080/03036758.2023.2258072

A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019

Friday, July 28th, 2023 | claly44p | No Comments

Rory MillerElizabeth RimmerKatharina BlattnerSteve WithingtonStephen RamMeg ToppingHemi KakaAnna BerginJoel PiriniMichelle SmithGarry Nixon. First published: 25 July 2023 https://doi.org/10.1111/ajr.13024

Often good research involves questioning quite basic assumptions. This one tests the assumption that including specialists in a rural hospital workforce will reduce the number of patients that need transfer to the base hospital. Something I think that many in the health system (and community) would consider axiomatic. But based on the results of this small study, the exact opposite may be the case. It has obvious health policy implications. Well done to those who did this study with minimal resource, and especially the students that were involved. (Garry Nixon)



The aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital.


A retrospective observational study.


Patients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals.


Six New Zealand (NZ) rural hospitals were included.


Patients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included.

Main Outcome Measures

The primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital.


There were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery.


Most patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.