Mandatory ultrasound training for rural general practitioners?

Friday, September 17th, 2021 | Rory | No Comments

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::

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.

Equitable spatial accessibility of COVID-19 vaccine?

Thursday, September 16th, 2021 | Rory | No Comments

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.


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.

Spatial accessibility to COVID-19 Vaccination Services

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! Eric Elder Medal winner; Honorary and distinguished fellows;

Tuesday, September 7th, 2021 | Rory | 1 Comment

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.

Kati winning Eric Elder Medal


Branko the distinguished.

Jill and Wendy receiving their fellowships

The place of Rural Hospitals in New Zealand’s Health System: an exploratory study

Thursday, September 2nd, 2021 | Rory | No Comments

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.

Building a sustainable rural physician workforce

Tuesday, August 24th, 2021 | Rory | No Comments

Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, Hill P, O’Sullivan B, Selvey LA, et al. Building a sustainable rural physician workforce. Med J Aust [Internet]. 2021 Jul 5 [cited 2021 Aug 10];215(1):S1–33. Available from:


Summary by Katelyn Costello

This is a collection of papers produced by the University of Queensland as a supplement in the July Medical Journal of Australia. Workforce maldistribution is a huge issue around the world. This piece attempts to address the rural workforce issue focusing on high quality and contextualised training (and sustaining) of physicians (RACP) to service rural populations in Australia. This 38 page document has been summarised into a few take-home points with some commentary/further questions relating to our context here in Aotearoa:

  • Connectedness and support networks:  
    • Rural training opportunities need to be attractive and prioritised  
    • Trainees and consultants report increased isolation and poorer support networks than urban counterparts 
      • We have the rural student clubs, the rural GP Network, Rural Health Conference and Rural Hospital Summit in NZ… just to name a few

        è What else could we do? Extra support/mentoring for new Fellows?


  • Rural generalism is awesome: 
    • Professional satisfaction and experiences are high in rural
    • However the definition of who and what is a rural generalist still isn’t clear for General Physicians and Paediatricians working in rural Australia
      • Is this a reason to further support that here in NZ rural physicians (including FACEM) should have dual training with Rural Hospital Medicine?
  • Don’t forget about regional areas:
    • Lower levels of work satisfaction were reported in regional areas. In the NZ context this is often an area that is staffed more by general physicians also rather than rural hospital specialist… Should the rural hospital model be expanded into regional areas?!? will the health reforms bring about any change?
  • We need to take a multifaceted approach
    • This diagram nicely summarises some of the key aspects. It focuses on general medicine/physicians but it could similarly be applied to rural general practice and rural hospital medicine

Rural postgraduate programme – position(s) available

Monday, August 2nd, 2021 | Rory | No Comments

Further information and application available here:

We want you


Who we are

The Department of General Practice and Rural Health is an academic unit within Otago Medical School. It was the first university department of general practice in New Zealand and is one of the oldest in the world.

Staff in this department come from a wide variety of disciplines and are involved in teaching and research in the fields of general practice and primary care.

We teach undergraduate medical students and have an active postgraduate programme which offers diploma, masters, and PhD opportunities.

The role

The rural post-graduate programme is seeking a Professional Practice Fellow to join its teaching team. In this role, you will assist with convening papers and residential workshops, as well as assisting with the continued development of the programme.

It would be an opportunity to see if you are interested in being more involved in rural health teaching. We are a distributed team so this role can be undertaken from anywhere in New Zealand.

Your skills and experience

•    Effective communication skills.
•    Understanding of the rural health setting and the associated training programme.
•    Be able to demonstrate sound leadership skills.
•    Previous experience in teaching at a tertiary level.

Further details

This is a part-time (0.5 FTE) fixed term position, from August to December 2021.

You must have the right to live and work in New Zealand to apply for this position.

For further information, please contact Rory Miller or Garry Nixon via the email addresses below.


To submit your application (including CV and cover letter) please click the apply button below. Applications quoting reference number 2101464 will close on Wednesday, 11 August 2021.

Additional Information

Note: As a part-time position, the salary range for this role will be the pro-rata equivalent of the annual full-time salary range listed.

Contact: Rory Miller

Contact: Garry Nixon

Do people living in rural and urban locations experience differences in harm when admitted to hospital?

Wednesday, June 2nd, 2021 | Rory | No Comments

Atmore C, Dovey S, Gauld R, et al. Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study. BMJ Open 2021;11:e046207. doi:10.1136/ bmjopen-2020-046207

People living in rural communities had no difference in hospital harm compared to people living in urban communities, except when they were transferred, and then more than double the harm – maybe they were sicker or maybe the transfer process itself was part of it, this needs to be looked into further. From this GP record review, 3% of patients admitted to rural hospitals were transferred.


Objective Little is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients’ rural or urban location using general practice data.

Design Secondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.

Setting New Zealand (NZ) general practice clinical records including hospital discharge data. Participants Randomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.

Outcomes Admission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.

Results Of 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location
was not associated with increased hospital harm risk
(aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95%
CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).

Conclusions Rural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.