COVID-19 impact on New Zealand general practice: rural–urban differences

Monday, May 23rd, 2022 | claly44p | No Comments

Eggleton K, Bui N, Goodyear-Smith F. COVID-19 impact on New Zealand general practice: rural–urban differences. Rural and Remote Health 2022; 22: 7185. https://doi.org/10.22605/RRH7185

This paper performed serial surveys in general practices across 4 countries and demonstrates something that many of us intuitively know – rural general practice is different: adaptable and resilient – in response to COVID-19 anyway. We agree with Kyle and his team that further efforts are required to define and understand NZ rural general practice – and would extend that to include all rural health providers.  

ABSTRACT

Introduction

In countries such as New Zealand, where there has been little community spread of COVID-19, psychological distress has been experienced by the population and by health workers. COVID-19 has caused changes in the model of care that is delivered in New Zealand general practice. It is unknown, however, whether the changes wrought by COVID-19 have resulted in different levels of strain between rural and urban general practices. This study aims to explore these differences from the impact of COVID-19.

Methods

This study is part of a four-country collaboration (Australia, New Zealand, Canada and the USA) involving repeated cross-sectional surveys of primary care practices in each respective country. Surveys were undertaken at regular intervals throughout 2020 of urban and rural general practices throughout New Zealand. Five core questions were asked at each survey, relating to experiences of strain, capacity for testing, stressors experienced, types of consultations being carried out and numbers of patients seen. Simple descriptive statistics were used to analyse the data.

Results

A total of 1516 responses were received with 20% from rural practices. A moderate degree of strain was experienced by general practices, although rural practices appeared to experience less strain compared to urban ones. Rural practices had fewer staff absent from work, were less likely to use alternative forms of consultations such as video consultations and telephone consultations, and had possibly lower reductions in patient volumes. These variations might be related to personal characteristics of rural as compared to urban practices or different models of care.

Conclusion

New Zealand rural general practice appeared to have a different response to the COVID-19 pandemic compared to urban general practice, illustrating the significant strengths and resilience of rural practices. While different experiences from COVID-19 might reflect differences in the demographics of the rural and urban general practice workforce, another proposition is that this difference indicates a rural model of care that is more adaptive compared to the urban one. This is consistent with the literature that rural general practice has the capacity to manage conditions in a different way to urban. While other comparable countries have demonstrated a unique rural model of care, less is known about this in New Zealand, adding weight to an argument to further define New Zealand rural general practice.

Doing without the residential component of a blended postgraduate rural medical programme during the 2020 COVID-19 pandemic in New Zealand: student perspectives

Wednesday, January 12th, 2022 | claly44p | No Comments

Katharina Blattner, Rory Miller, Mark Smith & Janine Lander (2022) 

Education for Primary Care, DOI: 10.1080/14739879.2021.2011626

To link to this article: https://doi.org/10.1080/14739879.2021.2011626  

In a post-COVID19 era we have all experienced a move into the virtual environment especially for ongoing education/professional development and will relate to this study’s findings.

ABSTRACT 

Aim: Rural-targeted postgraduate medical training is a key factor associated with entering rural practice. Rural health professionals often experience geographical and professional isolation, which can impact their training and education. In New Zealand, during the 2020 COVID-19 pandemic, an established distance postgraduate rural medical programme replaced its in-person residentials with virtual workshops. This study aimed to gain insights into the student experience of the virtual workshops, with emphasis on exploring the effects of the absence of an in-person component. 

Method: Qualitative exploratory design. All students who had completed a semester one 2020 University of Otago rural postgraduate module were invited by email to participate. Fifteen semi-structured interviews were conducted by video-conference. A thematic analysis was conducted using a general inductive approach. 

Results: Three themes captured the main issues. 1. Making sure everyone is in the same boat: the key roles of an in-person component were identified as consolidation of learning, benchmarking and connectedness. 2. Learning but not connecting: virtual workshops were well facilitated, allowed continuation of study and the convenience of staying home, however connectedness faded. 3. We’ve got to keep a human touch in a digital age: looking beyond the pandemic, opportunities for streamlining virtual content were identified, however there was concern around diminished communication and cultural aspects of learning and the absent connection with rural health services and communities. 

Conclusion: A virtual workshop is valuable in the COVID-19 environment but does not replace an in-person component of a distance postgraduate training programme for rural medicine 

If you would like the full text please contact katharina.blattner@otago.ac.nz

Exploring the response to the COVID-19 pandemic at the rural hospital–base hospital interface: experiences of New Zealand rural hospital doctors

Friday, November 12th, 2021 | claly44p | No Comments

Just in case you missed the highlight in today’s NZMJ!

Exploring the response to the COVID-19 pandemic at the rural hospital–base hospital interface: experiences of New Zealand rural hospital doctors

Garry Nixon, Katharina Blattner, Stephen Withington, Rory Miller, Tim Stokes. NZMJ 12 November 2021, Vol 134 No 1545

The study found that during the first L4 lock-down that communication and processes linking rural hosptials to base hospitals were disrupted. DHB support for rural hosptials varied widely and an established local leadership facilitiated an effective local response. Equity concerns persist regarding transfer, especially those who are critically unwell.

The paper is open access and can be found at:

https://journal.nzma.org.nz/journal-articles/exploring-the-response-to-the-covid-19-pandemic-at-the-rural-hospital-base-hospital-interface-experiences-of-new-zealand-rural-hospital-doctors-open-access

Along with a couple of media interviews!

https://www.rnz.co.nz/news/national/455546/study-highlights-dangerous-disconnect-rural-hospital-face-as-spectre-of-covid-19-looms

https://www.iheart.com/podcast/211-newstalk-zb-early-edition-25086386/?keyid%5B0%5D=Early%20Edition%20with%20Kate%20Hawkesby&pname=podcast_profile&sc=widget_share

 

Abstract

Aim

The COVID-19 pandemic stress-tested health systems globally and accentuated pre-existing health inequities. There is little understanding of the impact that the 2020 pandemic preparations had on New Zealand’s rural hospitals. This study explores rural hospital doctors’ experiences of the COVID-19 pandemic, with an emphasis on the rural hospital–base hospital interface.

Method

Seventeen semi-structured interviews were conducted with rural hospital doctors across New Zealand. A thematic analysis using a framework-guided rapid analysis method was undertaken.

Results

The regular communication channels and processes linking rural hospitals to their urban base hospitals were disrupted as the pandemic began. Established local leadership facilitated a rural hospital’s ability to make an effective local response. District health board (DHB) support for their rural hospitals varied widely and largely reflected the status of the pre-pandemic relationship. DHB understanding of rural hospital facilities and processes was considered to be poor. Ongoing uncertainty around managing and transferring acutely unwell patients with COVID-19 remained. Equity concerns centred on access to advanced care.

Conclusion

The experience of the COVID-19 pandemic has highlighted the resilience of rural hospitals as well as the challenges they face in operating at the margins of the healthcare system.

 

 

Rural-urban and within-rural differences in COVID-19 vaccination rates

Friday, October 8th, 2021 | claly44p | No Comments

Sun, Y., & Monnat, S. M. (2021). Rural-urban and within-rural differences in COVID-19 vaccination rates. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association.

https://onlinelibrary-wiley-com.ezproxy.otago.ac.nz/doi/full/10.1111/jrh.12625

Abstract:

PURPOSE: COVID-19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID-19 vaccination rates across the US rural-urban continuum and across different types of rural counties. METHODS: We retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county-level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID-19 vaccination rates across the USDA’s 9-category rural-urban continuum codes and separately within rural counties by labor market type. FINDINGS: As of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining-dependent counties and highest in recreation-dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share. CONCLUSION: Lower vaccination rates in rural areas is concerning given higher rural COVID-19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.

Commentary:

The higher overall COVID mortality rates areas (and higher case fatality rates) observed in rural areas in the US, particularly in the later part of the pandemic, is not news.1 We also know rural health services have struggled to cope in the US.2  The considerably lower vaccination rates in rural vs communities (46% vs 60%) noted in this paper is therefore an obvious concern.

But at least they know there is a problem. In NZ rurality is still not a variable in the vaccination data that’s being reported. Hopefully this is not too far away. In the meantime Jesse Whitehead and Ross Lawrenson have published a paper demonstrating poorer access to vaccination in rural NZ (already posted on LOFP).3

  1.  Pro G, Hubach R, Wheeler D, et al. Differences in US COVID-19 case rates and case fatality rates across the urban-rural continuum. Rural Remote Health2020;20(3):6074. doi: 10.22605/RRH6074
  2.  Underwood A. COVID-19: A Rural US Emergency Department Perspective. Prehosp Disaster Med 2021;36(1):4-5. doi: 10.1017/S1049023X20001417
  3. 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