Congratulations to Dr Nini Wynn in completing her postgraduate diploma in Rural and Provincial Hospital Practice (PGDipRPHP)
Ngāti Porou Hauora (NPH) provides health services to 9000 people in Gisborne and across the East Coast. In this publication key people in the organisation provide a fascinating insight into how NPH responded to the threat of COVID-19 as it reached Aotearoa in early 2020 and identifies learnings to take forward as Delta threatens. The importance of keeping connections and communication channels open across the organisation, community and DHB along with resilient and resourceful staff pulling together are highlighted along with fears and vulnerabilities.
The report can be accessed through NPH website:
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 It has not been peer reviewed but is open access.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.
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: https://www.mja.com.au/journal/2021/215/1/building-sustainable-rural-physician-workforce
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?
- We have the rural student clubs, the rural GP Network, Rural Health Conference and Rural Hospital Summit in NZ… just to name a few
- 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
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.
Taupō doctor appointed as Clinical Director Rural Health
The New Zealand Rural General Practice Network is pleased to announce the appointment of Dr Jeremy Webber to the new role of Clinical Director Rural Health.
The Clinical Director Rural Health (CDRH) will make a significant contribution to ensuring the rural voice is incorporated into the implementation phase of the Health Reforms recently announced.
Health Minister Andrew Little said, when opening the recent National Rural Health Conference in Taupō, that the opportunities for addressing the challenges rural New Zealand faces in accessing health services lie in the significant consultation that will be needed to develop the detail of the reforms.
Jeremy’s role will be critical to rural General Practice having input into these discussions.
The CDRH role is being supported by a group of PHOs who represent most rural general practices throughout New Zealand, and who are contributing significant funding to make this new position a reality.
In this position, Jeremy will bring his extensive clinical experience in rural health, systems knowledge, and expertise to support the Network’s strategic advocacy work.
Jeremy’s first task will be to set up forums with rural general practices so that ideas can be collated, developed, and tested before conveying these to the Transition Unit for consideration in the design of the new reforms.
Through involvement with rural providers and communities, Jeremy will provide rural leadership to Government’s policy developments and ensure that a rural voice is clearly heard and articulated by decision makers.
His work will include an explicit focus on the treaty commitment to Māori health as well as health equity for Māori and Pasifika. It will involve engaging with key stakeholders including rural healthcare providers, DHBs, Iwi groups, Primary Health Organisations, Alliance Leadership teams and rural communities.
Jeremy says he is looking forward to the impact he can make in this position during a period of significant change across the health sector.
“The CDRH role is an exciting appointment at an opportune time where the rural voice needs prominence and strength in the reshaping of health services in Aotearoa.”
“I am conscious of the calibre of all those involved in rural health delivery and look forward to listening and learning from their wisdom and working with them to achieve equitable health outcomes for rural communities.”
Jeremy is currently a Rural Hospital Medicine Specialist in Taupō Hospital where he has worked since 2016. His role involves working in the Emergency Department, the general inpatient unit, and in weekly rural clinics, often as a solo practitioner.
He is a passionate rural health professional, and this is reflected in his wide range of clinical experience in rural general practice, hospitals and emergency in Australia and New Zealand.
In Australia, Jeremy worked as a locum GP in Alice Springs, and as a rural GP for an Aboriginal Health Service for over three years.
Jeremy is enthusiastic about the education and training of rural medicine and is currently the Chair of the Division of Rural Hospital Medicine Board of Studies and is a Rural Clinical Educator at Auckland University.
As a member of the Royal New Zealand College of General Practitioners, Jeremy is also involved in training of Registrars and implementing rural medicine practice nationally.
Network Board Chair Dr Fiona Bolden says,
“Jeremy brings a wealth of experience with him across the spectrum of rural health services. He has been active in the rural health space in New Zealand for many years and has also shown his ability and interest in rural research and education during this time.”
“Rural general practice and rural hospitals need a champion at this time of change, someone who can communicate with those in the sector and can bring together the available research and data to help support a robust plan for rural health. I believe that with the support of all of us Jeremy will be very well placed to do that.”
Joint Clinical; Senior Lecturer in Rural Health & Senior Medical Officer Rural Hospital Medicine–2100407
DEPARTMENT OF GENERAL HEALTH AND RURAL PRACTICE
OTAGO MEDICAL SCHOOL – DUNEDIN CAMPUS
DIVISION OF HEALTH SCIENCES, UNIVERSITY OF OTAGO
CLUTHA HEALTH FIRST
The Otago Medical School – Dunedin Campus, in association with Clutha Health First, seeks to appoint a Senior Lecturer in Rural Health. This position provides an excellent opportunity for a clinical academic to establish themselves in one of the leading medical schools in Australasia.
The appointee will provide leadership in teaching and research in the field of Rural Health while supporting an effective and efficient service for patients in the Clutha District. There are opportunities for wide collaboration with researchers in the University’s well regarded medical and biomedical science departments.
In addition to holding the position of Senior Lecturer in Rural Health at the University of Otago, the appointee will concurrently hold a position as Rural Hospital Medicine Senior Medical Officer with Clutha Health First. This is a joint University/Hospital position and will be held as single contract with the University. The two separate roles equal the equivalent of one full-time position.
Academic Component – 0.5 FTE
The successful applicant will be based in Balclutha and be a member of the Department of General Practice and Rural Health, Otago Medical School – Dunedin Campus. The appointee will have appropriate experience in teaching and research. The incumbent will be responsible for teaching at both undergraduate and postgraduate levels. There will be significant opportunity for clinically based research, including undertaking a research based higher degree.
Clinical Component – 0.6 FTE
Clutha Health First provides primary, secondary and community-based services to a population of approximately 17,500. The Rural Hospital Medicine Senior Medical Officer (RHM SMO) is based within the 15 bed Inpatient Medical ward. The successful applicant will be responsible for all admitted patients being the sole rostered doctor on duty. Approximately 70% of all admitted patients are acute medical with the remaining 30% comprised of rehabilitation (e.g. post CVA, large joint replacement) and palliative care.
CHF is a Rural Teaching Centre for the University of Otago Rural Medical Immersion Programme hosting 5th year medical students for their full academic year. Other disciplines undertaking training include Rural Hospital Medicine registrar, GP registrars, nursing midwifery, occupational therapy, and social work students.
Collaboration and collegiality are important values in the Department, and we seek a colleague who will both enjoy and enhance our cooperative work environment. We are committed to equity and we value the benefits that diversity brings to our work and our community.
If you are looking for an exciting new opportunity and would like to learn more about joining our team, then please contact us for a confidential discussion via the contact details below:
Academic Component: Associate Professor Garry Nixon, Head of Section of Rural Health, Department of General Practice and Rural Health, Otago Medical School – Dunedin Campus.
Clinical Component: Gary Reed, Clinical Director, Clutha Health First.
To submit your application (including CV and cover letter) please click on the apply button below. There is no formal closing date and applications will be considered individually on receipt. The University reserves the right to close this vacancy at any time.
Contact: Associate Professor Garry Nixon Tel: 021 1782662
Contact: Gary Reed Tel: 027 228 5778
How might access to postgraduate medical education in regional and rural locations be best improved? A scoping review. Aust J Rural Health. 2021; 00: 1– 9. https://doi-org.ezproxy.otago.ac.nz/10.1111/ajr.12725, .
This scoping review from Sampsa is a good read. For me, the takeaway is the following quote:
“This study suggests that recognising the rural context is paramount. Context matters for learning and by linking learning to a professional environment provides meaning to the learner.”
Rural medical education is known as one of the most effective strategies in improving rural recruitment and retention. The aim was to identify modes of delivery to improve access to rural postgraduate medical education. Arksey and O’Malley’s methodological framework was used for conducting scoping reviews. CINAHL, Google Scholar, ERIC, PsycINFO, Medline and PubMed were searched to identify peer‐reviewed English‐language literature published between 2000 and 2019 focusing on postgraduate rural and regional medical education. A total of 102 articles were identified, with 51 included in the final analysis after applying inclusion and exclusion criteria. Outcome measures included: article type; research methodology; date of publication; country of origin; and study population. Through iterative reading, common themes were identified. A typology of 6 content themes emerged as follows: rural curriculum; procedural skills; rurally based learning; service delivery; workforce; and distance learning. The majority of articles focused on rural curriculum, and rurally based learning, with half originating from Australia or New Zealand. Although results strongly emphasised context and curriculum in rural environments, lack of specific and pragmatic approaches was noted. Surprisingly, few articles focused on rural distance learning utilising information and communication technology. Pathways to improve rural education access include recognition of the unique rural context in curriculums; development of rural educational faculty; and creation of opportunities for rural specialist training. Emphasis should be given for education provided through rural centres rather than urban facilities. Use of information technology could be increased, for example in remote trainee supervision programs.
“services can now develop care protocols relevant to their own context and based on their own epidemiology rather than estimating how to adapt protocols developed in urban high-technology contexts.”
An editorial written in the context of COVID-19 lockdown last year that Garry revisited. Open access and really well written.
? How is it resourced ?
edit: link fixed 11/5/21 11:59
Graduating in absentia, Cook Islands May 2021
Among the many students graduating from Otago University this year is Dr Vakaola Mafi who is being awarded (in absentia, in the Cook Islands) the Postgraduate Diploma in Rural and Provincial Hospital Medicine https://www.otago.ac.nz/courses/qualifications/pgdiprphp.html
Mafi, as he is known to friends and colleagues is the first Pacific Island Country-based doctor to complete the largely distance-taught diploma. His study was facilitated under an MOU between the Cook Islands Ministry of Health and the University of Otago.
Mafi grew up in Tonga and completed his medical degree at Fiji National University. He moved to the Cook Islands with his wife (who is also a doctor) seven years ago, working as a general medical practitioner both in Aitutaki and Rarotonga.
In 2016, with limited postgraduate clinical training options open to him , he began to study in the Otago Postgraduate Rural programme by distance. Determined to reach his goal, he worked steadily at completing individual papers one at a time, studying in his own time alongside his full time clinical commitments.
Mafi’s achievement is all the more significant in that his final paper was completed entirely virtually due to the Covid pandemic: when he was unable to travel to the 5-day residential in Taranaki, a virtual link-in was created by the rural postgraduate faculty. While far from optimal, the virtual connection ensured his continued access to study.
For Mafi the best aspects of his study have been gaining connections and friendships with rural and GP colleagues in New Zealand and others in the Pacific, gaining a peer group. The biggest gain has been learning relevant evidence-based practice to a NZ standard which he can apply in his daily practice. His thanks go to his family who have supported him throughout .