Leaning on Fence Posts

Darlow Ben, Brown Melanie, McKinlay Eileen, Gray Lesley, Purdie Gordon, Pullon Sue (2023) Influence of a rural interprofessional education placement on the rural health workforce: working in primary care, rural settings, and with Māori. Journal of Primary Health Care 15, 78-83.

OPEN ACCESS https://www-publish-csiro-au.ezproxy.otago.ac.nz/hc/HC22136

Rural workforce outcomes:

“Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers.”

Although a little disheartening, the authors’ findings are not that surprising given the design of their study. By only including data to 3 years after graduation we don’t really know what influence it has had on actual workforce outcomes. If we look at doctors, it’s essentially impossible to work in a rural area within the first 2 years of graduation. However the authors’ conclusion probably does align with overseas research that short rural placements have minimal impact on workforce outcomes.

Although probably not so important given the “negative” result, an issue with this study was it used self-reported geographic location. It will be great to see any future research like this to be linked to the Geographic Classification for Health (GCH)

Working with Māori outcomes:

There wasn’t anything “measurable” here. However, the free text thematic analysis showed participant’s attitudes towards working with Māori were really positive. Some “before” data might have been useful too though for comparison and to see what changes were linked to the programme.

A new research area to explore?:
The free text comments from this study show some positive attitude shifts towards rural health. It would be really interesting to see some more research into the benefits of the “rurally attuned” urban medical professional. It might not fix our rural health workforce crisis but there would hopefully still be some benefits to our communities!

(Katelyn Costello)

 

ABSTRACT

Introduction: Pre-registration interprofessional rural immersion programmes provide students with first-hand insight into challenges faced in rural clinical practice and can influence future practice intentions. The impact of short rural and hauora Māori interdisciplinary placements on early healthcare careers is unknown.

Aim: Explore whether a 5-week rural interprofessional education programme influenced graduates’ choices to work in primary care, rurally, and with Māori patients.

Methods: We conducted a survey-based, non-randomised trial of graduates from eight healthcare disciplines who did (n = 132) and did not (n = 479) attend the Tairāwhiti interprofessional education rural programme with hauora Māori placements. Participants were surveyed at 1-, 2-, and 3-years’ post-registration. Self-reported practice location and vocation were analysed with mixed-model logistic regression. Free-text comments were analysed with Template Analysis.

Results: We did not identify any measurable impact on rural or community workforce participation at 3-years’ post-registration. Free-text analysis indicated that a short rural interprofessional immersion placement had long-term self-perceived impacts on desire and skills to work in rural locations, and on desire and ability to work with Māori and embrace Māori models of health.

Discussion: Our study suggests that short rural immersion placements do not increase rural workforce participation during early healthcare careers. Three-years’ post-graduation may be too early to determine whether rural placements help to address rural health workforce needs. Reports from rural placement participants of increased ability to care for people from rural backgrounds, even when encountered in a city, suggest that assessment of practice location may not adequately capture the benefits of rural placement programmes.

Blattner K, Clay L, Nixon G, Richard L, Miller R, Crengle S, Anton R, Stokes T.  The place of rural hospitals in New Zealand’s health system: an exploratory qualitative study . Rural and Remote Health 2023; 23: 7583.

OPEN ACCESS: https://doi.org/10.22605/RRH7583

It’s great to hear non-medical perspectives on the place/role of our rural hospitals. With no clear definition of what a rural hospital is, this paper highlights the range of contexts our hospitals work across between primary and secondary care, and the strengths and challenges they face.  For local communities, rural hospitals are invaluable yet they can appear invisible to the wider health system.  We hope this work further informs the Rural Health Strategy due later this year.

Abstract

Introduction:  In Aotearoa New Zealand (NZ) there is a knowledge gap regarding the place and contribution of rural hospitals in the health system. New Zealanders residing in rural areas have poorer health outcomes than those living in urban areas, and this is accentuated for Māori, the Indigenous people of the country. There is no current description of rural hospital services, no national policies and little published research regarding their role or value. Around 15% of New Zealanders rely on rural hospitals for health care. The purpose of this exploratory study was to understand national rural hospital leadership perspectives on the place of rural hospitals in the NZ health system.
Methods:  A qualitative exploratory study was undertaken. The leadership of each rural hospital and national rural stakeholder organisations were invited to participate in virtual semi-structured interviews. The interviews explored participants’ views of the rural hospital context, the strengths and challenges they faced and how good rural hospital care might look. Thematic analysis was undertaken using a framework-guided rapid analysis method.
Results:  Twenty-seven semi-structured interviews were conducted by videoconference. Two broad themes were identified, as follows. Theme 1, ‘Our place and our people’, reflected the local, on-the-ground situation. Across a broad variety of rural hospitals, geographical distance from specialist health services and community connectedness were the common key influencers of a rural hospital’s response. Local services were provided by small, adaptable teams across broad scopes and blurred primary–secondary care boundaries, with acute and inpatient care a key component. Rural hospitals acted as a conduit between community-based care and city-based secondary or tertiary hospital care. Theme 2, ‘Our positioning in the wider health system’, related to the external wider environment that rural hospitals worked within. Rural hospitals operating at the margins of the health system faced multiple challenges in trying to align with the urban-centric regulatory systems and processes they were dependent on. They described their position as being ‘at the end of the dripline’. In contrast to their local connectedness, in the wider health system participants felt rural hospitals were undervalued and invisible. While the study found strengths and challenges common to all NZ rural hospitals, there were also variations between them.
Conclusion:  This study furthers understanding of the place of rural hospitals in the NZ healthcare system as seen through a national rural hospital lens. Rural hospitals are well placed to provide an integrative role in locality service provision, with many already long established in performing this role. However, context-specific national policy for rural hospitals is urgently needed to ensure their sustainability. Further research should be undertaken to understand the role of NZ rural hospitals in addressing healthcare inequities for those living in rural areas, particularly for Māori.