Search

Objective: There is a shortage of nurses, Aboriginal Health Practitioners, GPs and other staff in remote Australian health clinics. There is also high turnover of staff, leading to questions of 'who' is appropriate for remote First Nations practice? The aim of this paper was to identify the characteristics of staff who are likely to work well in remote First Nations settings, from the perspectives of remote health practitioners. Design: This is a qualitative study involving content analysis of interviews. Setting: The study is conducted in and with 11 Aboriginal Community Controlled Health Services across northern and central Australia. Participants: Eighty‐four staff working in these clinics who spoke about staff qualities suited to remote practice. Results: Participants identified a range of qualities desirable in remote practitioners, which were grouped into three topics: (1) professional qualifications and experience, including cultural skills; (2) ways of working, including holisitic approach, resilience, competence, and being a team player, approachable, flexible and hard‐working; and (3) specific community needs, namely the need for local First Nations staff, male practitioners and returning short‐term staff. The combination of experiences, ways of working, and fit to both the team and community were emphasised. Conclusion: Identifying the characteristics of staff who are likely to work well in these settings can inform recruitment strategies. This study found that a combination of professional qualifications, skills and experience as well as ways of working, individual characteristics and needs of communities are desirable for working in remote, First Nations settings. [ABSTRACT FROM AUTHOR]

Objective: To assess timeliness, efficiency, health outcomes and cost‐effectiveness of the 2018 redesigned Central Australian aeromedical retrieval model. Design: Pre‐ and postimplementation observational study of all patients receiving telehealth consultations from remote medical practitioners (RMPs) or Medical Retrieval and Consultation Centre (MRaCC) physicians between 1/1/2015 and 29/2/2020. Descriptive and inferential statistics measuring system efficiency, timeliness, health outcomes and incremental cost‐effectiveness. Findings: There were 9%–10% reductions in rates of total aeromedical retrievals, emergency department admissions and hospitalisations postimplementation, all p‐values < 0.001. Usage rates for total hospital bed days and ICU hours were 17% lower (both p < 0.001). After adjusting for periodicity (12% fewer retrievals on weekends), each postimplementation year, there were 0.7 fewer retrievals/day (p = 0.002). The mean time from initial consultation to aeromedical departure declined by 18 minutes post‐implementation (115 vs. 97 min, p = 0.007). The hazard of death within 365 days was nonsignificant (0.912, 95% CI 0.743–1.120). Postimplementation, it cost $302 more per hospital admission and $3051 more per year of life saved, with a 75% probability of cost‐effectiveness. These costs excluded estimated savings of $744,528/year in reduced hospitalisations and the substantial social and out‐of‐pocket costs to patients and their families associated with temporary relocation to Alice Springs. Conclusion: Central Australia's new critical care consultant‐led aeromedical retrieval model is more efficient, is dispatched faster and is more cost‐effective. These findings are highly relevant to other remote regions in Australia and internationally that have comparable GP‐led retrieval services. [ABSTRACT FROM AUTHOR]

Introduction: In February 2018 the Remote Medical Practitioner (RMP)‐led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC. Objective: To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia. Design: There were 103 and 72 respondents, respectively, to pre‐ and post‐implementation surveys of remote clinicians and specialist staff. Findings: Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available. Discussion: Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP‐led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills. Conclusion: Given the paucity of literature about optimal models for providing pre‐hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density. [ABSTRACT FROM AUTHOR]