Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer‐grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task‐shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer‐led, telemedicine and community‐based groups.

The COVID-19 pandemic is still unfolding. At least, 214 countries have reported confirmed cases, and 185 countries have confirmed local transmission, including Indonesia (WHO 2020, Ministry of Health of Indonesia 2020). The pandemic has transformed the way people interact, including in healthcare settings. Patients are under lockdown; human movements are restricted, and health workers are at risk of infection. There is no certainty regarding how long this pandemic will endure.

Background Accelerated by the coronavirus disease 2019 (COVID-19) pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed person-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied. Methods A qualitative study was conducted in three local health districts of rural New South Wales, Australia. Data were collected through in-depth interviews. A total of 13 participants was interviewed. Data were analysed using thematic analysis. Results Patient participants perceived telehealth as an alternative when specialist care was limited or absent. Both patients and clinicians perceived that the deeper caring relationship, enabled through face-to-face interactions, could not be achieved through telehealth services alone, and that telehealth services are often superficial and fragmented in nature. Patients in this study contended that virtual consultations can be distant and lacking in personal touch, and risk losing sight of social circumstances related to patients’ health, thereby affecting the trust placed in healthcare systems. Conclusions Simply replacing face-to-face interactions with telehealth services has the potential to reduce trust, continuity of care, and effectiveness of rural health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within an integrated service delivery model across diverse rural contexts in Australia.

ObjectiveTo describe effects of employing primary care doctors in hospital care and their roles in improving the quality of care and health outcomes of rural and remote patients.DesignA systematic scoping review.SettingPeer‐reviewed publications were sourced from 3 online journal databases (PUBMED, SCOPUS and Web of Science).ParticipantsAll study designs from peer‐reviewed journals that discussed effects of employing primary care doctors in hospital care Interventions: employing primary care doctors in hospital care.Main outcome measuresPositive and negative consequences of employing primary care doctors in hospital care, and the roles of primary care doctors in improving the quality of care and health outcomes.ResultsA total of 12 articles met the inclusion and exclusion criteria. Positive outcomes included improved access to specialised treatment, improved continuity of care, reduced waiting list and admission rates, improved skills, competence and confidence of primary care doctors, and increased satisfaction from both health providers and patients/families. Negative consequences reported included increased prescriptions and poorly documented history and physical examinations.ConclusionEmploying primary care doctors in hospital care can fill the gaps in the delivery of acute care, emergency medicine and maternity care. Primary care doctors bring advanced clinical skills and a patient‐centred approach to the hospital care. They also improve the quality of referrals leading to freed‐up clinical capacity of tertiary hospitals to treat more serious conditions. The provision of acute or emergency care and secondary care in rural and remote areas should be directed towards patient‐oriented not provider‐oriented policies.