BackgroundRural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers’ geographic choices and the success of training programs aimed at increasing rural provider recruitment.MethodsThis systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach.ResultsOf 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20–84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents.DiscussionThe review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider alternative models of healthcare delivery that promote a more diverse, interdisciplinary combination of providers.Electronic supplementary materialThe online version of this article (10.1007/s11606-017-4210-z) contains supplementary material, which is available to authorized users.

The BVOA-CHR offers a novel framework for the prospective studies on THR and on a national/international scale. Initial complication rates from the BVOA-CHR are similar to previous studies.

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms and report owner-assessed outcomes.Methods: Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between September 2011 and December 2012 were reviewed separately and in conjunction with previous data. An online, owner-administered outcomes assessment questionnaire (modified from the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire) was used to collect outcomes data from owners. Results:The incidence of surgeon and owner reported complications were 8.2% and 4.3% respectively. No significant association was identified between bodyweight, age, sex, breed or indication for THR and the incidence of complications. THR using the BFX cup/stem prosthesis had a significantly greater likelihood of complication compared to when using the CFX cup/stem prosthesis (p=0.002); a complication was 4.48 times more likely to occur when using the BFX cup/stem prosthesis versus the CFX cup/stem prosthesis. THR using the BFX cup/stem prosthesis had a significantly higher likelihood of complication compared to when using a hybrid prosthesis (BFX cup/CFX stem, CFX cup/BFX stem) (p=0.046); a complication was 2.85 times more likely to occur when using the BFX cup/stem prosthesis versus a hybrid prosthesis. In 95% of cases, owners described their satisfaction with the outcome of THR as 'very good' or 'good'. Conclusions:Complication rates from the BVOA-CHR are similar to previous studies. 'Surgeon' and 'clinic' are not variables in our analysis (contractual) but the data suggest that prosthesis type has a relationship with complication rate, with Biomedtrix BFX (circa 2012) having a high short-term complication rate.