No abstract

No abstract

Objective: To identify barriers to Indigenous patients taking up a rural general practice‐based cardiac rehabilitation program. We investigated the accessibility and appropriateness of the program and the role of Indigenous health workers (IHWs) in caring for Indigenous cardiac patients. Methods: A cross‐sectional survey of knowledge and views relating to cardiac rehabilitation was undertaken with 47 Indigenous cardiac patients and 41 health professionals in remote Queensland. Results: Only three patients were fully engaged in the program. Reasons for non‐participation included: lack of knowledge about rehabilitation, low income, and having a large extended family. Although the program incorporated a training component for IHWs covering prevention and follow‐up, most did not monitor patients specifically for their heart problems and thought they did not have adequate skills. Shared care was occurring in some settings but without the participation of IHWs. Conclusions: There was general agreement that IHWs do have a role in cardiac rehabilitation. There is a need for ongoing in‐service education or inclusion in training programs. Lack of understanding of the role of IHWs is a barrier to shared care. Cardiovascular disease needs to be addressed as part of the raft of chronic illnesses. Implications: Training about chronic illnesses and their management needs to be linked to structural adaptations in the delivery of health services to allow efficient use of each professional's skills. Clear role delineation needs to be negotiated to allow all health professionals to carry out their job effectively.

BackgroundContemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine.MethodsA scoping review was undertaken to answer the broad question ‘What is documented on rural generalist medicine?’ Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis.ResultsIncluded papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area.Important themes emerging from the review were:DefinitionExisting pathways and programmesScope of practice and service modelsEnablers and barriers to recruitment and retentionReform recommendationsThere were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery.ConclusionsSupported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine.