Belinda O'Sullivan

Estimates of chronic hepatitis B virus infection in Australia, 2000.

Objectives: To estimate the prevalence of chronic hepatitis B virus (HBV) infection in Australia and attributable proportions associated with specific demographic groups at higher risk of infection.

Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study

Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.

Duration and setting of rural immersion during the medical degree relates to rural work outcomes

Providing year‐long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation.

The stability of rural outreach services: a national longitudinal study of specialist doctors.

Objective: To explore the characteristics of specialists who provide ongoing rural outreach services and whether the nature of their service patterns contributes to ongoing outreach.

Specialist outreach services in regional and remote Australia: key drivers and policy implications

he need for more local specialist services to support rural communities is well established as T a significant issue in Australia. Although the specialist workforce is growing, providers are increasingly choosing to subspecialise and work in metropolitan practice. Access to medical specialists in major cities is consistently high at 162.1 full-time equivalent specialists per 100 000 population, but diminishes for people living in inner or outer regional (82.7 and 61.5 per 100 000 respectively) and remote areas (34.2 per 100 000).

Subsidies to target specialist outreach services into more remote locations: a national cross-sectional study.

Objective Targeting rural outreach services to areas of highest relative need is challenging because of the higher costs it imposes on health workers to travel longer distances. This paper studied whether subsidies have the potential to support the provision of specialist outreach services into more remote locations. Methods National data about subsidies for medical specialist outreach providers as part of the Wave 7 Medicine in Australia: Balancing Employment and Life (MABEL) Survey in 2014. Results Nearly half received subsidies: 19% (n=110) from a formal policy, namely the Australian Government Rural Health Outreach Fund (RHOF), and 27% (n=154) from other sources. Subsidised specialists travelled for longer and visited more remote locations relative to the non-subsidised group. In addition, compared with non-subsidised specialists, RHOF-subsidised specialists worked in priority areas and provided equally regular services they intended to continue, despite visiting more remote locations. Conclusion This suggests the RHOF, although limited to one in five specialist outreach providers, is important to increase targeted and stable outreach services in areas of highest relative need. Other subsidies also play a role in facilitating remote service distribution, but may need to be more structured to promote regular, sustained outreach practice. What is known about this topic? There are no studies describing subsidies for specialist doctors to undertake rural outreach work and whether subsidies, including formal and structured subsidies via the Australian Government RHOF, support targeted outreach services compared with no financial support. What does this paper add? Using national data from Australia, we describe subsidisation among specialist outreach providers and show that specialists subsidised via the RHOF or another source are more likely to provide remote outreach services. What are the implications for practitioners? Subsidised specialist outreach providers are more likely to provide remote outreach services. The RHOF, as a formally structured comprehensive subsidy, further targets the provision of priority services into such locations on a regular, ongoing basis.

Rural outreach by specialist doctors in Australia

Outreach healthcare is an important strategy to increase access to specialist medical services in rural and remote Australia. However, most research evidence about rural outreach work by specialist doctors is in the form of small-scale reports describing and validating outreach services for different specialties and contexts. No research systematically describes such outreach at a state/territory or national level. As such there is poor information to understand the level of workforce participation, where rural outreach services are delivered and the factors that influence rural outreach work. This thesis aims to systematically describe rural outreach work by specialist doctors in Australia to improve the basis of information for policy development and planning. It includes multiple studies to describe the extent of rural outreach work and the factors influencing participation and patterns of service provision, including service distribution and continuity. The thesis uses data collected between 2008 and 2014 as part of the Medicine in Australia: Balancing Employment and Life (MABEL) study, a large national longitudinal panel survey of Australian doctors. The findings suggest that rural outreach work is relatively common, involving one in five Australian specialists, mostly males, who participate for a range of reasons. Only 16% of outreach providers worked in remote locations, however as a proportion of all services, 42% were provided in outer regional or remote as opposed to inner regional locations. Outreach services were continued to the same town around half the time and the median length of continuing the main outreach service was six years. Increasing age did not influence participation but was correlated with remote outreach work. Additionally, mid-career specialists were more likely to continue rural outreach services, as opposed to those in early career or nearing retirement. A range of specialist types participated, however, generalists and otolaryngologists more commonly provided rural outreach services, worked in remote locations and sustained service provision. Specialists based in rural areas more commonly participated in rural outreach but three-quarters of all providers were metropolitan-based. Location also influences service distribution. Inner regionally-based specialists were less likely than metropolitan-based specialists to provide remote outreach services. Instead, remote outreach work was mainly undertaken by a combination of specialists living nearby or in metropolitan areas. Metropolitan specialists, whether working in the public or private sector, were more likely to travel to distant locations. Their outreach services were just as stable as those by rural specialists. Specialists working in private consulting rooms were more likely to participate in rural outreach and private specialists commonly participated to provide complex healthcare in challenging situations. However specialists in private consulting rooms tended to be less likely to work in remote locations. Private rural specialists restricted their travel distance to <300km. Working only privately, as opposed to in mixed or public practice, also reduced the stability of rural outreach services. Around half of all specialist outreach providers received subsidies for rural outreach work. Subsidies either from the Australian Government’s Rural Health Outreach Fund (ROHF) (19%), or another source (27%), were related to longer travel and the provision of services into more remote locations. Additionally, compared with non-subsidised specialists, RHOF subsidies supported specialists working in priority areas, who provided regular services they intended to continue, despite visiting more remote locations. This thesis addresses an important gap in systematic knowledge and understanding of rural outreach work. Such work is relatively common, by a range of specialists, mainly based in metropolitan areas and working in different practice sectors. However, complex drivers influence participation and patterns of rural outreach work, which broadly operate at individual, organisational and economic levels. Instead of a simple response, rural outreach work is likely to require multilevel policy and planning. Further, based on the extent and range of rural outreach services provided via different models in both regional and more remote locations, systems are likely to be needed to ensure outreach services are appropriately targeted, integrated and coordinated.

6. Development of methods

The New South Wales Child Health Survey was conducted in the NSW Department of Healths 19-station computer assisted telephone interviewing (CATI) facility, which was used to administer the 1997, and 1998 NSW Health Surveys of adults, and 1999 Older Peoples Survey. More than 95 per cent of people in NSW have a telephone in their household, making CATI interviewing an efficient, reliable, and safe method of collecting information for population surveys. Methods were mostly consistent with previous NSW Health Surveys, except for methods of sampling of children, use of proxy respondents, introductory questions, and bi-lingual interviews.

2. Executive summary

The New South Wales Child Health Survey 2001 has provided the first statewide data on the health and wellbeing of children aged 0-12 years, to inform health policy and planning. This report outlines the development of the survey, including the consultation process; the development of the survey instrument; and the survey methods used.

Development of a child and youth health report card for Central Sydney, 2000.

This article describes how the first Child and Youth Report Card for the Central Sydney Area Health Service (CSAHS) was developed. The purpose of the Report Card is to contribute to the improvement of child and youth health outcomes through supporting service planning by providing regular information on the status of child and youth health in CSAHS to managers, planners, health professionals and other relevant stakeholders in child and youth health.