Dennis Pashen

Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence‐based policy

BACKGROUND Poor retention of health workers is a significant problem in rural and remote areas, with negative consequences for both health services and patient care. OBJECTIVE This review aimed to synthesise the available evidence regarding the effectiveness of retention strategies for health workers in rural and remote areas, with a focus on those studies relevant to Australia. DESIGN A systematic review method was adopted. Six program evaluation articles, eight review articles and one grey literature report were identified that met study inclusion/exclusion criteria. RESULTS While a wide range of retention strategies have been introduced in various settings to reduce unnecessary staff turnover and increase length of stay, few have been rigorously evaluated. Little evidence demonstrating the effectiveness of any specific strategy is currently available, with the possible exception of health worker obligation. Multiple factors influence length of employment, indicating that a flexible, multifaceted response to improving workforce retention is required. CONCLUSIONS This paper proposes a comprehensive rural and remote health workforce retention framework to address factors known to contribute to avoidable turnover. The six components of the framework relate to staffing, infrastructure, remuneration, workplace organisation, professional environment, and social, family and community support. In order to ensure their effectiveness, retention strategies should be rigorously evaluated using appropriate pre- and post-intervention comparisons.

Are Australians willing to be treated by a physician assistant

Background: Physician assistants (PAs) are deployed to extend the role of the general practitioner and other doctors in Canada, England, Scotland, The Netherlands, the United States and elsewhere. Because Australians have little experience with this type of provider, we undertook a study to test the willingness of patients to be treated by a PA. Method: A time trade-off preference survey was administered to women naive about PAs in Northern Queensland in 2009. Each survey described one of three scenarios of injury and asked the patient to make a decision between waiting four hours for a doctor or one hour for a PA. Results: A total of 229 candidate patients unconditionally participated (225 met criteria). Two-thirds were between the ages of 20 & 35 years. All but two of the participants (99%) selected to be treated by the PA regardless of the scenario. When choices of time differences between a doctor and a PA were reduced to 2 hours and 1 hour, respectively, the preferential choice of seeing the PA persisted. Conclusion: Australian women in Northern Queensland were willing to be treated by a PA as a theoretical construct and without actual experience or knowledge of PAs. The familiar doctor care was traded for that of a PA when access to care was more available. Developing PAs in Australian society may be practical and patient attitudes more accepting, than realized. The concept of willingness to be treated has utility in socioeconomic research.

Dialogues on health care education in remote Australia

O ne of the challenges of providing health care to remote communities is the recruitment and retention of doctors. This paper is a description of a unique approach in Australia to issues of rural health disparity and a national response. It describes the broader programme and one example of this approach in remote north-west Queensland, the Mount Isa Centre for Rural and Remote Health, and some of its programmes.