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.

Objectives:The aim of this study was to compare the coverage of Japanese encephalitis (JE) immunization obtained from a recall survey and immunization registers at community health centers (CHCs) in Bali Province, Indonesia. Methods: A population-based survey was conducted, and random 2-staged selection of clusters of sub-villages was performed. The sample consisted of households with children aged 9 months to 15 years old. Interviews were carried out with carers to recall JE immunization status. The recall immunization status was considered valid when name, date, and confirmation of immunization were available in an immunization register at a CHC. Descriptive analysis was performed. The completeness of the information within immunization registers at CHCs was assessed. Results: The coverage of JE immunization obtained from the recall survey was 93.8% (95% confidence interval [CI],). It decreased to 74.9% (95% CI, 72.8-77.2) after being validated against immunization registers. The recall coverage of JE immunization was significantly higher than immunization register data suggested. This discrepancy varied from 6.5% to 36.4% across 6 districts; however, none of these districts achieved the recommended target coverage of 95%. The quality of immunization registers varied across CHCs. Conclusion:The use of an immunization register may result in underestimating the true coverage of vaccination programs, and its utilization for measuring immunization coverage requires further consideration.

This study explores the contribution of counseling to improving acceptance of and adherence to anti-retroviral therapy (ART) among people living with HIV (PLHIV) and identifies key issues associated with its implementation. We conducted a longitudinal mixed-methods study in Bali Province between 2015 and 2017. The study participants were 170 newly diagnosed PLHIV and 17 outreach-counselor workers (OWs). We interviewed PLHIV for their experiences in receiving counseling, and acceptance of and adherence to ART. We surveyed four counseling domains (privacy, contents, frequency, and duration) and explored the key findings through in-depth interviews. In addition, 24 exit interviews and record reviews were performed. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Out of 170 PLHIV who received the counseling program, 139 (81.76%) accepted ART, and 52 (37.4%) discontinued ART in six months of follow up. Although counselors covered most of the content (16/17 components), the median time and frequency of counseling were insufficient. Despite a high score of HIV counseling provided to PLHIV in our study location, the overall acceptance of and adherence to ART remains fair or moderate. Our study suggests that counseling before ART initiation is inadequate for improving acceptance and adherence to ART in Bali Province. This reduced effectiveness is influenced by internal issues (interpersonal skills, limited technical capacity) and external factors both from PLHIV and society (stigma, disclosure, discrimination).

Background Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events. Methods A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach. Results We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community. Conclusions Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.

A ‘rural proofing’ framework, which offers assessment of the potential impacts of policies on rural and remote communities, has been advocated for by state governments and interest groups throughout Australia. It is argued that rural proofing can be used to redress health inequities between urban and rural and remote communities. While implementation of rural proofing in some countries shows promising results, there are many social and spatial contexts that should be considered prior to its adoption in Australia. Rural proofing is not the best option for rural health policy in Australia. It has been imported from communities where the urban/rural divide is minimal. It is based on a rigid urban/rural binary model that targets disparity rather than accommodating the diversity of rural communities. Rural proofing concentrates on tick-the-box activities, where rural communities are not sufficiently consulted. There is no unified federal ministry in Australia with responsibility for rural and remote affairs. Considering potential shortcomings of rural proofing for health policies, it is imperative for Australia to have a specific rural health policy at both federal and state levels.