Rural Australians have poorer access to health services than Australians living in metropolitan areas primarily because of shortages in the health professional workforce. Nurses taking on advanced skills could help this situation by relieving doctors but our understanding of the factors that enhance or inhibit uptake is poorly understood in rural areas of Australia.The aim of this study is to identify the barriers and enablers associated with the implementation of advanced nursing roles in rural general practice specifically although an urban general practice was included to ensure that the diversity of practices were represented. The selection of general practices was based on (1). a standardised classification system that uses geographic location and population base as the key criterion and (2). ease of access for the research team. The general practices were all located within 3 hours drive of the researchers' home base. Using case study design four rural and one metropolitan located general practices were included. The researchers compared recorded nursing activities with job descriptions, educational opportunities and advanced competency standards. Interviews with practice principals, practice managers and nurses were undertaken. Findings are categorised as: personal which includes motivation, knowledge and time; workplace which includes status, guidelines and practice conventions and routines; and policy which includes national payment systems, and scope of practice. The potential for nurses to advance their practice and meet the needs of patients, particularly in the specialist areas of chronic care and health promotion, is still under developed in the rural practices. The findings have led to the development of a framework for the introduction of advancing practice roles for nurses that will meet the needs of a currently, under-served community.
Introduction: Australia has one of the highest rates of obesity in the developed world. In response to increasing rates of overweight and obesity in rural Australia, one regional primary health network commissioned the development of a multi-faceted weight and lifestyle management program, addressing nutrition, physical activity, and psychological approaches to behavioral change. This study evaluated the success of the program that was implemented in multiple general practices within regional New South Wales. Methods: De-identified data were received from 16 general practices that participated in the Murrumbidgee Lifestyle and Weight Management Program (MLWMP). Patient weight outcome and functional status measures were determined using descriptive statistics (SPSS). Results: Mean body mass index (BMI) of the 1217 participants was 37.4 kg/m2 and 75% of participants were female. Almost 40% of participants who had a BMI ≥ 40 kg/m2 had been diagnosed with a mental health condition. Upon completion of the program at 6 months, participants had lost an average of 3.2 kg. Over 31% of participants had lost at least 5% of their initial weight and 40% had reduced their waist circumference by at least 5 cm. Overall health and functional status measures were significantly higher upon program completion. There were significant improvements in quality of life measures regardless of level of weight loss during the program. Conclusions: The MLWMP, implemented in general practices within rural and regional Australia, had positive effects on both practices and participants demonstrating the value of intervention programs in primary care. Participants achieved a modest reduction in BMI, waist circumference, and weight. Further work is needed to determine the longer-term success of the program.
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