BackgroundPeople use emergency department services for a wide variety of health complaints, many of which could be handled outside hospitals. Many frequent readmissions are due to problems with chronic disease and are preventable. We postulated that patient related factors such as the type of condition, demographic factors, access to alternative services outside hospitals and patient preference for hospital or non-hospital services would influence readmissions for chronic disease. This study aimed to explore the link between frequent readmissions in chronic disease and these patient related factors.MethodsA retrospective analysis was performed on emergency department data collected from a regional hospital in NSW Australia in 2008. Frequently readmitted patients were defined as those with three or more admissions in a year. Clinical, service usage and demographic patient characteristics were examined for their influence on readmissions using multivariate analysis.ResultsThe emergency department received about 20,000 presentations a year involving some 16,000 patients. Most patients (80%) presented only once. In 2008 one hundred and forty four patients were readmitted three or more times in a year. About 20% of all presentations resulted in an admission. Frequently readmitted patients were more likely to be older, have an urgent Triage classification, present with an unplanned returned visit and have a diagnosis of neurosis, chronic obstructive pulmonary disease, dyspnoea or chronic heart failure. The chronic ambulatory care sensitive conditions were strongly associated with frequent readmissions. Frequent readmissions were unrelated to gender, time, day or season of presentation or country of birth.ConclusionsMultivariate analysis of routinely collected hospital data identified that the factors associated with frequent readmission include the type of condition, urgency, unplanned return visit and age. Interventions to improve patient uptake of chronic disease management services and improving the availability of alternative non-hospital services should reduce the readmission rate in chronic disease patients.

Background: Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.

Background: The calls for increased numbers of researchers in rural health are growing. To meet this demand, training is needed. If training is to be effective, the value placed on research, the organisational need for research training and key targets for research skill development within a rural health organisation must be understood. Methods: This qualitative study was underpinned by a critical realist perspective that allowed exploration of the organisational, cultural and structural contexts of research training and of the ability of individuals to act within these contexts. Individual interviews with purposively selected key informants from the organisation's board, executive and facility management (n = 7) and two focus groups with a convenience sample of frontline health workers with interests in research (total n = 11) were held. Data were analysed using NVivo software and thematic analysis. Results: The themes emerging from this study were the fragmentation of research activity, a need for systems that support research and collaboration for expertise. Conclusions: This study has identified an overreliance on individual activity leading to a fragmented approach to research. There is a need for supportive structures, coordination and workplace leadership to overcome a longstanding culture that views research as out of the rural scope of practice. Identifying research training targets, partnering for educational expertise and planning for long-term sustainability are necessary steps toward increasing research activity in the longer term.

BackgroundMental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia.MethodThis study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development.ResultsWith MHEC-RAP, these ED providers are no longer ‘flying blind’. They are also more confident to manage and care for emergency mental health patients locally. For these providers, access to specialists who are able to conduct assessments and provide relevant and responsive advice for emergency mental health presentations was valued. Assessing the fit between the consumer and service as a requirement for the development, evaluation, and ongoing management of the service should result in decisions about design and delivery that achieve improved access to care and meet the needs of their consumers. The experience of these providers prior to MHEC-RAP is consistent with that reported in other rural and remote populations suggesting that MHEC-RAP could address limitations in access to specialist care and change the provision of emergency mental health care elsewhere.ConclusionMHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.

This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.

Hospital emergency departments (EDs) are common providers of emergency mental health care. Access to specialist expertise can affect and improve patient outcomes. The Mental Health Emergency Care-Rural Access Programme (MHEC) provides access to mental health specialists for rural and remote communities in western New South Wales. In 2011, 46 of the 48 EDs used the MHEC programme, which provided 1487 clinical services, an average of 29 services per week. This represented 60% of all MHEC activity. A video assessment was conducted during 571 (38%) of these MHEC contacts. Patients attending a non-base hospital (<50 beds) were twice as likely to receive a video assessment as those attending the larger base hospitals, and video was used more with increasing remoteness. Patients from non-base hospitals were also more likely to be admitted locally after a video assessment. When a decision to admit was made, patients from non-base hospital EDs assessed by video were less likely to be transferred out of their community to a mental health inpatient unit than those assessed by telephone triage only (46% vs 62%; P = 0.016). The MHEC programme is a practical, relevant and responsive solution that was designed for the Australian health system, but the same model could be adapted for implementation in other countries.

The Mental Health Emergency Care-Rural Access Programme (MHEC) aims to improve access to specialist emergency mental health care in rural and remote communities in New South Wales. It provides a range of services including emergency telephone triage and video assessment. The present report provides a detailed description of the structure and function of the MHEC model, and identifies matters concerning adaptation and transferability. Structure: the MHEC can be contacted 24 hours/day, every day of the year; no caller is refused assistance. Function: the MHEC provides information services, clinical services and other programme activities. Adaptation of the model and implementation elsewhere (transferability) should be informed by local needs, existing practices and the components of access. The programme has already attracted the attention of two other regions in Australia interested in implementing emergency telepsychiatry programmes. The MHEC model is a practical solution for improving access to specialist emergency mental health care in underserved areas.

These findings highlighted the need for HCPs to be more aware of 'grey areas' in English-language proficiency and the cultural lens through which migrants understand health.