Jaclyn Bishop’s research while affiliated with Western Australia Health and other places

Aim This systematic review aims to describe and compare the characteristics of Hospital in the Home (HITH) models of care within Australia. Design A systematic review of peer‐reviewed Australian literature. Data Sources Seven databases were searched in January 2024, followed by citation searching. Articles were included if they were described the HITH model of care and were published between 1994 and 2024. Review Methods Covidence was used to facilitate the removal of duplicates, independent total and abstract screening and full text review. The Critical Appraisal Skills Program (CASP) was used to assess the quality of evidence, and title and abstract screening and full text review were completed by multiple authors. This ensured that all articles met the inclusion criteria and were then assessed, and the final articles were assessed using matrix analysis, and results were presented using narrative synthesis. Results Ten articles met the inclusion criteria, highlighting three models care; the medical model, the nursing model and the brokerage model. Conclusions There is limited research available that includes the model of care and patient outcomes. Future research needs to consider the differences between HITH programs, such as the model of care, admission pathway, utilisation of telehealth and geography of the population. Implications for the Profession This review may assist Australian HITH health professionals to improve the efficacy of the HITH model of care delivered within their health service and increase translatability of future HITH research. Impact This study highlighted for the first time the models of HITH care utilised within Australia. Three models of care are currently utilised within Australia, this knowledge may assist health services seeking to enhance their HITH model of care and policy writers. Reporting Method This review adhered to the EQUATOR guidelines, Preferred Reporting Items for Systematic Reviews and Meta‐Analysis. Patient or Public Contribution No patient or public contribution. Trial Registration: Registered with the international prospective register for protocols of systematic reviews in health social care CRD42024500950

To determine the barriers, benefits, and enablers of acute home-based care in Australia for older people (aged 65 and over). A systematic review for people aged 65 and over receiving acute home-based care in Australia was conducted using various databases (CINAHL, Medline, PsycINFO, SCOPUS, Web of Science, PubMed, Informit) and citation searching in September 2023. The Critical Appraisal Skills Program (CASP) was used to assess the quality of the evidence and a thematic analysis approach was utilized to narratively synthesize results. Ten studies were included, consisting mostly of cohort studies in metropolitan areas. Barriers included inefficacy, patient demographics, and carers. Benefits included efficacy, high satisfaction, and medical management. Enablers included education, holistic assessments, and support interventions. Within the literature there was a significant research gap regarding HITH for older people in rural areas of Australia. Patient outcomes were closely aligned with admission pathways.

Introduction With Australiaʼs ageing population, especially in rural regions, promoting physical activity among older adults is crucial. Objective To identify factors influencing participation of older adults (60 years or over) from a rural community in a modified sport program and assess satisfaction with a pilot modified sport program informed by these findings. Design Insights and ideas from two focus groups exploring community perspectives on a modified sport program informed the development of a six‐week pilot modified sport program delivered with the local fitness centre. Post‐program surveys assessed participant satisfaction, willingness to continue, and likelihood of recommending the program to others. Findings Nine participants attended the focus groups, highlighting increased social connection, health management, and healthy ageing as key motivators. Joint and health concerns, cost, and time constraints emerged as main barriers. Preferences for the program included weekly sessions, alternating sports, indoor venues, and supporting modifications, but maintaining traditional rules. Thirteen participants participated in the pilot modified sport program. There was strong program attendance (86%). All participants (13/13) rated their satisfaction as very satisfied. They were highly likely to recommend the program to others (8.5/10) and were interested in continuing modified sport after the pilot (7.7/10). Discussion This study demonstrates for the first time that modified sport is of interest to older people in the rural setting, and that delivering such a program is feasible in a small community. Rural communities implementing modified sport should consider the availability of suitable facilities and equipment, access to an engaging facilitator and participant cost. Conclusion Through a strong connection between the health service and community fitness centre, a modified sport program was developed and implemented, well‐attended and enjoyed by participants in a rural community.

Introduction: Pharmacists serve an important role in rural communities, and in some cases they may be the only health professional available. Their recruitment and retention is a major concern for rural communities and health services; however, a deeper understanding regarding the advantages and challenges of sustaining a rural pharmacy workforce is somewhat limited. The aim of this study was to develop a deeper understanding of pharmacists' perspectives about factors influencing pharmacist recruitment and retention to rural and remote communities. Methods: The exploratory study, carried out in rural Tasmania and rural Western Victoria, used a qualitative descriptive design. Structured interviews, lasting between 30-60 minutes, were conducted by a single researcher using the Pharmacist Community Apgar Questionnaire via face-to-face, telephone or videoconferencing technology. Data were analysed thematically using verbatim transcription, extraction of significant statements and identification of similarities in formulated meanings, grouping the similar meanings and significant statements that pertained to the phenomena of interest. Specifically, qualitative data were used to provide a deeper understanding of factors identified as key assets, capabilities, or those most challenging for pharmacist recruitment and retention. Results: The advantages and disadvantages rural communities face in recruiting and retaining pharmacists are presented. These insights are linked to the advantages of financial income, incentives and moving allowance. Further advantages include the degree of practice autonomy, breadth of tasks, the perception of the community, loyalty to the pharmacy and its pharmacists, along with community recognition. Challenges associated with the recruitment and retention of pharmacists centred on the need for spousal or partner employment opportunities, having greater proximity to schools, access to social or cultural opportunities, along with good transport connections. Further challenges included housing, the cost of schooling for children, having adequate locum or peer coverage and opportunities to host interns. Discussion: The study provides a deeper exploration of the meaning and experiences of factors that previous research has shown are considered advantageous or challenging to the recruitment and retention of pharmacists in rural areas. Through the voices of pharmacists living and working in a rural area, the findings further enlighten our understanding regarding how the multifaceted and complex nature of health workforce planning may be addressed. As such, greater pharmacist recruitment and retention is enabled through adequate financial compensation and incentives, along with additional tax incentives for business and health services. Further, innovation is required to enhance economic sustainability. Locum coverage and intern opportunities also require innovative approaches to address concerns among potential candidates. Lastly, efforts to enable and support social connections such as schooling and spousal employment, while building community connection and a sense of rural community belonging, remain essential to recruit and retain pharmacists. Conclusion: Rural pharmacist recruitment and retention is complex, requiring a multi-pronged approach to implement practical solutions. Given this complexity and the unique features of each rural community, solutions require whole-of-community ownership to create innovative solutions. Recognition of specific advantages and challenges can address key driving factors for pharmacist recruitment and retention in rural communities.

Objectives The aim of this study was to explore the intention of health professionals to use evidence generated through an integrated knowledge translation (iKT) activity undertaken during the COVID-19 pandemic to answer a time-critical research question about the delivery of community-based group programmes to rural clients via virtual technology, and describe the participating health professionals and researchers’ perceptions of the iKT partnership. Design Multimethod study incorporating qualitative and quantitative approaches. Setting Two regional health services in Victoria (Australia). Participants 26 allied health professionals (knowledge-partners) from eight disciplines across two regional health services and eight researchers from five Victorian universities. Intervention An iKT approach was used to facilitate problem identification, evidence synthesis and adaption of evidence to the local context. Data collection and analysis Participants were invited to complete a survey (knowledge-partners) and undertake a semistructured interview (knowledge-partners and researchers) on their experiences. A process log of collaborative activities tracked the type of engagement activities, who attended and the outcomes. The survey and process log results were analysed descriptively, the interviews using thematic analysis and a comparison of results approach applied to evaluate similarities and differences in the perception of the partnership from separate data collection and analysis processes. Results The survey indicated strong positive attitudes towards using research evidence in practice as well as strong intentions to use it in the future by knowledge-partners. Knowledge-partners indicated that their expertise was used in the research process, although there was greater collaboration in some steps of iKT. The context of COVID-19 facilitated collaboration between knowledge-partners and researchers through a sense of urgency and shared purpose. Rapid team development was a key mechanism that enabled iKT. Team participation was necessarily pragmatic and flexible in nature to facilitate knowledge-partner involvement. Participants suggested the iKT process was likely to result in greater end-user buy in and a powerful example of how to upskill health professionals without a significant impact on their day-to-day workload. This project was considered by knowledge-partners to be more likely to have an impact compared with other projects without a research partner. Conclusions This study highlights how researchers and knowledge-partners can work effectively and rapidly to address a time-sensitive problem of mutual interest. Establishing and nurturing rural-based researcher and knowledge-partner networks is key to enabling agile and timely responses to the changing evidence needs of the health system.

Increasing evidence of the effects of the COVID-19 pandemic on healthcare workers’ mental health and wellbeing has prompted concerns about the longer-term impacts on healthcare delivery and health workforce sustainability. For rural health services and communities, the pandemic has compounded existing challenges including workforce shortages, potentially leading to further health inequalities. This qualitative interview study aimed to explore factors within and external to the health service environment that influenced health service staff mental health and wellbeing in rural and regional Victoria, Australia, during the first two years of the COVID-19 pandemic (2020-2021). Participants were recruited from nine publicly funded rural and regional health services. Semistructured interviews were conducted via videoconference, audio-recorded, and transcribed. Data were analysed using a five-stage framework approach. Eighteen health service staff from four rural areas participated in the study. A range of factors that were perceived by participants to influence their wellbeing were identified. These were coded to four main themes: (1) rural community relations, (2) the nature of the health workplace, (3) self-care and supportive networks, and (4) public health measures and the unpredictable nature of the pandemic. Factors coded to these themes were described as both positive and negative influences on health staff mental health and wellbeing. Optimising the mental health and wellbeing of rural health staff is imperative to the sustainability of this workforce during and beyond the COVID-19 pandemic. Rural health services must consider the community and health service (meso-level), individual (microlevel), and broader pandemic context (macrolevel) when developing and implementing strategies to promote staff wellbeing. Strategies must encompass the development of senior leadership capabilities, mechanisms to support effective leadership, and optimal communication processes within health services. Given the potential for community support to positively influence rural health staff wellbeing, community engagement should be a feature of health service wellbeing strategies.

Background: The primary aim of this study was to describe if there was a change in physical functioning of rural clients with chronic diseases who were unable to attend their structured exercise groups during the COVID-19 pandemic. The secondary aim was to describe their physical activity during lockdown and their wellbeing upon return to their structured exercise groups. Method: Physical functioning measures collected in January to March 2020 (prior to suspension of structured exercise groups due to the lockdown) were repeated in July 2020 (when face-to-face activity resumed) and compared. A survey collected information about the client's level of physical activity during lockdown and wellbeing measures at the end of the lockdown. Results: Forty-seven clients consented to provide physical functioning tests and 52 completed the survey. Only the modified 2-min step-up test displayed a statistically (but not clinically) significant change (n=29, 51.7vs 54.1 rep, P=0.01). Physical activity undertaken during lockdown was less in 48% (n=24), the same in 44% (n=22) and increased in 8% (n=4) of clients. Despite the lockdown, clients had high global satisfaction, high subjective wellbeing and normal resilience. Conclusions: Clinically significant changes in physical functioning when clients were unable to attend structured exercise groups for three months during the COVID-19 pandemic were not observed in this exploratory study. Further research is required to confirm the impact of isolation on physical functioning in those participating in group exercise to improve their chronic disease management.

Introduction: An adequate healthcare workforce remains essential for the health of rural communities. Strategies to address rural health workforce challenges have often centred on the medical and nursing workforce; however, addressing the rural pharmacist workforce also remains critical as they are often the first point of contact for health advice. Initiatives have increased pharmacist supply; however, key issues such as poor attraction, recruitment, and retention to rural areas remain. The aim of this study was to support the recruitment and retention of pharmacists in rural areas of Australia through the development of the Pharmacy Community Apgar Questionnaire (PharmCAQ). Methods: A modified Delphi technique was employed to develop the PharmCAQ. A panel of experts were purposively selected. Eight representatives were from organisations with rural experience relevant to the study including the Society of Hospital Pharmacists of Australia, the Pharmaceutical Society of Australia, the Pharmacy Guild of Australia, the Pharmacy Board of Australia, and a representative of a government health agency, who also leads a hospital pharmacy. Three additional participants included local and international academics with health policy and rural health workforce expertise. All participants participated in three separate focus groups of 45-60 minutes duration, where the review and refinement of factors that drive recruitment and retention of pharmacist were discussed. Face and content validity was achieved through the representatives, while internal consistency was achieved when the tool was piloted among 10 rural pharmacists in rural Victoria. Results: Fifty key factors that impact the recruitment and retention of pharmacists were identified, developed and succinctly described. All factors were grouped into five classifications: (1) geographic, (2) economic and resources, (3) practice and scope of practice, (4) practice environment and (5) community practice support. After final consensus, the factors and their definitions formed the final questionnaire. Lastly, the reliability of PharmCAQ was determined, with a Cronbach's alpha coefficient of 0.852. Conclusion: While the development and use of the Apgar questionnaire for the recruitment and retention of health professionals is not a novel idea, seeking to specifically focus on pharmacists is unique. However, 10 factors were similar to factors associated with rural recruitment and retention of both physicians and nurses; they encompassed geographic, community support, and economic and resource factors. Regardless of similarities or differences between health professions in terms of recruitment and retention, as a mechanism for addressing the worsening health professional shortage currently experienced in rural areas, the PharmCAQ was developed to support the recruitment and retention of the pharmacist workforce in rural areas.

Objective: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. Design: Cross-sectional design involving face-to-face, telephone or video conferencing interviews. Setting: Twelve rural communities across Tasmania and Western Victoria, Australia. Participants: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. Main outcome measures: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. Results: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high- and low-performing communities. Overall, the highest-rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. Conclusions: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community.

Aims: This commentary aims to describe a case of how meaningful co-design between rural health service leaders and a health service-embedded research unit can identify emerging research priorities and optimise translation. Context: The challenges facing rural health services are unique, and the important role of health service leaders in the research response is increasingly recognised. Poorly-designed research can contribute to research waste through reduced applicability of results to rural communities, and an opportunity exists to increase research co-designed with rural health services through the involvement of research users during study planning. Approach: In early 2020, leaders at a rural Victorian health service approached the embedded health service research unit to request research be conducted on an emerging issue: rural staff well-being in the face of the COVID-19 pandemic. This was based on their concern regarding the lack of available COVID-19-specific evidence to inform organisational policy. In collaboration with the rural health service executive, a translation-focused study of staff well-being with nine rural Victorian health services was developed. Key co-design activities of the project included involving research end-users as study investigators and conducting formal stakeholder engagement regarding study design and outcomes. Conclusion: Meaningful co-design of research with health services is a multifaceted process that can assist researchers and end-users alike in identifying and responding to emerging health issues. In the rural setting where there is a vital need for impactful health research, we recommend that researchers should consider employing co-design processes in order to minimise research waste and optimise the translatability of research findings.