Spiers M C, Harris M
Barossa Hills Fleurieu Region, Mount Barker, South Australia.
Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.
Rural Remote Health. 2015 Apr-Jun;15(2):3069. Epub 2015 Apr 27.
The optimum supply of an allied health workforce in rural and remote communities is a persistent challenge. Despite previous indicative research and government investment, the primary focus for rural and remote recruitment has been on the medical profession. The consequent shortage of allied health professionals leaves these communities less able to receive appropriate health care. This comprehensive review incorporates a literature analysis while articulating policy and further research implications.
The objective was to identify drivers to recruitment and retention of an allied health workforce in rural and remote communities. This issue was observed in two parts: identification of barriers and enablers for students accessing allied health undergraduate tertiary education, and barriers and enablers to clinical placement experience in rural and remote communities. A search of empirical literature was conducted together with review of theoretical publications, including public health strategies and policy documents. Database searches of CINAHL, Medline, ERIC, PsychInfo and Scopus were performed. Selection criteria included Australian research in English, full text online, keywords in title or abstract, year of publication 1990 to 2012 and research inclusive of rural and remote context by application of the Australian Standard Geographical Classication (ASGC) Remoteness Structure. Theoretical publications, or grey literature, were identified by broad Google searches utilising a variety of search terms relevant to the review objective. Allied health professions were defined as including audiology, dietetics, occupational therapy, optometry, orthoptics, orthotics and prosthetics, pharmacy, physiotherapy, podiatry, psychology, radiography, social work, speech pathology and Aboriginal and Torres Strait Islander Health Workers.
A total of 28 empirical publications met the selection criteria with a further 22 grey literature texts identified with relevance to the research objective. Patterns of barriers and enablers for rural and remote student transition in the allied health professions were identified in the literature. Recruitment pathways to allied health tertiary studies in rural and remote communities are vague and often interrupted, and the return of graduates is haphazard. Students from rural and remote communities face an assembly of barriers. They often experience secondary education disadvantage with inadequate subject choices, pathways and opportunities. Programs designed to facilitate transition to tertiary study are often limited in their capacity to address cumulative concerns. Students also face financial imposts and are confronted by daunting social isolation, and separation from families and support systems. In regard to clinical placement, the disincentives weigh heavily. The financial burdens of a rural placement offer little inducement. Social isolation associated with a placement far from home is more acutely felt by students when there is inadequate administrative support and consequent disillusionment. Students also lack a frame of reference to pursue a rural placement option, and are often discouraged by the cumulative commitments involved.
Clear and accessible pathways to allied health training for students from rural and remote communities are pivotal to a stronger representation of this cohort among graduates. Similarly, greater representation of rural and remote clinical placements for allied health undergraduate students is an important facilitator. Despite regional coordination and strategies designed to promote a broader range of placement opportunities, the problems remain. This review has consequences for policy and program development for growth of the rural allied health workforce in Australia, as well as identifying knowledge deficits to guide future research endeavours.
为农村和偏远社区提供充足的专职医疗人员一直是一项长期挑战。尽管此前有一些指示性研究并得到了政府投资，但农村和偏远地区招聘工作的主要重点一直放在医学专业上。因此，专职医疗专业人员的短缺使得这些社区获得适当医疗保健的能力下降。本综述在阐述政策及进一步研究意义的同时，还纳入了文献分析。
目的是确定农村和偏远社区专职医疗人员招聘和留用的驱动因素。该问题从两个方面进行观察：确定学生接受专职医疗本科高等教育的障碍和促进因素，以及农村和偏远社区临床实习经历的障碍和促进因素。对实证文献进行了检索，并对理论出版物进行了综述，包括公共卫生战略和政策文件。对CINAHL、Medline、ERIC、PsychInfo和Scopus数据库进行了检索。选择标准包括澳大利亚的英文研究、在线全文、标题或摘要中的关键词、1990年至2012年的出版年份，以及通过应用澳大利亚标准地理分类（ASGC）偏远结构涵盖农村和偏远地区情况的研究。通过广泛的谷歌搜索，利用与综述目标相关的各种搜索词，确定了理论出版物或灰色文献。专职医疗专业被定义为包括听力学、营养学、职业疗法、验光、斜视矫正、矫形和假肢、药学、物理疗法、足病学、心理学、放射学、社会工作、言语病理学以及原住民和托雷斯海峡岛民卫生工作者。
共有28篇实证出版物符合选择标准，另有22篇灰色文献文本被确定与研究目标相关。文献中确定了农村和偏远地区学生在专职医疗专业过渡方面的障碍和促进因素模式。农村和偏远社区专职医疗高等教育的招生途径不明确且常常中断，毕业生回流也很随意。来自农村和偏远社区的学生面临一系列障碍。他们往往在中等教育方面处于劣势，学科选择、途径和机会不足。旨在促进向高等教育过渡的项目往往在解决累积问题方面能力有限。学生还面临经济负担，并且面临令人生畏的社会孤立，以及与家庭和支持系统的分离。在临床实习方面，不利因素影响很大。农村实习的经济负担几乎没有吸引力。当行政支持不足并导致学生失望时，远离家乡实习带来的社会孤立感会让学生感受更为强烈。学生也缺乏选择农村实习的参照标准，并且常常因涉及的累积负担而望而却步。
为农村和偏远社区的学生提供清晰且便捷的专职医疗培训途径，对于这一群体在毕业生中占更大比例至关重要。同样，为专职医疗本科学生提供更多农村和偏远地区临床实习机会也是一个重要的促进因素。尽管有区域协调和旨在促进更多实习机会的战略，但问题依然存在。本综述对澳大利亚农村专职医疗人员队伍增长的政策和项目发展具有影响，同时也确定了知识空白以指导未来的研究工作。
