Monash University, Bendigo, VIC
Monash University, Melbourne, VIC.
Med J Aust. 2015 Oct 5;203(7):297. doi: 10.5694/mja15.00369.
To explore the characteristics of specialists who provide ongoing rural outreach services and whether the nature of their service patterns contributes to ongoing outreach.
DESIGN, PARTICIPANTS AND SETTING: Specialist doctors providing rural outreach in a large longitudinal survey of Australian doctors in 2008, together with new entrants to the survey in 2009, were followed up to 2011.
Providing outreach services to the same rural town for at least 3 years.
Of 953 specialists who initially provided rural outreach services, follow-up data were available for 848. Overall, 440 specialists (51.9%) provided ongoing outreach services. Multivariate analysis found that participation was associated with being male (odds ratio [OR], 1.82; 95% CI, 1.28-2.60), in mid-career (45-64 years old; OR, 1.44; 95% CI, 1.04-1.99), and working in mixed, mainly private practice (OR, 1.73; 95% CI, 1.18-2.53). Specialists working only privately were less likely to provide ongoing outreach (OR 0.51; 95% CI, 0.32-0.82), whereas metropolitan and rural-based specialists were equally likely to do so. Separate univariate analysis showed travelling further to remote towns had no effect on ongoing service provision. Outreach to smaller towns was associated with improved stability.
Around half of specialists providing rural outreach services continue to visit the same town on an ongoing basis. More targeted outreach service strategies should account for career stage and practice conditions to help sustain access. Financial incentives may increase ongoing service provision by specialists only working privately. There is some indication that outreach services delivered to smaller communities are more stable.
探讨持续开展农村外展服务的专家的特点，以及他们的服务模式性质是否有助于持续外展。
设计、参与者和设置：2008 年对澳大利亚医生进行的一项大型纵向调查中提供农村外展服务的专科医生，以及 2009 年新加入该调查的医生，随访至 2011 年。
向同一农村城镇提供外展服务至少 3 年。
在最初提供农村外展服务的 953 名专科医生中，有 848 名提供了随访数据。总体而言，440 名专科医生（51.9%）提供了持续的外展服务。多变量分析发现，参与与男性（优势比[OR]，1.82；95%可信区间，1.28-2.60）、中年（45-64 岁；OR，1.44；95%可信区间，1.04-1.99）和混合、主要私人执业（OR，1.73；95%可信区间，1.18-2.53）有关。只从事私人执业的专科医生提供持续外展服务的可能性较低（OR 0.51；95%可信区间，0.32-0.82），而大都市和农村专科医生提供持续外展服务的可能性相同。单独的单变量分析表明，前往偏远城镇的距离较远对外展服务的持续提供没有影响。向较小城镇提供外展服务与稳定性提高有关。
大约一半提供农村外展服务的专科医生继续定期访问同一城镇。更有针对性的外展服务策略应考虑职业阶段和实践条件，以帮助维持服务的可及性。仅从事私人执业的专家提供的经济激励可能会增加持续服务的提供。有一些迹象表明，向较小社区提供的外展服务更稳定。
