Introduction: In Italy, many facilities have started adopting telemedicine services since their regulation in 2020. Rural areas mainly benefit from telemedicine implementation due to their geographic features. We investigated the interests, attitudes, and perceptions of healthcare providers operating in the Italian Dolomites regarding the adoption of telemedicine. Furthermore, we explored the relationship between technostress and the intention to integrate telemedicine services during daily practices.Methods: We developed a structured interview protocol based on existing literature and following the key principles of constructivist grounded theory to investigate five areas of interest in telemedicine. After the interview, participants completed the Italian version of the Technostress Creators Scale (TCS) to evaluate the current technostress experienced in work activities, and a TCS-adapted version to measure technostress values generated through telemedicine services.Results: A content analysis of the interviews highlighted four main factors that can help communities more readily accept telemedicine services: the convenience of not having to travel, the ageing population, cost savings, and a sense of community. Regarding the scales, there were positive significant correlations between most of the subscales.Discussion: Our findings confirm that telemedicine fosters perceived security and service quality in rural settings. Despite moderate technostress, professionals remain supportive, highlighting the role of perceived usefulness. Key barriers include low digital literacy and reduced social contact, underscoring the need for strong patient-provider relationships and targeted digital training to ensure successful implementation.Conclusion: Telemedicine offers vital support in improving healthcare access in remote areas. Overcoming barriers like low digital skills and poor connectivity requires infrastructure investment and training. Evaluating technostress alongside digital readiness is essential for future research.
Introduction: People who have experienced sexual assault have many acute needs requiring timely attention. In New South Wales (NSW), Australia, reported sexual assault rates have been increasing over the past decade, with reported rates increasing at a higher rate outside metropolitan areas. These regional and rural areas experience chronic shortages of medical and forensic examiners able to deliver timely care. The aim of this study was to identify the motivations, barriers and facilitators affecting the recruitment and retention of examiners in regional and rural NSW, Australia.Methods: Doctors and sexual assault nurse examiners who have worked as examiners for NSW sexual assault services in a non-metropolitan area were recruited to participate in semi-structured interviews. Written informed consent was obtained, and interviews were recorded and transcribed. Data were coded using a combination of deductive and inductive approaches. Themes were developed according to Braun and Clarke's thematic analysis approach.Results: A total of 13 participants were interviewed, of whom 11 were female and 2 were male; 9 were doctors and 4 were nurses. Five key themes were identified: structural challenges of rural service delivery, near invisibility in the health system, isolation and missed connections with colleagues, inability to thrive, and sense of duty to patients, colleagues and community. While motivated by obligation to colleagues and community, barriers of travel time over large geographic areas and insufficient examinations to maintain skills were present. Potential facilitators such as peer support, contributing to policy and funded training opportunities were considered to be lacking.Conclusion: To ensure the sustainability of rural sexual assault medical workforces, change addressing isolation and invisibility is needed. Future changes to services should be considered from a rural lens, as rural examiners face unique barriers to workforce participation and are essential to service delivery.
Introduction: In remote areas and an increasingly aging society, patients with rheumatic diseases often experience delayed diagnoses due to limited access to specialists, which significantly impacts their quality of life. Effective training of primary care physicians is therefore essential to improve the quality of rheumatic disease care in these areas. Entrustable professional activities (EPAs) offer a robust framework for evaluating learners by defining specific, observable units of work. This study aimed to develop a consensus-based list of essential EPAs for young generalist physicians to enhance the quality of rheumatic care in underserved, remote settings.Methods: We employed a modified Delphi method to build consensus among an expert panel of 25 members, including specialists in rheumatology, internal medicine, and family medicine (21 of whom had direct remote medical experience). The research team synthesized an initial task list from national and international medical education and rheumatology curricula. Experts rated each task on a five-point Likert scale over four iterative rounds. Consensus was defined by an average score of ≥4.0, a standard deviation of <1.0, and ≥75% agreement.Results: Response rates were exceptionally high throughout the process (96-100%). The Delphi rounds culminated in a finalized list of 14 EPAs. Key refinements included narrowing technical procedures (eg joint aspiration) to the knee and rephrasing clinical tasks to emphasize the timing of specialist collaboration. Expert feedback underscored the necessity of early diagnosis, maintaining a broad differential diagnosis during initial assessments, and the indispensable nature of structured handover skills in resource-limited environments.Conclusion: This study successfully established a specialized EPAs framework for generalists in remote areas, addressing a critical gap between general residency training and subspecialty curricula. The list emphasizes managing rheumatic diseases within the constraints of limited resources while ensuring appropriate specialist synergy, ultimately aiming to improve patient outcomes in rural communities.
Introduction: Access to comprehensive primary health care in very remote Aboriginal communities in the Northern Territory (NT) of Australia is limited by local primary healthcare workforce shortages. Digital health technologies (DHTs) have the potential to improve access, but user co-design of the technology is a critical success factor for uptake, effectiveness, and sustainability. This study aimed to elicit the relative preferences of a very remote Aboriginal community and their primary healthcare providers (clinicians and health service managers) for DHT attributes on a common scale.Methods: Twenty-four attributes of DHTs were identified through qualitative research with a very remote, almost exclusively Aboriginal, community to improve access to comprehensive primary health care. A D-efficient incomplete block design was used to arrange the attributes in a best-worst scaling survey for preference elicitation. The survey was administered in-person from January to June 2024 by Aboriginal community-based researchers to a target sample of 20% of the community's Aboriginal population, stratified by age and gender. Primary healthcare providers working in the NT were invited through professional networks from November 2024 to September 2025 to complete the same survey online. Results were analysed using multinomial logit models by stakeholder group: Aboriginal community members and primary healthcare providers.Results: Representative samples comprising 46 Aboriginal community members (24% of the community's adult population) and 50 NT primary healthcare providers (80% clinicians and 20% health service managers) completed the survey. Results showed a substantial divergence between Aboriginal community members' and healthcare providers' preference scores for DHT attributes; 12/24 (50%) attributes differed significantly between the groups. However, both groups had high preference scores for 'a support person available to interpret so patients can understand, communicate, and participate in discussions with [the] health professional', 'respect[ing] the patient's culture and community', and 'minimis[ing] travel away from community'. The Aboriginal community members' preferences for DHTs to reduce wait times for a specialist appointment, reduce wait times on the day of any healthcare appointment, and functionality to involve a family member/carer in discussions with health professionals when needed, were considered less important by healthcare providers. Instead, primary healthcare providers preferred that DHTs be used to provide information to help patients clearly understand and manage their own and their family's health.Conclusion: When designing comprehensive primary healthcare models that use DHTs to optimise service delivery in remote NT Aboriginal communities, it is of utmost importance for Aboriginal community members and healthcare providers that the service delivery models provide support persons to help patients understand, communicate and participate fully in healthcare discussions, demonstrate respect for the patients' culture and community, and minimise travel away from community. Investment in DHTs for remote NT Aboriginal communities should prioritise solutions that reduce the time to obtain a specialist appointment and wait times on the day of any healthcare appointment. Given the notable differences between the preferences of Aboriginal community members and primary healthcare providers, it is important that all stakeholders are involved in design through implementation, monitoring and evaluation to ensure effective and sustainable digital health initiatives.
Introduction: By providing additional clinical information at the bedside, point-of-care ultrasound (PoCUS) has the potential to improve patient care, especially in rural settings where local consultative imaging and specialist services are limited or absent. PoCUS can safely facilitate de-escalation or escalation of care, which, in a rural context, can include a change in the decision to refer or transport out of town to a higher level of care. This study aimed to understand the utility of PoCUS for rural family physicians (FPs) by assessing how PoCUS affects their diagnostic certainty and clinical decision-making.Methods: Convenience sampling was used to recruit five FPs from different rural communities in British Columbia, Canada, a geographically large province that experiences inclement weather. FPs collected data on their PoCUS exams over 2-10 weeks. They recorded their pre- and post-PoCUS diagnostic probabilities on a 0-100% scale, with 0% representing complete confidence that a patient does not have a working diagnosis and 100% complete confidence that a patient does. Each diagnostic probability was assigned to one of three diagnostic certainty categories according to the following scheme: 25-74% corresponds to low, 6-24% or 75-89% corresponds to intermediate, and ≤5% or ≥90% corresponds to high. FPs recorded their patient care plans at pre- and post-PoCUS. Each plan was assigned to one of six levels of care, ranging from discharge without referral or follow-up to transport out of town to a higher-level facility. The Wilcoxon signed-rank test for clustered data was used to assess the statistical significance of changes in diagnostic certainty and the planned level of patient care following PoCUS use. Scans were grouped/clustered by FP during analysis.Results: Altogether, FPs collected data on 68 PoCUS exams. All nine PoCUS organ systems, as defined by BC PoCUS, were scanned. Overall, PoCUS led to an increase in diagnostic certainty and a shift to less specialized patient care plans. Diagnostic certainty increased in 68% of cases (p=0.01). The planned level of care for patients changed in 36% of cases (decreased in 32% and increased in 4%), but this change was not statistically significant (p=0.08). For 13 patients, there was a change in planned out-of-town transport to a higher level of care (high urgency) or referral to a specialist (low urgency). Overall, transport was removed for four patients and added for two other patients.Conclusion: Consistent with the few other studies from high-income countries on this topic, our findings indicate that PoCUS positively impacts patient care by usually increasing rural FPs' diagnostic certainty, which can influence their clinical decision-making. The most important PoCUS-facilitated change observed was whether to transport out of town, which can result in major cost savings if appropriately avoided or greatly improve patient outcomes if the need for transport is recognized sooner. Our findings, if validated by larger studies, will likely help to drive PoCUS policy and practice decisions in Canada.
