Rural: Overview

This Virtual Issue draws together a number of articles that have recently been published in The Australian Journal of Rural Health (and elsewhere) exploring dimensions and impact of the implementation of the National Disability Insurance Scheme (NDIS) on people, services and the workforce in regional, rural, and remote areas of Australia. It draws attention to some of the challenges, limitations, and undue complexity, experienced by rural people with disability and their families negotiating the system.

Abstract
In rural Australia, recent trends reveal an exponential increase in the rates of physical inactivity, central obesity, metabolic syndrome, and cancer in the population. The limited rural health workforce, which is struggling to meet this growing burden, is boosted by digital technologies such as My Health Record, Cardihab, Healthdirect, and MindSpot, all of which offer opportunities for improved diagnostics, monitoring, and management of chronic diseases. However, implementing proven digital health technologies in rural communities has been challenging on numerous fronts. This perspective aims to (1) highlight the rural health gap and propose a way forward in implementing evidence-based digital health technologies in the rural, regional, and remote communities of Australia and (2) guide future rural health policy.

Abstract
Objective: Quality indicators (QIs) specific to older adults receiving health care in rural and remote settings can be used to monitor healthcare quality, inform service improvements, and outcomes for these populations. This scoping review aimed to identify population-based QIs used to evaluate healthcare quality received by older people in rural and remote settings.

Methods: Two academic databases and grey literature sources were searched to identify population-based rural QI monitoring programs or rural QIs, routinely used and reported since 2012. QI program and specific characteristics, including country of origin, dimension of care quality captured, domain represented, QI type, data sources used, reporting strategies, and care settings were summarised.

Findings: Nine QI programs from seven countries with 52 QIs were identified. The QIs measured quality-of-service delivery (n = 28, 54%), accessibility (n = 11, 21%), resources (n = 9, 17%), and hospital readmissions (n = 4, 8%). Most QIs were outcome (n = 25, 48%) or process (n = 19, 37%) indicators, considering the dimension of safe healthcare. Three QIs (6%) measured rural hospital readmission in older people residing in rural areas.

Conclusions: Three QIs measuring the proportion of older adults with unplanned rural hospital readmission were identified that could facilitate consistent reporting and benchmarking of care provided to older adults residing in rural and remote communities. Given the known disparities in equitable access and quality of healthcare for older people residing in rural and remote areas, these findings highlight the need for QIs across all quality dimensions to monitor healthcare quality and drive improvements in access and quality of healthcare.

Abstract
Introduction: Oral and maxillofacial (OMF) injuries encompass all forms of trauma to the tissues of the oro-facial complex, the face, jaws and mouth. In rural areas, where healthcare access is often limited, OMF injuries pose unique challenges. These challenges are compounded by environmental factors, occupational hazards and socioeconomic disparities, making rural populations particularly vulnerable to such injuries. This study explores the epidemiology and geographical variation of OMF injuries in Queensland, Australia.

Methods: Data for injury from several Queensland hospital emergency departments were obtained from state register Queensland Injury Surveillance Unit for the years 2015-2021. Data parameters included patient demographics, mechanism, intent and location of injury.

Results: The data (n=9095) revealed that OMF injuries are more prevalent in rural areas and increasing in incidence. Those in inner and outer regional areas sustained injuries 1.8-2.2 times more than the metropolitan population and the incidence was 8.7-11.7 times higher in remote and very remote locations (p<0.05). Approximately 70% of injuries occurred among males in all populations, with peak age of injuries noted as 15-24 years. Assault-related injuries were the predominant cause of injury, notably more common in regional (35.6%) and remote (45.7%) areas compared to metropolitan regions (19.8%) (p<0.05).

Conclusion: The high proportion of OMF injuries experienced in rural areas signifies a considerable health concern. This may be attributable to engagement in risk-taking behaviours, contributing as aetiology or exacerbators. These findings underscore the need for targeted interventions aimed at addressing the mental health and risky behaviour patterns in rural communities. Further research should consider wider aetiological and exacerbating factors including social determinants of health, ethnicity and cultural factors that underlie interpersonal violence in these communities.