Associate Professor Denise Blanchard

Introduction: Australians in rural areas experience limited access to services and poorer health outcomes than residents of metropolitan areas. Nurse practitioners (NPs) were introduced in 2000 to reduce pressure on the health system, address workforce shortages and improve rural populations' access to health care services. Objective: This scoping review sought to identify, examine and synthesise research evidence of NP practice in Australian rural primary health care services to better understand how NPs are addressing service gaps in rural areas and to identify existing gaps in our knowledge. Design: Peer-reviewed and grey literature from July 2012 to June 2022 was accessed from seven electronic databases, grey literature and hand searching of reference lists and citations. Findings: From 154 articles, 19 articles of relevance were identified. Several projects describe the processes required for success, whilst others reported the challenges and barriers encountered. Limited research evidence of rural NP practice exists with a significant gap about how roles operate and their value in primary health care. Discussion: Uptake and envisaged benefits of rural primary health care NP roles have yet to be realised, with barriers to implementing and sustaining NP roles persisting. Low-level awareness with ambiguity at health service and community level adversely impact on systematic implementation of NP roles. Conclusions: Robust evaluations demonstrating the value of NP skills and practice are needed in combination with bipartisan support from all levels of health care and government providing adequate funding to enable effective implementation of NP roles in poorly resourced rural areas.

Background Communication difficulties, including hypokinetic dysarthria and swallowing difficulties (dysphagia), affect a large percentage of people diagnosed with Parkinson¿s disease. Onset of these symptoms has been identified in up to 78% of people with early-stage Parkinson¿s disease. Communication difficulties are frequently disregarded until they have a significant impact on quality of life, while the person may often be unaware of indicators of dysphagia and the associated risk of aspiration pneumonia. Objective The aim of this article is to increase awareness of the importance of identifying and addressing the communication and swallowing difficulties experienced by people living with Parkinson¿s disease. Discussion Early identification, regular review and monitoring enable the clinician to support the implementation of evidence-based, effective interventions. Collaboration with the multidisciplinary team, including speech pathology, is needed to enable the person to live well with Parkinson¿s disease and to prevent aspiration pneumonia, a leading cause of death in Parkinson¿s disease. A vignette prepared in collaboration with a person living with Parkinson¿s disease and his wife provides an ¿insider perspective¿ of the pervasive impact of difficulties with communication and swallowing.