Influence of Rurality When Accessing Emergency Healthcare During Exacerbation of Asthma A Scoping Review

Main Article Content

Alannah Stoneley, Registered Paramedic; Bch (Hons)
Judith Anderson, PhD
Clare Sutton, MSc

Abstract

Background: Asthma is a significant contributor of respiratory illness throughout Australia, taking a toll on all genders and age groups. The rural healthcare workforce is currently undersupplied, and this worsens with the degree of rurality posing disadvantages in healthcare access. Lower asthma-related mortality rates in metropolitan cities than other areas of Australia indicate a need to explore the extent of the impact that residing rurally has on access to emergency healthcare for asthma-related emergencies.


Methods: A scoping review of literature was conducted utilising the steps articulated in Peters et al. (2020)methodological approach. The databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Emcare, Medline and PubMed were searched using key words. After screening 20 articles were included.


Results: Four main themes emerged including the impact of access to resources; individual behaviours and attitudes; education and health literacy; and rural clinician adherence to guidelines.


Conclusion: Several challenges are associated with living in rural areas which may impact patients ability to access emergency healthcare during an asthma-related emergency. Further research is recommended to determine the extent to which these challenges influence access to emergency healthcare and explore strategies to break down these barriers to ensure equitable emergency healthcare.

Article Details

How to Cite
Stoneley, A., Anderson, J., & Sutton, C. (2024). Influence of Rurality When Accessing Emergency Healthcare During Exacerbation of Asthma: A Scoping Review. International Journal of Paramedicine, (7), 131–145. https://doi.org/10.56068/QIWM3456
Section
Reviews

References

Adams, M. E., Lazarsfeld-Jensen, A., & Francis, K. (2019). The implications of isolation for remote industrial health workers. Rural and remote health, 19(2), [88]-[97]. https://doi.org/10.22605/RRH5001

Adelson, P., & Eckert, M. (2020). Skin cancer in regional, rural and remote Australia; opportunities for service improvement through technological advances and interdisciplinary care. Australian Journal of Advanced Nursing, The, 37(2), 25-30. https://doi.org/10.37464/2020.372.74

Aftyka, A., Rybojad, B., & Rudnicka-Drozak, E. (2014). Are there any differences in medical emergency team interventions between rural and urban areas? A single-centre cohort study. Australian Journal of Rural Health, 22(5), 223-228. https://doi.org/10.1111/ajr.12108

Agusala, V., Vij, P., Agusala, V., Dasari, V., & Kola, B. (2018). Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas. J Int Med Res, 46(8), 3172-3182. https://doi.org/10.1177/0300060518773621

Australian Institute of Health and Welfare. (2020). Asthma Cat. no. ACM 33. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/contents/asthma

Bennett, K. J., Borders, T. F., Holmes, G. M., Kozhimannil, K. B., & Ziller, E. (2019). What is rural? Challenges and implications of definitions that inadequately encompass rural people and places. Health Affairs, 38(12), 1985-1992.

Bian, J., Cristaldi, K. K., Summer, A. P., Su, Z., Marsden, J., Mauldin, P. D., & McElligott, J. T. (2019). Association of a School-Based, Asthma-Focused Telehealth Program With Emergency Department Visits Among Children Enrolled in South Carolina Medicaid. JAMA Pediatr, 173(11), 1041-1048. https://doi.org/10.1001/jamapediatrics.2019.3073

Bourke, L., Sheridan, C., Russell, U., Jones, G., DeWitt, D., & Liaw, S.-T. (2004). Developing a conceptual understanding of rural health practice. Australian Journal of Rural Health, 12(5), 181-186. https://doi.org/10.1111/j.1440-1854.2004.00601.x

Boyd, L., & Archer, F. (2007). Developing a web-based education program for people with asthma in rural and remote areas Journal of Emergency Primary Health Care 5(4), 1-12. https://doi.org/10.33151/ajp.5.4.432

Braithwaite, J., Hibbert, P. D., Jaffe, A., White, L., Cowell, C. T., Harris, M. F., Runciman, W. B., Hallahan, A. R., Wheaton, G., Williams, H. M., Murphy, E., Molloy, C. J., Wiles, L. K., Ramanathan, S., Arnolda, G., Ting, H. P., Hooper, T. D., Szabo, N., Wakefield, J. G., & Hughes, C. F. (2018). Quality of Health Care for Children in Australia, 2012-2013. JAMA: Journal of the American Medical Association, 319(11), 1113-1124. https://doi.org/10.1001/jama.2018.0162

Butz, A., Pham, L., Lewis, L., Lewis, C., Hill, K., Walker, J., & Winkelstein, M. (2005). Rural children with asthma: impact of a parent and child asthma education program. J Asthma, 42(10), 813-821. https://doi.org/10.1080/02770900500369850

Cvetkovski, B., Armour, C., & Bosnic-Anticevich, S. (2009). Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthma. Australian Journal of Rural Health, 17(4), 195-200. https://doi.org/10.1111/j.1440-1584.2009.01071.x

Doherty, S., Jones, P., Davis, L., Ryan, N., & Treeve, V. (2007). Evidence-based implementation of adult asthma guidelines in the emergency department: a controlled trial. Emergency Medicine Australasia, 19(1), 31-38. https://doi.org/10.1111/j.1742-6723.2006.00910.x

Doherty, S., Jones, P., Stevens, H., Davis, L., Ryan, N., & Treeve, V. (2007). 'Evidence-based implementation' of paediatric asthma guidelines in a rural emergency department. Journal of Paediatrics & Child Health, 43(9), 611-616. https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105884621&site=ehost-live

Fecho, K., Ahalt, S. C., Appold, S., Arunachalam, S., Pfaff, E., Stillwell, L., Valencia, A., Xu, H., & Peden, D. B. (2022). Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case. JMIR Form Res, 6(4), e32357. https://doi.org/10.2196/32357

Fennell, K. M., Hull, M., Jones, M., & Dollman, J. (2018). A comparison of barriers to accessing services for mental and physical health conditions in a sample of rural Australian adults. Rural and Remote Health. https://doi.org/10.22605/RRH4155

Fishe, J., Finlay, E., Palmer, S., & Hendry, P. (2019). A Geospatial Analysis of Distances to Hospitals that Admit Pediatric Asthma Patients. Prehospital Emergency Care, 23(6), 882-886. https://doi.org/10.1080/10903127.2019.1593565

Franks, T. J., Burton, D. L., & Simpson, M. D. (2005). Patient medication knowledge and adherence to asthma pharmacotherapy: a pilot study in rural Australia. Therapeutics and Clinical Risk Management, 1(1), 33-38. https://doi.org/10.2147/tcrm.1.1.33.53598

Horner, S. D. (2008). Childhood asthma in a rural environment: implications for clinical nurse specialist practice. Clin Nurse Spec, 22(4), 192-198; quiz 199-200. https://doi.org/10.1097/01.NUR.0000311708.40190.ca

Joanna Briggs Institute. (2022). JBI Manual for Evidence Synthesis https://jbi-global-wiki.refined.site/space/MANUAL/4687770/11.3+The+scoping+review+and+summary+of+the+evidence

Juturu, P. (2021). Assessing emergency healthcare accessibility in the Salton Sea region of Imperial County, California. PLoS One, 16(6), e0253301. https://doi.org/10.1371/journal.pone.0253301

Kassean, H., & Poordil, M. (2011). Utilization of emergency medical services in mauritius. Journal of Health Management, 13(4), 389-400. https://doi.org/https://dx.doi.org/10.1177/097206341101300402

Kew, K. M., & Cates, C. J. (2016). Home telemonitoring and remote feedback between clinic visits for asthma. Cochrane Database Syst Rev, 2016(8), Cd011714. https://doi.org/10.1002/14651858.CD011714.pub2

Larson, A., Ward, J., Ross, L., Whyatt, D., Weatherston, M., & Landau, L. (2010). Impact of structured education and self management on rural asthma outcomes. Australian Family Physician, 39(3), 141. https://pubmed.ncbi.nlm.nih.gov/20369116/

Locke, E. R., Thomas, R. M., Woo, D. M., Nguyen, E. H. K., Tamanaha, B. K., Press, V. G., Reiber, G. E., Kaboli, P. J., & Fan, V. S. (2019). Using Video Telehealth to Facilitate Inhaler Training in Rural Patients with Obstructive Lung Disease. Telemed J E Health, 25(3), 230-236. https://doi.org/10.1089/tmj.2017.0330

Morgans, A., & Archer, F. (2005). Impact of rural identity on access to emergency health care for asthma: Impact of community perceptions Prehospital and Disaster Medicine, 20(S2), S140. https://doi.org/10.1017/S1049023X00015132

Morgans, A., Archer, F., Walker, T., & Thuma, E. (2005). Barriers to accessing ambulance services in rural Victoria for acute asthma: patients' and medical professionals' perspectives. Australian Journal of Rural Health, 13(2), 116-120. https://doi.org/10.1111/j.1440-1854.2005.00665.x

NSW Ministry of Health. (2021). Asthma Deaths. https://www.healthstats.nsw.gov.au/#/indicator?name=-res-asthma-dth&location=NSW&view=Trend&measure=DSTRate&groups=Regional%20Health%20Districts,Sex&compare=Regional%20Health%20Districts&filter=Regional%20Health%20Districts,All%20LHDs,Metropolitan%20LHDs,Regional%20LHDs&filter=Sex,Persons

O’Meara, P. F., Tourle, V., Stirling, C., Walker, J., & Pedler, D. (2012). Extending the paramedic role in rural Australia: a story of flexibility and innovation. Rural and Remote Health, 12(2), [131]-[148]. https://doi.org/10.22605/RRH1978

Pate, C. A., Zahran, H. S., Qin, X., Johnson, C., Hummelman, E., & Malilay, J. (2021). Asthma Surveillance - United States, 2006-2018. MMWR Surveill Summ, 70(5), 1-32. https://doi.org/10.15585/mmwr.ss7005a1

Penninga, L., Lorentzen, A. K., & Davis, C. (2020). A Telemedicine Case Series for Acute Medical Emergencies in Greenland: A Model for Austere Environments. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 26(8), 1066-1070. https://doi.org/10.1089/tmj.2019.0123

Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. (2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119-2126. https://doi.org/10.11124/jbies-20-00167

Piggott, S., Carter, S., Forrest, H., Atkinson, D., Mackean, T., McPhee, R., & Arrow, P. (2021). Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities. Rural and Remote Health, 21(4), 6862. https://doi.org/10.22605/rrh6862

Shaw, D., & Siriwardena, A. N. (2014). Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study. BMC Emergency Medicine, 14(1), 18-18. https://doi.org/10.1186/1471-227X-14-18

Spencer-Goodsir, H., Anderson, J., & Sutton, C. (2022). The nature of paramedic practice in rural and remote locations: A scoping review. Australasian Journal of Paramedicine, 19. https://doi.org/10.33151/ajp.19.9

Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D., Horsley, T., & Weeks, L. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine, 169(7), 467-473.

Van der Merwe, L., De Klerk, A., Kidd, M., Bardin, P. G., & Van Schalkwyk, E. M. (2006). Case-control study of severe life threatening asthma (SLTA) in a developing community. Thorax, 61(9), 756-760. https://doi.org/10.1136/thx.2005.052308

Wilde, E. T. (2013). Do emergency medical system response times matter for health outcomes? Health Economics, 22(7), 790-806. https://doi.org/10.1002/hec.2851

Withy, K., & Davis, J. (2008). Followup after an emergency department visit for asthma: urban/rural patterns. Ethn Dis, 18(2 Suppl 2), S2-247-251. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693416/

Worley, P., & Champion, S. (2020). Improvement of Access, Quality and Distribution of Allied Health Services in Regional, Rural and Remote Australia. National Rural Heatlh Commisioner. https://www1.health.gov.au/internet/main/publishing.nsf/Content/815AFEED0337CF95CA2581D30076D095/$File/National%20Rural%20Health%20Commissioner's%20Allied%20Health%20Report%20to%20the%20Minister%20June%202020.pdf

Most read articles by the same author(s)