Joanne Dollard

... inspiring me, in particular Antonina Mikocka-Walus, Heather Tan, Dr Susan Selby, Marijeta Kurtin, Neha Mahajan, Rosie King and Karina Bria. I have made lifelong friends. ... thank friends Dr Jane Edwards and Dr Sarah Cotton, niece Sonya Ballinger and sister Rosie Thomson. ...

This paper reports on research to ascertain the views of general practitioners (GPs) practising in rural and remote areas of South Australia, on evidence-based medicine (EBM). It follows our previous paper that identified, through a literature search, the key issues in moving towards EBM in general practice in these areas1. The objective of the paper was to identify perceived barriers and potential solutions to evidence-based general practice in rural and remote South Australia. An interview survey was conducted in the year 2000 at 89 of 104 GPs' (86%) surgeries in three rural Divisions of General Practice in South Australia. EBM was viewed positively by 85%, and 94% reported practising EBM. However, barriers to EBM were identified by 84% and four key themes were identified. GP-related barriers identified by 60% included difficulty finding, appraising and applying evidence and lack of time to read, reflect and update practice. Patient related barriers (23%) included an apparent ...

Cardiac rehabilitation (CR) has an evidence base but traditional models may not readily apply to people living in rural and remote regions. : To outline published comprehensive and non-hospital based CR models used for people discharged from hospital after a cardiac event that have potential relevance to those living in rural and remote areas in Australia. The PubMed database was searched using Medical subject headings (MeSH) terms and the key word 'cardiac rehabilitation' limited to clinical trials. Articles were retrieved if they included at least two components of CR and were not based in an outpatient setting. No CR models specifically developed for rural and remote areas were identified. However, 14 studies were found that outlined 11 non-conventional comprehensive CR models. All provided CR in a home-based setting. Health professionals provided support via telephone contact or home visits, and via resources such as the Heart Manual. Reported outcomes from these CR programs varied: ranging from an increase in knowledge of risk factors, to improvements in physical activity, decreased risk factor profile, improved psychological and social functioning and reductions in health service costs and mortality. Home-based, CR models have the most substantive evidence base and, therefore the greatest potential to be developed and made accessible to eligible people living in rural and remote areas.

To determine whether older community-dwelling people underestimate their own perceived chance of falling compared with that of other older people (comparative optimism), and whether a history of falls is associated with comparative optimism. A sample of community-dwelling South Australians aged ≥65 years (n= 389) completed a computer-assisted telephone interview about their 12-month fall history, their perceived chance of falling and their rating of other older people's chance of falling. Respondents were comparatively optimistic about their chance of falling (Z =-8.1, P < 0.001). Those who had fallen in the last 12 months had a lower comparative optimism score (Z =-3.0, P < 0.003). As older people were comparatively optimistic about their likelihood of falling, they might not find fall prevention messages relevant. When older people present with a fall, clinicians could provide fall prevention information consistent with how older people present themselves.

To determine whether older community-dwelling people underestimate their own perceived chance of falling compared with that of other older people (comparative optimism), and whether a history of falls is associated with comparative optimism. A sample of community-dwelling South Australians aged ≥65 years (n= 389) completed a computer-assisted telephone interview about their 12-month fall history, their perceived chance of falling and their rating of other older people's chance of falling. Respondents were comparatively optimistic about their chance of falling (Z =-8.1, P < 0.001). Those who had fallen in the last 12 months had a lower comparative optimism score (Z =-3.0, P < 0.003). As older people were comparatively optimistic about their likelihood of falling, they might not find fall prevention messages relevant. When older people present with a fall, clinicians could provide fall prevention information consistent with how older people present themselves.

This study aimed to understand older people's perceptions of their and other older peoples' falls risk, to increase understanding of why older people might not believe falls are relevant to themselves. One-third of the people aged≥65 years (older people) fall yearly. Many older people do not participate in falls prevention programmes because they purport they are not personally vulnerable. A qualitative study was conducted, guided by the tenets of grounded theory. Semi-structured interviews were conducted with nine community-dwelling older people living in metropolitan Adelaide, South Australia. The interview explored participant's direct and indirect experience of falling, their perceived chance of falling in the next 12 months and that of others of the same age and sex to themselves and their reasons for this. Participants carefully presented themselves as being 'not the type who fall', who they view negatively. They believed their or their friends past or future falls were (or could be) because of factors outside of their personal control or because they were not paying attention at that moment of falling, as opposed to being the type of person who falls. They used these explanations as strategies to maintain or protect their identity as being physically competent. Older people know that falling can be viewed negatively. Falling is a threat to their identity as the type of person who does not fall. This explanation is consistent with self-presentation theory, where people use accounting strategies in social interaction to create a desired impression. Falls prevention messages are likely to be rejected if the target group associate the message with a negative identity. These findings can assist nurses to understand older people's reluctance to engage in falls prevention and can stimulate thinking regarding alternative engagement strategies.