Rural Patient Transport and Transfer: Findings from A Realist Review

The Applied Policy Research Unit is pleased to announce the release of their fourth realist review, “Rural Patient Transport and Transfer: Findings from A Realist Review”. The report, commissioned by the Rural and Remote Division of Family Practice, addresses the question: “What are the best practice models for transferring medically complex rural patients to secondary/tertiary care?” by summarizing evidence from a comprehensive review of academic and grey literature on emergency transport systems across Canada and comparable international jurisdictions.


Findings are presented by key themes including evidence regarding:

  • Timing to secondary referral or tertiary care;
  • Equipment and technology;
  • Health Human Resources
  • Dispatch and Communication
  • Governance


Recommendations align with a number of provincial priorities including the need for:

  • patient- and community-centred approaches to rural transport and transfer
  • improved communication at all system levels
  • interprofessional teamwork
  • (rural) generalism to support and sustain crucial services in smaller communities
  • virtual care to link smaller sites with regional referral and tertiary centres for consultations
  • an integrated and iterative approach to quality improvement.


You can download the report from the APRU website . Please contact Jude Kornelsen ( for any further information.


Coming Soon…


CRHR is launching several public engagement projects in 2016-17, including a complementary website called CRHR Public. This site will forefront visual modes of communication: short videos, infographics, and photos connected to our publications.

This public outreach and knowledge translation project is headed by our Media Assistant, Evonne Tran. The aim of the broader initiative is to better communicate our research findings to the general public.

We’ll continue updating our regular website (// with our text-based blog, publications, and reports.

Updates on our re-branding and social media platforms will be coming soon!

Announcing: Documentary Film Project


The Centre for Rural Health Research is excited to announce that we are producing a documentary film about women’s experience with rural maternity services. Welcome to our videographer, Tamara Wojciechowska!

Here is our recruitment poster for the Tofino area:


Through this film, we want to raise awareness of what women and their families have to deal with in order to give birth, when living in a rural community in British Columbia. The film will also highlight the social dimension of what happens when a community loses local maternity care.

We believe this documentary project will create an impact to support better maternity services for women and their families in rural communities in BC and throughout Canada.

For over a decade, we have conducted extensive research and published numerous articles on various aspects of rural maternity care. Key publications include:

For more publications and reports, see our Journal Publications and APRU Reports pages.

Primary Maternity Units in Australia (an international research collaboration)

The Australian government has declared a commitment to improving women’s access to maternity care in rural and remote areas, following the adverse effects of prior maternity service closures. In an international context, Primary Maternity Units (PMUs) provide birthing services in areas geographically separated from ideal obstetrics and neonatal services.

A recent study, “Primary Maternity Units in rural and remote Australia: Results of a national survey,” conducted in part by the Center for Rural Health Research’s Dr. Jude Kornelsen, sought to investigate and describe how PMUs operate throughout rural and remote Australia. The study is intended to inform both policy makers and health care professionals regarding the function and role of PMUs across Australia’s rural and remote regions. The researchers hope to identify what areas will require governmental support to improve rural women’s access to proper maternity care.

Sustaining Rural Maternity and Surgical Care

In a newly published article, “Sustaining rural maternity and surgical care,” Dr. Jude Kornelsen, Dr. Stuart Iglesias, and Dr. Robert Woollard comment on the “Joint Position Paper on Rural Surgery and Operative Delivery” they co-authored in 2015, this time focusing on three main issues: providing rural health service closer to home, the impasse on safety, and operative delivery. They look at how the adoption of health services provided closer to home has impacted three communities in rural BC. Next they present undeniable evidence that rural surgical care has long been facing a service closure crisis, similar to that of maternity care. They recognize the need for action, and follow this up with background information on the relationship between general surgeons and family physicians with enhanced surgical skills (FPESS), and how their professional links impact the international discussion on defining and evaluating “safety.” For the third issue, the authors comment on the importance of local caesarean section services, and argue that unless a link can be fostered with surgical programs, these too will be unsustainable in rural and remote areas. Finally, Drs Kornelsen, Iglesias, and Woollard present and discuss the current need for all health care professionals and partners to align for a system change. They suggest that while interprofessional relationships will require significant attention, such an alignment will enable responsible policy to be implemented and lines of accountability to be maintained in each essential jurisdiction.

Where are the Midwives?

Over the past two decades there has been a slow erosion of maternity services in rural and remote areas in Canada. Many rural residents have been vocal about their opposition to the closures. However, the voices of health care professionals have been missing from the dialogue. In the recently published commentary “The Closure of Rural and Remote Maternity Services: Where are the Midwives?” Dr. Leslie Barclay and Dr. Jude Kornelsen argue that it is the responsibility of professional bodies to advocate for sustaining maternity services in rural and remote areas. The authors defend their belief that it is necessary for midwives to speak out and advocate as a means to effect system changes for both political and strategic reasons. Researchers must continue to develop evidence that can be used as a basis for strong advocacy on behalf of women living in rural and remote areas. System-level changes cannot be done by individuals alone; they require collective effort from professional bodies in all pertinent fields. Those who read this article will gain insight into the current situation facing rural and remote women, and how we all have a role to play in maintaining maternity services.

Reconceptualizing Risk

Maternity services in rural and remote regions of Canada, France, the United States, and comparable jurisdictions are facing closures. Australia has seen a closure of nearly half of their maternity units over the past two decades. Dr. Lesley Barclay (University of Sydney) has carried out fieldwork on how growing rates of maternity unit closures has impacted rural and remote residents in Australia. This research was part of the Australian Rural Birthing Index Project (ARBI), which was developed to assist in planning appropriate levels of maternity services for various rural communities. Dr. Barclay was supported by a team of researchers from Canada and Australia, including CRHR’s very own Dr. Jude Kornelsen.

A full description of the main findings has been made in a 2016 article titled “Reconceptualising risk: perceptions of risk in rural and remote maternity service planning.” The paper reports participants’ perceptions of risk in relation to the closure of rural maternity services, obtained through semi-structured individual and group interviews, focus groups, and group discussions. The analysis covers various clinical, legal, political, financial, cultural, emotional, and operational risks associated with the closure of rural maternity services. Understanding these risks, whether they are perceived or observed, is vital to the planning and improvement of rural and remote health services.