Concurrent Speakers

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Sarah Baggio
A national quality of care collaboration to improve paediatric palliative care outcomes
Biography

Sarah Baggio has a Bachelor of Health Sciences (Physiotherapy) and Honours Bachelor of Kinesiology (Human Movement Sciences). She started her career in adult palliative care at Bridgepoint Health in Toronto Canada. In 2006, Sarah re-located to Australia and has worked for CHQ ever since. In 2011 she worked as the Physiotherapist for the Neuro-Oncology team and joined the Paediatric Palliative Care service in 2012. Currently, Sarah is the Allied Health Clinical Education Coordinator for the Quality of Care Collaborative –Australia (QuoCCA) project based at the Lady Cilento Children’s Hospital.

Abstract

Background: In Australia, there is 1 death of a child per 60 adult deaths (Australian Bureau of statistics, 2014). However, the prevalence of children with a life limiting condition is increasing with an estimated 32 per 10,000 children aged 0-19 years living with a life limiting condition.

In Australia, many families live in regional and rural locations. There can be a mismatch between the significant needs of this group of patients and the available skilled workforce available to care for them, particularly in rural locations.

Preferred location of care influences Paediatric Palliative Care Service models with an emphasis on timely access to local supports, as well as specialist input when required. Modality of support includes telehealth, telephone support (including after hours) and “pop-up” visits. Types of support include pain and symptom management, practical supports and psychosocial care.

Project aims: This study aims to promote high quality palliative care to children in close proximity to their home through education initiatives, evaluation and research.

It is hypothesized that providing targeted and varied educational initiatives based on a learning needs analysis, to regional, rural and remote health care teams and community services will ultimately improve the quality of paediatric palliative care (PPC) provided to children and their carers/families across the country.

Methods: Human Research and Ethics Committee (HREC) approval and site-specific assessment approval has been sought from local jurisdictions.

A mixed methods design is being used for this study. Evaluation is ongoing and includes three phases:

  1. Baseline learning needs analysis/capability; (on-line learning needs analysis, including a capability tool (CT) was sent to health professionals in regional, rural and remote settings via networks
  2. Educational initiatives and evaluations (pre-post confidence survey); workshops and ‘pop-up’ specialist case consults across the country
  3. Consumer and Health Clinician Engagement. (FamCare-2 survey & Discovery Interviews).

Results: The top 4 identified learning needs are: (1) preparing families for the death of their child, (2) management of the dying child, (3) paediatric palliative care resources and (4) communication. The Paediatric Palliative Care – CT results show many capabilities requiring further support

This educational initiative has improved the confidence and capability of the local health teams to providing quality palliative care to children, at home or in a hospital close to their home

Conclusion: The pop-up model provides opportunities for meaningful conversations about care planning, inter-disciplinary team support Unanticipated positive outcomes include improved networking between local & tertiary services.

Slides | Paper
Andrea Baldwin
Rising to workforce challenges: e-PIMH in rural and remote Queensland
Biography

Dr Andrea Baldwin is a Service Development Leader at the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH). QCPIMH provides leadership, advocacy, professional development and support for health professionals, to promote the mental health and emotional wellbeing of Queensland parents, infants and young children and families.

Abstract

Rural and remote health managers encounter the same workforce challenges over and over again: the challenge of responding skilfully to high-risk disorders in areas of low population density; the difficulty of providing appropriate professional development and support for isolated clinicians; frustrations associated with high staff turnover.

Perinatal mental health disorders, including anxiety and depression, can have enduring negative impacts on mothers, fathers, their infants, and the entire family. Suicide is a leading cause of death for mothers in the first year after the end of a pregnancy. Parental mental health issues, and/or problems in the parent-infant relationship, can have life-long adverse effects on the health, wellbeing and development of children.

e-PIMH is a pilot project implemented by the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH) from February to August 2016. The project operated in the four most rural Queensland Hospital and Health Services: South West, Central West, North West, and Torres and Cape.

The project used a central point of contact (‘one stop shop’) to provide non-clinical advice and support, training, education and resources, for rural and remote practitioners working with parents, infants and families. The aim of this pilot project was to increase capacity within the existing rural and remote workforce to support perinatal and infant mental health, detect perinatal and/or infant mental health issues, and make early and appropriate referrals. Participating organisations included primary and secondary healthcare providers, along with early childhood services and young parents’ services, several of which were Indigenous-led organisations.

Twelve training sessions were conducted with 172 participants, mostly front-line workers. Seventy-two meetings were held with 159 people, including medical staff and service managers. Most trainings and meetings were conducted face-to-face in regional centres, augmented by extensive use of videoconferencing, telephone and email contacts. A regular email was sent out, print and audio-visual resources were distributed, and staff were linked with other services for advice, referral information and supervision.

A survey to evaluate the e-PIMH pilot garnered a 30% response rate. The paper will report on key findings including:

  • participants’ self-reported benefits from participating in e-PIMH, for themselves and their clients
  • perceived strengths of the e-PIMH model for building capacity in the rural and remote workforce to respond early and effectively to high-risk disorders, support isolated staff, and reduce the negative impacts of staff turnover
  • suggested improvements to the e-PIMH model.
Slides | Paper
Ruth Ballweg
Physician assistant staffing in a rural New Zealand hospital
Biography

Ruth Ballweg is a US physician assistant leader who has been worked with the Ministry of Health in New Zealand and Queensland Health to develop and implement physician assistant pilot projects. Ruth is currently the Director of International Affairs for the National Commission on Certification of Physician Assistants (NCCPA). She is also Professor Emeritus of Family Medicine at the University of Washington in Seattle, where she was the Director of the MEDEX Northwest Physician Assistant for 29 years. A main focus of her career is rural health access, including a “grow your own” community-based approach to health workforce needs in small, rural and remote communities. She has worked extensively in Alaska with the Alaska Native Tribal Health Consortium (ANTHC) and community health centres to develop and implement new models of primary health care. As a clinician Ruth has worked in family medicine, public health, with emergency medicine evacuation and transport.

Abstract

Uptake of the physician assistant role has been slow in Australia and New Zealand despite the completion and positive evaluation of several pilot projects. Delays have resulted from “slow” governmental action as well as absence of “models” that can be readily adopted by health care delivery systems. This paper describes the successful model of PA emergency department utilisation in the small rural hospital in Gore on New Zealand’s South Island.

The town of Gore is 64 kilometres north-east of Invercargill and 70 km west of BalcluthaDunedin. Gore is a service town for the surrounding farm communities. Operated by Gore Health, the Gore Hospital provides a broad range of services. A busy 24-hour emergency room is a key feature of Gore Hospital. which has often relied on locum tenens doctors for staffing.

In 2013 Gore Hospital’s emergency department was chosen to participate in the Ministry of Health’s pilot project to bring US PAs—on two year contracts—to small New Zealand communities to demonstrate how PAs could expand health care access in New Zealand’s remote communities and small cities. At the completion of the two-year pilot, Gore Hospital maintained the PA role and has sequentially hired two more PAs to provide emergency care.

This paper will describe the service needs of the Gore Hospital, and consider the development and acceptance of the PA role from the viewpoint of patients, the emergency room staff and the community. Details of the education, past medical experience and clinical skill set for each PA will be reviewed. Recruitment and selection processes will be described along with salary and benefit considerations, relocation support and orientation activities.

The paper will provide detailed information on the utilisation of the three PAs including productivity, types of patients seen, scheduling, supervision, and interface with other hospital departments. The paper will also describe PA communication with ER physicians in the larger Invercargill regional hospital for consultation and transfers.

Finally the paper will consider the “learnings” from the Gore PA experience and provide recommendations for the development of PA roles and staffing patterns in similar rural hospitals throughout New Zealand and Australia. These include (1) recruitment of PAs with rural experience; (2) orientation and development of the PA role; (3) inclusion of the medical and nursing staff in development and support of the PA role; and (4) retention issues.

Slides | Paper
Lesley Barclay
What have we learned from the Australian Rural Birth Index study?
Biography

Emeritus Professor Lesley Barclay was until recently the Director of the Centre for Rural Health (North Coast) for Sydney University. She is known as an educational leader, health services researcher and systems reformer whose projects have improved maternal child health services in urban and remote Australia and internationally. Professor Barclay has been and remains an investigator on NHMRC and ARC grants with most of those awarded in recent years being rural, remote or Indigenous focused.

Dr Barclay’s national leadership was exemplified in her role as chair and most recently deputy chair of National Rural Health Alliance; an organisation of 33 peak rural health bodies. She is also known for her international expertise and advice, for example leading AusAID and World Bank projects in Asia and the Pacific. Most recently she has worked as a short-term technical advisor to WHO on a report on maternal child health services provided by WHO to nations in the region. She has just resigned from a role as a Board member on the North Coast Local Health District Board and until 2015 was on the region’s Medicare Local Board.

Lesley Barclay is known for her mentoring and training, exemplified by 12 of the 35 PhD students she has supervised over the last decade being appointed as professors in midwifery or maternal child health. Professor Barclay has edited two books, written three book chapters, published 56 refereed papers in the last five years and written or contributed to numerous government or agency reports.

Lesley was awarded an AO in 2004 in recognition of her contribution to professional and international development and child health. She is one of the very few Distinguished Fellows of the Australian College of Midwives and one of the few women designated a Samoan Chief, recognising her work in that country.

Abstract

This NHMRC funded investigation began as an exercise in testing a Canadian developed maternity services planning tool for its utility and validity in Australia.

Careful work with our statisticians and with around 170 rural and remote birthing facilities across Australia demonstrated that we can develop a mathematically valid planning tool for Australia. While this is useful we also learned that the application of this requires not only judgement but also contextual analysis. So we also developed, scrutinised and assisted by an expert group, a toolkit to apply this planning tool.

What we found in our field work across four states and territories was surprising. This was not only an absence of evidence in relation to planning decisions about whether a service existed or not, but jurisdictional differences. Some states were more likely to have services than others. The ones that did had fewer services and did not appear to tie their decision making to “need”. This was also more surprising than we expected. Population vulnerability, that is sociodemographic or clinical need did not determine the existence of or nature of services.

We learned about the challenges of applying and evidence based tool through fieldwork which also taught us lessons that were not necessarily anticipated. For example the struggle to get good clinical governance of rural and remote health services. The absence or poor quality of networking, in many cases, of regional services to small services or any networking at all; compounded the problem of clinical governance. The value of networks that reach out from regional hubs appear to be common sense and essential and their absence was surprising. Finally a fallacious sense of risk that often governed decisions that in and of themselves added risk.

Slides | Paper
Lesley Barclay
Improving health outcomes through integration of pharmacists into Aboriginal health services
Biography

Emeritus Professor Lesley Barclay was until recently the Director of the Centre for Rural Health (North Coast) for Sydney University. She is known as an educational leader, health services researcher and systems reformer whose projects have improved maternal child health services in urban and remote Australia and internationally. Professor Barclay has been and remains an investigator on NHMRC and ARC grants with most of those awarded in recent years being rural, remote or Indigenous focused. Dr Barclay’s national leadership was exemplified in her role as chair and most recently deputy chair of National Rural Health Alliance; an organisation of 33 peak rural health bodies. She is also known for her international expertise and advice, for example leading AusAID and World Bank projects in Asia and the Pacific. Most recently she has worked as a short-term technical advisor to WHO on a report on maternal child health services provided by WHO to nations in the region. She has just resigned from a role as a Board member on the North Coast Local Health District Board and until 2015 was on the region’s Medicare Local Board. Lesley Barclay is known for her mentoring and training, exemplified by 12 of the 35 PhD students she has supervised over the last decade being appointed as professors in midwifery or maternal child health. Professor Barclay has edited two books, written three book chapters, published 56 refereed papers in the last five years and written or contributed to numerous government or agency reports. Lesley was awarded an AO in 2004 in recognition of her contribution to professional and international development and child health. She is one of the very few Distinguished Fellows of the Australian College of Midwives and one of the few women designated a Samoan Chief, recognising her work in that country.

Abstract

Background: Aboriginal and Torres Strait Islander people are often prescribed multiple medicines to manage their co-existing co-morbidities and are at high risk medication misadventure. Pharmacist-delivered medication management and education services are a missing link in most Aboriginal Health Services (AHSs). A non-dispensing pharmacist working with other members of the health care team within an AHS could improve medication use, reduce errors and improve health outcomes for clients with chronic disease.

Aim: This study investigated how pharmacists might better address the medication management needs of Indigenous people. It explored the attitudes and perceptions of clients, health professionals and pharmacists.

Method: Eighteen focus groups with 102 Indigenous clients, and 31 semi-structured interviews with health professionals were conducted at 12 AHSs. Focus groups and interviews were recorded, de-identified and transcribed. Transcripts were coded and analysed thematically. A cross sectional survey gathered data from pharmacists about their engagement with Aboriginal Health Services.

Findings: Aboriginal and Torres Strait Islander people in this study reported that they found medicines confusing and difficult to manage. They reported that they often received little or no advice about their medications and that they found community pharmacies culturally unsafe environments in which to discuss their health.

Aboriginal Health Service staff stated that they often did not refer clients to pharmacies for medicines counselling or medication review as they feared pharmacists were too busy or not culturally competent to manage their clients.

Pharmacists who participated in the survey did not work closely with their local AHSs. They were uncertain as to how to broker relationships with the AHS.

Conclusion: Co-location, within an AHS, would allow a pharmacist to regularly engage with clients and to deliver appropriate level of service, be that stand alone medication counselling, a full medication review or group education.

Closer working relationships between the pharmacist and AHS service providers would facilitate improved inter-professional healthcare. The AHS pharmacist could implement medication management programs, provide education and support for AHS staff and broker relationships with community pharmacies.

Being integrated within the AHS would enable a pharmacist to develop the trust, relationships and cultural competency needed to enable effective communication with Aboriginal and Torres Strait Islander clients and AHS staff.

This research whilst specific to Aboriginal and Torres Strait Islander people informs integration of pharmacists into a variety of primary care settings. The presentation will explore relationship brokerage, new models of care and funding options for pharmacists.

Slides
Elizabeth Barrett
Achieving better ear health for Aboriginal children by improving collaboration and communication
Biography

Dr Elizabeth Barrett has a medical degree from the University of NSW and further qualifications in family planning and health management and a Masters Degree in Public Health. She is a Fellow of the Faculty of Public Health Medicine. After clinical practice, Dr Barrett worked in public health and senior health management positions in rural and metropolitan NSW. She is currently a medical adviser with the NSW Rural Doctors Network and a surveyor for the Australian Council on Healthcare Standards. Dr Barrett’s previous commitments include President of Quality Management Services, membership of the Optometrical Board of NSW, membership of the Charles Sturt University (CSU) and University of Western Sydney Advisory Councils and the CSU Ethics Committee. She has been engaged in research for the Australian Medical Workforce Advisory Committee, The National Health Strategy and Hepatitis B prevalence and management in Western NSW. Dr Barrett has undertaken rural health consultancies in China and Queensland and occasionally works as a relief hospital Director of Clinical Services.

Abstract

Hearing loss associated with ear disease is highly prevalent among Aboriginal and Torres Strait Islander children, with far reaching consequences if not recognised and treated early, as it delays speech and language development and therefore impedes learning. In comparison to the transitory nature of most ear disease in non-Aboriginal children, otitis media is frequently chronic and not amenable to treatment in Aboriginal children, for reasons still not fully understood. Further, the true extent of ear disease and its complications are not accurately known in the Aboriginal population because of lack of consistent data collection. The NSW Rural Doctors Network (RDN) provides over 1,200 outreach services to rural and remote communities in NSW and the ACT with the aim of increasing access to health services for people living in regional and remote towns, and Aboriginal communities in both rural and urban locations.

In NSW there has been a recent shift from population-based screening of Aboriginal children to a better public health approach focussed on prevention and targeted surveillance. We profile an ear, nose and throat (ENT) outreach service operating in the Port Macquarie and Kempsey region giving Aboriginal children access to the full spectrum of culturally appropriate treatment; from primary care delivered through local Aboriginal medical services, to surgical procedures performed by outreach specialists at the local public hospital. This equitable access to care is only possible because of the shared vision, commitment and cooperative attitudes of all the providers involved. We highlight the critical role the Aboriginal ear health coordinator plays in fostering trust from the Aboriginal community, and coordinating the many administrative and logistical aspects of the service.

This service is part of the Healthy Ears, Better Hearing, Better Listening (HEBHBL) program that is funded by the Department of Health and administered by the RDN. The HEBHBL program is the result of a comprehensive needs assessment that identified gaps in ear health services for Aboriginal children and youth living in urban, regional and remote areas of NSW and the ACT. This is one of many ENT outreach services operating under the HEBHBL program; each based on this similar model of interagency cooperation; each also unique depending on existing relationships and available resources. Plans to further expand ENT services are outlined which will further improve ear health and contribute to closing the gap in health status for the Aboriginal population.

Slides | Paper
Rosie Beardsley
The Right Place: a community initiative that enables streamlined care and services
Biography

Rosie Beardsley is responsible for creating increased capability within Huon Regional Care to enable redesign and service improvement activities. Central to the role is promoting a systems’ view of service delivery and models of care, with people at the centre. Rosie plays an active role in the leadership team to create a learning culture that supports service and program activities, professional development and collaborative practice. Rosie brings with her passion, drive and a comprehensive understanding of what is required to deliver integrated, team-based care. She has extensive experience in safety, quality and governance in health, strategic and clinical services planning, human resource management including team development, and system redesign. Most recently Rosie has worked within the primary health sector as Manager, Service Design and Risk Assessment for Primary Health Tasmania. Here she led a skills-based team to deliver the Shared Transfer of Care Program—an $11m federally funded program to improve transfers of care for people living with chronic illness. Rosie also held the positions of Manager of the Northern Integrated Care Service and Director of Clinical Services at Calvary Health Care Tasmania. 

Abstract

Rural health and community support systems can be complex and for many consumers, difficult to navigate without assistance. In many cases, people may only ask for information or assistance once. If they experience a negative encounter, they may not return, and consequently, may miss out on a range of services that are available to them.

Following extensive community consultation in the Huon Valley Tasmania, the community identified that service providers needed improved knowledge of available services in the local area. Also identified was the necessity for consumers to receive a positive reception and easy-to-understand information and assistance at their first point of enquiry.

The Right Place is a community-based initiative that is underpinned by the philosophy that ‘no door is the wrong door’ to make it easier for residents and visitors in a Tasmanian rural community to find and access the service they need. The Huon Valley working group framed it positively to welcome and reinforce engagement with community members in their services, telling them ‘You’ve come to the right place’. Training and collateral materials were developed to support visual recognition of the concept.

The Right Place is an approach that prioritises people being central to their own care. It promotes communication, collaboration and engagement across all community sectors. A shared approach to transfers of care is linked to fewer hospital admissions, and increased consumer experience satisfaction.

Staff in community centres and local businesses are facilitated in workshops and provided with resources that give ready reference to local service contacts. The essential concept is to facilitate the connection to assist the person to access the service they need.

The concept has been adopted in other Tasmanian communities. Consequently, The Right Place now has a governance structure that facilitates other Tasmanian communities to form local working groups to become The Right Place communities.

A website has been launched to support communication across communities www.therightplace.org.au.

Through analysis and evaluation of The Right Place, several unexpected positive impacts have emerged.

This paper describes the background, initiative, development, implementation and evaluation of The Right Place in the Huon Valley in Tasmania.

Slides | Paper
Graham Bidstrup
Uncle Jimmy Thumbs Up! nutrition and healthy lifestyle program
Biography

Graham “Buzz” Bidstrup has enjoyed a 40-year career in the Australian music industry; co-writing and co-producing the chart-topping hit “No Secrets” for The Angels and working on over 100 albums as a record producer and session player. He co-founded the Australian bands, The Party Boys, GANGgajang and The Stetsons. Buzz was appointed manager and music director for Indigenous entertainer Dr Jimmy Little AO in 1999 until Jimmy’s passing in April 2012. He was the founding CEO of The Jimmy Little Foundation in 2005 remaining in that position for 10 years and in 2007 Buzz established Uncle Jimmy Thumbs Up! Ltd www.thumbsup.org.au. Thumbs Up! is a not-for-profit company using music and new media to deliver nutrition and healthy lifestyle education to Indigenous children and families in remote communities. Thumbs Up! has also delivered trachoma, alcohol and other drugs and domestic violence awareness programs.

Abstract

Uncle Jimmy Thumbs Up! has been delivering nutrition and healthy lifestyle education since 2008. Using music and video as the engagement tools, the resulting “Good Tucker” songs and videos from the program delivery have been a catalyst for many residents in communities to take up healthy eating and lifestyle practices within the whole community.

Thumbs up! enjoys continuing partnerships with major store groups who display  Thumbs Up! signage including ALPA ( Arnhem land Progress Association) in the NT, Outback Stores in the NT and WA, Retail stores Group in FNQ and Cape York and several independent outlets. The signage placed in store reinforces the core message of “Good Tucker – Long Life” that is the subject of the songs and videos produced from structured workshops held at schools and in community.

Thumbs Up! was successfully funded by the Federal Department of Health for six years and three successful evaluations showed that the program was indeed working. Unfortunately, Government funding for the core nutrition program, Uncle Jimmy Thumbs Up! was withdrawn under the Abbott Federal Government but the company has been able to diversify into other areas of health promotion while still delivering healthy lifestyle messages as they continue their work.

Thumbs Up! is currently working in the APY lands of SA in partnership with the Indigenous Eye Health Unit of Melbourne University on a Trachoma awareness program the also combines elements of the nutrition program including “cook ups” and store appearances by Thumbs Up! facilitators, who are all entertainers in their own right.  Other recent projects have included a suite of alcohol and other drugs and family and domestic violence awareness videos and messages for the NT Department of Heath and social inclusion and media and music training in the NT community of Wadeye (Port Keats).

Thumbs Up ! also recently conducted a highly successful intensive workshop at Uluru with over 70 students from APY, NPY and WA border schools on the power of words and communication.  Many teachers in schools across Australia continue to use the healthy lifestyle lesson plans and educational aids on the Thumbs Up ! website that have been recently mapped to the National curriculum.

The lesson plans, healthy food songs, videos and AOD messages can be found on our website http://www.thumbsup.org.au

Slides | Paper
Janice Biggs
Making inroads to understand and improve the acceptability of digital health care
Biography

Janice Biggs is the Health Literacy and Underrepresented Groups Initiative Lead at Healthdirect Australia. Having spent most of her career in health and university settings, she has worked across a broad spectrum of public health agendas, including community development, chronic disease prevention, policy development, and the implementation and evaluation of programs designed to improve health. She has also worked as a researcher on an NHMRC-funded project, setting up a national surveillance system studying rare conditions of pregnancy. Janice is passionate about taking a social determinants and health equity approach to the work undertaken by Healthdirect Australia. This includes understanding digital access and equity in e-health to maximise the role of Healthdirect Australia in ensuring that services can appropriately serve all population groups. Before moving to Australia, Janice worked for the NHS Workforce Confederation in the UK, on the widening participation agenda. Janice holds a Doctorate of Public Health from UNSW in applying novel evaluation methods to public health programs, a Masters of Public Health from UNSW and a Masters of Policy Studies in Education, Institute of Education, London where she studied the wider benefits of learning to low-income earners.

Abstract

Introduction: Access to healthcare in rural and remote Australia can be problematic; advances in digital technologies that provide timely health advice and information have the potential to positively impact health outcomes. Despite these advances, studies have shown a divide between users and non-users of technologies. Average computer literacy rates across lower income and disadvantaged groups, are also lower.

Healthdirect Australia is funded by the Commonwealth and NSW VIC WA SA NT Governments to deliver innovative multi-channel services to ensure all Australians have access to free and trusted health advice when and where they need it. To inform further service enhancements aimed at improving health outcomes, it was important to understand how Healthdirect Australia’s services can benefit population groups with greater health needs. This research explores the acceptability and appropriateness of telephone and digital health services among; Aboriginal and Torres Strait Islanders, CALD and socially and economically disadvantaged community members.

Methods: We conducted 24 focus groups comprising Aboriginal and Torres Strait Islanders, CALD and low SES people from rural, remote and metropolitan areas (n=160) and 20 in-depth interviews with health professionals. Focus groups and interviews allowed for a grounded exploration of issues, by giving participants a voice to describe their lives, experiences of health care, and what is important to them. Systematic comparative analysis was used to develop a framework of dominant themes.

Results: Our findings go beyond identifying users and non-users of technology, as the majority of participants had access to a phone line/internet. All participants expressed confidence performing online searches and were willing to seek-out advice for routine health issues. Cultural appropriateness, fundamental literacy and the ability to understand if they had sufficient information to manage their own health, acted as a barrier to the advice being useful in improving self-management skills, and maximising its ability to supplement face to face services. Participants’ information seeking behaviours and timing of active engagement was different across the three groups, highlighting a number of improvement opportunities to actively engage and support consumers.

Conclusion: Increasing access to trusted, free, health advice is crucial to people in rural, remote areas to achieve better health outcomes. With the ongoing expansion of digital technologies to support the management of health issues, this research explores how Healthdirect Australia can improve the acceptability of services to increase health literacy and self-efficacy to manage routine health issues across a diverse population.

Slides | Paper
Irene Blackberry
Technology to support carers of people with dementia: local and global opportunities
Biography

Associate Professor Irene Blackberry is the John Richards Chair of rural ageing and aged care research at La Trobe University in Wodonga, Victoria. She is President of the Australian Association of Gerontology Victoria and founded its rural chapter. Irene is a medical graduate and health services researcher with significant skills in designing and implementing pragmatic randomised trials in primary care. She has over 70 publications and her current research interest is in improving care for older people with complex chronic conditions in rural settings.

Abstract

Aims: Novel technology, including the use of smartphone apps, is being increasingly applied across healthcare delivery. Technology holds the promise of providing innovative solutions to broaden the scope and reach of health practice. Ongoing challenges that affect service provision for people with dementia in rural areas include identifying and locating appropriate services within a fragmented health system and the need for people to travel long distances to access health services and support. We set up a collaboration to develop a smartphone application, Service Navigation and Networking for people with Dementia in Rural Communities (SENDER), which aimed to address these challenges.

Methods: Using a co-design and co-production approach, we piloted and evaluated the feasibility, acceptability and impact of SENDER with 20 carers and service providers for people with dementia in two rural health areas in Victoria, Australia. Through usage monitoring, focus groups, and questionnaires conducted prior to and after a trial period of usage, we examined how participants used SENDER, how it changed the carers’ knowledge of dementia services and support networks, how it affected their social connectedness to other dementia service users and providers, how its use affected carers’ burden, and how it affected service use. Throughout the study, we remained in close contact with participants to obtain informal feedback about the app’s ease of use and its functionality, and to trouble-shoot challenges that arose for users new to smartphone use.

Relevance: Smartphone app technology has the potential to ease service navigation and connect dementia care givers and providers with each other. The app provides local guidance however the technology has the potential for global applications.

Results: The navigation function supported carers to better identify and locate services. The networking function enabled rural dementia service providers and carers to share information and provide much-needed emotional and practical support. Using the app enhanced the carers’ confidence in engaging with smartphone technology.

Conclusion: Involvement of carers and service providers in the app design and beta-testing process is crucial to add research evidence about how to capitalise on revolutions in technology and best uses of technology to assist in better provision of rural dementia care. There is a world of opportunities for use of technology in rural health, this study began to explore some of these opportunities.

Slides
Nichole Bloomfield
Wellness dreaming: focusing on what is strong, not what is wrong
Biography

Nichole Bloomfield is a passionate and active member of the community and a proud Wiradjuri woman with over 21 years’ experience in project management, quality assurance and management in Indigenous affairs in Victoria. Through sustaining stakeholder engagement across the community, government and private sectors Nichole has become well-known to many members of the Aboriginal and Torres Strait Islander community across Melbourne’s north-west. She hopes to see improved and culturally appropriate access and services for Aboriginal Elders, women and men and people living with a disability and for our society to ensure there is greater support and wellbeing now and in the future for our community. Let the strengths of our communities shine and lead the way to self-determination.

Abstract

Project overview: Aboriginal and Torres Strait Islander people are constantly being told what’s wrong with their health, family, behaviour - with everything: which can reinforce negative perceptions and dismiss the importance and potential of community empowerment. Cohealth’s Koolin Balit initiative, the Wellness Dreaming Project, encourages an alternative approach by agencies; one that focuses on the strengths of individuals, families, groups and the community, affecting achievable and sustainable change to improve wellbeing.

Implementation: Wellness Dreaming Messenger training was delivered to Aboriginal and non-Aboriginal staff from cross-sectoral agencies; Aboriginal-controlled, mainstream, government and non-government sectors. Fostering leadership, trained Messengers utilise Wellness Dreaming facilitation skills to deliver Dreaming Circles, strength-based conversations in existing groups which are safe and supported. Participants are encouraged through various activities to focus on their strengths, their resilience and their dreams to discuss ‘wellness’ as they envisage it; focusing on what is strong, not what is wrong, missing or broken. This ‘flips’ the way wellness and health is often approached by identifying ‘needs’ and encourages participants, staff, and communities to focus on what is strong, present and can be built upon.

Outcomes: Forty-four staff across the North-Western metropolitan region of Melbourne from 27 cross-sectoral agencies were trained as Wellness Dreaming Messengers. One hundred and seventy-eight people have participated across the region so far, including women’s groups, elder’s groups, community and youth groups. The outcomes of Dreaming Circles were not predetermined, allowing the community to lead and articulate wellness from their strengths. Wellness Dreaming encourages both Aboriginal and non-Aboriginal health and community staff to work together, with this project encouraging collaboration with staff from housing, employment, health, education, local Government, non-Government and Aboriginal Community Controlled Organisations. The story of the Wellness Dreaming approach is best described in our six minute film which can be viewed at: https://www.youtube.com/watch?v=h4Fa46IxDvs

Conclusion and implications for the future: Wellness Dreaming is a strength-based approach that is adaptable to various settings to enable community voices to be at the forefront of change in health and community services. Continued training and workforce development to expand Wellness Dreaming Messengers in the community will encourage the voices of Aboriginal and Torres Strait Islander peoples to articulate wellness through community led action. Intellectual, physical and capital investment from Government and NGO sectors will strengthen Aboriginal voices and community led wellness.

Slides | Paper
Siobhan Bourke
Online rural sexual health education for health practitioners: what’s important, what’s not?
Biography

Dr Siobhan Bourke is a Sexual Health Physician who has been working in education for over ten years. She is currently working for the Centre for Excellence in Rural Sexual Health and The University of Melbourne as a Senior Lecturer and as Liaison Physician at VCS Pathology. Her interests lie in education for health professional regarding Sexual Health Care. Other than education, Dr Bourke's interests are in contraception, adolescent sexual health care and cervical cancer. Dr Bourke has a MBBS (Hon), FAChSHM, MPH (Int. Health), Grad Cert PH (Sexual Health) and Grad Dip in Clinical Education.

Abstract

Background: Rural doctors have limited accessible professional development opportunities compared to metropolitan doctors. Professional development resources that focus on sexual health consultations and specifically address the needs of rural patients and practitioners are non-existent in Australia, yet the need for such training has been identified.

Method: To contribute to the current online resources available for rural doctors, the Centre for Excellence in Rural Sexual Health (CERSH) instigated the production of online learning modules in partnership with the Australian College of Rural and Remote Medicine (ACRRM), and the NSW STI program unit. In total, eight modules have been completed. All modules are appropriate for continuing professional development and are accredited by RACGP and ACCRM. Certification for nursing log books is offered.

Results: The module content was determined in collaboration with experts in the field and focuses on identified needs of rural health practitioners. Modules topics include: sexual history taking, privacy and confidentiality, contract tracing in small communities and avoiding assumptions in sexual health care. These modules are designed for the adult learner and have variety within the design to appeal to different learning styles. Choice of modules for specific areas of interest and an opportunity to reflect on practice and elements for improvement are offered. The modules also highlight the differences and similarities between urban and rural practice.

All modules are presented with references, learning activities, reinforcing activities and resources for further learning or use in practice. CERSH is evaluating the modules to aid continued improvement and a post evaluation is structured to assess clinical confidence in sexual health.

Conclusion: The modules promote inquiry based learning, and provide opportunity for rural doctors to critique and reflect on their own practice. The project highlights the need for rural specific sexual health clinical education, in a modality that is accessible to rural practitioners.

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Catherine Bourke
Working together to improve autism diagnosis in a rural community
Biography

Catherine Bourke is a social worker at Mudgee Community Health Centre in rural NSW. She has 20 years' experience in counselling, group work and case work with children and families in both the government and non-government sectors. Catherine has recently completed a piece of qualitative research, “Autism Diagnosis in a Rural Community: Are There Opportunities for Improvement?” This has led to the establishment of Mudgee Autism Working Party. This cross-disciplinary group aims to examine and implement improvements to local clinical practice. As a member of the NSW Carers Advisory Council, she helps provide advice to the NSW Government on matters relating to carers. Catherine is passionate about using evidence to improve practice in rural areas.

Abstract

Background: Diagnosis of autism at the youngest possible age can reduce family stress, provide earlier access to intervention services and lead to better developmental outcomes for children. In 2015, research was completed by the presenting author about the experience of families during the diagnosis of their child in a rural community, and the perceived enablers and barriers for local health and early education professionals in the process of identification, referral and diagnosis of autism in young children. Using a critical realist perspective, semi-structured 1:1 interviews were conducted with nine parents of children who had been diagnosed with autism. Parents were interviewed about their child’s diagnostic pathway and opportunities for improvement. Three focus groups were conducted with 22 health and early education professionals about their experience of identifying and/or diagnosing autistic children. Possible improvements to practice were identified by participants. Thematic analysis was used to analyse the data. The final report included recommendations for improving the process of autism diagnosis in rural communities.

In 2016, a working party was formed in the rural community of the author to support translation of the research findings into practice. The working party currently includes a GP, public and private allied health professionals, a consumer representative, a nurse and a community agency representative.

Approach: The group have worked collaboratively to reduce the complexity involved in the autism diagnostic process for young children in their rural community. The group coordinated training for professionals in a tool to identify young children at risk of autism and are developing improved referral pathways and resources. They are trialling models of assessment and referral, with the aim of improving local diagnostic process. They continue to work together to improve practice outcomes.

Outcomes: Seventy professionals attended training and reported an increase in knowledge and confidence in early detection of autism. A referral pathway and tool are being trialled and positive feedback has been received. Local GPs assisted to coordinate additional training for local doctors. It is anticipated that further outcomes will be available to report at the conference. Little additional funding has been required to implement these initiatives.

Conclusion: There are significant barriers in the diagnostic process and many opportunities for improvement. Consumer outcomes can be improved when there is collaboration across disciplines, services and systems that is informed by research, local context and a shared vision.

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Helen Bowden
Preventing falls through medication reviews in remote Northern Territory communities
Biography

Helen Bowden is a registered pharmacist with over 20 years’ experience in the industry, working in a variety of roles, including pharmacy management, Quality Use of Medicines programs, remote health service pharmacy support, training of pharmacy assistants, professional services implementation and facilitation of evidenced-based professional development opportunities for health professionals. She is currently the Indigenous Health Policy Manager at the Pharmacy Guild of Australia. Helen grew up in country Victoria, on the Murray River, but has lived in a range of locations across Australia, including a few years managing the community pharmacy services on Christmas Island and the Cocos (Keeling) Islands. She is now based in the Northern Territory and is a passionate advocate for equitable access to medicines and quality pharmacy services for all Australians, especially those living in rural and remote locations.

Abstract

This project, funded by the Northern Territory PHN, aimed to improve access to medication reviews in order to reduce the rate of falls, and to increase knowledge of medication interactions as a means of preventing falls in those aged over 50 years living in the community. The program was facilitated by the Pharmacy Guild of Australia (NT Branch) in liaison with Aboriginal Community Controlled Health Organisations (ACCHO) and NT Department of Health Clinics between June and December 2016 and delivered by community pharmacies.

This multifaceted project involved community-based education sessions for Aboriginal and Torres Strait Islander people aged 50 years and over living in remote communities of the NT, a pharmacist-facilitated desk audit to identify patients at risk of falls, provision of one-to-one medications reviews, and training to remote clinic staff regarding medicines and other factors that increase the risk of falls.

This presentation will provide an overview of the project as well as the end results to showcase how community pharmacy can be utilised in partnership with other health service providers to facilitate better outcomes for Aboriginal and Torres Strait Islander People in remote communities. The presentation will also highlight the importance of medications in the context of falls prevention for older Australians.

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Jenny Brabender
Emergency patient record access
Biography

Jenny Brabender (RN, MN) is the Senior Clinical Business Analyst for ISA Healthcare Solutions. ISA’s software product MMEx provides the platform for the Kimberley Aboriginal Medical Service. Jenny has worked innovatively and collaboratively with the KAMS team to provide features that support the unique working environment in the north-west of Australia. Jenny has been working within healthcare for over 20 years with a background in nursing. Jenny’s career has included roles in clinical specialities, management and education. Her love of information technology encouraged her to take roles that combined clinical and IT domains. Jenny spent several years in Indonesia working with marginalised and rural people, giving her a unique understanding of challenges and methodologies that can make an impact. One of the many initiatives in this time included implementing a telemedicine model that spanned multiple islands, clinical specialities and technologies. Jenny continues to impact health outcomes for patients through developing collaboratively fit-for-purpose IT tools for clinicians.

Abstract

A remote, multi-site Aboriginal Medical Service in Western Australia has been using an electronic medical record as their primary health care clinical record for seven years. During this time a number of innovations have been developed which have improved the care delivery to patients in an incredibly remote part of Australia.

In this presentation, a representative of the Aboriginal Medical Service will outline how the customer, together with the Vendor developed a software feature that has enhanced emergency patient care in this remote region. Due to the transient nature of the patient demographic, high rates of chronic disease/comorbidities and English being a second and sometimes third language among many of their patients, the customer needed something to assist in ensuring the continuity of care, for the many patients who end up at an acute care facility around the region.

The software enhancement allows a pre-approved organisation, in this case, 6 remote hospitals, to be able to search for and access the patient’s primary health record if they present to the hospital requiring treatment.

When the patient presents, the hospital searches for the patient in the organisations’ patient lists. They select the correct patient and after recording patient consent or inability to provide consent, the record is made visible to the hospital for a period of 24 hours.

A secure and encrypted message is sent to clinical leaders at the AMS, advising them that the patient has presented to the hospital and that the patient clinical record has been accessed.

Staff at the primary health care site are aware of the patient’s presentation, and are able to provide appropriate follow up that they otherwise would not if they did not know of the presentation. Since training was completed, there has been an average of 173 ED Access episodes per month. Following the patient encounter, staff at the hospital, record a progress note, advising the reason for presentation, findings, management and importantly whether the patient was admitted of discharged.

The customer will talk about governance and training models implemented, and outline the impact that the ability to share the patient primary clinical record has had on the lives of those who live in this remote outback area, and how she monitors the program to ensure protocols are respected.

The vendor will outline some of the technical challenges of developing this feature and how organisations using this feature address privacy concerns and will provide a live demonstration of the feature.

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Fiona Brooke
Food insecurity in Australia
Biography

Fiona Brooke trained as a medical anthropologist, with an interest in how people interact with the Western medical model. She has spent over 25 years working in the health sector. While working in the Commonwealth Department of Health, Fiona worked in aged care, disability care, infectious diseases and workforce and lead the review of the Medical Specialist Outreach Assistance Program, which informed the development of the Rural Health Outreach Fund.

Abstract

Setting out to examine food insecurity and how it impacts those affected in Australia is not as simple a task as may be initially anticipated.

We can identify the broad groups most affected, but trying to quantify them is far from straight-forward. We report data to the United Nations annually on the level of food insecurity in Australia, but when that data is deconstructed, it is of very poor quality. The data collection upon which the official statistics are based does not sample in remote and very remote communities, and evidence from other sources shows that food insecurity in these communities is at high levels, with up to 30 percent of households affected. The degree to which individuals and households are affected by food insecurity is difficult to assess as surveys only ask whether an individual or household has been unable to afford to buy food at any time in the previous 12 months.

The human health impact of food insecurity can be devastating and begins before conception through into old age. And the evidence, both from Australia and Internationally, is devastating. Children who are food insecure regularly by the time they are age 3 may suffer whole of life consequences impacting their health, education and employment. But the International evidence also shows that simple interventions at this early stage can not only limit the impact, but if maintained can remove it.

Food insecurity is also a significant driver of growing obesity rates. People who can’t afford to buy healthy food, buy what they can afford – which is usually energy dense, nutrition poor foods. And if this isn’t factored into programs focussing on reducing rates of obesity, then Governments risk wasting money on programs that cannot work.

To date, Government interventions to address food insecurity have generally focussed on the down stream impact – providing food relief or vouchers for the purchase of food. There are some notable exceptions and some long running programs working in remote communities.

In an upcoming report, we present the evidence and solutions. This presentation will highlight the key findings of this report and present a range of solutions for consideration, while also raising areas for further research.

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Louise Brown
A school-based service-learning model: what are the outcomes for Aboriginal pupils?
Biography

Louise Brown is a speech pathologist and is currently the Course Coordinator of the speech pathology program at James Cook University. She is a Life Member and former National President of Speech Pathology Australia. She spent much of her professional life ‘down south’ in Victoria in both clinical and university settings. Since arriving in Townsville, she has been actively pursuing clinical placements and learning opportunities for the speech pathology students, which will have positive outcomes for our communities.

Abstract

The overview: Service learning is increasingly being recognised as an important part of health curricula and contributes to the community engagement of universities. International literature has recognised its contribution to community engagement and acknowledged its offering of a sustainable model to address gaps in health care services in rural and remote areas. Little is known in Australia, and this paper aims at covering some of this dearth.

The model and aims: The service learning program Speech Pathology for Living and Learning (SELL) located in Katherine (NT) has successfully generated a nexus between health and education in trying to address the health services gaps in speech pathology. For the last three years, the program has serviced primary school pupils, and this paper will present the results from quantitative measurements of pupils' improvements

In the context of the SELL program – Speech Pathology Student–led clinic in primary school - the study first objective was:

  1. Firstly, to investigate whether criterion-referenced scaling, applied to paediatric speech can be used as one systematic method of documenting some movements or changes toward the therapeutically desirable objectives assisting for planning and evaluating overall progress over time;
  2. Secondly, to establish whether the criterion-referenced scaling may be a culturally acceptable measure for language difference and language disorder for Australian Indigenous pupils as it has been recommended for other Aboriginal international communities.

Method: A set of 112 individuals results was gathered over the seven cycles of student–led clinics at one primary school. Summary T-scores were calculated using a statistical package for the social sciences. T-scores are incrementally increasing with the pupils' progress. The interesting aspect of this mathematical translation to this study is drawn from the aggregation of attainment across individuals, and may be used for the entire cohort.

Findings: The pupils presented with measurable and significant improvement during one cycle over six weeks of therapy and the series of cycles. The positive and raised slope of the trend line demonstrates the overall progress the pupil cohort has achieved from seven cycles of six weeks block intervention over a three year period.

Overall, over 50% of Aboriginal students achieved their expected goals level with 70 % achieving above expected level.

Conclusion: This pilot study demonstrates that the application of criterion reference tools is appropriate for Aboriginal pupils in the Katherine context and has the potential to assist paediatric speech pathology.

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Leanne Brown
Where are they now? Tracking allied health graduates after rural placements
Biography

Dr Leanne Brown is a Senior Lecturer and Academic Team Leader at the University of Newcastle, Department of Rural Health, where she has been based since 2003. She is an Advanced Accredited Practising Dietitian with more than 20 years’ experience in the dietetics profession. She graduated from the University of Newcastle in 1994 with an undergraduate degree in Nutrition and Dietetics and worked as a clinical dietitian for eight years in a number of metropolitan hospitals, gaining a broad range of dietetic and management experience. Dr Brown completed her PhD (Nutrition and Dietetics) at The University of Newcastle. Her doctoral research investigated the barriers to the provision of a best practice dietetics service in rural areas. Ongoing research interests include dietetic workforce, rural dietetic services, sports nutrition, body composition and best practice dietetic services for rural areas.

Abstract

The Commonwealth-funded Rural Health Multidisciplinary Training (RHMT) program provides support for rural health student placements in order to help build health workforce capacity in rural and remote areas. The University of Newcastle Department of Rural Health (UONDRH) offers both short-term and long-term, immersion placement experiences. Students live and study together in a multi-disciplinary environment, with the purpose of extending their understanding of interprofessional collaboration and community engagement. The aim of this ongoing study is to track the employment outcomes of allied health students undertaking immersion placements using a longitudinal, mixed-methods study design.

Method: Allied health students participating in long-term, immersion placement experiences at UONDRH in the disciplines of Diagnostic Radiography, Nutrition and Dietetics, Occupational Therapy, Physiotherapy and Speech Pathology are invited to participate in one or more components of the study. These include: (i)an end-of-placement survey; (ii)an end-of-placement semi-structured interview; and (iii)follow-up surveys at one, three and five years after graduation.

Results: One hundred and twenty-nine students have completed follow-up surveys at 1 year (response rate 57%) and 3 years after graduation (n=24, response rate 53%). Follow-up surveys indicate that 48% of graduates were working rural (RA2-RA5) after 1 year and 38% after 3 years. Rural origin was a significant factor in choosing a rural work location after graduation (p = 0.030). Rural placement experience also had a significant influence (p = 0.01) on graduates’ decision to enter rural practice. Graduates of urban origin who chose a rural workplace location were 3.938 times (95%CI 1.573–9.854) more likely to have been influenced by their rural placement experience than those who took work in a metropolitan location. Meanwhile, 22% of those based rurally indicated ‘no plans to leave’ their current position.

Conclusions: This study provides insights into the influence of rural placements on future workplace location and the external factors that impact on intention to stay or leave a rural area. Ongoing support of rural placements for students of rural and urban background will continue to help address rural allied health workforce shortages. Ongoing longitudinal data is required to determine the longer term workforce outcomes and barriers to retention.

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Matthew Bryant
Pain management services: the northern Queensland experience
Biography

Dr Matthew Bryant (FANZCA, FFPMANZCA, FRACGP, FACRRM, Grad Dip Rural GP, MBBS) is Director of the North Queensland Persistent Pain Management Service. His team of 35 people (25 full-time-equivalent staff) provide multidisciplinary care to a population of 800,000 people, across five hospital and health services, and an area of 770,000 square kilometres. Prior to obtaining his Pain Medicine and Anaesthesia Fellowships, Matt worked as a rural GP in a number of locations across north Queensland and the Northern Territory. He is currently a Senior Lecturer at James Cook University, a member of the Townsville Hospital Foundation Board, and Chairman of the ANZCA Faculty of Pain Medicine Queensland Regional Committee.

Abstract

Prior to 2011, the Townsville Pain Management Clinic was a team of 6 full-time-equivalent (FTE) staff, and provided a service to local patients only. Following a significant increase in funding from the Queensland Government, the North Queensland Persistent Pain Management Service (NQPPMS) now consists 35 staff (25 FTE) in Townsville, Mackay and Cairns. We provide patient education, multi-disciplinary patient assessment and management, tele-health, group programs and interventional procedures for people throughout North Queensland. Staffing includes Pain Medicine Specialists and Registrars, Addiction Medicine, Psychiatry, Rehabilitation Medicine, Neurosurgery, Nursing, Physiotherapy, Psychology, Occupational Therapy, Pharmacy and Administration. Our team receives in excess of 1000 referrals each year, and provides approximately 500 occasions of service each month. Services are provided face to face in Townsville and by satellite staff in Cairns and Mackay; via outreach to Cairns, Mackay and Mount Isa; and via tele-health to people throughout North Queensland.

Our key achievements have included:

  • The development and implementation of an innovative and locally appropriate model of care.
  • An efficient patient triage and flow process, beginning with a self-management, multi-disciplinary education and motivation workshop in line with contemporary models elsewhere.
  • Recruitment and retention of a full multi-disciplinary team, spread over three Hospital and Health Services.
  • The development of a locally appropriate Pain Management Program.
  • Accreditation to train Pain Medicine Specialists.
  • Provision of the full range of medical procedural pain management interventions.
  • Integration within James Cook University teaching for Physiotherapy, Psychology, Occupational Therapy, Nursing and Medical students.
  • Integration with Registrar teaching for General Practice, Anaesthetics, Rehabilitation Medicine, Palliative Care Medicine and Emergency Medicine.
  • Enrolment in the electronic Persistent Pain Outcomes Collaboration (ePPOC) – an international benchmarking pain management outcomes tool.
  • Integration with the Townsville Acute Pain Management Service.
  • A successful roll-out of multi-disciplinary health professional educational workshops in Cairns, Mackay, Mount Isa and Townsville, with approximately 400 participants giving strongly positive feedback. NQPPMS is now an accredited RACGP CME training provider.
  • The presence of a great team with a strong work ethic and high morale.

A narrative describing the development of NQPPMS will be presented: successes, barriers and challenges. This will include activity and outcomes data, along with a description of strategies developed to support colleagues and manage patients with chronic pain across the regional, rural and remote spectrum. Patient flow will be illustrated by a case presentation.

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Shellie Burgess
A nurse-led bowel screening project: cutting the crap on cancer prevention
Biography

As a young adult Shellie Burgess became very motivated to give back to the rural communities that had given her so much during her childhood and she found her path through health care. Shellie made it her mission to bring high-quality health services to the regional, rural and remote communities that she saw as being the lifeblood of our wonderful country, while recognising that replicating city models of care wasn’t necessarily the answer. Shellie has worked as a rural outreaching physiotherapist in north and west Queensland and central west NSW in both the public and NGO systems, before moving into management. With a Diploma of Remote Health Management, Shellie has worked in the non-government sector for the past seven years with Divisions of General Practice, Medicare Locals and now with Marathon Health as the Primary Health Services Manager. With over 13 years’ experience in the rural, regional and remote health industry, Shellie has proudly lead teams in the development and delivery of many preventative health, early intervention and chronic disease management models of care and was recently a keynote speaker at the World Indigenous Allied Health and Close The Gap Conference in 2016.

Abstract

Aims: To enhance the completion rates of bowel screening assessments in rural NSW thereby increasing the early detection and treatment of bowel cancer in over 50 year olds.

Methods: A Primary Health Care Nurse (PHCN) led pilot project was implemented over an approximate 3 month period in 7 rural NSW towns. The project involved developing a new model of service delivery for bowel cancer screening in people who had not completed a screen within the past 2 years. A partnership was developed with Clinical Genomics, the producers of the ColoVantage Home test kit for use of their faecal immunochemical test kit during the pilot which was seen as a more user-friendly option than the kits available under the National Bowel Cancer Screening Program (NBCSP). GP engagement with the project was also ensured in each of the local communities.

A pathway of care was developed by the PHCNs, including a starting point of providing education on bowel cancer, prevention and the use of the ColoVantage kit to eligible participants, who once consented were given a kit to complete at home. Follow-up phone calls were made to encourage completion of the kit and conduct an evaluation upon completion. Pathology results were directly communicated to the participant’s NTD as per standard procedure with Marathon Health receiving weekly updates on completion rates and results. The pathway of care was completed when the participant either returned a negative screen result or had made an appointment with their GP should they have received a positive result.

Relevance: Western NSW has the second highest incidence of bowel cancer in NSW as well as poorer rates of early detection despite the NBCSP. Like with all rural health service delivery, new and innovative models are required to overcome the barriers to accessing and participating in preventative health from the consumer level.

Results: A completion rate of 81% was achieved, 45% higher than that of NBCSP (n=36%). A positive screen result of 7.2% was returned, just slightly above the national average (n=7%). Consumer feedback identified both the ColoVantage kit and the personal engagement with a PHCN were key attributes to the success of the project.

Conclusions: A Primary Health Care Nurse led bowel screening project, utilising the ColoVantage Home kit is extremely effective in enhancing return rates in rural communities. By considering barriers from the consumer’s perspective when developing service delivery models, participation can be substantially enhanced.

Paper
Deb Butler
Vision to reality: implementing Aboriginal cultural security in the Northern Territory
Biography

Deb Butler is a Jawoyn woman, born and raised in Katherine, Northern Territory (NT) and has over 15 years’ experience working across government in various project and policy roles. Deb has a Bachelor of Business and is currently studying a postgraduate qualifications in public health. Deb is currently the Director, Aboriginal Health Policy within the NT Department of Health. In her current role Deb is responsible for providing strategic leadership in the development, implementation and monitoring of policies, programs and activities that promote Aboriginal health and wellbeing. A key part of this work is the implementation of the NT Health Aboriginal Cultural Security Framework 2016-2026. Deb has been a representative on a variety of state and national steering committees and is currently a member of the National Aboriginal and Torres Strait Islander Health Standing Committee (NATSIHSC), a sub-group of Australian Health Ministers Advisory Council (AHMAC). NATSIHSC is responsible for providing strategic advice and leadership to progress the national Aboriginal health agenda.  NATSIHSC recently finalised the renewal of the AHMAC Aboriginal Cultural Respect Framework 2016-2026, which provides a nationally consistent approach to action in health care design and delivery for Aboriginal and Torres Strait Islander people.

Abstract

The Northern Territory (NT) is a vast area with a relatively small population. Aboriginal and Torres Strait Islander (Aboriginal) people make up almost 30 percent of the population and maintain a strong connection to land, culture and languages. It is estimated that between 80 -100 Aboriginal languages and dialects are spoken in the NT and many Aboriginal people live outside of the city centres of Alice Springs and Darwin.

The significant gaps in health outcomes between Aboriginal and non-Aboriginal people are well documented; and Aboriginal Territorians experience poorer health outcomes than Aboriginal people in other states/territories.1

While there are many factors that affect health such as geography, education, housing and racism, the health system itself, by virtue of its accessibility and responsiveness, is a powerful determinant of health. For this reason, NT Health has developed and is implementing the Northern Territory Health Aboriginal Cultural Security Framework 2016-2026 (the framework). This strategic policy aims to re-orient the public health system to be more responsive to the rights, values, and needs of Aboriginal people and communities.

This paper/presentation will outline the development and implementation of the framework. The presentation will cover the mechanisms that that are supporting implementation such as resource development, training, a fund to trial innovations in cultural security and the establishment of a monitoring and evaluation framework.

The presentation will cover the challenges as well as the early lessons learnt in implementing strategic health policy in a vast geographic area and with diverse cultures.

Reference: Australian Health Ministers’ Advisory Council 2015, Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report, AHMAC, Canberra.

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