Concurrent Speakers

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Liam Caffery
Telehealth substitution of rural outreach services: an economic analysis
Biography

Liam is a Senior Research Fellow and Director of Telehealth Technology for the University of Queensland’s Centre for Online Health. He has an active research agenda in health services research and health informatics with special interests in imaging informatics, Indigenous health and rural health. He is actively involved in telehealth service delivery via his work programs, including: Res-e-care, Health-e-regions and PAH Telehealth Centre. Liam has worked in health informatics for the past 20 years. Previously Liam had over a decade’s clinical experience as a diagnostic radiographer.

Abstract

Introduction: CheckUP, in partnership with the Queensland Aboriginal & Islander Health Council is the jurisdictional fund holder of the Commonwealth Government’s Outreach program funds that are used to provide a range of medical, allied health and nursing services to rural and remote communities and Aboriginal and Torres Strait Islander peoples. Currently, these services are provided by face-to-face outreach clinics.

Telehealth is the delivery of health care at a distance using information and communication technologies. Many health care providers use telehealth as an alternative method of delivering health care services which traditionally may have only ever been available face-to-face. It is considered “best practice” to provide healthcare using a combination of face-to-face and telehealth as opposed to a complete replacement of face-to-face services. The suitability and proportion of telehealth substitution varies by specialty, complexity, and case mix.

Telehealth may reduce the cost of health care provision when avoided travel costs associated with outreach services are considered. The aim of this study was to identify how CheckUP provided outreach services and costs may be affected through the substitution of these services with telehealth.

Methods: We performed a cost comparison study where the actual costs of providing face-to-face outreach clinics were compared to a modelled cost of providing the same service using a blended face-to-face and telehealth service delivery model. We modelled seven clinician reimbursement models and three rates of telehealth substitution (25%, 50% and 75%). Models were stratified by health discipline. We modelled the 16 health disciplines that accounted for the top 50% of CheckUP services for both activity (number of visits) and cost of providing the service. Costs were reported from the perspective of CheckUP.

Results: Thirteen of the sixteen health discipline services were less expensive to provide using a blended face-to-face / telehealth service model in at least one of the reimbursement models and telehealth substitution rate permutations. The resultant cost savings were observed to increase as the rate of telehealth substitution increased. The telehealth substitution rate at which costs savings were realised varied by discipline − some disciplines (e.g. GP, podiatry) realised savings at a 25% substitution rate whereas, other disciplines (e.g. physiotherapy, dermatology) only realised saving at a 75% substitution rate. Three disciplines never resulted in cost savings using telehealth substitution.

Conclusion: Degree of substitutability of face-to-face services with telehealth, travel savings and cost of telecommunications required for a telehealth service need to be considered on a case-by-case basis to determine if telehealth will result in cost savings.

Slides | Paper
Laurinne Campbell
HPV self-sampling for cervical cancer screening: engaging under-screened rural-remote Aboriginal women
Biography

Ms Laurinne Campbell has an extensive background in rural and remote nursing in primary health care and mental health, being a registered nurse and social worker. She also holds a Family Planning NSW Well Women’s Certificate and a Certificate IV in Work Place Training and Assessment. Laurinne lives and works in western NSW communities as a Primary Health Care Nurse for Marathon Health. Her personal exposure of living in the bush has shaped her professional work giving her first-hand experience in navigating the tyranny of distance in accessing services systems. Laurinne’s interests include access and equity in accessing health and mental health services in rural and remote communities specifically for women; and developing opportunities in promoting innovative and timely cancer screening.

Abstract

Aims: Cervical cancer is the second most common cancer in women and the sixth leading cause of death worldwide. The incidence of cervical cancer in Aboriginal women is more than twice that of non-Aboriginal women and their mortality rate is fourfold higher. Despite this, Aboriginal women are significantly under screened with respect to cervical cancer screening due to complex cultural and socio-economic factors.

The recent discovery of HPV as the primary causative agent in most cervical cancers has opened the door to HPV testing as an alternative to the traditional Pap test as a means of detecting cervical cancer. HPV testing as a primary screening test allows for self-sampling which may overcome some of the barriers to Pap testing, including being less-obtrusive, and this may make in a more acceptable screening practice for Aboriginal women. This study is exploring the feasibility and acceptability of HPV self-sampling as a cervical screening approach for Aboriginal women using a nurse-led community engagement approach.

Methods: Following a comprehensive collaboration and co-creation process, eight rural centres in Western NSW were selected. Primary Healthcare Nurses (PHCNs), are working alongside Local Aboriginal Land Council Community Engagement Workers to identify, engage with, and provide culturally appropriate education to, Aboriginal women around the value of cervical cancer screening. Women are firstly offered assistance in procuring a regular Pap test and if they refuse, consenting women are assessed for eligibility for the study via an interview. Eligible participants can then conduct the self-sampling. HPV testing is being conducted by the Victorian Cytology Service with results forwarded to the participant, their nominated GP and the PHCN. Follow-up by the PHCN includes a discussion of the results, including referral information if required, along with an Evaluation Questionnaire.

Results: Within the first month of the pilot, 6 of the 8 sites have commenced the trial. Of the expected 266 sample size, a total of 11 participants have been recruited and their swabs sent for cytology. Early results suggest a general interest and acceptance of the HPV self-sampling concept within the local Aboriginal communities.

Conclusions: At the completion of the pilot, we will have developed a model created with and for Aboriginal women. It is anticipated that the results of this study will contribute to the work of others who are trialling the use of self-sampling and will inform the National Cervical Screening Program (May 2017), specifically in relation to Aboriginal women.

Slides | Paper
David Campbell
Scope of practice of East Gippsland nurses and allied health practitioners
Biography

Dr David Campbell (MBBS, DRANZCOG, DCH, FACRRM, FRACGP) is Censor-in-Chief for the Australian College of Rural and Remote Medicine and has served for many years on the ACRRM Board, first as the Victorian Director, then Vice President, and President 2005-2007. He has practised as a rural doctor in Lakes Entrance, Victoria, since 1983 and is a foundation member and Fellow of the College. Dr Campbell is Associate Professor, Rural Community-Based Medical Education with Monash University, and Director of the Monash University School of Rural Health in East and South Gippsland. He has special interests in medical education, rural medical workforce and emergency medicine, and is an instructor with Advanced Paediatric Life Support Australia, as well as principal author and instructor with the Rural Emergency Skills Training (REST) Course in Australia.

Abstract

Rural and remote communities in Australia continue to experience reduced access to health services compared to metropolitan communities. The resulting need for rural doctors to work to an expanded scope of practice in response to relative professional isolation, and the concept of the “rural generalist practitioner” has been well documented and understood. However, the extent to which rural nurses and allied health practitioners work at an advanced generalist level is less well understood. Moreover, there is limited evidence about the experience of rural nursing and allied health practitioners in responding to the health needs of their communities by increasing their scope of practice through education and upskilling.

The aim of this research project is to gather data on the perceptions and experience of established nursing and allied health practitioners working in small rural communities in meeting the health needs of their community. It will focus on the expanded scope of practice, identification of learning needs, and experiences in gaining expanded knowledge and skills. Participants’ approaches to clinical risk management and their level of understanding of the concept of “adaptive expertise” will also be explored.

Nurses and allied health professionals from the East Gippsland area have been invited to complete an online anonymous questionnaire, answering questions regarding their scope of practice, with specific focus on professional development and training needs. Data will be collected through an online questionnaire using Qualtrics, enabling data availability to the researchers for collation and analysis.

We propose that the results of this study will be presented as the introduction to a Workshop on this topic at the NRHA Conference. This Workshop will build on our understanding of the scope of practice of rural generalist nursing and allied health practitioners and will provide a key platform for discussion about managing their professional development and training needs. This will assist in the planning of rural nursing and allied health education programs and the on-going professional development requirements of established rural practitioners.

Funding for this research was provided by the Rural Workforce Agency Victoria.

Slides | Paper
Lindsay Cane
Telecare for kids: supporting kids in isolated communities
Biography

Lindsay Cane is an experienced CEO and Company Director with broad skills and experience in leading and managing organisational development and growth within the NGO sector. She has held the position of CEO Royal Far West, a private charity and NGO that provides specialist health and development services to children living in rural and remote communities, since July 2011. Over the last 5 years Lindsay has led a major transformation program within RFW. Lindsay has steered the expansion of RFW services from NSW to a national service and expanded the service delivery model to include innovations such as RFW Telecare for Kids, the new Windmill Disability Program and Young Indigenous Leadership Camps. Lindsay has a proud history of working within the health, sport and community sectors. She has previously led organisations such as Netball Australia, The Asthma Foundation (NSW) and the Australian Physiotherapy Association. She is also a skilled industry consultant and has provided strategic management, business development and executive coaching services to a range of health, charity, drug and alcohol, sporting and community development agencies. Recognised as a strong organisational leader, Lindsay has previously been a finalist in the Telstra Business Women’s Awards and is a graduate of the Sydney Leadership program. Lindsay is a graduate member of the Australian Institute of Company Directors, Director of the Confederation of Australian Sport and a member of Women on Boards Australia. She is a keen traveller and amateur photographer.

Abstract

The early years of a child’s life set the stage for life-long achievement. When those early years are challenged by remoteness, disadvantage and an absence of support, which is often the case for kids who don’t live in the cities, the result in later years can be unnecessarily devastating and costly.

At RFW we want every child to receive the emotional, social, learning, physical and behavioural support they need for success in school and life and we don’t want to see country kids disadvantaged just because of where they live.

So we design and develop programs that we can deliver, directly and via Telecare, to children, families, teachers and health professionals living in rural and remote communities. Our programs address and support important health, developmental and learning deficits for children in pre-schools and schools—programs that are not available to these children because of the absence of a local, specialist paediatric workforce. Some of our most popular Telecare for Kids programs include Tele-mental health, Tele-anxiety, Tele-speech and Tele-movement and regulation.

This presentation will provide an overview of the RFW Telecare for Kids program and hopefully stimulate thinking around some of the clever ways we can all find new solutions to the challenge of rural isolation and lack of service.

Slides
Christine Cannon
A first for Ferdy’s: our tertiary level research experience on Palm Island
Biography

Christine is the descendant of the Girramay and Yindiji ancestors. She was born and raised on Palm Island. Christine graduated from grade 12 at Bwgcolman Community School, located on Palm Island, with a QCE (Queensland Certificate of Education) and she is currently doing her Cert III in Community Service (Aged Care). Christine is employed by the Townsville Aboriginal and Torres Strait Islander Health Service. Christine is the Youth Worker at Ferdy’s Haven Rehabilitation Aboriginal Corporation on Palm Island. Ferdy’s Haven is a 16-bed residential facility for both men and women 18 years and over with alcohol and drug issues. Christine’s role as the Youth Worker, is to work with youth from ages 14 to 24 years old. Christine develops programs for early intervention and prevention education to the Palm Island youth and wider community. She also participates in community and stakeholder meetings and community events. Christine also volunteers her time with the SES and PIRFBS (State Emergency Service/Palm Island Rural Fire Brigade Service) on Palm Island. Christine wants to play her part with providing the best service outcome for her community.

Abstract

Working in a remote Indigenous community has many challenges in delivering an effective drug and alcohol harm minimisation and treatment program. We live and work in the community and have firsthand experience of the cost of drug and alcohol misuse, this behaviour now normalised is not consistent with Aboriginal culture.

Ferdy’s Haven is an Aboriginal Community Controlled Health Organisation which provides a residential recovery program for people who self-identify as having a substance misuse problem and self-refer on Palm Island. Services were initially established in early 1980 on the Alcoholics Anonymous (AA) program. However, the AA program does not meet everybody’s needs and is not consistent with the harm minimisation strategies within the current Australian National Drug Strategy.

Now, times have changed since the early 1980s, and community social issues have evolved and escalated with the introduction of other forms of drugs and substances resulting in high levels of drug and alcohol consumption that is now affecting young people and their families in the community. Tackling the issues has meant that we need to evaluate how we provide our service and we recognise that our programs need to change to meet the needs of the community today.

The Australian National Drug Strategy is developed on evidence based research and we realised that this was needed at Ferdy’s Haven and became research partners with James Cook University though the Townsville Aboriginal and Islander Health Service in 2015.

This is the first time that Ferdy’s Haven has been involved with a formal research process in the last decade. This is an important process which included Ferdy’s from the beginning, the youth workers were trained as research assistants and were involved in developing the survey tool through to data analysis in the project.

Young people doing research with young people and finding out the issues is really important for our service delivery and building Ferdy’s to meet the community’s need. Our experience has been positive, the interim findings of the research has provided more insight into the lives of the young people and their needs for us. The research process has been a steep learning curb for Ferdy’s but we see this as having potential to building a better service for our remote community. We would like to share our story with you.

Slides | Paper
Ann Carrington
Recognising and responding to domestic violence: exploring the role of student dentists
Biography

Ann Carrington, PhD, BSW (Hons), is a Lecturer in Social Work at James Cook University. Her practice has been predominantly with those who have experienced domestic violence and/or sexual assault. She developed the ‘Vortex of Violence’ practice model for working with women who have experienced domestic violence as published in the British Journal of Social Work. She continues to research and write in the area of domestic violence, violence against women, integrated responses and other social and gendered issues. Her other area of research and practice interest is the integration of spiritual theory and practice in social work. Areas of interest within this field include: integration of spirituality in social work theory, practice, research, ethics and pedagogy; and exploration of how spiritual theory and practice may add to social works understanding of issues of power, control, privilege, vicarious trauma/burnout and reflective practice.

Abstract

The role of student dental practitioners in recognising, responding and appropriately managing domestic violence within a clinical setting in regional, rural and remote communities has not been investigated previously in Australia.  Whilst extensive clinical training is provided to students throughout undergraduate dental degrees, anecdotal reports suggest that they feel ill-prepared for responding appropriately in both practice and the community to women who experience domestic violence.  This presentation reports on an innovative partnership between Dentistry and Social Work at James Cook University and the Cairns Regional Domestic Violence Service to collaboratively address this problem through an educational intervention, which was evaluated by dental student researchers.

The aim of the research was to explore dental students’ perceptions of the effectiveness and value of the ‘Recognise and Respond to Domestic Violence’ educational intervention for their clinical placements and to inform dental curriculum design.

A mixed methods approach was taken using pre and post intervention surveys and focus groups in order to identify and document undergraduate dental students’ understanding, perceptions and preparedness in managing domestic violence clinically. The intervention involved a series of “Recognise and Respond to Domestic Violence” workshops delivered by expert facilitators for 234 Bachelor of Dental Surgery students in Clinical Years 3 – 5. Knowledge and perceptions of domestic violence before and after the workshops were compared and contrasted.  Focus groups then enriched the evaluation data on the value, effectiveness and clinical application of the intervention.

Findings indicated a significant increase in students’ understanding, perceptions and theoretical knowledge regarding domestic violence.  Students also reported that they were enabled to embed an awareness of domestic violence into their clinical assessment and patient management. Focus group data confirmed the useful nature of the knowledge gained in the workshops.  However, the findings indicate that while recognition of domestic violence was achieved, further educational strategies are required to strengthen dental students’ confidence in responding appropriately both within clinical practice and the wider community. 

Recommendations include embedding the domestic violence content into the undergraduate clinical curriculum. Further strengthening  of dental students’ capacity to respond to domestic violence should be developed across the clinical years through learning experiences that include simulation and role plays, which provide opportunities to practice techniques and employ strategies that were introduced in the workshops.  Although the findings of this small study cannot be generalised, they suggest that this socially accountable, educational initiative would be valuable for other dental programs.  

Slides | Paper
Hannah Castledine
Ten years of trachoma elimination in rural Western Australia: lessons from the field
Biography

Hannah Castledine is the Nutrition Coordinator in the Health Promotion team at WA Country Health Service in the Pilbara. Hannah has led the trachoma health promotion program for the region since 2015. This has enabled her to develop strong partnerships with remote communities and observe the continually declining trachoma rates in the region. Hannah has vast on-the-ground experience with people living in remote communities and has delivered programs on a number of health priority areas to these groups. She is especially passionate about working towards nutritional status improvement in Aboriginal populations.

Abstract

Introduction: Trachoma is an important eye infection, which affects an estimated 84 million people, and is responsible for 8 million cases of preventable blindness worldwide. The international Alliance for Global Elimination of Trachoma by the year 2020 (GET2020) is a WHO-led initiative which unites countries, including Australia, in a commitment to eliminate trachoma as a public health problem by 2020. Australia has several areas in which endemic trachoma persists, including rural and remote Aboriginal Communities in Western Australia (WA). The WA Trachoma Program formed in 2006, and applied evidence based guidelines, and a coordinated strategic approach to reducing trachoma across WA. We review program data and discuss their implications for trachoma elimination in Australia, identifying key lessons learned.

Methods: Reported trachoma screening data from more than 50 Aboriginal Communities across WA were analysed to provide an understanding of program progress. Key challenges and barriers to effective implementation have been documented, as well as reflections from key stakeholders. The impact of identified program milestones and key program decisions are analysed with respect to the changing rates of trachoma prevalence.

Results: The trachoma prevalence in WA has dropped from 24% in 2006, to 2.6% in 2015. Program KPIs improved over this time, with the number of ‘at risk’ communities screened increasing from 75% to 100%, and the number of children in the target group screened increasing from 39% to 89%. Program milestones that facilitated these successes included: increased funding; clearly identified KPIs; a coordinated approach to screening; innovative workforce solutions; formation of a Program Reference Group; and excellent relationships with key stakeholders and Aboriginal Communities.

Discussion: As Australia nears its target of eliminating trachoma as a public health problem by 2020, significant challenges to this goal remain. New programmatic issues threaten elimination in some areas, including the limitations of the screening tool, the highly mobile Aboriginal population and issues of program fatigue. New strategies are required that address these issues: greater coordination between jurisdictional programs; renewed Community engagement with the use of more generic health promotion messaging; and a sharp focus on key social determinants, particularly environmental health conditions.

Conclusion: Trachoma is a worldwide problem and Australia is the only developed country with endemic trachoma. The WA Trachoma Program has demonstrated that a flexible and responsive approach can greatly reduce trachoma prevalence as we near our target of elimination by 2020.

Slides | Paper
Branko Celler
The CSIRO National Telehealth Trial: significance for rural and remote health care
Biography

Professor Branko Celler is highly regarded as an innovator and pioneer in the development and use of biomedical instrumentation for the telemonitoring of chronically ill patients at home. He was Head of School of Electrical Engineering at UNSW for nine years and established the Biomedical Systems Laboratory, which was successful in winning more than $15m in competitive grants. He has an abiding and ongoing interest in supporting health and socio-economic development of rural and remote communities through the smart use of ICT. Prof Celler has previously held positions as Executive Dean of the College of Health and Science at Western Sydney University and Chief Scientist at the CSIRO ICT Centre. He is an inaugural Fellow of the Australian College of Health Informatics, a Fellow of the IEEE and a Fellow of the Australian Academy of Technological Science and Engineering. He has published more than 200 journal articles and refereed conference proceedings. In 2006 Prof Celler established a start-up company, Telemedcare Pty Ltd, which now operates internationally and is respected for its innovation and excellence in telehealth. Prof Celler is Emeritus Professor and an active researcher at UNSW and recently joined Telemedcare as its PT Director of Research.

Abstract

The results of the CSIRO National Telehealth trial were recently released and very widely publicised. In a Before and after Controlled Intervention (BACI) design involving >230 patients, the keynote results included a reduction of 46% in the rate of expenditure on medical services after one year, a 53.2% reduction in the rate of admission to hospital and a 70-76% reduction in the rate of LOS. Patient acceptance of the technology was >83%, and >89% of care coordinators would recommend telemonitoring services to other patients. The return on investment was calculated to be between 5-6.

These results strongly suggest that new models of care for the management of chronic disease in the community, based on at home telemonitoring and care coordination can improve healthcare outcome and reduce hospitalisation in both urban and rural and remote settings.

Longitudinal vital signs data and periodic patient administered clinical questionnaires provide powerful tools for early identification of an exacerbation of a patient’s condition and permit the early mobilisation of clinical resources to avoid unnecessary hospitalisation.

In this paper we consider the consequences of this trial for the delivery of health services in rural and remote communities and discuss whether at-home or community health centre based telehealth could alleviate the impact of clinical shortages, overcome the tyranny of distance and facilitate better patient self-management and healthcare outcomes.

We will present methods for identification of at risk patients, the training of staff, selection, implementation and deployment of telehealth technologies and services into homes and community health centres and the assessment of internet availability and performance.

We will present a set of protocols, based on international best practice guidelines, for responding to alerts and alarms generated by the telehealth system. The value of video conferencing in rural and remote settings where internet availability can be extremely patchy will be discussed and the importance of adequate bandwidth and data speed discussed with concrete examples presented.

Given the lack of clinical specialists in rural and remote communities, the ability to connect to specialists in urban and regional centres becomes a critical necessity. Whilst traditional telehealth systems provide a good baseline for the provision of tele monitoring services, are they sufficient to support remote specialist consultations in emergency settings? We will discuss a blueprint for telehealth solutions for mobile community nursing as well as telehealth services that can be delivered from community health centres under remote medical supervision.

Slides | Paper
Laurie Clay
Achieving better ear health for Aboriginal children by improving collaboration and communication
Biography

Laurie Clay is a decedent from of the Kamilaroi Nation from Denman in NSW Hunter Valley. He has worked in Aboriginal health since 1993. He is married and has four adult children. He enjoys his work and the dignity and self-esteem it brings, and enjoys meeting and engaging patients old and new. Laurie enjoys life and believes we live in the best country in the world. He likes watching and being part of sporting activities, engaging in outdoor activities as much as possible. Laurie lives at Crescent Head and travels to Port Macquarie for work at Werin Aboriginal Clinic daily. He is currently employed as a Regional Aboriginal ENT Co coordinator. In the time he has worked in Aboriginal health, chronic disease has been the majority of his focus, coordinating clinics, screening, referrals and follow up, access for patients to allied health services, coordinating and facilitating in conjunction specialist clinics. His current position is invigorating as he has had to learn new skills sets and training and he has been introduced to a new patient cluster and age group with the hearing program. The Ear and Hearing Clinics facilitate education management and treatment, with a pathway to the visiting ENT specialist who attends four times a year. Laurie likes to keep fit and likes to be active, playing rugby union with Kempsey Cannonballs whom he originally joined in 1990. He enjoys encouraging and motivating the younger players and volunteers with maintenance of the home ground. He has been a volunteer first aid officer as well. Laurie plays golf and has won numerous Club Championship Awards at Crescent Head Club. He coached a children’s golf clinic from 1998 to 2000 and has run Charity Golf Days for Diabetes Australia for over 10 years. He has volunteered in community events with Crescent Head Lions Club as first aid officer over the past several years, has attended Juvenile Camp retreats with the McLeay Valley Diabetes Group to volunteer his services educating children and their families on Diabetes. He has been breeding birds for over 30 years, mostly finches since his teens.

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
Sharon Clews
Working in the third space: bridging between cultures in Aboriginal mental health
Biography

Sharon Clews is a Wongi woman originally from Coolgardie in the Goldfields regions of WA.  Sharon is currently employed as the Senior Program Officer in Aboriginal Mental Health at WA Country Health Service. The WACHS is funded to provide a state-wide specialist Aboriginal mental health service. The SSAMHS program has established multidisciplinary specialist teams located in mainstream mental health services across Country WA, which provide culturally and clinically safe care to Aboriginal mental health consumers. Sharon’s role supports the specialist teams in their role working with the Aboriginal community. In the last fourteen years Sharon has worked in the Aboriginal community controlled health sector in Victoria and WA in a variety of roles in the primary health care sector, moving to Department of Health to work in public health in Aboriginal sexual health and blood-borne viruses in 2010. In the past four years she has worked in the Aboriginal mental health area. Sharon is passionate about working in roles where she can work with the Aboriginal workforce. Sharon holds a Bachelor of Health Science (Health Promotion) and Masters of Public Health (Policy).

Abstract

The WA Country Health Service (WACHS) Specialist Aboriginal Mental Health Service (SAMHS) demonstrates how mainstream rural and remote mental health services and Aboriginal families can work together to bridge the gap between cultures.

SAMHS aims to provide a whole-of-family, whole-of-life approach to mental health service delivery, which is consistent within the cultural needs of Aboriginal people. SAMHS workforce work with established multi-disciplinary teams located within mental health services across country WA, to provide culturally and clinically safe care to Aboriginal mental health consumers.

Bhabha theorised that are three cultural spaces; the dominant, the minority and a third cultural space whereby people interact in a hybrid context. By operating in this “third space”, WACHS non-Aboriginal and Aboriginal mental health staff are enabled to benefit from mutual learning and improve the service provision to the Aboriginal community, family and individuals.

After five years of operation across WACHS’s seven regions, the service model has clearly demonstrated its flexibility to adapt across diverse communities and different acute and community mental health settings, whilst consistently delivering positive results attuned to the local community. Aboriginal cultural engagement with the service in both client numbers and occasions of service has markedly increased since the program commenced.

Partnerships are central to the third space, which embody a collaborative approach to improving the mental health of Aboriginal people in WA, including the use of traditional healers. WACHS has learned that by committing to partnerships to develop effective modes of practice that recognise the unique capacities (knowledge, skills, and experience) each sector can contribute in building culturally appropriate mental health services within the community.

This third space has also bought some fundamental changes to the work place. It draws a picture of how workers co-teach and co-learn by engaging in an interactive, ongoing and ever changing process. Using techniques such as a questioning approach, analysing, defining the issue, seeking other perspectives, critical reflection through dialogue, and recording activities / observations will all help in creating and developing the third space.

It reminds staff that learning is a process, is ongoing, is open-minded, is an inquiry, is individual, is about understanding and creating and not memorisation or finding the correct answers.

The presentation will outline and provide regional case studies in how SAMHS operates in this third space in a grounded, practical manner.

Slides | Paper
Sheila Cook
Rural care for gestational diabetes: how do we compare?
Biography

Dr Sheila Cook is the Director of Diabetes and Endocrinology at Toowoomba Hospital, and Deputy Director of Clinical Training at the University of Queensland Rural Clinical School, Toowoomba. She completed her specialist endocrine and obstetric medicine training in Brisbane and since arriving at Toowoomba Hospital in 2006, she has established the Diabetes in Pregnancy Clinic, the Endocrine and Diabetes Services, Acute Medical Unit and Outreach Diabetes Service. Dr Cook is passionate about education and improving the partnerships with rural hospitals so that people can enjoy high-quality diabetes care in their own communities. She works in close partnership with GPs in her region and the six rural hospitals that provide antenatal care to women in the Darling Downs Hospital and Health Service. She is currently working on a website that provides point-of-care diabetes guidelines for primary care providers and rural hospitals. Dr Cook's research work has focused on gestational diabetes, diabetic ketoacidosis and the role of dietary interventions to improve clinical outcomes for people with type 1 diabetes.  In 2016, she commenced a PhD, while continuing to wrangle her four children, ten chickens, one dog, one cat and multiple fish.

Abstract

Background: Tight glucose control in pregnancy improves perinatal outcomes for women with gestational diabetes. Thus, management guidelines recommend access to a multidisciplinary team who educate women on diet, exercise and glucose monitoring in pregnancy. In rural areas, access to such care is often limited to these women, however there is little data to evaluate the perinatal outcomes in these women.

Aim: To compare the perinatal outcomes of women diagnosed with gestational diabetes mellitus attending rural hospitals with those attending the larger referral hospital in that health district.

Method: We conducted a retrospective chart audit of women diagnosed with gestational diabetes mellitus in the health district between 1 January 2012 and 31 December 2013.

Results: During the study period, 447 women with gestational diabetes delivered a total of 467 babies. The baseline characteristics of the women from rural centres and the major centre were comparable, with high rates of overweight and obesity in both groups (77% vs 76%, p 0.34 ), and similar glucose results on the oral glucose tolerance test. Women in rural centres were less likely to receive diabetes education (86% vs 94%, p = 0.005), less likely to commence medical treatment (70% vs 49.5%, p 0.01), and less likely to achieve optimal glucose control (35% vs 58%, p <0.001). Rates of vaginal delivery was highest in those women delivered in rural hospitals (61% vs 52%), while rates of elective caesarean section were highest among the rural women who were referred for antenatal care (45%) compared with the regional women (21%, p < 0.01). There were no significant differences in the average birthweight of the offspring in each group (3292g vs 3380g), or rates of macrosomia (12.4%, 11.3%). Rates of shoulder dystocia was significantly higher in rural women (3.4% vs 0.3%, p 0.012), while rates of neonatal hypoglycaemia were similar in both groups. At the time of discharge, rural women were less likely to breastfeed their babies (69.6% vs 79.4%, p 0.023).

Conclusion: In this retrospective study, rural women were less likely to receive diabetes education, less likely to commence medical treatment for GDM and less likely to achieve optimal glucose control. Although birthweights of offspring were comparable, rural women were more likely to suffer shoulder dystocia and less likely to breastfeed their babies at discharge. This study has important implications for rural women and has prompted improved support for the rural hospital antenatal services in this district.

Slides | Paper
Dorothy Coombe
Alcohol advertising in rural Australia
Biography

Ms Dorothy Coombe is the current President of the Country Women’s Association of Australia. Dorothy also represents the CWAA on the Council of the National Rural Health Alliance. Dorothy has been a member of the following two Ministerial Review Committees: The Privacy Regulations and Industry Standards in the Direct Marketing and Telemarketing Industry Sectors; and Deregulation of the Direct Marketing Industry. She is Chair of Foodbank Victoria and holds several other Board positions, including Foodbank Australia, The Australian Communications and Media Authority, National Rural Women’s Coalition, FarmSafe Australia, National Rural Law and Justice Alliance, Associated Country Women of the World, and the Regional Rural Remote Communications Coalition. She has also been on the boards of Australian Direct Marketing Association and the Australian Telemarketing Association. Dorothy is married to Max Oates and they have two sons and two grandsons. Her interests are family, friends, sport (love it all, Go Bombers!) and horse racing and breeding and she loves a good biographical book.

Abstract

As an iconic community organisation, focusing on women and families, the CWAA has enjoyed a respected role in Australian society. We are acknowledged as a knowledgeable and responsible rural and remote community partner. Our work over 90 years across rural and remote communities has engendered first-hand experience of the complex role that alcohol plays in our society.

This paper examines the role of alcohol advertising in rural communities. By exploring the experiences of our CWAA members and their families, and with input from a number of our partner organisations, I aim to strengthen rural and remote communities by providing access to information and national advocacy on the current alcohol advertising standards, the role of alcohol advertising and its particular effect on women and children.

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Kelly Cork-King
Vision to reality: implementing Aboriginal cultural security in the Northern Territory
Biography

Kelly Cork-King was born and raised in Darwin and has been working in the Northern Territory Government for approximately 23 years in various project and policy roles across government and ministerial offices. Kelly has been acting in the role of Executive Director OAHPE since January 2016 and is responsible for the overall management of the Office, including its sub-branches of Aboriginal Health Policy; Aboriginal Workforce Development; Primary Health Care Transitions; and Stakeholder Engagement and Consumer Participation. Kelly joined the Department of Health, Office of Aboriginal Health Policy and Engagement (OAHPE) in 2013 in the Stakeholder Engagement and Consumer Participation branch and was responsible for the development of a number of key policies, guidelines and toolkits to support improved consumer participation in health care. Kelly has also been instrumental in the development of a pilot training program to improve health literacy and cultural competency in health care. During this time Kelly has also been engaged in the development of workforce initiatives to improve the participation of Aboriginal and Torres Strait Islander employees in the health workforce, and in the work to progress primary health care services to Aboriginal community control in urban and remote settings.

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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Elizabeth Cotterell
Engaging rural clinicians in implementing paediatric emergency medicine research findings
Biography

Elizabeth Cotterell trained in paediatrics and subspecialised in Paediatric Emergency Medicine at Sydney Children's Hospital, Randwick, taking on a consultant position in 2002. Her role involved teaching and supervision of junior medical staff as well as collaborative research as part of paediatric emergency medicine research network (Paediatric Research in Emergency Departments International Collaborative (PREDICT). Liz moved with her family to Armidale, northern NSW, in 2010 to undertake a position as Associate Professor at School of Rural Medicine at University of New England and general paediatrician at Armidale Rural Referral Hospital. Her current work involves teaching paediatrics to undergraduate medical students as well as supporting junior medical and nursing staff education. Recent research involves supervision of projects involving paediatric pain management in rural emergency departments and management of developmental dysplasia of hips in rural setting. She is a co-investigator of the NHMRC-funded Centre of Research Excellence in Paediatric Emergency Medicine, with focus on clinical guideline development and knowledge translation research, particularly as applies to the regional and rural setting. Her husband, three children and two beagles love the rural lifestyle, enjoy the lack of traffic and the opportunities for outdoor activities in the distinct seasonal weather of the New England Tablelands.

Abstract

Introduction: The majority of ill or injured children requiring emergency care present outside of the tertiary setting yet most randomised control trials are conducted in tertiary paediatric emergency departments (ED). Understanding how to effectively apply research findings to the setting in which most children present with illness or injury is important in achieving effective health care improvements for children, regardless of where they present. Knowledge translation (KT) research aims to get an understanding of why there are practice variations and implement and evaluate strategies to accelerate evidence use.

PREDICT (Paediatric Research in Emergency Departments International Collaborative) is a peer recognised research network that is investigating KT strategies in non-tertiary settings. Bronchiolitis and head injury are among the most common presentations for children to ED. Evidence based clinical guidelines and clinical decision rules provide the basis for best practice for these conditions respectively and PREDICT has been at the forefront of research in these areas.

Method: Two research projects will be presented that represent models for engagement of rural clinicians

  • A world first cluster randomised control trial (cRCT) will investigate the most effective KT strategies for implementing an Australasian bronchiolitis guideline, involving tertiary, metropolitan, and regional sites.
  • An audit of practice variation in cranial Computer Tomography (CT) rates for acute paediatric head injury across 30 EDs will compare regional and rural sites to tertiary sites. This study will also include qualitative telephone interviews to identify information needs of doctors and nurses to inform the content and methods to deliver KT strategies to improve appropriateness of cranial CTs in children with mild head injuries.

Results: Participation in the cRCT and cranial CT audit by regional and rural sites will be reported. The recruitment of sites and engagement in the research process will be presented as a model for rural clinician involvement in KT.

Conclusion: An understanding of the best KT strategies to implement research findings in paediatric emergency care within regional and rural health settings is fundamental to improving the care of all children presenting with acute illness or injury.

Slides | Paper
Kelli Craig
Blackrobats: social inclusive, Indigenous community circus
Biography

Kelli Craig (Blackrobats) and Jenny Sader (Children’s Activity Groups Association, Circus Arts North), have an accumulation of 45 years of community circus. This has consisted of, from a grass-roots level, many hours of play, laughter, learning. With belief and determination to bring circus to children and youth. Circus activities allow freedom of expression, with a strong impact children, impacts them for life and this filters into community. Blackrobats, has recognition from renown circus troupes Circ du Solei, Circ du Monde, Circus Oz and National Institute of Circus Arts(NICA). Both Kelly and Jenny have completed Train the Trainer with Circ du Monde, using circus as a social medium. Kelly has a wealth of community engagement, strong connections with families, passion and cultural understanding. Jenny has used her knowledge and the value of the impact of social circus in developing programs to work in schools and community throughout north Queensland. She works as a youth and community worker and has been strongly involved in arts projects for young people. Both are working towards the continuation of Blackrobats to build upon the strengths of young people through circus, while helping them to acknowledge their strengths, and full potential in a safe, harmonious environment.

Abstract

The many attributes of using circus/dance/theatre to nourish ourselves have been well documented and in the last ten years have seen a surge of uptake in a wide and varied capacity.

Many of us who were brought up with compulsory competitive sports understand the feeling of striving to WIN—be a WINNER—and flat out FAILING. Human nature is well endowed with a good dose of competitiveness within.

The notion that we are not good enough if we don’t win, drives us to share a medium where most can find a place or space to express themselves and feel self satisfaction. One of the mitigating factors alluded to overall health is self worth.

Inclusivity goes right back to our early development as a species. Without it our mobs survival was unlikely in the old world, both physically and socially. Though masked with an infinite number of individual issues, humanity is able to shine through when people feel connectivity. To connect we need to feel intrinsically included.

Benefits from social action circus, has a ripple effect. Not a cure but definitely an aid in addressing intergenerational trauma. While this is a human condition, in this instance it relates directly to the impact that colonialism has had on the First Nation peoples and the mixed families that have grown since then.

Blackrobats is a predominantly Indigenous community youth circus group, that has operating since 1996 with it’s roots in the outer regions of Kuranda, FNQ. With up to 40 youth at any given time, with over 200 young people being involved since the inception, Blackrobats program is used to support individuals and the communities they live in, using circus/dance/theatre as a tool for engaging youth in the arts

Social inclusion and recognition is essential to the health of our peoples, feeling connected creates a sense of well being. Blackrobats creates pathways that can affect future choices.

An accessible art form in that it exists purely within each human. Even when under resourced with material and equipment, we have always managed to work on the ground with the creativity of our bodies.

There has been unprecedented relationship and identity development with the broader, global social circus networks, ACAPTA, CIRCA, Cirque du Soleil, Circus Oz, NICA. These being the more renowned companies plus the many devoted individuals that have given their time and energy to the Blackrobats phenomena.

Jillibalu is one of the Blackrobats participants who has now become the first Indigenous person in Australia to graduate from NICA.

Slides
Felicity Croker
Recognising and responding to domestic violence: exploring the role of student dentists
Biography

Dr Felicity Croker is a Senior Lecturer in Dentistry at JCU who is strongly committed to educating a socially accountable health workforce who can contribute effectively to low-resource communities within the tropics. Her work is informed by over 30 years of interprofessional practice, teaching and research in regional, remote and disadvantaged communities within Australia and the Asia-Pacific region. Felicity is currently engaged in several collaborative, capacity-strengthening projects that involve students and community partnerships. These include the NHMRC-funded 'Rural engaging communities in oral health' (Rural ECOH) project, mapping graduate intentions and destinations, and the partnership initiative to develop dental students' confidence and competence in recognising and responding to domestic violence.

Abstract

The role of student dental practitioners in recognising, responding and appropriately managing domestic violence within a clinical setting in regional, rural and remote communities has not been investigated previously in Australia.  Whilst extensive clinical training is provided to students throughout undergraduate dental degrees, anecdotal reports suggest that they feel ill-prepared for responding appropriately in both practice and the community to women who experience domestic violence.  This presentation reports on an innovative partnership between Dentistry and Social Work at James Cook University and the Cairns Regional Domestic Violence Service to collaboratively address this problem through an educational intervention, which was evaluated by dental student researchers.

The aim of the research was to explore dental students’ perceptions of the effectiveness and value of the ‘Recognise and Respond to Domestic Violence’ educational intervention for their clinical placements and to inform dental curriculum design.

A mixed methods approach was taken using pre and post intervention surveys and focus groups in order to identify and document undergraduate dental students’ understanding, perceptions and preparedness in managing domestic violence clinically. The intervention involved a series of “Recognise and Respond to Domestic Violence” workshops delivered by expert facilitators for 234 Bachelor of Dental Surgery students in Clinical Years 3 – 5. Knowledge and perceptions of domestic violence before and after the workshops were compared and contrasted.  Focus groups then enriched the evaluation data on the value, effectiveness and clinical application of the intervention.

Findings indicated a significant increase in students’ understanding, perceptions and theoretical knowledge regarding domestic violence.  Students also reported that they were enabled to embed an awareness of domestic violence into their clinical assessment and patient management. Focus group data confirmed the useful nature of the knowledge gained in the workshops.  However, the findings indicate that while recognition of domestic violence was achieved, further educational strategies are required to strengthen dental students’ confidence in responding appropriately both within clinical practice and the wider community. 

Recommendations include embedding the domestic violence content into the undergraduate clinical curriculum. Further strengthening  of dental students’ capacity to respond to domestic violence should be developed across the clinical years through learning experiences that include simulation and role plays, which provide opportunities to practice techniques and employ strategies that were introduced in the workshops.  Although the findings of this small study cannot be generalised, they suggest that this socially accountable, educational initiative would be valuable for other dental programs.  

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Angela Crombie
Rural health and its influence on the GP perspective of dementia
Biography

Angela Crombie is the Director of Bendigo Health’s Collaborative Health Education and Research Centre (CHERC) where she is responsible for the day-to-day operations, coordination and management of education programs, research and projects across the organisation. Angela has a nursing background and over the past 20 years she has specialised in aged care in clinical, education and research work. Angela is a passionate advocate for rural and regional research and has focused her research activities on improving the quality of life of people with dementia living in rural areas. Most recently she has worked with rural GPs to explore their perspective of their role in dementia diagnosis and management, and to identify similarities and differences between rural and metropolitan based GP perspectives, which is the focus of her presentation.

Abstract

Aims: The study aimed to explore the General Practitioners (GPs) perspective of their role in dementia diagnosis and management, and to identify similarities and differences between rural and metropolitan based GP perspectives.

Methods: A systematic, non-probabilistic sampling approach was employed to recruit rural and metropolitan based GP participants. GPs were invited to complete a brief questionnaire consisting of 24 positively and negatively worded dementia attitudinal statements to be rated on a six point Likert-type scale. GPs also completed a brief demographic data form. Data was entered into Excel for descriptive analysis and was also exported into SPSS for statistical analysis.

Relevance: Australia, like the rest of the developed world, is in the midst of a dementia epidemic. This phenomenon will be most keenly felt in rural Australia where the proportion of people living and dying with dementia will increase more than in metropolitan areas, and where access to both general and specialist services to support people with dementia and their carers is restricted. The significant role the GP plays in the lives of older people as both a primary health-care provider and as a point of referral to other general and specialist health services cannot be under-estimated, particularly in rural areas where they are often the only health professional in the local community.

GPs clearly play a pivotal role in the diagnosis and management of dementia, however evidence indicates inconsistencies in the way in which GPs perform this role. Understanding the way in which individual GPs think about dementia is essential in order to identify common issues that may influence their practice and that may be amenable to change.

Results: In total, GP Attitudes and Confidence Survey questionnaires were returned by 51 rurally-based GPs and by 79 GPs from metropolitan locations. All GPs who responded to the survey also provided some information on basic demographics which allows an insight into the overall context of responders. There were some statements to which the majority of all GPs felt strongly about, however there were quite a few statements that GPs obviously felt less confident about.

Conclusions: The data supports the theory that GPs differ in their perspective on the diagnosis and management of dementia. GP responses to the questionnaire statements were influenced more by age and gender than by geographic location.

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Sarah Crombie
Creating a successful partnership between Aboriginal health workers and allied health staff
Biography

Sarah Crombie is an occupational therapist in her third year of clinical practice. Sarah studied at Curtin University in Western Australia, during a placement at Mount Magnet 6.5 hours north-west of Perth, Sarah developed a passion for Aboriginal health. She commenced as a new graduate occupational therapist with The Aboriginal Children’s Therapy Team in Dubbo, NSW. Sarah has a special interest in preschool aged screening, school readiness and effective group intervention. Sarah hopes to further her career in OT and community development in remote Indigenous communities across Australia.

Abstract

As a Commonwealth funded, paediatric, allied health team servicing the Aboriginal population in our community, we would like to share our service delivery models and workplace partnerships that make this multidisciplinary allied heath team a success.

We service birth to eight year old Aboriginal children for speech pathology, occupational therapy and psychology. Each discipline works in collaboration with our Aboriginal health workers (AHWs) to provide a comprehensive family centred and culturally relevant service.

A cohesive partnership between our AHWs and allied health clinicians has proved essential to our overall service delivery. This key philosophy contributes to successful client outcomes by assisting in client engagement, attendance at appointments, culturally relevant parent education and goal setting.

We have established key roles and responsibilities guiding this partnership through policy and position descriptions which builds the positive working relationship for joint assessments, home visits, therapy sessions, case planning meetings and outreach screening programs. All these tasks require on the job upskilling and sharing of information with your colleague.

AHWs share ideas on wider social and family issues and ideas on what will work best for the family. Clinicians share information on the specifics of their discipline to build the knowledge base of the AHWs in relation to allied health. This sharing of information and upskilling of each profession increases the knowledge of the whole team but most importantly benefits the child.

This case study demonstrates the successful working partnership;

Anna was referred to the program for all three services. The AHWs completed an initial screening on Anna and completed an intake with her mother. This included speech pathology and occupational therapy screening with a detailed parent interview. This step was crucial to engagement into the service. It was identified at the initial meeting that the mother had a hearing impairment and a signing translator via video link was organised for subsequent appointments. The AHWs also provided transport for the family and linked them in to services, including Mission Australia, to assist with other family goals. They organised a case conference with the school, and all allied health staff and external agencies involved. This team approach meant that the service could be coordinated and culturally engaging for Anna and her mother.

This case study and other clients accessing the program benefits from the cohesive partnership between the AHW’s and allied health clinicians.

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Lisa Crossland
Improved diabetic retinopathy screening and monitoring in rural and remote communities
Biography

Lisa Crossland holds a PhD, a Masters in Public Health and Tropical Medicine and a Honours degree in English Literature. She has worked extensively in Australian rural and remote communities, as well as the United Kingdom and New Zealand. Lisa is the Senior Research Fellow in the Centre for Health System Reform and Integration at the Mater Research Institute, Brisbane, focusing on primary health care service innovation and sustainability and general practice organisational development in relation to the Health Care Home.

Abstract

Background: There are currently 848,000 Australian adults with type 2 diabetes, most cared for in general practice and primary health care settings. Diabetic retinopathy (DR) is the leading cause of preventable blindness in Australians under the age of 60. Currently, only 50% Australians with diabetes are achieving the screening guidelines set out by the National Health and Medical Research Council. Diabetic patients living in rural and remote communities are further disadvantaged by limited access to ophthalmology services. Up to 50% of people with proliferative DR, who do not receive timely treatment, will become legally blind within five years.

This paper presents the outcomes of a NHMRC partnership grant along with an evaluation of rural and remote outreach screening service which trialled DR screening and monitoring. It focuses on findings from regional, rural and remote service settings.

Method: Three rural classified general practices trialled DR screening over three years and were compared with three matched practices carrying out routine care. Screening practices were provided with a camera and accredited training to undertake the review of retinal images. Ophthalmic support was provided by ‘buddy ophthalmologists’ via remote conferencing or email. An evaluation of a remote outreach DR screening service with visiting ophthalmology services and a local GP reviewing retinal images was also undertaken. Clinical (screening) data and the experiences of patients, GPs, nurses and Aboriginal Health Workers were collected to assess outcomes.

Results: Appropriate recorded screening evidence was 99% in intervention versus 33% in the matched practices undertaking routine care during study period. Appropriate follow-up (≤ 12months) of mild-moderate DR was 100% in rural intervention practices versus a range of 0–53% in practices undertaking routine care. The remote outreach screening service increased DR screening rates from 16 to 66% and improved local service coordination. All patients valued the decreased need for travel and all diabetes care available in one site. Health professionals valued increased opportunities to use images for patient education; use of cameras to detect other pathology; positive links with buddy ophthalmologists; improved relationships with local optometry services.

Conclusion: Results informed the establishment of the DR screening MBS item numbers for rural remote and Indigenous communities. We have now developed an online accredited GP training program to support GPs and health services to establish effective DR screening approaches in practice.

Slides
Anne Curtis
Taking consumer engagement to the next level
Biography

Anne Curtis is Project Manager, Health Consumers Queensland. She has significant experience working in rural and metropolitan hospitals and health services in Australia and New Zealand, in senior communication, consumer and community engagement and project management roles. While in New Zealand, Anne also managed an NGO consumer and community engagement organisation focused on having the community’s voice heard in health planning and service delivery. As project manager, Anne supervises the project team managing relationships with Queensland health service providers and the consumer and carer network. Anne also leads the development of training and skills development programs for consumers and health service staff.

Abstract

This workshop will focus on practical health consumer engagement based on real experiences in rural and remote Australia. It will consider different methods of consumer engagement, and the issues and considerations with each method. The workshop will consider how we take consumer engagement to the next level – beyond the provision of information to consumers, to meaningful consultation and, ideally, on to genuine consumer involvement – and the particular issues that arise in a rural and remote context.

The workshop will comprise a full 1.5 hour concurrent session, with the presenters selected and coordinated by CHF. Possible presenters could include a rural and remote Primary Health Network reflecting on their experiences with community and consumer engagement; a state/territory health consumer organisation with rural and remote experience; and someone working in Aboriginal and Torres Strait Islander health. In relation to the format of the workshop, it is expected that each presenter would make a short initial presentation, then participate in an interactive Q&A panel discussion.

Paper