Concurrent Speakers

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Fiona Hall
Reducing medication misadventure: a comparative analysis of telepharmacy and home medication reviews
Biography

Upon graduating as a psychologist Fiona Hall worked as a counsellor and psychologist in educational, community and hospital settings in rural, remote and metropolitan locations in Australia.  Following this she worked as a clinical psychologist and researcher providing mental health services for more than a decade and completing post-graduate studies in clinical hypnotherapy, acute care in the community and a Doctorate in Psychology. The last ten years in the workforce have been committed to progressing the National allied health workforce and mental health reform agendas through the management of Statewide projects and programs. Fiona lives with her family in Cairns, North Queensland and works for the Allied Health Professions Office of Queensland, where she manages statewide strategic workforce planning and policy development activities and provides leadership to allied health professionals in the Torres and Cape Hospital and Health Service of Queensland Health.

Abstract

Background: Medication misadventure is a serious issue with two to three percent of all hospital admissions being medication-related. The federally funded Home Medicine Reviews (HMRs) have provided an avenue for pharmacists to undertake medication reviews to reduce medication misadventure and they have been shown to be beneficial in improving quality use of medicines and overall health outcomes. The HMR program does not give reasonable access to medication reviews in Cape York due to accessibility and funding restrictions. A service model was required to address the challenge of providing medication reviews and to reduce the incidence of medication misadventure within the funding parameters.

Methods: A service model using telepharmacy was trialled in ten primary health care clinics throughout Cape York. The solution supported individualised, culturally appropriate medicine education/counselling, via telehealth to outpatients who had complex or extensive medication regimes or were recently discharged from hospital. Resources were developed to support the service model. A comparative analysis evaluated the outcomes of the state-funded telepharmacy service model to the HMRs using a cost analysis, clinical variables, patient safety factors and patient satisfaction.

Results: Telepharmacy delivery is a more cost effective way to deliver medication management reviews to remote communities than the current Home Medication Review funding model, which is not financially viable for remote communities. The safety evaluations indicated an improvement in service quality, safer use of medications and reduced hospitalisation due to medication misadventure. The comparative analysis has informed business model planning and provided a better understanding of cost difference for remote pharmacy medication review methods.

Discussion: The telepharmacy trial has increased access to services, developed clear process and increased the capacity to provide treatments closer to home. Phase two of the implementation will embed the service model within the rural and remote facilities.

Slides | Paper
John Hall
Improving outcomes from rural trauma—a national rural emergency responder network
Abstract

Critical illness intersects with the workload of rural doctors in Australia, mostly via their on call responsibilities to rural hospitals. A significant proportion of these are prehospital incidents - vehicle crashes, farming injuries, bushfire etc. Effective care for such patients requires integration of prehospital ambulance services, retrieval services and tertiary level trauma services all the way through to rehabilitation.

Ambulance services in rural areas are often volunteer-based and with increasing remoteness via the ‘tyranny of distance’ comes the likelihood of increased delay in arrival of specialist retrieval services.

South Australia has implemented the Rural Emergency Responder Network (RERN), whereby selected rural doctors with advanced skills in emergency care and airway management are trained and equipped to provide support to emergency services in the event of a prehospital incident.

Australia is a vast country. Whilst dedicated retrieval services exist, they may be a considerable delay until their arrival. Current models of trauma care are typically metrocentric and fail to acknowledge the potential for rural clinicians with advanced skills to ‘value add’ in defined circumstances.

Development of a national model of rural responders using existing skill base will offer an extra mantle of safety for rural Australians. Such a formalised network also offers local community resilience in the face of crisis such as bushfire, flood or cyclone … and lends itself to a ready made cadre in case of State or National disaster.

This soapbox presentation describes the scope and practice of RERN, including the effective tasking to prehospital incidents, audit of cases and clinical governance. Potential benefits of a national rural responder network will be discussed.

Slides
Fiona Hall
Workforce redesign to improve access to compression garments services in rural facilities
Biography

Upon graduating as a psychologist Fiona Hall worked as a counsellor and psychologist in educational, community and hospital settings in rural, remote and metropolitan locations in Australia.  Following this she worked as a clinical psychologist and researcher providing mental health services for more than a decade and completing postgraduate studies in clinical hypnotherapy, acute care in the community and a Doctorate in Psychology. The last ten years in the workforce have been committed to progressing the national allied health workforce and mental health reform agendas through the management of Statewide projects and programs. Fiona lives with her family in Cairns, North Queensland and works for the Allied Health Professions Office of Queensland, where she manages statewide strategic workforce planning and policy development activities and provides leadership to allied health professionals in the Torres and Cape Hospital and Health Service of Queensland Health.

Abstract

Background: Delivery of malignancy related lymphoedema services including provision of compression garments in rural and remote Queensland has been difficult due to staff and skill shortages. Consumers have undertaken lengthy, expensive travel to metropolitan centres to access services. The service barriers and access issues have prompted Queensland Health stakeholders to examine the scope of compression garment selection, fitting and supply that can be safely and effectively delivered by generalist occupational therapist and physiotherapists in smaller regional, rural and remote locations to improve local access to this service for community members.

Methods: A new service model involved an evaluated trial of compression garment selection, fitting and monitoring provided by generalist occupational therapists and physiotherapists (i.e. physiotherapist or occupational therapist who had not completed a formal lymphoedema training program (e.g. Level 1 or 2 course), but had undertaken, an on-line education program with support of lymphoedema therapists, supported by telehealth, implementation resources and governance processes.  The service model included a training model that paired generalist occupational therapists and physiotherapists in rural areas with a lymphoedema therapist The online education program covering pathophysiology, assessment and management of lymphoedema, compression garment prescription, monitoring and care accompanied one-on-one telehealth delivered coaching sessions.  Telehealth was used to support the supervised practice stage of the training program and was used if required in the post-training phase if generalist clinicians required support from their lymphoedema therapist coach.

Results: Seven rural and remote health facilities have implemented the telehealth supported compression garment selection, fitting and monitoring service model.  There were 69 referrals and 58 garments provided during a 12 month trial period. Evaluation demonstrated that the delivery of compression garment selection, fitting and monitoring by generalist occupational therapists and physiotherapists supported by defined training, supervision and governance processes is safe, effective and positively evaluated by consumers and health professionals.

Discussion: The service model has provided sustainable workforce and service solutions and improved access to care for consumers in rural and remote Queensland. Phase two of the service model implementation is underway and will promote and expand the model for the provision of compression garments for the treatment of lymphoedema.

Slides | Paper
Beverley Hamerton
A time for change—primary health care demonstration sites
Biography

Beverley Hamerton spent the early part of her career in emergency and critical care nursing. In 2002 she left the relative safety of those practice areas to start working in remote locations. As a sole nurse practitioner on Murray Island in the Torres Strait, Beverley had some of the best clinical practice experiences of her career. It was the time in which she came to understand the importance of primary health care and ponder on the impact of the social determinants of health. Recently she has worked in various roles as a health executive and has been heavily involved in establishing robust primary health care services or programs.  She is currently engaged in transitioning two small rural hospitals from inpatient services to an integrated primary health care model, complemented by an aged appropriate accommodation project that focuses on maintaining the independent quality of life of both individuals and groups. This journey has had many challenges but also many rewards. Community members are awakening to other possibilities in health care and how those expanded services will work to keep their families and friends living longer and living well in a locality they know and love.

Abstract

Due to a multitude of complex factors and challenges the design and delivery of health services require change in rural and remote areas of Australia. In 2008 the Rural Health Alliance wrote “a new health system must be less dependent on health professionals. This will mean keeping people healthy through early intervention, health promotion and promoting healthy environments, enabling people to engage more fully in disease self-management, redesigning professional roles and finding appropriate funding methods for a range of diverse circumstances.” Nowhere is this circumstance more applicable than the Wheatbelt.

In the agricultural boom of the 1930s to 50s a fundamental hallmark of each Wheatbelt town was a fully functioning, local, board managed hospital, with a service range spreading from emergency care and medical inpatients, to maternity care and general theatre. Over time both high and low residential aged care beds were added to the mix and as a result the Wheatbelt region currently boasts 24 small hospitals, most of which are located within 50kms of each other. In today’s health environment not only is the ageing infrastructure incredibly expensive to maintain, the service models that were in place no longer meet the health needs of the population. Hence—a time for change.

In 2012/13 the Wheatbelt was provided with an opportunity to explore a partnership with community to ultimately result in a conversion from the provision of traditional hospital based care to an integrated primary health care model, excluding inpatient options. An oft debated subject of health leaders was how to best navigate this considerable shift in thinking for both the staff and community members whose range of reactions moved on a continuum from wary and openly distrustful to willingly embracing new ideas and hopeful of a better future. In the end what proved successful was encouraging a genuine primary health care approach to managing change from the “bottom- up”. Without actually naming it as such the “winds of change” were steeped in a philosophy of:

  • dominant characteristics: personal, like a family
  • leadership style: mentoring, facilitating, nurturing
  • management of employees: teamwork, consensus and participation
  • project glue: loyalty and mutual trust
  • strategic emphasis: human development, openness
  • criteria for success: concern for community, teamwork, achieving the goals.

This presentation highlights two case studies which demonstrate how the idea of using a “no wrong door” mindset gave rise to mushrooming of truly innovative problem solving and community centred care outcomes.

Slides | Paper
Beverley Hamerton
Emergency Telehealth Service—innovative model of emergency care for rural Western Australia
Biography

Beverley Hamerton spent the early part of her career in emergency and critical care nursing. In 2002 she left the relative safety of those practice areas to start working in remote locations. As a sole nurse practitioner on Murray Island in the Torres Strait, Beverley had some of the best clinical practice experiences of her career. It was the time in which she came to understand the importance of primary health care and ponder on the impact of the social determinants of health. Recently she has worked in various roles as a health executive and has been heavily involved in establishing robust primary health care services or programs.  She is currently engaged in transitioning two small rural hospitals from inpatient services to an integrated primary health care model, complemented by an aged appropriate accommodation project that focuses on maintaining the independent quality of life of both individuals and groups. This journey has had many challenges but also many rewards. Community members are awakening to other possibilities in health care and how those expanded services will work to keep their families and friends living longer and living well in a locality they know and love.

Abstract

Geographically, the Western Australia Country Health Service (WACHS) is the largest area health service in Australia, covering 2.55 million square kilometres. Dispersed populations and regional isolation challenge access to specialist medical care and in particular specialist emergency medicine (EM).

The Emergency Telehealth Service (ETS) aims to deliver accessible, quality EM to country WA Emergency Departments (EDs) using the telehealth modality and Consultant Emergency Physicians (FACEMs).

High definition video conferencing equipment, installed in participating EDs enables ETS to deliver accountable, timely EM – supporting patient management in 75 rural EDs seven days a week. ETS doctors activate and control the equipment in response to a call for assistance ensuring local clinicians are hands-free to care for their patients.

  • An innovative model of care places specialist Emergency Physicians ‘in the room’ with rural clinicians and patients, where normally only a nurse or a GP would be available. ETS delivers services to 76 sites.
  • Improved transfer co-ordination with efficient appropriate referral.
  • ETS has demonstrated the capacity to deliver improved access and outcomes for rural emergency patients.
  • Enhances local clinician capacity, enabling better management of high acuity patients, supporting professional development and reducing professional isolation.
  • Enhanced community confidence, reinforced by positive patient feedback.
  • ETS has delivered over 34,000 consults with 76% of patients treated and discharged home, demonstrating the ability to manage a variety of clinical cases.

Effectively pioneering a new service delivery model for emergency medicine, ETS has raised the clinical standard of patient care in rural hospitals and contributed to country GP workforce sustainability. ETS has introduced improved EM clinical governance, best practice and clinical leadership that is generally only available in metropolitan EDs.  ETS is repeatedly and positively referenced by local communities, clinicians, and health consumers as a valuable addition to the delivery of emergency care during times of fiscal restraint.

Slides
Denise Hampton
Culturally respectful health care and findings from participant evaluations
Biography

Denise Hampton is a very proud and strong Ngyiampaa and Paakantji woman of Western New South Wales who is passionate about improving positive outcomes in all areas of health for Aboriginal people, particularly in rural and remote locations. Denise has worked in health and education both within government and non-government organisations. Denise has completed a Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Practice), Western Institute TAFE, NSW as well as completing a Graduate Diploma in Indigenous Health Promotion, University of Sydney, Sydney School of Public Health. Denise’s current role is an Aboriginal Project Officer, Broken Hill Department of Rural Health, The University of Sydney, New South Wales.

Abstract

Providing culturally appropriate services is critical in enhancing healthcare accessibility and acceptability for Aboriginal people in rural and remote Australia. Significant State and Federal investments have been made to support the provision of cultural education for practicing health professionals and pre-registration health students undertaking clinical placements within this context. Aboriginal staff across the University Departments of Rural Health contribute significantly to the provision of this education and ongoing cultural support; this contributes to the practice and provision of culturally respectful healthcare.

The Broken Hill University Department of Rural Health works collaboratively with the Far West Local Health District to provide cultural education to existing and new health professionals in the region. This Department also has carriage of education delivery to all health students undertaking their clinical placements across the District where communities have a significant proportion of Aboriginal residents. The approach includes problem-based learning case scenarios that present authentic and contemporary issues confronting Aboriginal communities within a safe learning environment to discuss the implications of these issues and government responses. This contributes to participant insight and understanding of Aboriginal health and well-being.

In 2015, 90 health professionals and 265 health students participated. Everyone completes a post-participation evaluation that explores their knowledge and understanding of Aboriginal issues, and how their learning applies within their role. Key themes from these evaluations include increased understanding and knowledge of: Aboriginal health and culture, communication skills, disparities between Aboriginal and non-Aboriginal people, and how to advocate and educate others to support change. These findings are significant for higher education institutions and their approach to the inclusion of Aboriginal experience and perspectives in cultural curriculum.

There is a clear focus on the learning outcomes for the participants, but there is limited literature and evidence on the impact of providing and facilitating cultural education for Aboriginal staff. We propose the need for additional research in this area to address significant gaps in our knowledge on the organisational, structural, and professional elements that may contribute to the well-being and resilience of Aboriginal cultural education facilitators.

Slides
Amanda Hand
Healthy Utopia Mob, Brighter Futures
Biography

Amanda Hand is the current Manager of Organisational Effectiveness at Urapuntja Health Service. Over the past 20 years she has worked in the Aboriginal Community Controlled Health Sector in urban, regional and remote Northern Territory and Queensland. Her roles have focused on system and quality improvement from both a clinical and business perspective, ensuring services maintain patients at the centre of their business model.

Abstract

Urapuntja provides services to a population of approximately 1000 permanent residents who live on 16 homeland communities. The service is unique, in that they deliver an outreach service to all 16 outstation communities every week and the primary clinic is not in the middle of the community.

Urapuntja has been delivering core primary health care services to the community since 1977.

The team at Urapuntja understand the importance of every role in the ongoing functionality of the service. The way the team supports unique skill sets and collaborates with external clinicians has led to a strong sense of responsibility to deliver best practice care in a respectful environment. The team continues to work on effective communication and understanding of roles to further enhance their ability to work together. The service actively encourages cross skilling to enable team members the opportunity to understand the key attributes each team member brings to the programs being run.

The team welcomes the support of external providers both within the organisations service catchment area as well as those that visit on a regular basis. They work to ensure that all community members are aware of service visits as well as actively promoting the benefits of attending. Mixed service visits are seen as an opportunity to improve health literacy in the community and all of family attendances at consults are encouraged.

The establishment of a Teen and Family Health Festival demonstrates the team’s ability to effectively work together in planning and delivering an event for over 200 community members as well as staff from 15 organisations. This planning took into consideration appropriate health promotion as well as ensuring it connectivity to Patient Information and recall systems to effectively capture data.

The festival had a key focus of bringing families together for ''Healthy Utopia Mob, Brighter Futures''. This included 5 local organisations (NT Government Schools, Barkly Shire Council, Aged Care, Arid Edge and UHSAC) and 10 visiting services (RFDS Mental Health, Dietician, Podiatrist, Baker IDI, NDIA, ITECH, Caylus, Contact Inc, NTG Remote Sexual Health, Dental Truck and Trachoma Team) as well as community women making and providing bush medicine. .

The success of the event is a testament to the teams firm commitment to delivering comprehensive primary health care that is accessible to all in the community, with a tangible improvement in health check access from the previous year of 103.3%.

Slides
Catherine Harding
“Going at half speed”: Parkinson’s disease in rural and regional Australia
Biography

Assoc Prof Catherine Harding MBBS, MHPED, MPH, FRACGP, PHD,  is an academic and a general practitioner. Associate Professor Harding works for the School of Medicine, Sydney, University of Notre Dame, Australia and is Head of Rural Clinical Sub-school in Wagga Wagga. She has extensive experience as an educator both in the field of academic medicine, working with medical students and general practice registrars, and in the field of public health and community education. She has also previously worked in community health and worked as a rural general practitioner for more than 20 years.

Abstract

Aims: Parkinson’s disease (PD) has a higher prevalence in rural regions, yet these areas often lack services and support for patients and their carers. This study adds to the evidence for the negative impact of Parkinson’s disease (PD) on quality of life (QoL) of individuals living in rural and regional Australia and explores key issues in service delivery for patients living with this chronic condition. 

Methods: Twelve patients with PD and five of their carers participating in a dance therapy class and support group in a regional centre were recruited to the study. Semi-structured interviews provided an in-depth exploration of the issues affecting the QoL of these patients.

Relevance/results: PD has a substantial impact on the lives of the individuals and their carers. ‘Parkinson’s Disease Quality of Life Questionnaire’ scores for those interviewed showed a cross section of disease severity ranged from 105 to 165 (out of a maximum of 185 points).

There were comments such as ‘I’m happy with what I’ve got,’ that indicated a stoical acceptance of their condition and available services. There was a dominant theme that ‘the body gets slower and slower,’ as one participant noted ‘everyone was walking past me ... you go at half speed with Parkinson’s disease.’ Parkinson’s disease has a significant impact on rural lives, as one participant said he had gone from ‘living on my own farm, being my own boss’ to a situation where ‘my son’s running the farm, I just do what I can.’

Regular access to a neurologist, ongoing physiotherapy, dance therapy classes, the specialist PD nurse and social groups were regarded as particularly beneficial for improving QoL. However access to services was not ideal with delays to initial specialist appointments and a lack of awareness of available services. 

Carers discussed how Parkinson’s disease ‘impacted on our life terribly,’ commenting that ‘that part of life we’ve done away with.’   As one woman said it was ‘like when a mother never really sleeps well with babies,’ it was like going back to looking after a child. One particularly touching comment was the women who said ‘for my own safety and his I moved into the other room. That was a very difficult thing after we’ve been married 56 years. That’s something you don’t anticipate’. Illness has also brought unexpected benefits ‘we’ve become more considerate of each other.’

Conculsions: PD has a significant impact on the QoL of people living in regional Australia. Services in these areas are harder to access and understanding key issues for this population identifies avenues for improvement of support and care.

Slides | Paper
Joy Harrison
Partnerships making a difference
Biography

Joy Harrison is a registered nurse working in rural hospitals for many years and is currently a clinical nurse specialist working for a rural health service focused on refugee and migrant health. She has worked in this role in rural area for 10 years, covering north-west NSW. During this time, she has delivered a variety of programs for clients from a non-English speaking background in collaboration with other agencies. She travels extensively, focusing on the health needs of CALD (culturally and linguistically diverse) people, with provision services and access to interpreter services. Ms Harrison completed a PHCRED scholarship in 2010 that explored the experiences of English speaking, secondary settlement refugees and migrant new arrivals in accessing healthcare in northern NSW. Sharing the stories of successful encounters and events creates greater understanding as we learn from each other.

Abstract

Refugee Migrant Health Nurse from Hunter New England Health ( HNEHealth), Joy Harrison and Judith Roberts from Northern Settlement Services(NSS) co-ordinate a Multicultural Womens Group.

Weekly we meet at the local Uniting Church Hall.  Health and Settlement in a country city, Armidale in Northern NSW collaborate in confidential sharing of information to the betterment of local CALD (Culturally and Linguistically Diverse) women. The community of 23,500 has a high ratio of diverse cultures due to the rural University of New England (est 1955). Information of what is locally available or connecting to services is a priority, with education on child safety.

Armidale is a refugee friendly council and over the years some have settled and remained. Migrants move to the area for work or better schooling. Overseas students from a wide variety of countries come to study, with scholarships and bring their young families. Consequently there is a wide scope of needs to be addressed. Language barriers, Transport, Immunisation, Post arrival Health checks, Dental assessments. Medicare eligible or privately insured for obstetrics makes a huge difference.

In collaboration with Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) Tracy Tierney and local Music Teacher Sandi Smoulders the idea grew.

The music program provided an opportunity for women and young children from diverse cultural backgrounds in Armidale, to connect in a fun creative musical experience.

This was a collaboration of three rural services and a community member. 

Primary funding came from Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) with support from Hunter New England Health and Northern Settlement Services. A community music educator delivered the program in two hour sessions over 4 weeks. The community embraced the music.  Ten cultures were represented with 55 participants over the 4 weeks. The music sessions created an inclusive and safe environment that gave great pleasure to both women and children. Connections were made as the music became the ‘common language

This welcoming safe environment allowed trust to develop with facilitators Tracy, Joy and Judith. Consequently, increased interaction with families resulted in being able to provide further individual support.

Women, who participated, reported that their feelings of isolation and stress reduced.  Friendships also developed. Mothers were able use techniques learnt in the workshops to enhance their interactive time with their children and others.

 

Slides
Joanne Harrison-Clarke
Building cultural bridges and two-way understanding: Aboriginal people leading mainstream health
Biography

Joanne Harrison-Clarke is a proud Wotjobaluk woman from the Wimmera region in Western Victoria. Born in Morwell, Joanne grew up around Melbourne and country Victoria. She had to grow up fast, being one of five children with two of her siblings sadly being removed as part of the Stolen Generation. As a young girl, Joanne had left school and was caught up in the welfare system, being made ward of the state at the age of 14. Two years later she was to meet the love of her life while working in the childcare sector, and gave birth to two beautiful children by the time she was 20. By this time Jo wanted to get an education and a career in welfare. With support from Ballarat TAFE, Joanne achieved a Diploma in Indigenous Welfare Studies. This included travelling and working in Melbourne at the Victorian Aboriginal Health Service (VAHS) as an Aboriginal health worker. Over the course of 23 years Jo built her career working with various Aboriginal and government organisations. During this time she obtained skills and knowledge in Aboriginal health, welfare and justice, many of them leading to great opportunities that enhanced and further develop her career in education, community development/connectedness, and project management whilst building strong partnerships from a grass roots approach. Many of the organisations Joanne has contributed to include the Victorian Aboriginal Health Services (VAHS) where she began working as a health worker and mental health worker. At the Ballarat Aboriginal Co-operative Jo was hired as the Suicide Prevention Worker for Aboriginal children aged 12-25 years, which then lead her to Malmsbury Youth Detention Centre as a Koori Liaison Officer. By 2003, Jo and her family moved to Melbourne where she began work at the Victorian Aboriginal Child Care Agency (VACCA) working on the Larkinjaka program in the Child Protection Unit, and then for Victorian Aboriginal Community Controlled Health (VACCHO) Organisation where she was employed for a number of years as the Maternity Project Officer, Palliative Care Project Officer and Sexual Health Officer, and also achieved two diplomas in Frontline Management and Community Development while working for VACCHO. After her time at VACCHO, Jo decided to further her career in education, which led her to gain her TAA and TAE at Kangan Institute’s Indigenous Education Centre in Broadmeadows. She went on to deliver cultural awareness training around Melbourne and surrounding areas as an educator and cultural facilitator for both the Indigenous Education Centre and RMIT University. Having contributed to the community in Melbourne Jo felt inspired to continue her work back home on country. With a new goal she set out and developed the first-ever cultural awareness training package specific to the five clans in the Wimmera region called Yanng Ngalung Maligundidj, which means, Walk with the Wergaia. The training is delivered to health professionals, Department of Health and Human Services, the Police Force, schools, and home and community care workers is presented within 2-4 hour sessions depending on targeted groups. When she isn’t facilitating, Jo is employed two days a week as a support officer developing the Reconciliation Action Plan on behalf of GWM Water. This involves working with Traditional Owners and their Land Councils/Aboriginal Registered Parties to create a RAP with input from the Aboriginal agencies.

Abstract

Background: Aboriginal and Torres Strait Islander peoples living in rural and remote locations are uniquely positioned to lead mainstream health organisations towards more culturally responsive and safe service delivery, leading to improved access to services. Since 2010, the Wimmera PCP has led the Towards Cultural Security project and since 2014 has successfully delivered a bi-partisan model of cultural awareness training utilising both Aboriginal and non-Aboriginal facilitators.

Method: A local Traditional Owner with expertise in delivering cultural awareness training was recruited to the project. The expected outcome was the development of a replicable training model that might be utilised across PCP catchments within the region, and tailored to the health and welfare workforce. The training component was complemented by the auditing of the physical environments of the health and welfare services participating in the project, along with the development of comprehensive reports which provided a set of practical and realistic actions for each service to implement to enhance their physical environments.

The unexpected outcome was the development of a relationship of immense trust and respect between the partners/stakeholders, and consequently led to the co-facilitation of the training by both an Aboriginal and non-Aboriginal trainer, as well as broader interest in the training across other sectors including justice, police and education.

Results: Increase in the number of staff participating in training sessions, across multiple sectors, and thereby increasing the sustainability of the training. Positive changes within the participating workplaces including the adoption of relevant cultural protocols, policy changes for Aboriginal employment, support and engagement of existing Aboriginal staff, identification of cultural champions, the establishment of an Aboriginal Advisory Group to inform policy, and Board and Executive level endorsement to fulfil targeted outcomes.

Conclusion: Local evidence-based insights to review service delivery in rural mainstream health and welfare organisations can drive significant positive change for use by Aboriginal people. This can be achieved through measuring and reporting on capacity building initiatives using local qualitative and quantitative data aimed at improving Aboriginal health outcomes. Role modelling behaviours for Aboriginal and non-Aboriginal people to work side-by-side, promotes a shared understanding of the cultural needs and context for improving health and wellbeing outcomes for rural communities. Senior leadership support in creating local grass roots solutions enables relationships to foster, enhancing the level of trust and respect required to achieve significant actions and outcomes.

Slides | Paper
Catherine Hawke
The ARCHER study of health and wellbeing in young rural Australians
Biography

Catherine Hawke is a public health physician, Associate Professor and A/Deputy Head of School at the School of Rural Health, University of Sydney, Orange, NSW. Her main research interests include rural and Aboriginal health, adolescent health and health services research. She provides academic leadership and management to the Orange Campus of the School of Rural Health and teaches public health. She chairs the Western NSW Health Research Network to advance interdisciplinary, multiagency health research in the Central West NSW, is a member of the University of Sydney, Human Research Ethics Committee and also enjoys working with the Hoc Mai Foundation, to teach research skills in Vietnam.

Abstract

Aims: To describe new evidence from the longitudinal ARCHER (Adolescent Rural Cohort Study of Hormones, Health, Education, Environments and Relationships) study of rural adolescent health.

Methods: The ARCHER Study is a three-year multidisciplinary longitudinal rural study of adolescents (recruited at 9 to 14 years) from two regional centres in the Central West of NSW. The ARCHER study includes an extensive yearly survey of adolescents and their parent(s)/guardian using questionnaires, anthropometry, blood and urine collection. Measures include universal aspects of adolescent health and wellbeing, such as education, health risk behaviours, mental and physical health. Data analysis was performed to explore trends over time and by age.

Results: 342 young people were recruited to ARCHER with 82% retention across four waves of data. At baseline, the mean age was 11 years, 45% were female and 11% were Aboriginal or Torres Strait Islander adolescents. Plasma testosterone and oestradiol levels confirmed that the majority of the adolescents were in early puberty. The young people came from diverse socioeconomic backgrounds, although participating families were generally more affluent and better educated than the broader regional population. Interesting patterns over time emerged for mental health, with between 10 and 18% experiencing significant depressive symptoms and rates increasing with age. According to adult reports, only approximately 1 in 10 young people met national guidelines for physical activity, and between 79 to 84% lived in a smoke free household. Prevalence of overweight and obesity ranged from 26 to 28% overall (females 29 to 32%; males 23 to 25%). Analyses have demonstrated associations between gender, mental and physical health and stage of puberty.

Relevance: Adolescence is a critical phase of life during which foundations for future health and wellbeing are established. Understanding and promoting rural adolescent health and wellbeing will contribute to addressing known rural health inequities.  

Conclusions: We have successfully recruited a cohort to answer novel research questions. Data generated will further our understanding of puberty and its effects as well as providing insight into the specific determinants of health for young people growing up in non-metropolitan NSW.

Slides | Paper
Ged Hawthorn
Healthy agspirations: a dynamic partnership making big impacts in the bush
Biography

Ged Hawthorn is a clinical pharmacist with a keen interest in rural health. Raised on a property near Forbes, NSW, Ged completed all of his education in country NSW. Since graduating, he has worked solely in rural and remote regions of NSW and has been active in developing the next generation of rural health leaders. Ged was the founding chair of the Future Health Leaders Advisory Group for Western NSW from 2014-2016, which strived to work with the LHD to plan and improve healthcare delivery in the region. In this role, Ged led the development and implementation of the Healthy Agspirations initiative, an innovative partnership between Future Health Leaders and NSW Young Farmers aiming at improving the health literacy and engagement between farmers and rural health professionals. Outside of his work at Orange Base Hospital, Ged is a guest lecturer for Charles Sturt University and Sydney University School of Rural Health at their campuses in Orange, is a keen furniture-maker and is working towards the goal of being able to have a balance of the best of both the worlds of farming and pharmacy in the future.

Abstract

Background: Farmers experience greater isolation, poorer mental wellbeing, increased risk factors for chronic disease and have a shorter life expectancy. For the Healthy Agspirations (HA) team, these are their mums, dads, brothers, cousins and grandparents.

HA was a unique collaboration between Future Health Leaders and NSW Young Farmers, which began with a simple idea: you cannot have resilient farming communities without an agile rural health workforce – and vice versa.

HA partnered with Batyr – a youth-based preventative mental health organisation, R U OK?which aims to break down the stigma associated with suicide, and Royal Far West – a non-government organisation delivering services to improve the health of country kids. HA were sponsored by the Centre for Rural & Remote Mental Health, Westfarmers and Western NSW LHD.

Aims

  • Enhance engagement between young farmers and health professionals
  • Promote why we all love to work and live in the bush
  • Raise money for rural charities while having fun!

Methods: The HA initiative collected and analysed event participant data and survey feedback, as well as social media analytics to evaluate overall impact.

Results: The HA team developed and implemented four events across NSW – a mental health awareness initiative (Dinner in the Dark, Hay, 120 people); had over 70 people run in HA merchandise at Dubbo Stampede and City to Surf; and 250 people attend the HA Charity Ball in Orange. 

HA achieved its overarching goal – to engage with young farmers and health professionals across events while raising money for rural charities.

The initiative raised $25,000 and had direct participant reach of 440 people.

Retrospective social media analytics identified HA reached over 86,000 people via Future Health Leaders and NSW Young Farmer networks, with 1333 people directly engaged from registering interest on Facebook. This does not include traditional print media reach in The Land and Glovebox Guide.

Post event surveys and anecdotal feedback indicated strong engagement between health professionals and farmers.

Conclusions: We will never tackle the increasing burden of rural chronic disease without developing dynamic partnerships with organisations outside of traditional health networks. The strong partnerships developed throughout 18 months of implementing these events are testament to the simple idea that sparked this initiative. The HA team knew that if motivated young health professionals worked with motivated young farmers, usually considered as groups with little common ground, big things can happen.

When you are able to harness the passion, ideas and energy like this, rural Australia has a brighter future ahead!

Slides
Travis Holyk
Building a primary care model for rural and remote First Nations
Biography

Dr Travis Holyk is the Executive Director of Research, Primary Care and Strategic Services at Carrier Sekani Family Services and is an Adjunct Professor at the University of Northern British Columbia. Through his diverse training, he is able to merge health administration with knowledge acquisition and translation. As such, his current portfolios include research, program development, program administration and quality assurance, thereby ensuring that all programs and services meet their intended outcomes. Travis has been a leader in developing and administering innovative health and social programs that continue to have a positive and lasting impact in First Nations communities. Travis oversees physician and nursing services provided to 11 First Nations spanning a geography of 76,000 km2, using varied funding arrangements and technology to address complex health needs of rural and remote populations. He has been guiding those services towards an interdisciplinary approach to wellness. To meet the needs of innovative programing, he has been involved in the development of information sharing agreements in the health sector, penned research ethics policy and has conducted a considerable amount of research into health and social issues.

Abstract

As with many other indigenous populations, First Nations communities in British Columbia Canada remain extremely disadvantaged in access to high quality, timely and culturally sensitive primary care services that meet their individual community needs. First Nations people in British Columbia suffer some of the worst burdens of chronic disease and fall at the bottom of just about every social determinant of health. Health issues are increased for those living in rural and remote areas due to limited access to services, geography, mistrust and poverty.

In north central British Columbia Carrier Sekani Family Services was created to reassert First Nations control of justice, health, child and family services, all of which have been negatively impacted by colonization. For over 25 years, Carrier Sekani Family Services (CSFS) has been working to offer holistic wellness services to 11 member First Nations extending over an expansive geographical area of 76,000 square miles.

This presentation will focus on Carrier and Sekani First Nation efforts to develop a sustainable, high quality and community-based model of primary care service delivery. Through discussion that will include personal stories and data from a comprehensive evaluation, we will provide insight into CSFS primary care model including lessons learned/challenges, successes and recommendations for policy shifts to improve primary care service delivery to remote and semi-remote Aboriginal communities.

Specifically we will address how the model has created:

  • A shift in physicians’ practice: from periodic in-person visits to consistent community visits complemented by the use of telehealth, resulting in a continuity of care, holistic approach and early diagnosis and treatment.
  • A rising emphasis on health and wellness maximizing impact on community health by targeting lifestyle diseases such as obesity, diabetes, hypertension, cardiovascular disease and chronic renal disease.
  • An integrated team approach.
  • The use of technology, including a shared Electronic medical record to improve shared care planning.
  • The policy and financial shifts required to nurture this innovative model.
Slides | Paper
Kim Hosking
Connecting mental health in South Australia
Abstract

This is a story of how, as PHN’s the CSAPHN and the APHN could use their opportunity and leverage, to improvement access to mental health services for rural communities and to better integrate and coordinate service delivery.

It is a story of how PHN’s coordinating across a State can leverage an all of State solution that ensures all of population solutions.

Service provision across SA has in the main, been provided by localised service deliverers, operating within their own environment and strategies and funded variously by the Commonwealth or State. These providers have been supplemented by a small number of private providers. The State provides varying levels of complex care from regional locations, available 9 till 5 and often remote from significant populations. Resourcing and delivery has been unconnected and has lacked integration.

There is a reliance on the metropolitan area for services to the country population in inner regional areas, as well as for more complex and specialised needs. There are no resident psychiatrists in rural SA.

The CSAPHN, drew on its needs assessment and coordinated with the APHN to relate needs that are serviced by the metropolitan area. The CSAPHN values local solutions, delivered locally and relevant to each community. There are 120 significant communities in rural SA and the CSAPHN is prepared to create 120 solutions.

The CSAPHN did not seek to create one solution. It did not seek to design generic solutions. Instead, it invited expressions of interest from providers, to design local activities, take into account low, moderate and complex needs, in a step up and step down framework for service delivery. To widen opportunity, the CSAPHN and the APHN mirrored the approach permitting state-wide providers to submit expressions that crossed boundaries and linked up care across the low to complex range.

The outcome of the process was the selection of a wide range of ‘preferred’ providers who the combined PHN’s worked with to co-design the activity to be contracted.

The second step to this process was the creation of a central point of referral. Hosted by the APHN this ensures all referrals are received at one point and referred to the ideal provider based on geography, timeliness and complexity of need. It provides accountability and reporting advantages for contracting of services and relieves costs for small providers.

The central referral is also being embraced by the State with work underway to link state provided complex care services. This work will provide a single door for all clients across SA regardless of their location or need and ensure best results in timeliness and quality of services.

Slides