Concurrent Speakers

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Gillian MacSmith
Be a Bosom Buddy Salon Project: empowering hairdressers to promote screening mammograms
Biography

Gillian MacSmith has a background in dietetics with experience working in both tertiary referral hospitals and large regional hospitals. After three years working as a clinical dietitian, Gillian moved into the area of public health and health promotion. In her current role as a marketing and recruitment officer with BreastScreen NSW, Gillian works closely with rural and remote communities across Western and Far West NSW Local Health Districts to promote breast screening. Gillian holds a Master of Nutrition and Dietetics and is currently completing her Master of Public Health/Health Management. Gillian grew up in rural NSW and has a strong interest in rural and remote health, with a particular focus on innovative approaches to improving health equity.

Abstract

Background and aim: Breast Cancer is the most common cancer affecting women in Australia. Screening mammograms are the most effective way of detecting breast cancer in women over the age of 50. Yet, approximately one in two eligible women in NSW are not having regular screening mammograms.

The Be a Bosom Buddy Salon Project is built upon the unique relationship shared between a woman and her hairdresser. It is based on strong community and consumer engagement and founded on the settings based approach to health education. The Project aims to engage hairdressers to discuss key breast health messages with their clients in order to increase screening rates amongst women aged 50-74 years.

This paper will describe the intervention phase of the Project including the initial education provided to hairdressers as well as the resources and ongoing support provided.

Method: From January 2016, hairdressing salons across Orange, Bathurst and Dubbo were invited to take part in the project.

Participating salons received a one-on-one initial education session, which included information on BreastScreen NSW, becoming a Bosom Buddy Salon, the target audience and the four key messages to discuss. The session also included support on how to engage in conversation and use the promotional materials.

Salons were provided with a pack, which included: the “We are helping save lives. Ask me how.” mirror stickers for display, copies of the free Bosom Buddy Magazine for women to read and take home; pink pens and emery boards to give away and a one page summary of the initial education.

Hairdressers were provided with fortnightly support for the first month, then monthly and were required to attend Quarterly Forums for ongoing education.

Results: There are 24 Bosom Buddy Salons involved in the Project with a second round of recruitment planned for October 2016.

Preliminary results demonstrate the Project is reaching the target audience and that women feel comfortable talking about mammograms with their hairdresser. Hairdressers report the project is easy to deliver and that there is positive feedback from their clients.

Project outcomes will be available mid-2017 and include effectiveness of the Project on influencing screening rates in women aged 50-74.

Relevance: The Project highlights that interventions founded on strong community and consumer engagement are well suited to rural communities, and provide the foundation for innovative, settings based interventions to improve health.

Slides | Paper
Julia Marley
Diabetes screening in pregnancy: failing rural women in Western Australia
Biography

Assoc Prof Julia Marley has been conducting collaborative research into improving Aboriginal health and building research capacity in the Kimberley since 2006. Her research projects include improving the quality of preventive health programs for Aboriginal people by trialling new programs and evaluating their effectiveness; improving screening for diseases by trialling new screening protocols; and improving the quality of primary health care for Aboriginal people by evaluating health services. She is also Chair of the Kimberley Aboriginal Health Planning Forum Research Subcommittee and provides advice on conducting research in the Kimberley.

Abstract

Background: Screening recommendations for gestational diabetes mellitus (GDM) are for all pregnant women who are not known to have diabetes or GDM to have an oral glucose tolerance test (OGTT) at 24-28 weeks gestation. Anecdotally there are poor GDM screening rates in rural, remote and Aboriginal populations in Western Australia (WA). We aimed to determine the rate of screening for diabetes during pregnancy in rural WA after universal screening was introduced in 2012.

Methods: Antenatal records of 551 women aged 16 years or more without pre-existing diabetes and with singleton pregnancies delivered in 2013 were retrospectively audited (39.0% Australian Aboriginal; 8.3% other high risk ethnicities). GDM was primarily diagnosed using criteria at the time (OGTT: fasting glucose ≥ 5.5 mmol/L, or 2-hr glucose ≥ 8.0 mmol/L). Other tests included fasting and random blood glucose, HbA1c and glucose challenge test. The Modified Monash Model (MMM) was used to categorise health service remoteness. A linear regression model was created using a backwards step-wise approach to identify factors that were associated with OGTT screening.

Results: The health services of most Aboriginal women audited were located in MMM3 (rural towns; 42.3%), MMM6 (remote towns; 23.7%) and MMM7 (very remote towns / communities; 32.6%), while most non-Aboriginal women (92.2%) received their care in rural towns (MMM2 and MMM3). Only 276 (50.0%) women were screened with OGTT; 119 (21.6%) women had no record of being screened for GDM. There was a significant decrease in OGTT recorded (56.1% to 38.4%; P < 0.001 for trend) and concomitant increase in other tests recorded (16.4% to 47.9%; P = 0.001 for trend) as health service remoteness classification increased. In multivariate analysis women with a previous GDM diagnosis (OR 6.2; 95% CI 1.8-22.0; P = 0.004), high risk GDM ethnicity other than Aboriginal (OR 3.0; 95% CI 1.4-6.2; P = 0.004) and Aboriginal ethnicity were associated with being screened with OGTT (OR 0.47; 95% CI, 0.33-0.68; P < 0.001). Of those screened with OGTT there was a high rate of GDM diagnosed: 14.8% v WA average of 6.2%.

Conclusions: These results suggest that while women present for antenatal care at 24-28 weeks gestation there are specific problems with the OGTT as a screening test for GDM in rural WA. For screening to be effective it should be acceptable and available to all at risk. Further work is required into alternative screening strategies for GDM.

Slides
Carmel Marshall
Mental wellbeing in rural communities: a capacity building approach
Biography

Carmel Marshall is Planning and Development Manager at CentacareCQ. The main focus of this role is to help ensure the organisation is sustainable and relevant into the future, so requires an understanding of the influences on the environment in which CentacareCQ will be operating over the next five to 15 years. This picture then informs the decisions and actions taken in the current environment to move CentacareCQ towards its desired future. Identifying ways to implement solutions that fit with local needs is part of CentacareCQ’s community development and asset based approach to supporting communities. Carmel’s previous roles with the Institute for Sustainable Regional Development and Rockhampton Regional Development Limited included research and project work in sustainable regional development.

Abstract

The Queensland Mental Health Commission has been working with stakeholders across rural and remote Queensland to identify an approach to mental health promotion, prevention and early intervention that supports the unique circumstances of rural and remote communities. The recently released Queensland Rural and Remote Mental Health and Wellbeing Action Plan aims to build on the strengths and resilience of rural and remote communities, with actions to: enable greater opportunities for good mental health and wellbeing; strengthen communities; and ensure that services are responsive and accessible. It builds on work already underway through the Early Action: Queensland Mental Health Promotion, Prevention and Early Intervention Action Plan 2015-17, which aims to support Queenslanders to start well, develop well, learn well, work well, live well and age well.

In rural central Queensland, in the Local Government Area of Central Highlands, a Mental Health and Wellbeing Hub has been established as one part of the Live Well priority area. This community mental health and wellbeing project is aimed at building capacity in communities to understand and identify the local community assets and needs for good mental health and wellbeing. The project will use a community of practice model to provide an environment for capacity building, developing ‘wellbeing hubs’ in 5 of the small localities within the Central Highlands Local Government Area. A desired outcome is that these Hubs can be maintained without the need for ongoing funding. The emphasis is on localities where service providers are less resourced, with the aim that the community is still able to identify and tap into resources and supports in spite of a lack of an overt “service provider presence”.

The project is being delivered by CentacareCQ with support from CQ Rural Health and Central Highlands Regional Council. The project is using an approach of leveraging from what is already available in the Central Highlands region. This paper will present: the rationale for the model being implemented; the criteria used to identify the localities for the Hubs; the tools and approach being used to encourage development of local capacity; and the progress and reception of the project so far.

Slides | Paper
Jackie Marshall
The healing of song—The Soldier’s Wife
Biography

Jackie Marshall is renowned for her gutsy-yet-tender vocal style. She has released two critically acclaimed albums, Fight ‘n’ Flight and Ladies' Luck, the former shortlisted for the Australian Music Prize. Initially trained in jazz at the Queensland Conservatorium, Jackie has written music for children’s puppet theatre in Slovenia, was once crowned The Peppercorn Queen at much-fabled Nymagee Outback Country Music Festival, and has played just about every gig worth mentioning in the country, but can’t remember a single one of them. Or at least not much. She works on a lot of projects and takes a keen and compassionate interest in the theoretical and philosophical side of her practical and therapeutic music endeavours in the community. Jackie thrives on working with her friends and hopefully inspires them to embrace and develop and cherish their unique creative identity. She also loves to write.

Abstract

In years gone past, songs were the form of documenting our stories—telling the stories of those who had gone before, our histories, our tragedies and our hopes. And music accompanied, being the one thing that could transverse those feelings that could sometimes not be voiced. This is at the very heart of The Soldier’s Wife.

The past 30 months has seen a small group of Queensland songwriters go on a truly remarkable songwriting journey—to tell the stories of women whose partners have served in conflict over the past 60 years. To tell the stories of soldiers’ wives and their families and of their personal sacrifice.

The songwriters have talked to almost 100 women—aged from 25 to 104 years old. From varying backgrounds and conflicts, from remote and regional areas to inner cities, their personal journeys all have similar themes of love, of loss, of existence and most of all of resilience.

The artists use their voices and their muse to hold legacy to these stories and to share them on stage. These are not just stories of incredible women—they are stories of our history and of the new generation.

Paper
Lee Martinez
The rural art palette in recovery: light and dark in a journey of arts and mental health
Biography

Lee Martinez is a Whyalla woman who lives and works in country SA providing a life-long experience and understanding of those residing in rural and remote areas. Lee works for the Department of Rural Health Uni SA as the Mental Health and Aboriginal Health Academic. We work with community to increase the rural health workforce in country areas. Lee has a passion for working with consumers, including the lived experience in service delivery and ensuring people in rural and remote areas have access to the quality services that meet their needs.

Abstract

Arts and mental health is a growing area of research, which seeks to bridge the gap in the recovery process by both promoting public awareness surrounding mental illness and fostering participant wellbeing.

The opportunity for rural consumers of mental health services to participate in ‘arts in mental health’ programs within their local community are few and far between and yet is known to increase opportunities for social connection.

Artistic expression has been the aim of these community arts projects, with participants demonstrating varying levels of prior arts knowledge and ability.

This presentation will discuss two separate, although connected, arts projects and will share the engagement process, provide an insight into the process of delivering such a program, pre and post evaluation of participants using a baseline social inclusion scale and provide insight to public response to two exhibitions of works from the programs.

The evidence highlights that art plays a valuable role in engaging people who may be marginalised due to having a mental illness. It allows participants to switch off from issues that may be distressing them, promoting wellbeing and social inclusion.

We anticipate that this presentation will add to the evidence base of how arts and mental health can strengthen community connections and decrease stigma.

Slides | Paper
Kellie Mastersen
'Don't make smokes your story': Aboriginal and Torres Strait Islander anti-smoking campaign
Biography

Kellie Mastersen, is a health marketing professional and campaign manager in the Department of Health. Kellie has worked on the implementation of mass media, evidence based behaviour change programs including the National Drugs Campaign, BreastScreen Australia Campaign and most recently the National Tobacco Campaign. The latest phase of the National Tobacco Campaign launched a new a mass media campaign targeting Aboriginal and Torres Strait Islander smokers aged between 18-40 years in 2016, with promising evaluation results. The campaign aims to change the smoking behaviour of the target audience and evaluation research demonstrates the success of this campaign model. Kellie worked closely with community to ensure culturally appropriate message territories were incorporated to deliver a positive, empowering and supportive smoking cessation campaign.

Abstract

The Don’t Make Smokes Your Story campaign aims to encourage Aboriginal and Torres Strait Islander smokers to quit using an empowering, positive approach. The campaign, launched on 1 May 2016, is part of an integrated strategy that includes mainstream, local, digital and social media outlets and community events.

The Australian Government’s National Tobacco Campaign, Don’t Make Smokes Your Story, is part of a range of tobacco control measures implemented at the national, state and local level targeting high rates of tobacco use and the subsequent poor health outcomes amongst Indigenous Australians.

The campaign strategy draws on research by the Menzies School of Health Research and the Australian Government Department of Health, which recommended targeting Indigenous smokers with messages depicting both immediate and long term health consequences of smoking while acknowledging quitting is challenging and providing encouragement and support.

The campaign was developed in consultation with Indigenous smokers, their families, and health workers. Over 70 focus groups were conducted by market research consultancy ORC International with help from local community organisations in urban, regional, rural and remote communities. Concepts from five agencies were tested to identify a potentially successful campaign with ongoing modifications in response to audience feedback to maximise effectiveness, salience and appeal. The campaign story was found to be very believable, credible and delivered important messages. The focus on the benefits of quitting and positive role modelling had high appeal.

Campaign evaluation results demonstrate the campaign is delivering against key objectives. There is high awareness among the target audience, with 75% of Indigenous smokers aged 15+ aware of the campaign. The campaign is regarded as easy to understand, believable and thought provoking.  The majority felt the campaign was relevant to them, made them worry about their smoking and would make them more likely to quit/stay quit.  Importantly, the campaign has successfully encouraged smokers in a non-judgemental way, with the majority saying they felt hopeful, inspired and empowered to quit.

The campaign has generated behaviour change with 9% of smokers exposed to the campaign quitting and 27% reporting that they had reduced the amount they smoke. A substantial proportion of respondents said they had discussed smoking/quitting with family or friends (20%), or with a doctor (8%) or health intermediary (7%).  Stated future intentions to change smoking behaviour were also very high.  Use of support tools - the MyQuitBuddy app and QuitNow website- increased substantially over the period of campaign activity.

Slides | Paper
Suellen Maunder
Indigenous theatre production: Proppa Solid
Biography

Suellen Maunder is a Founding Member and Artistic Director and Chief Executive Officer of JUTE Theatre Company, a multi-award winning regional company based in Cairns. Suellen is a director, actor and producer. Suellen was one of the key players in gaining $2.7m in capital works funding from State Government and was integrally involved in the design and development of the Centre of Contemporary Arts in Cairns and consulted on the $2m rehearsal studio development at the Centre. She is currently on the board of Diversity Arts Australia and is a member of the Regional Arts Working Group of the Queensland Arts and Cultural Chamber. From 2009 to 2012 Suellen served on the Theatre Board of the Australia Council for the Arts and in 2011/2012 was a member of the Arts Queensland Sector Plan Reference Group. From 2000 to 2007, Suellen was a Trustee of the Board of the Queensland Performing Arts Trust and has served on a range of boards and funding assessment panels. She was an Adjunct Lecturer at JCU, Cairns Campus from 2008 to 2012. Suellen is committed to the growth of high-quality professional theatre practice in the regions.

Slides
Jennifer May
Lightning speed in which direction? Artificial intelligence, technology and rural communities
Biography

Professor Jennifer May AM is Director of the University of Newcastle Department of Rural Health (UONDRH). Jenny's role encompasses oversight of undergraduate teaching activities, research and evaluation in medicine and allied health disciplines across the University of Newcastle rural footprint. The UONDRH also supports postgraduate training and retention of the rural workforce. Her research interests include new models of general practice in rural and remote areas, and primary health care integration. Her area of PHD study was related to regional centre medical workforce including both specialists and GPs. She works at Peel Health Care, a not-for-profit general practice in Tamworth, NSW. She holds fellowships of both the Royal Australian College of General Practitioners and the Australian College of Rural and Remote medicine. Jenny is also the Rural Doctors Association of Australia (RDAA) representative and past Chair of the National Rural Health Alliance. She has been involved in numerous committees and working parties around rural health issues and is on the Commonwealth Government advisory group on Alcohol and Other Drugs (ANACAD). Jenny has lived and worked in the New England area since 1984 with a five year sojourn in remote Western Australia's Pilbara and two year's work in a remote Indigenous community in British Columbia, Canada in 2004 and 2016. She was named Telstra RDAA Rural Doctor of the Year in November 2014.

Abstract

Background: Rural communities have been the beneficiary of a number of amazing technological innovations. In an environment where proximate resources in terms of skilled health professionals are lower than in metropolitan areas, an understanding of the thirst and capacity of communities to accept and benefit from the technology revolution is essential. High rates of acceptability of technology characterise rural communities. The use of digital health records and communications and the saturation of smart phones in rural and remote settings is widespread. Yet, more technological advances are on the horizon and how will they impact rural health?

Applications such as standalone computerised decision support tools operated by consumers and bypassing health professionals are being trialled. This is occurring without evaluation or discussion on the wider impact of online interactions in lieu of current models of face to face consulting. Consequent health related outcomes for rural communities and those with lower rates of health literacy have not been studied. This paper seeks to consider the likely enablers and barriers to uptake of Artificial intelligence (AI) in rural communities.

Methods: A realist perspective was taken to this topic. The complexity of interventions such as the relationship to computers means there is a need to consider both the mechanism of the change and how the context interacts in order to deliver the outcome.

Results: Diagnostic applications involving algorithmic and actuarial data are becoming more common. Applications involving integration of data are now in use not only in the medical environ but also in community settings. Whilst data synthesis is available, empathy and clinical judgement functions are not yet replicated. Current applications such as an app that diagnoses heart rhythm abnormalities cannot currently ensure decision making is accessible and contextually appropriate to the patient. Anecdotal evidence suggest that brokerage and care coordination are needed to ensure that interventions best fit the presenting problem.

Access to enabling infrastructure including fast broadband, and affordable connectivity with its necessary diseconomy of scale must be prioritised. Patients with disabilities and with chronic medical conditions are most likely to benefit but least likely to gain equitable access.

Conclusion: Increases in technological applications have been seen as the way to reduce distance and increase access for rural citizens Technological advances will become available for rural communities and will drive new models of service provision. Are rural communities ready for this? This value can be maximised with health professionals supporting this augmentation to services and a ready approach to evaluating technical and patient satisfaction outcomes. Careful measurement of the costs of these advances is imperative as a net benefit to rural communities cannot be assumed.

Slides
Tracey McCann
Telepractice and NDIS: providing specialist intervention for rural and remote families
Biography

Tracey McCann is currently the Head of RIDBC Teleschool at the Royal Institute for Deaf and Blind Children in Sydney, Australia. Prior to moving to New South Wales, Tracey worked as an educator for Education Queensland for over 30 years. During this time, she worked in regional centres as both a teacher of the deaf and Head of Special Education Services in primary and secondary schools . Tracey has always had a keen interest in technology and its uses in supporting both parents and staff. Having experienced the difficulties of accessing high-quality specialist services both personally and professionally whilst living in regional Queensland, Tracey is a passionate advocate for increasing the use of technology to provide access to skilled professionals and specialist services for families across Australia, regardless of their geographic location.

Abstract

With the National Disability Insurance Scheme rolling out across Australia, and families and adults now having access to funds to pay for services and therapies, there has never been a more important time to ensure that the service and health providers have the necessary specialist and expert skills in order to deliver a high quality service that families and adults can access, regardless of where they live.

Families in rural and remote areas of Australia very often do not have local access to experts in the fields of disability and often are forced to use local providers whose knowledge and skills may be limited.

Likewise, specialist services in isolated areas find it challenging to improve their knowledge and skills in order to deliver high quality therapy and intervention.

The Royal Institute for Deaf and Blind Children (RIDBC) has been delivering expert specialist services to families of children with a hearing loss or vision impairment in these rural and remote locations across Australia since 2002.

As NDIS has rolled out in regional areas of Australia, RIDBC has continued to be a leading provider of services for hearing and vision support, as well as supporting regional and local service providers in developing and increasing their knowledge and skills in providing intervention services for these low incidence disabilities.

This presentation will outline how RIDBC has traditionally provided this support to families through telepractice and how it has adjusted its programs and ways of support to meet the needs of families and local service providers in an NDIS world.

The presentation will also look at ways a remote service provider using a telepractice model can remain a valid option in a regional context and how local providers can be engaged in developing their understanding of disability and enhancing their skills in supporting  families and adults.

The provision of assessments and early intervention therapy services delivered remotely through telepractice in the areas of vision impairment and hearing loss will also be outlined as well as ways in which a specialist service such as RIDBC is able to pass on knowledge and skills to local service providers using videoconferencing.

Families across Australia now have access to funds to procure the services they require for their child regardless of their geographical location and this can be achieved through both local providers and experts in the field though the use of videoconferencing.

Slides
Sally McCarthy
EMET: providing emergency medicine education and training for rural emergency department teams
Biography

Associate Professor Sally McCarthy (FACEM, MBA) is the inaugural Medical Director of the Emergency Care Institute NSW. Sally works clinically as a senior emergency physician at the Prince of Wales Hospital in Sydney having previously been Director, Emergency Medicine at that and other hospitals. Previous president of the Australasian College for Emergency Medicine, Sally continues to be actively involved in a number of college committees, including the Rural Regional and Remote Committee and is convenor for the College’s Annual Scientific Meeting this year. She is a member of the Board of the International Federation for Emergency Medicine and also a Clinical Lead for the NSW Whole of Hospital Program.

Abstract

The Australasian College for Emergency Medicine (ACEM), with funding support from the Commonwealth Government has been providing the Emergency Medicine Education and Training (EMET) Program since 2011. The EMET Program aims to:

  • provide emergency medicine training sessions delivered by specialist emergency physicians (FACEMs) to the doctors, and the multidisciplinary teams they work with, in their emergency care workplace settings in regional and rural hospitals, and
  • promote and supervise doctors including Visiting Medical Officer (VMO) GPs, hospital employed medical officers and locums who are working in rural and regional settings to undertake ACEM’s Emergency Medicine Certificate and Diploma programs.

This is achieved through to provide training and professional support to GPs and other medical officers who are caring for patients in regional and remote emergency departments and other emergency care facilities.

EMET delivery is coordinated though hub sites which are usually a larger hospital, with on-site FACEM staff, and educational facilities, who deliver emergency training and supervision to sites within their local network and/or regional or remote facilities within their state. There are a range of delivery models for EMET that are customized to meet local needs. Involvement of FACEMs for the development and delivery of training is the lynchpin of the program, but a number of hubs also have a Program Support Officer to perform organizational and administrative tasks, promote the Program and optimize FACEM time for direct education and clinical supervision.

In 2016 ACEM was able to fund and support 50 EMET hub sites. Since commencement of the program:

  • at least 350 regional, rural and remote hospitals have been provided with training sessions in emergency medical care
  • in excess of 6,000 training sessions have been conducted, from 1-hour to full-day workshops
  • there has been more than 55,000 attendances, by doctors, nurses and paramedics at these training sessions.

The EMET Program is highly valued by its target group of GPs and other doctors delivering emergency care in rural, regional and remote settings, and there is strong engagement of all stakeholders with the Program. This has resulted in benefits in many priority areas for national rural health and improved emergency medical care for patients in rural communities.

Slides | Paper
Maureen McCarty
Australia’s health workforce: geographical distribution and the relevance of a vulnerability index
Biography

Maureen McCarty has over 25 years’ experience in health service delivery and workforce planning in both the public and private sectors. She is currently the Director of the Workforce Data Analysis Section, Health Workforce Division, at the Australian Government Department of Health. The section is responsible for management of the National Health Workforce Dataset, an online data tool and production of the department’s health workforce supply and demand studies, including the Australia’s Future Health Workforce reports. Previously, Maureen managed the workforce planning program at Health Workforce Australia, which produced Australia’s first major, long-term national projections for the health workforce out to 2025.

Abstract

Recent literature suggests health workforce geographic distribution mechanisms, such as geographic classification systems, incentives and regulatory measures, can be useful in helping to direct health professionals into priority areas. However, strategic analysis is required to refine and better target distribution policies across a range of workforce programs.

The Department of Health is conducting geospatial analysis of the distribution of primary health services across Australia. Taking into consideration a range of datasets, it is possible to explore not only the supply of health professionals and primary health services in a particular geographical region or catchment, but also additional factors, such as the socioeconomic, demographic and geographic characteristics of a community.

This research aims to support development of a vulnerability index for use by policymakers, to better identify the unique needs of communities, at a more refined level than what current mechanisms offer.

A vulnerability index in the health workforce context will support evidence-based policy around improved rural and remote health workforce initiatives, to ensure the community has an adequate level of access to health services in the right place, at the right time.

Paper
Matthew McGrail
Are practice locations associated with GPs having school-age children and working spouses?
Biography

Dr Matthew McGrail is a full-time Senior Research Fellow of the Monash University School of Rural Health, based at Churchill campus. His research interests include measures of access to health care, workforce distribution, rural workforce location decisions and mobility, and rural health workforce policies and incentives. Matthew is a Chief Investigator of the NHMRC-funded Centre for Research Excellence in Medical Workforce Dynamics, which conducts the MABEL study (Medicine in Australia: Balancing Employment and Life), where he leads the Rural workforce supply, distribution and mobility research theme. He was also Chief Investigator of the recently completed Centre of Research Excellence in Rural and Remote Primary Health Care program, where he led research of improved measures of healthcare access, notably producing the national Index of Access. Matthew was a co-developer, with Emeritus Prof John Humphreys, of the Modified Monash Model which was adopted in 2015 by the federal Department of Health to underpin many of their rural health workforce incentives and policies.

Abstract

Background: Qualitative studies regularly identify two non-professional factors as key barriers to both take-up and continuation of rural practice by GPs: (1) fewer school choices, especially at the secondary school level and (2) limited employment opportunities for spouses. However, there exists little empirical evidence of the strength of associations between these factors and practice location.

Aim: To investigate associations between observed GP work locations during a seven year period and (i) having school-age children; and (ii) spouse employment.

Methods: The main outcome is the practice location, geocoded using the Modified Monash Model (MMM) scale, of all GPs participating in the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal study 2008 - 2014. Firstly, in each year GPs were defined by whether or not they had at least one school age (5-18) or secondary school age (12-18) child. Secondly, GPs were annually defined by whether they had a spouse who was either working or looking for work. Generalized estimating equation models were used to test associations between having one of these primary characteristics of interest and work location.

Results: Male GPs with secondary school-age children were significantly less likely to be located in smaller rural MMM 3-7 communities compared to MMM1-2 (OR 0.92, 95% CI 0.86-0.99); however, no association was found for male GPs with children of any school-age. In contrast, female GPs with children of any school-age were significantly less likely to be located in a rural location of any size (OR 0.91, 95% CI 0.85 – 0.98). Male GPs with a spouse in the workforce were no more likely to work in one MMM rurality level than in another; in contrast, female GPs with a spouse in the workforce were consistently less likely to be working in rural locations, although this was statistically significant only in smaller rural and remote communities (MMM 4-7: OR 0.89, 95% CI 0.80-0.99).

Conclusions: This evidence shows that both spouse employment and educational opportunities are associated with GP location choices, though their strength is moderate at best. Contrasting patterns are seen between male and female GPs, with female GP location more strongly related to their spouse’s employment needs. Schooling needs are also gender-linked with the effect on female GPs work location taking effect with their children being of early school-age. Rural development strategies, including strengthening educational and employment opportunities, may enhance the ability of rural communities to recruit and retain health and other professionals.

Slides | Paper
Kristy McGregor
Channel Country Ladies Day
Biography

Kristy McGregor is passionate about building vibrant rural communities through the arts and community-driven events. Kristy spent a number of years living on a cattle station on the remote Queensland–SA Border, and in other remote towns in western Queensland. It was in western Queensland that she was involved in coordinating a number of arts projects connecting local artists with women across the west, and established the Channel Country Ladies Day in 2012, a project she continues to be involved in, despite now living across the Tasman. Kristy presently works in local government and resource management policy, as a Regional Policy Advisor with Federated Farmers of New Zealand, an advocacy organisation for agriculture and rural communities. When not forging new contacts on either side of the Tasman, Kristy is studying for her Masters in AgriScience, with an interest in rural sociology and community development, at Massey University. Most recently, she has co-founded a festival to link community with their local food producers.

Abstract

On the edge of the desert each October, an arts festival is providing women from remote Australia with the opportunity to prosper. The Channel Country Ladies Day ties together arts and health, both subtly and recognizably, to enable social and emotional wellbeing, and women’s health.

Journey into Channel Country region with two women from outback Queensland to understand how they founded an event as a means of reducing social isolation and enriching women’s lives. Connecting women with health professionals is building long-term relationships and empowering women with the knowledge of available resources, and awareness of aiding their own health. A drop-in Artsbreak Area, and arts and performance workshops are providing women with new found skills and confidence, and improving how women feel about themselves. In many cases, explorations of self through the arts allows for the development of self-representation and the shaping of identity. Women, artists, and health professionals are peers for the weekend.

Creative solutions, combined with clinical responses, leads to improvements in relationships and mental health by helping rural women to cope with daily stresses caused by drought and social isolation. Through the voices of remote women, we will showcase a model to inspire health practitioners to consider diverse solutions to health care in rural and remote practice.

Discover how an investment in grass roots, locally driven health responses is an integral part of preventative health care, reducing the higher expenses of clinical care. Join Red Ridge in a presentation where you will feel the rich experiences that has made a difference to the lives of women and their families living in remote and indigenous communities, where an incredible arts and health model is changing people’s lives.

Slides
Cari McIlduff
Empowering Aboriginal families in parenting: Jandu Yani U 'For All Families'
Biography

Cari McIlduff was born in South Australia; however, she grew up in Canada, living and working with Indigenous Canadian friends and mentors. As a young woman she was given the responsibility of raising two of her younger cousins who had lost their Indigenous father to suicide.As a mother-figure, she has parented through trauma and chaos. While navigating a challenging family dynamic, she obtained a Bachelor degree in Psychology in Canada, has worked in early childhood intervention in a rural Regional Office in Canada and has been teaching The Positive Parenting Program (Triple P) for more than five years in diverse cultures in both Canada and Australia. Cari is currently a PhD candidate at the University of Queensland where she is discovering how to best work with Indigenous communities to successfully implement evidence-based programs. After meeting team members of the Jandu Yani U (For All Families) Research project, Marninwarntikura Women’s Resource Centre, the lead community organisation working with The University of Sydney, asked Cari to support project implementation in a way that is appropriate for the community context. Cari lived and worked in the Fitzroy Valley in the Kimberley region of Western Australia during 2016, supporting parent coaches to bring Triple P to a range of families. During 2017 she will continue to support parent coaches and work with the community to build capacity and sustainability as the program expands.

Abstract

During the population-based (Lililwan) study of Fetal Alcohol Spectrum Disorder (FASD) prevalence in the remote communities of the Fitzroy Valley in Western Australia, families and teachers reported challenging child behaviours as a major problem for all children. In response, Marninwarntikura Women’s Resource Centre initiated a partnership with clinician-researchers to bring the Positive Parenting Program (Triple P) to the Valley. In other Australian Aboriginal communities Triple P has been found to be effective for increasing carer confidence and parenting skills resulting in improved child behaviour.

In April 2016, a workshop was held in Fitzroy Crossing with the local Advisory Group to ensure community understanding and consent for the program. The group selected Triple P level 4, which includes all 17 core parenting skills and an additional 7 skills relevant to children with complex needs. This was based on recognition of the complexities of family life in the Valley, similar to those in other remote communities.

With the imperative to building community capacity, 20 women (18 residents, 12 Aboriginal, from 10 local organizations) were trained in July 2016 by an Aboriginal implementation consultant and a trainer with experience in diverse Aboriginal communities. Following weekly support, consultation and team-building with 18 local trainees, all were accredited as “Parent Coaches” in August 2016. Training and accreditation provided a safe space for women to share past historical trauma and parenting experiences and reflect on how they have impacted their own parenting skills. Parent Coaches are very motivated to share their skills: 3 parent groups have commenced and 2 parents have completed the program. Feedback from trainees is excellent. One Parent Coach wrote:

‘…I’m glad we’ve been taught the Positive Parenting Way
I can’t wait to tell my countrymen and hear what they got to say.
I hope they feel like I do and practice it everyday
‘Cause it makes you feel real deadly when bringing up kids this way….’

One employer of a Parent Coach acknowledged the program empowered women and built self-esteem, stating:

This training and support has been the making of her.’

The strategy of engagement through extensive consultation; gaining support of key Aboriginal community organisations; collaboration; and the provision of ongoing trainee support by an experienced Triple P Practitioner has been essential for the successful implementation of the program. An approach that ensures that Aboriginal communities are equal partners in program delivery and evaluation is imperative for efficacy, engagement and sustainability of programs.

Slides | Paper
Kellie McMaster
Hub and spoke cardiac rehab telehealth model: improving access for rural people
Biography

Kellie McMaster has been working at Wimmera PCP since August 2007 as well as completing a Teaching Degree in Primary Education. She spent two years teaching before having twins and then returning briefly to teaching before re-joining the Wimmera PCP in the role of Team Support. Kellie took on the role of Service Coordination and is now working full-time as an Agency Liaison Officer. Kellie has lived most of her life in Horsham and has a firm understanding of the Wimmera and surrounding areas.

Abstract

Background: People living in rural Australia do not always have the same opportunities for good health as those living in major cities and health outcomes tend to be poorer outside major cities. One of the main contributors to higher death rates in regional and remote areas is coronary heart disease. These higher death rates may relate to differences in access to services, risk factors and the regional/remote environment.

Over the past two years, the Wimmera Southern Mallee Health Alliance has collaborated with the Wimmera Primary Care Partnership (WPCP) to provide innovative community focused cardiac rehabilitation education via telehealth. Prior to this work, cardiac rehabilitation as an eight week multi-disciplinary program was only available at Wimmera Healthcare Group (WHCG) in Horsham. Many patients in the region previously have not accessed, or completed, such programs due to the burden of travel. Economy of scale has dictated that multi-disciplinary approaches to cardiac rehabilitation have not been available in the rest of the 29,000 sq/km of the Wimmera.

Method: During the pilot, a multidisciplinary team based at WHCG Horsham, Western Victoria (the `Hub’), provided the education component via telehealth, with outlying health services, Rural Northwest Health and West Wimmera Health Services ( the `Spokes’) providing the physical activity component. Staff were trained to use videoconferencing effectively with groups so that all patients could be ‘virtually’ brought together to learn and interact as if they were all in the same room. This allows remote community members to access a high quality, best practice program, close to home, with improved peer support.

Results: This regional alliance has developed a Hub and Spoke Cardiac Rehabilitation Model of Care. Delivered via videoconferencing, practitioners at rural centres can now provide best practice, multi-disciplinary cardiac rehabilitation programs for remote patients.

This model has:

  • provided access to rural community members who may have limited or no access to rehabilitation
  • saved thousands of dollars in travel costs and time spent travelling
  • provided opportunities for peer support and increased social connectivity
  • supported staff and enhanced telehealth skills
  • enabled rural practitioners to broaden their scope of practice
  • provided cost effective delivery of a multidisciplinary secondary prevention cardiac rehabilitation program
  • been embraced with enthusiasm by practitioners and consumers
  • been analysed against both heuristic and human factors
  • provided a replicable model for delivery of specialised interventions to remote populations.

Conclusions: Evaluation of this model shows a significant increase in uptake of cardiac rehabilitation in the Wimmera, a more skilled rural workforce and better coordinated services for rural patients.

Slides | Paper
Arone Meeks
Gender spirit and the sliding scale of sexuality—visual arts in remote communities with health messages
Biography

Arone Meeks lives in Cairns, where he now creates works of art that speak to us of cross cultural interaction, relationships, gender, traditional and modern spirituality and his environment. His extensive accomplishments achieved in study, residencies, commissions, community arts, and public art, certainly attribute to an outstanding career to date, which will only continue to grow given his passion and determination. His works are testament not only to his skills and talents as a painter, sculptor and printmaker, but also to his wonderful sense for colour and design that allows his work to shine. He is currently working part time in Indigenous sexual health and in remote communities, delivering Cert 3-4 in Aboriginal and Torres Strait Art Identify and culture.

Slides
Rod Menere
Remote health workforce safety and security: problems and solutions
Biography

Rod Menere has over forty years’ experience in nursing and community development. He has a background in general and mental health nursing, a Bachelor’s Degree in Community Health Nursing, and a Master’s in Primary Health Care. Nursing has been good for Rod and, hopefully, visa versa. Throughout his career he has managed frequent transitions across his primary interests of remote area nursing, international health and development, and community mental health. He has worked extensively in Central and Northern Australia, Solomon Islands, Vanuatu, Cambodia and Papua New Guinea. Rod’s long-standing interest in remote health workforce issues is reflected in his past publications. In the 1990s he wrote the Remote Area Nursing Orientation Manual. He is very concerned that many staff commencing work in remote and isolated areas, especially those on short-term contracts, still do not have access to comprehensive pre-placement orientation. Safety and security remain significant issues for staff working in remote areas. Rod is honoured that through his participation in the CRANAplus Safety and Security project, he can contribute to identifying issues, and promoting remote workforce wellbeing.

Abstract

A range of significant occupational health and safety challenges affect clinicians resident in remote communities, as well as visiting Allied Health, Medical Specialist, Retrieval and Management staff. While violence towards the remote health workforce has not been accurately quantified, it has been identified extensively in research and the national media. In 2016, violence took the life of one clinician and forever damaged the lives of at least two others.

However, remote area workforce safety and security involves much more than assault and provision of on-call services. Vehicle accidents are the largest single cause of severe injury and death of remote health staff. Sub-standard infrastructure has been a primary cause to others. Bullying and harassment has also been identified by clinicians as a major health challenge, and a cause of changing staff retention behaviours.

Consultation to date with remote area staff has detailed a number of safety and security concerns. Seventy percent of those surveyed have had no formal training in the use of four-wheel drive vehicles or emergency communications equipment. Fifty percent of staff had no structured orientation. While eighty-five percent considered clinic buildings were secure, twenty-five percent identified that their accommodation was unsafe or not secure. Forty percent of clinics were consistently implementing safety protocols – a good start. However, thirty percent of clinics had no indigenous health staff – a real challenge to promoting effective, culturally safe services in remote communities. Thirty percent identified violence, bullying and harassment as the primary reason for their decision to leave work.

While there’s no quick fix, the Remote Area Workforce Safety and Security Project has identified practical interventions that will improve remote area workforce safety and security. Some responses are built on OHS guidelines and industry accepted standards such as ‘Never Alone’. Some interventions will require considerable resource input to facilities, equipment and training.

However, to improve safety and security, all primary stakeholders including clinicians, recruitment agencies, managers, employers, communities, educators, researchers, professional organisations, and government must be committed to introduce and sustain a culture of safety into remote area health services.

Slides | Paper
Karl Metzler
Physician assistant staffing in a rural New Zealand hospital
Biography

Karl Metzler is CEO of Gore Health Ltd, the company responsible for managing the delivery of health services at a rural community hospital and health hub in Gore, Southland, New Zealand. Karl’s vision, inspiration, and empathy for health has seen Gore Health become a leader in rural healthcare in New Zealand. At the Westpac 2013 Southland Business Awards Karl won the Business Personality of the Year award. Karl is very familiar with the challenges of delivering healthcare in a rural community and his innovative approach to healthcare delivery has seen several new technological and workforce initiatives aimed at alleviating some of the many issues facing rural healthcare being piloted at Gore Health. Karl is passionate about health and patient-centred care. He received a MA/MSc in Clinical Psychology at the University of Stellenbosch, South Africa in 1994. He immigrated to New Zealand in November 1998, joined the SDHB as a clinical psychologist and then joined the darkside to become Manager of Community Mental Health Services. He completed a Diploma in Business Management at Waikato University in 2004. Karl is married to Ann and has three children. Trout fishing and a Sky Sport subscription are his closest allies!

Abstract

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

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

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

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

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

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

Slides | Paper
Alicia Michalanney
Yuwa—Art for welcome and way-finding
Biography

Alicia Michalanney works for the WA Country Health Service (WACHS) as the Goldfields region’s Director of Population Health. She lives in the regional centre of Kalgoorlie-Boulder, which links the remote and arid Western Desert in the north with the pristine turquoise beaches of the coastal area around Esperance. Alicia enjoys the diversity of the region and is passionate about delivering safe and accessible health services for its entire population, including the Aboriginal communities, which account for more than 12 per cent. Alicia began her career as a physiotherapist at Royal Perth Hospital before returning to the country more than fifteen years ago with her husband, John. During this time Alicia has led WACHS Goldfields in its clinical service planning, facility redevelopment and clinical reform program. One of the highlights of her career has been overseeing the 10-year, $125 million redevelopment of the region’s two major hospitals and seeing them turned into vital, modern health campuses. While working on the redevelopment program, Alicia had the opportunity to meet local Aboriginal community members to hear their needs and ideas for new health service facilities. These early discussions were the start of what grew into the Yuwa—Art for Welcome and Wayfinding project in Kalgoorlie, an innovative partnership between Aboriginal people, local artists and the health service. This seemingly straightforward project has reaped some surprising benefits and helped to transform the way Aboriginal people relate to the hospital environment. The project was so successful it has been repeated across all the redevelopment projects in the Goldfields.

Abstract

The use of art to improve health and healing environments in our hospitals is widely demonstrated. This case study explored the use of art in hospital redevelopment to achieve culturally appropriate, culturally safe and ultimately culturally effective design that positively impacts on the healing environment, and on patients and the broader hospital community.

It highlighted the value of community consultation and engagement guiding art creation and purpose consistent with the needs of the local community.

In the rural setting Aboriginal and Torres Strait Islander people are a significant part of the community and account for a disproportionately high number of patients through the hospital doors. The important part that art plays in aboriginal culture and social fabric means that it can contribute even more to the welcome of these patients into the unfamiliar hospital environment.

In this project, consultation with community groups identified that use of natural light, access to outdoor sitting areas, use of plants that are indigenous to the region, use of art and imagery, especially aboriginal art that was by local artists, would all assist greatly in helping aboriginal clients feel more comfortable accessing health services. It was also discussed that for many aboriginal clients in the region English was a second language and that traditionally characteristics of the land were used for way-finding rather than signs and writing (even if written in language).

This critical feedback guided the health service to work with a group of local artists forming a community of arts and health practice for the life of the project. Themes representative of the region reflect safety, wellness and welcome drawing on local aboriginal imagery, motifs and stories. These were incorporated in sculptures, exterior decorative design, paintings and most importantly into way-finding vinyl designs for the floors throughout the building. The sense of welcome was further enhanced by continuing imagery across other media such as t-shirts of staff members, pamphlets and banners.

The response to the project funded by the Percent for Art Scheme and the health service redevelopment was so successful that the health service invested in arts and health beyond the initial outlay implementing a consistent community and artist engagement strategy across all redevelopment work and beyond the initial campus to other areas of the service. Art and health practice is now integral to campus redevelopment and part of hospital life.

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

Alicia Michalanney works for the WA Country Health Service (WACHS) as the Goldfields region’s Director of Population Health. She lives in the regional centre of Kalgoorlie-Boulder, which links the remote and arid Western Desert in the north with the pristine turquoise beaches of the coastal area around Esperance. Alicia enjoys the diversity of the region and is passionate about delivering safe and accessible health services for its entire population, including the Aboriginal communities, which account for more than 12 per cent. Alicia began her career as a physiotherapist at Royal Perth Hospital before returning to the country more than fifteen years ago with her husband, John. During this time Alicia has led WACHS Goldfields in its clinical service planning, facility redevelopment and clinical reform program. One of the highlights of her career has been overseeing the 10-year, $125 million redevelopment of the region’s two major hospitals and seeing them turned into vital, modern health campuses. While working on the redevelopment program, Alicia had the opportunity to meet local Aboriginal community members to hear their needs and ideas for new health service facilities. These early discussions were the start of what grew into the Yuwa—Art for Welcome and Wayfinding project in Kalgoorlie, an innovative partnership between Aboriginal people, local artists and the health service. This seemingly straightforward project has reaped some surprising benefits and helped to transform the way Aboriginal people relate to the hospital environment. The project was so successful it has been repeated across all the redevelopment projects in the Goldfields.

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
Richard Mills
Service continuity and clinical governance support: a role for regional GP relievers?
Biography

Richard Mills trained as a biochemist and worked for a biotech company in the 1980s before studying medicine at Southampton University in the UK. He became a general practitioner in 1992 and spent the next 15 years working in a semi-rural location in the south of England. He was attracted by working in a multidisciplinary team with access to a local ‘cottage’ hospital and maternity unit. He also developed an interest in medical education and GP training.
In 2008 he took a sabbatical and was invited to work for the Aboriginal Community Controlled Health Service (ACCHS) on North Stradbroke Island in Queensland. The sabbatical lasted somewhat longer than expected and after almost five years on ‘Straddie’ he took up a post as GP/Medical Educator for the Institute for Urban Indigenous Health where he has assisted in the successful expansion of GP registrar training and supervision in ACCHS  across the south-east corner of the State. In 2016 he completed a Graduate Certificate in Health Professional Education at Monash University and enjoys blending general practice with a regional role in facilitating continuous quality improvement in a rapidly evolving inter-professional, cross-cultural environment.

Abstract

The presentation will describe how the role of Relieving GP has developed in the context of a regional Aboriginal Community Controlled Health Service (ACCHS).

The visiting doctor is a full-time employee of the Organisation and provides, during periods of recreational or study leave, continuity of service by a GP familiar with local medical software, policies, procedures and (often) prior experience of working with resident staff and Community.

The position is combined with that of medical educator, supported by a Regional Training Provider (RTO), which ensures continuity of supervision for GP registrars whilst creating opportunities for quality improvement activities and peer coaching or review.

The model is an alternative to employing high cost, short-term locums with additional benefits for organisational and clinical governance which can be shared at regional level.

Slides | Paper
Olivia Mitchell
Continuous quality improvement for cultural responsiveness in rural health care
Biography

Olivia Mitchell holds a Bachelor of Science degree with Honours and a PhD in Pharmacology from the University of Melbourne. From 2006 to 2015, Olivia worked in the pharmaceutical and medical devices industries where she developed knowledge and expertise in the business of health care, the challenges faced by rural residents in accessing health care and dominant health care practices. In 2013 Olivia re-engaged with the academy and accepted a teaching position within The University of Melbourne Department of Pharmacology. In 2015, she accepted a research-focused position in the Culture and Rural Health stream of research at The University of Melbourne Department of Rural Health (DRH), based in Shepparton, Victoria. Olivia is currently involved in several research and community engagement projects and has a particular interest in improving access to health care for marginalised social groups. Throughout her career Olivia has won a variety of academic and industry awards.

Abstract

If the health and life-expectancy disparities between Aboriginal and Non-Aboriginal Australians are to improve, then mainstream rural health services must become more culturally responsive. In recent years, continuous quality improvement (CQI) has been utilised as a means of improving the delivery of health care for rural and remote Aboriginal communities. In addition, using CQI to improve the cultural responsiveness of hospitals for Aboriginal and Torres Straight Islanders has been trialled to some extent, evaluated. In 2011 The Continuous Quality Improvement tool: Aboriginal health in acute health services and area mental health services (CQI tool) was developed, after the Victorian Department of Health Improving Care for Aboriginal People (ICAP) and Koori Mental Health Liaison Officer (KMHLO) programs were formally reviewed. The self-reflexive CQI tool was designed to provide a process for Victorian health services adopt in order to provide more culturally responsive care to Aboriginal people.

The present study aimed to uncover barriers and enablers to the uptake and completion of the cultural competency tool in rural Victorian health services and gather information, where possible, about how the tool has been used and reported on within rural health services. Semi-structured interviews were conducted with 20 CEO’s, Executive Directors, Finance Directors, Clinical Services Directors/Managers, Quality Managers and Nurse Unit Managers from rural health services across the greater Goulburn Valley area in Victoria. Analysis identified reasons for use or lack of use of the tool, the self-reflexive nature of the tool and issues of accountability. The ability of the current CQI tool to effect real cultural change within rural health organisations is discussed and the appropriateness of the accountability associated with the CQI tool is critically examined.  If rural health services are to appropriately service the needs of all residents, processes to increase cultural inclusion have to be prioritised.

Slides | Paper
Sarah Moeller
Starlight Children’s Foundation and Earbus Foundation of Western Australia: an impactful partnership
Biography

Ms Sarah Moeller has an undergraduate degree from the University of Melbourne in Science, majoring in Genetics and Psychology and a Masters degree in Social Work also from the University of Melbourne. Sarah joined the Starlight Children’s Foundation after her graduation in 2014 and is now the Manager of Research and Evaluation. Sarah is passionate about increasing the understanding of needs and experiences of seriously ill children, young people, their families and health professionals in order increase Starlight’s program impact.

Abstract

Since 1988, the Starlight Children’s Foundation (Starlight) has been delivering programs, in partnership with health professionals, which support the total care of children, young people and their families who are living with a serious illness or a chronic health condition.

The Captain Starlight program was first launched in in 1991 and today there are 111 Captain Starlights across Australia. The program is delivered by professional performers from a wide range of backgrounds including actors, clowns and comedians. They engage with children and young people through activities such as art, music, story-telling, comedy and games to alleviate boredom and reduce anxiety. With a specific commitment to reaching regional and remote areas, the Captain Starlight program has been operating in the Northern Territory since 2006. In 2015 Captain Starlight undertook over 128 trips to 35 different Indigenous communities and reached over 400 children per month.

On the basis of this work, a partnership was formed with Earbus Foundation of Western Australia in early 2015. Earbus mobile ear health clinics offer full primary health care to Aboriginal children in schools, day-cares, kindergartens and playgroups. As well as providing comprehensive ear screening, the Earbus employs GPs, audiologists and ENTs in order to reduce the incidence of middle ear disease in Indigenous and at-risk children in Western Australia below the World Health Organization benchmark of 4%. The focus of Earbus’s work is Otitis media, which can affect every aspect of early childhood development, including the ability to learn and succeed in school and hence creating lifelong barriers that prevent children from achieving their full potential

This paper will explore the successful partnership between Starlight and Earbus and examine its role in reducing the incidence of Otitis media. Feedback from health professionals working with Starlight regularly has highlighted that Captain Starlight’s presence in the health clinics encourages attendance and reduced anxiety in children waiting for their health check. Earbus Foundation KPI data shows both the Pilbara and Godlfields regions of WA to be significantly improved across a range of important ear health measures.

The paper will provide practical insights into successful on-the-ground service delivery, draw out insights and highlight lessons learnt. Earbus and Starlight are currently planning to undertake further research in order to ensure the program is meeting the needs of rural and remote living Indigenous children in Australia.

Slides | Paper
William Moorhead
Effective rural placements: a national study of experiences amongst multidisciplinary health students
Biography

William Moorhead is Chair of the National Rural Health Student Network and a final year medical student at the University of Queensland. Before starting his medical degree in 2015, he completed a Bachelor of Pharmacy. William’s passion for rural health stems from the wonderful care he received growing up in Bundaberg, and on his family’s travels across Australia. He aspires to be a rural medical generalist, influencing positive change in rural communities. To that end, he has written a submission to change the treatment guidelines on type 2 diabetes care for the Kimberley. William has taken part in the John Flynn Placement Program at Bargara, Queensland. He has also visited Atherton, Stanthorpe, Warwick and many other places as part of his medical studies and Rural Health Club activities.

Abstract

Aim and objectives: There is significant evidence that positive rural experiences can increase the intentions of health students to practise rurally following graduation. However, research is increasingly showing that any experience does not necessarily equal a good experience. While positive rural placements increase rural practice intentions, poor experiences have been shown to turn students away.

Members of the National Rural Health Student Network (NRHSN) have anecdotally expressed concerns that the quality and accessibility of rural placements may vary based on which health degree one chooses to study. The NRHSN Executive Committee subsequently undertook a study of its membership to compare and contrast a range of placement factors between different health degrees.

Method/design: The NRHSN undertook a national, survey-based, cross-sectional study to assess the attitudes and experiences of its medicine, nursing and allied health student members with regards to rural clinical placements. The survey included questions regarding demographics; rural background; details of university study; perceived positives and negatives of rural placements; number of rural placements undertaken; and a number of details relating to the most recent rural placement undertaken.

Results: Responses were received from 897 health students, of which 542 were studying medicine and 355 were studying dentistry, nursing, midwifery or an allied health degree.

Compared with medicine students, non-medicine students were significantly more likely to have to organise the majority of their placement themselves (20% vs 7%; p<0.001). They were also significantly less likely to have control over their placement location (69% vs 78%; p=0.023) and to be provided with financial (36% vs 67%; p<0.001), mental health (32% vs 49%; p<0.001) and social (28% vs 49%; p<0.001) supports. Non-medicine students were also less likely to have staff available to orient them to the health service (71% vs 85%; p<0.001) and community (37% vs 57%; p<0.001) where they were undertaking their placement. Compared with medicine students, non-medicine students on average spent an additional $55 per week on accommodation (p=0.024) and had a total increased placement cost of $563 (p=0.016).

Overall, 62% of respondents indicated that their most recent rural placement had increased their intention to practice in a rural or remote location in the future.

Conclusion: We found that amongst NRHSN members, those studying health degrees other than medicine had significantly less rural placement support in all domains when compared with medicine students. Rural placements increased rural practice intentions for the majority of students.

Slides | Paper
Anna Morell
Australia’s health workforce: geographical distribution and the relevance of a vulnerability index
Biography

Anna Morell is in her final year of a Professional Doctorate in Applied Public Health (DrPH) through the University of New South Wales’ Future Health Leaders Program. Her research focuses on Australia’s rural and remote health workforce, geographic distribution mechanisms and retention. Anna is employed in the Health Analytics Branch at the Australian Government Department of Health, and conducts project work in collaboration with department’s Health Workforce Division. Anna is experienced in health workforce policy and project management and worked previously in the International Health Professionals work group at Health Workforce Australia, where she managed the Rural Health Professionals Program. Anna’s qualifications include a PRINCE2 Practitioner certification and a Master of Health and International Development from Flinders University of South Australia.

Abstract

Recent literature suggests health workforce geographic distribution mechanisms, such as geographic classification systems, incentives and regulatory measures, can be useful in helping to direct health professionals into priority areas. However, strategic analysis is required to refine and better target distribution policies across a range of workforce programs.

The Department of Health is conducting geospatial analysis of the distribution of primary health services across Australia. Taking into consideration a range of datasets, it is possible to explore not only the supply of health professionals and primary health services in a particular geographical region or catchment, but also additional factors, such as the socioeconomic, demographic and geographic characteristics of a community.

This research aims to support development of a vulnerability index for use by policymakers, to better identify the unique needs of communities, at a more refined level than what current mechanisms offer.

A vulnerability index in the health workforce context will support evidence-based policy around improved rural and remote health workforce initiatives, to ensure the community has an adequate level of access to health services in the right place, at the right time.

Paper
Bronwen Morrison
Five years of ADI integrated rural health patrols in New Ireland, PNG
Biography

Dr Bronwen Morrison (FRACGP MBBS (Hons) BA Grad Dip Writing) is a general practitioner based on the Central Coast of New South Wales, Australia, with an interest in public health, rural and tropical medicine, and women's, youth and mental health. She worked in human resources, teaching and training prior to her career change to medicine. Bronwen is also President of PAIGA, a small not-for-profit organisation supporting development work in the Papua New Guinea Highlands. She spent six months of 2016 volunteering as patrol doctor for Australian Doctors International in the beautiful province of New Ireland, Papua New Guinea, travelling with a local allied health team and delivering health worker training and clinical services to remote communities.

Abstract

Australian Doctors International (ADI), with New Ireland Provincial Health and Kavieng Hospital in New Ireland, PNG, have provided outreach services to remote rural areas since 2011, to deal with the needs of a rapidly growing population in maternal and child health, communicable and lifestyle disease. Integrated Health Patrols combining local allied health expertise with ADI Patrol Doctors deliver one patrol per month to local government areas; two-thirds are more than four hours’ travel from Kavieng Hospital. In addition to eye, dental, physiotherapy, sexual and reproductive health, medical care and community health education, the patrol supports rural health workers with training and organisational input to build on local health services in line with government health goals.

Integrated Health Patrol achievements include a total 69 patrols (711 days on patrol), with over 220 New Ireland health centre, aid post or village visits, 13,762 patients seen by ADI Patrol Doctors (63% in remote/very remote locations) and 90,161 services delivered by allied health patrol professionals, at a cost of approximately PGK22 (AU$10) per patient seen, over 2,220 teaching hours with rural staff, and over 80% of rural staff attending ADI in-service workshops.

ADI engaged an external evaluator to review the first five years of the patrol program. Successful outcomes include strategies to address identified gaps. First, yearly patrols to multiple sites in each local government area increase limited rural access to health services, including where aid posts have closed. Second, training and other patrol team input, including Local Health Managers when available, increases levels of supervision and support for remote health workers. Third, high maternal health needs are addressed by focused on-the-job and in-service health worker training and Patrol Midwife, MCH and Family Planning Officers. Fourth, government priority areas of tuberculosis, diabetes, malaria and respiratory infections are addressed by inclusion of Disease Control and Community Education officers on patrol, and focused health worker training provision.

This unique model of rural health service provision has the advantages of cooperative partnerships focused on government goals, a flexible team approach delivered cost-effectively to community doorsteps, and a reporting system whereby patrol data is used to inform future planning of health services and workforce training. The integrated patrol model has potential application in other PNG provinces and the Asia Pacific region. A staged handover is planned by 2021 wherein local partners are enabled to take over aspects of patrol and in-service programs currently managed by ADI.

Slides | Paper
Joshua Mortimer
Effective rural placements: a national study of experiences amongst multidisciplinary health students
Biography

Dr Joshua Mortimer is a Junior Medical Officer at Coffs Harbour Base Hospital and Media Officer for the Australian College of Rural and Remote Medicine's Future Generalists' Committee. He has been involved with rural health advocacy and research for a number of years, including as past Vice Chair of the National Rural Health Student Network. Joshua received his Medicine and Honours degrees from the University of New South Wales and has previously been a finalist in the NSW Health Innovation Awards for his research into cancer care in regional NSW. He has a passion for all things rural and believes that no one should have to suffer poor health outcomes simply because of where they choose to live.

Abstract

Aim and objectives: There is significant evidence that positive rural experiences can increase the intentions of health students to practise rurally following graduation. However, research is increasingly showing that any experience does not necessarily equal a good experience. While positive rural placements increase rural practice intentions, poor experiences have been shown to turn students away.

Members of the National Rural Health Student Network (NRHSN) have anecdotally expressed concerns that the quality and accessibility of rural placements may vary based on which health degree one chooses to study. The NRHSN Executive Committee subsequently undertook a study of its membership to compare and contrast a range of placement factors between different health degrees.

Method/design: The NRHSN undertook a national, survey-based, cross-sectional study to assess the attitudes and experiences of its medicine, nursing and allied health student members with regards to rural clinical placements. The survey included questions regarding demographics; rural background; details of university study; perceived positives and negatives of rural placements; number of rural placements undertaken; and a number of details relating to the most recent rural placement undertaken.

Results: Responses were received from 897 health students, of which 542 were studying medicine and 355 were studying dentistry, nursing, midwifery or an allied health degree.

Compared with medicine students, non-medicine students were significantly more likely to have to organise the majority of their placement themselves (20% vs 7%; p<0.001). They were also significantly less likely to have control over their placement location (69% vs 78%; p=0.023) and to be provided with financial (36% vs 67%; p<0.001), mental health (32% vs 49%; p<0.001) and social (28% vs 49%; p<0.001) supports. Non-medicine students were also less likely to have staff available to orient them to the health service (71% vs 85%; p<0.001) and community (37% vs 57%; p<0.001) where they were undertaking their placement. Compared with medicine students, non-medicine students on average spent an additional $55 per week on accommodation (p=0.024) and had a total increased placement cost of $563 (p=0.016).

Overall, 62% of respondents indicated that their most recent rural placement had increased their intention to practice in a rural or remote location in the future.

Conclusion: We found that amongst NRHSN members, those studying health degrees other than medicine had significantly less rural placement support in all domains when compared with medicine students. Rural placements increased rural practice intentions for the majority of students.

Slides | Paper
Gavin Mosby
Our community driving our health
Biography

Gavin Mosby is currently the chair of Gudhmud ATSI Health Corporation, the local health committee of Masig Island, Torres Strait, Queensland. He is a TO of Masig, which is part of the Kulkalgal nation of Zenadth Kes (Torres Strait Islands). Born on Thursday Island and raised and educated in Cairns, Far North Queensland. Gavin’s professional background is in hospitality and catering. He obtained his qualification as a chef in 1991 and worked for many of the major hotels and resorts from Mossman to Townsville, including the Sheraton, Radisson, Park Royal and Hilton groups. He started commercial fishing in the east cost fishery in 1990 out of Cairns for coral trout, eventually bringing him back to the Torres Strait region. After obtaining his maritime licence he began working throughout the Eastern Torres Strait now working tropical rock lobster and alternately bech de mer in the off seasons. After relocating back to Masig in 1990, he began working for the community freezer as the company’s processing manager. He has also been a part of the Masigalgal Turtle and Dugong Management Plan, his role as the Turtle and Dugong Officer working for the Torres Strait Island Regional Council. He has actively engaged in a number of community development projects, including the reinstatement of the Yorke Island Fisherman’s TSI Corporation. Gavin currently is a member of the Torres Strait Prawn Management Committee as well as a regional representative to Australian Fisheries Management Authority in most commercial fisheries matters. His main interest is health, fishing and sport. Gavin still fishes commercially for rock lobster, coral trout, mackerel and bech de mer. He is currently the Student Welfare Officer of the local primary campus and working alongside the Local Council’s Healthy Lifestyle Officer to initiate and run the school walking bus and breakfast club programs. Gavin’s philosophy is, “Work hard together to walk forward as one for those who will come after us in the future.”

Abstract

Aim: Our project “Lessons from the Best to Better the Rest” looked at high continuously improving services to find factors that might be associated with high continuous improvement. We found that ‘communities driving health’ was one of them. The aim of this paper is to understand the way in which one Torres Strait Islander community drove healthcare resulting in high levels of continuous improvement.

Methods: A case study design, in partnership with the services, was used. The services were selected through standard continuously quality improving (CQI) audits. We visited services and interviewed service providers, clients, community members, and managers at the local and regional levels (n=134). We then looked at themes within each service and compared themes across the services at the macro (external system), meso (local system) and the micro health system (client – health provider interaction). Feedback visits and collaborative meetings with all services were conducted.

Relevance: Community participation in health care is continually promoted. How this plays out in different services varies. The benefits of community participation are seen to be a level of community ownership and more relevant and accessible health services.

Results: In this health service, located in the Torres Strait, we have an important example of a community driving health care, using a holistic model of health, and working in partnership with trusted health professionals. Community history and culture influenced all aspects of health so that a unique local way of doing things prevailed. ‘Our culture is our way of life’. This resulted in a highly continuously improving accessible service with trusting and valued relationships between community members and dedicated health providers. The usual clear distinction between ‘patient’ and ‘provider’ was absent. “Whole of community” means health promotion and treatment is for all. One crucial element is the Gudhmud Aboriginal and Torres Strait Islander Health Corporation Health Committee bringing together community and health leaders, and other agency staff about issues to do with the overall health of the whole community. 

Conclusions: This is a clear example of what is often talked about as the ‘gold standard’ in community participation.  “Our culture is our way of life’ and ‘serving our people’ underlie all aspects of service and result in a high continuously improving health service. The community is in control of operationalising their health care and working in highly valued partnerships with their dedicated health professionals.

Slides
Alice Munro
Nothing changes if nothing changes: a remote Aboriginal residential rehabilitation service evaluation
Biography

Alice Munro is a rural social worker and accredited mental health social worker who has worked to establish and deliver Aboriginal drug and alcohol services across the Murdi Paaki region of NSW since 2009. In 2014, Alice commenced a PhD with the National Drug and Alcohol Research Centre (NDARC). Her research is evaluating community-led drug and alcohol programs and a remote Aboriginal residential rehabilitation service in Western NSW. Alice lives and works on Wiradjuri country in Orange, NSW.

Abstract

Background: Risky levels of drug and alcohol-related harm among Aboriginal Australians are both a consequence of, and contribute to, the disproportionate health and social gap between Aboriginal and non-Aboriginal Australians, especially in rural and remote Australia. High quality Aboriginal drug and alcohol residential rehabilitation services are an important form of treatment for Aboriginal substance users and are therefore making a vital contribution towards the Government’s target to close the life expectancy gap within a generation. However, limited available evidence exists about the models of care being delivered, client characteristics and the range of data being collected.

Orana Haven Residential Rehabilitation Service (OH) is a 3-month voluntary rehabilitation program for Aboriginal males. OH is a dynamic Aboriginal Community Controlled Health Organisation that has been in operation since the 1980s and is the only service of its kind in Western NSW. The National Drug and Alcohol Research Centre (NDARC) have been invited to partner with Orana Haven Residential Rehabilitation Service (OH), located in remote western NSW, to work with them to evaluate, tailor and monitor their program from 2015-2017.

Aims:

  1. Outline the OH Model of Care;
  2. Describe the demographic and client characteristics of OH between 2011 and 2016; and
  3. Analyse perceptions of staff and clients about their experience of the OH program, especially in relation to OH’s primary purpose of providing culturally safe drug and alcohol treatment.

Methods: This research adopted a mixed methods approach to evaluate the program, including the analysis of five years of demographic, referral and service utilisation characteristics of clients, and semi-structured interviews with staff and clients to understand the perceptions of the program.

Results: The Model of Care was developed in consultation with OH staff and clients. The program is defined by three guiding principles (strong governance, skilled staff and effective and culturally safe service delivery) and five core components (consistent routine and rules, counselling and case management, groups, culture and identify and learning and development of skills.)

From 2011-2016, the service had a total of 329 clients (average age 36 years) access treatment, with the median length of stay of 55 days. A total of 84% of clients identified as Aboriginal or Torres Strait Islander and 77% were referred from Corrective Services.

Themes from the qualitative analysis included: hopes for the future, impact of substance abuse for both clients and staff, the positive perception of the rehabilitation being located in a remote location and the importance of culture and spirituality that is embedded within the program.

Conclusions and implications: This is the first evaluation of this kind focusing on defining and strengthening a remote Aboriginal drug and alcohol rehabilitation service in Australia. The implications of this research is to highlight the value of Aboriginal residential treatment to clinicians, academics, policymakers and senior bureaucrats more broadly, as well as make recommendations to strengthen the OH model of care to ensure it continues to be leading service in the field of Aboriginal substance abuse treatment, both in Australia and internationally.

Slides | Paper
Monica Murray
Tele-home monitoring in rural and remote health district and Aboriginal Medical Services
Biography

Monica Murray is currently employed by Western NSW Integrated Care Strategy as a Project Manager, coordinating a three-year district-wide initiative to develop and implement innovative locally led hospital-substitution models of care. Projects have included the expansion of Hospital in the Home and Ambulatory Care into rural and remote health facilities and coordinating two Home Tele-Monitoring Trials. Monica has a background in nursing, midwifery, child and family health and management of community and allied health in central west NSW. She completed HETI Rural Research Capacity Building Program (2012) Healthy Kids Study: BMI at pre-school immunisation and Healthy Kids Check, nurse and parent perception and level of concern and an uncompleted Masters in Public Health. Her professional interest include research, change management and rural/remote health.

Abstract

NSW Health rural e-health strategy provided funding to rural Health Districts to trial remote tele-home monitoring in the Hospital in the Home (HITH) setting. Two trials commenced in Western NSW Local Health District (WNSWLHD) in 2016.

Trial one is targeting HITH inpatients with acute, post-acute or sub-acute illness and community outpatients with chronic disease. Multiple sites are participating including large base health services, medium-sized procedural hospitals and small rural and remote health facilities.

Remote tele-health home monitoring is an emerging technology and service, provided to small degree in WNSWLHD by non-government organisations like Integrated Living and CareWest. The WNSWLHD trial represents an opportunity to pilot tele-home monitoring technology with public health service clinicians and key community partners to test how it can be integrated into current HITH, community health and Primary Health Networks in rural and remote NSW. Staff initially targeted to manage tele-home monitoring are community or HITH nurses.

The second trial is a partnership between WNSWLHD and Bila Muuji Aboriginal Medical Service Group. Eight Aboriginal Medical Services in Bourke, Brewarrina, Wellington, Orange, Dubbo, Coonamble, Forbes and Walgett will trial tele-home monitoring with their community clients with chronic disease. The partnership will facilitate sharing of resources and early learnings from the first trial and supporting local Aboriginal Medical Services to test tele-home monitoring within their unique business models, staffing and clientele.

The purpose of the trials are to expose clinicians to this technology; test tele-home monitoring equipment with existing clients and evaluate if the additional biometric data contributes to better informed health care decisions and earlier detection of clinical deterioration in health status. The trial objectives include:

  • acceptance of tele-home monitoring by health service medical and nursing clinicians and patients
  • useability of tele-home monitoring within existing rural and remote HITH, community health, primary care and AMS service delivery
  • relevance of tele-home monitoring with the target groups to detect early deterioration in health potentially leading to reduced frequency of hospitalisation, presentation to the emergency department, decreased  length of stay or increased referrals to HITH
  • improve patient knowledge and capacity to self-manage.

Guidelines, clinical tools, professional and patient resources were developed, with trial one training and patient enrolment commenced in May 2016. Trial two partnership with Aboriginal Medical Services commenced in October 2016.

Progress reports will be presented on both trials, outlining early learning’s, key challenges, issues and successes.

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