Concurrent Speakers

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Kris Ralla-Baker
IDEAS Van—bringing specialist ophthalmic treatment to rural and remote communities
Slides
Michelle Reay
Channel Country Ladies Day
Biography

Michelle Reay and her husband Jon run Durham Downs Station, a 2.2-million-acre cattle station in far western Queensland, 220km west of the closest town of Eromanga. Having completed a Bachelor of Exercise Science (Honours) at John Moores University in Liverpool, Michelle has lived in the Channel Country ever since arriving from England and taking up work for a contract musterer in the area 17 years ago. Between ensuring the education of her four boys through School of the Air and now boarding school, and travelling hundreds of kilometres to participate and assist with community events, Michelle never stops. In 2015 she completed the Rural Leaders Bootcamp and in 2014/15 she participated in the Women’s Advanced Leadership Program with Women and Leadership Australia. Michelle’s involvement in the Channel Country Ladies Day stems from the inaugural event at Durham Downs, which she helped to make happen despite the challenges of weather that were thrown at the organisers. Of Ladies Day she says "seeing the profound impact this event has on the women attending and all the people volunteering to help with the weekend. There’s an energy created that is unlike any other event I have been to and I love being a part of something so positive. Bringing just women together with such great attitudes and aspirations in remote locations like we do—with open minds and without judgement, just seems to generate infinite inspiration and connection that creates energy and motivation that keeps you going and going. It’s great to be part of a committee made up of such dedicated and diverse women."

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
Sara Renwick-Lau
WANTED: Doctors for Mallacoota—a remote community’s approach to finding doctors
Biography

Dr Sara Renwick-Lau is Mallacoota’s doctor with a passion for providing her small remote community with the right care, at the right time and in the right place—those three things being etched into the core of her practice ethos. From her medical student days Sara has been committed to training and working in small remote communities around Australia, along the way encountering the many inspiring and talented rural GPs who have been invaluable mentors. After learning “general” specialties at the Royal Darwin Hospital, she participated in the PGPPP as a junior doctor and as a medical educator then completed her GP training in small remote communities in Arhnem Land, NT. Sara and her family discovered the small, remote idyllic hamlet of Mallacoota in Victoria in 2008 and joined the Mallacoota Medical Centre as the third doctor. This gave her the opportunity to pursue a challenging and rewarding career and her favourite family and outdoor activities. In 2016 when she became the sole doctor serving the medical needs of the whole town and many thousands of annual visitors, instead of burnout she chose to inform and engage her local community, who now take a large responsibility for doctor recruitment and the continuity of their own medical services. This leaves Sara with a little more time to enjoy time with her family and other important things, like surfing, riding her horse and learning how to ride a skateboard. Find out more about Sara and her community recruitment team at www.mallacootamedical.com on Facebook @mallacootadoctorsearch.

Abstract

Imagine you live in a small Victorian RA4 town, recently the subject of ABC’s Backroads Program. Half-way between Sydney and Melbourne, 3.5 hours from Canberra, in the heart of Australia’s Wilderness Coast surrounded by the 88,360 ha Croajingolong National Park. Trekking the surrounding wilds, fishing in your pristine bream-filled lake system, golfing to the sound of the waves breaking ~ an everyday possibility.

You are likely to be over 50 as is 57% of Mallacoota’s resident population of around 1,000. During the Christmas - Easter period you experience the population swell by 5000. And if you need to visit hospital, you know that you are two hours from any hospital or emergency care.

In recent years the town had three doctors in a private medical practice providing a full range of services but since December 2015, due to retirements, only one. In April 2016 your remaining GP organised a community meeting to inform you that she needed your assistance, particularly in securing new doctors for the town. Traditional approaches to attracting doctors had been unsuccessful.

Your vibrant community brings people together for music, fishing, photography, artisan markets, bird watching, writing and book clubs, sports clubs, walking groups, a contemporary art gallery, a local radio station and many other groups and activities. It is thus no surprise that you now have a new community group committed to finding doctors to join the local medical service and welcoming them into your community. Because that’s what your community is like.

This paper shares “the story so far” of Mallacoota’s search for additional doctors. The authors will give you a very special insight into the actions that they have undertaken in the last year to educate this tiny, isolated community about the health care issues they face and how they have responded under the leadership of their local GP: setting up a Community Doctor Search Working Group and a community charitable fund to assist the Medical Practice and build community resilience. Finally, after an exposé of medical challenges in paradise, they will, hopefully, be able to share their success in locating and welcoming one or two experienced rural medical practitioners to their wonderful town.

The authors are the community’s only GP, two members of the Doctor Search Working Group and of the newly formed Mallacoota Community Health, Infrastructure and Resilience Fund (CHIRF).

Slides | Paper
Janet Richards
Providing socially accountable medical education: student perceptions from two Australian medical schools
Abstract

Background: Flinders University (FU) and James Cook University (JCU) are founding members of the Training for Health Equity Network (THEnet), an international community of practice involving eleven socially accountable health professional schools that align their training, research and service with the needs of underserved populations. An important strategy of THEnet schools involves integration of the social mission into many elements of medical education. However, socially accountable health professional education assumes that learners understand the social mission of their school and the social accountable curriculum as it was intended to be understood. Currently, scientific evidence to substantiate this assumption is lacking. It is important for schools addressing the workforce shortage in underserved areas to understand student perceptions of this mission.

Aims: The aim of this study was to describe how learners at socially accountable medical schools perceive and engage with the social mission of their school. Developing a robust understanding of learners’ perceptions may inform curricular development.

Methods: This qualitative study draws on the results from two Australian medical schools that participated in the international study Accounting for Learners’ Perceptions of Social Accountability in THEnet Schools. A mixed convenience and purposive sample of domestic, final year undergraduate medical students were recruited (n=14) to participate in semi-structured interviews. Interviews were transcribed in full and analysed using abductive coding in a grounded theory framework.

Results: The participants of JCU perceived the schools social mission to prepare graduates with an understanding of social justice, social inequity, health workforce shortages and health disparities in disadvantaged communities. While initially their career intention may not have been to practice rural medicine over half the participants reported developing a genuine interest in rural, Indigenous and tropical medicine during their rural and remote clinical placements. Participants reported agreeing with and seeing the value of JCU’s social mission.

The majority of FU participants studied medicine with intent to practice in rural or remote regions which was reinforced by a curricular focus on cultural awareness, social accountability and diversity. The clinical placements reflected the schools social mission by exposing interested students to rural and remote clinical contexts. Those participants not interested in rural practice while agreeing with and valuing the school mission did not change their career intention.

Conclusions: Learners at both medical schools understood and valued, or grew to value, the social mission of their schools however clinical experiences in underserved settings alone did not necessarily change their career intentions.

Slides | Paper
Catherine Ridley
Empowering Aboriginal families in parenting: Jandu Yani U 'For All Families'
Biography

Catherine Ridley is a Wankajanka woman, born in Kalgoorli, who grew up on Christmas Creek Station on the edge of the Great Sandy Desert. She now lives with her husband and five children (four adult children and one in secondary school) in Fitzroy Crossing. Catherine has many skills in various areas, she is a qualified interpreter and obtained an Indigenous Community Management Degree and a Bachelor of Applied Science Degree through Curtin University of Technology. She is also in the process of starting a Masters Degree. Catherine is also a registered carer and has worked for various government departments in her career. She works as a Remote School Attendance Strategy (RSAS) Program Manager in which she leads the RSAS team in supporting and assisting families to have their kids attending school on a regular basis. This includes late student pick ups, family visits, keeping records of activities with the families, engaging families with the school, working with the department of education and various community programs, referring families to appropriate agencies, recognising the students attending school on a regular basis and their families’ hard work to get them there. Catherine believes teaching parents skills like those in the Positive Parenting Program (Triple P) are key to the RSAS strategies. Catherine was trained in Triple P in May 2016 and joined the team of 18 newly trained local parent coaches in August. She has been a huge support and motivator to the team and has already taught four classes to families throughout the Fitzroy Valley. She is well known and respected throughout the Fitzroy Valley and is fast becoming known for her knowledge about parenting skills.

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
Andrea Rieniets
Use of arts for 0–12 year olds to lead change in local communities
Biography

Andrea Rieniets is a songwriter, composer, musical director, musician and singer performing at venues such as Womadelaide and the Famous Spiegeltent; and directing community choirs such as Adelaide’s Before You Were Blonde contemporary community choir, and Sing It Up Big Australian Indigenous Choir.

Abstract

Kids Thrive is Melbourne’s leading arts and community development organisation committed to child-led community change. Kids Thrive co-designs and delivers programs partnering artists with specialists in children’s health, education, welfare and social justice. It uses the arts to tackle issues that children experience arising from trauma, disadvantage and cultural conflict, and to expand children’s creativity, communication and social skills.

Andrea Rieniets and Ande Lemon as Directors of Kids Thrive bring over 30 years’ experience as respected artists and community cultural development workers. Ande and Andrea’s work takes a long-term, heart-centred view of children as collaborators in, and creators of community.

Slides
David Roberts
Engaging rural Aboriginal communities through social media to promote healthy lifestyles
Biography

David Roberts completed a Bachelor of Arts (Social Science) at Monash University Gippsland, and has spent 25 years as a community development worker in a range of environments, including health, youth, welfare, education and sport. In his spare time, David has been actively involved in sport as a coach, administrator and volunteer. During the last 11 years, he has led junior basketball teams to compete and experience the sporting culture of the USA. David is an early adopter of technology and has been innovative at utilising this in the workforce, including SMS marketing, online training, video storytelling and social media. David’s current employment with the ‘Sport and Health Social Marketing Strategy’ at GippSport has successfully combined his sporting interest, love of technology and commitment to community into one role. Working with the Aboriginal communities across Gippsland to share positive stories, promote community events, interview local role models, promote healthy choices and ultimately improve the health outcomes for the Indigenous community through social media has been one of David’s most rewarding employment opportunity’s to date. David looks forward to sharing these experiences and the projects key learning’s with you.

Abstract

Project overview: This Victorian Koolin Balit funded project aims to improve the burden of chronic disease among Aboriginal communities and ultimately increase life expectancy. This project has involved the implementation of a sport and health social marketing strategy to deliver population based health promotion, improve healthy lifestyles among Gippsland Aboriginal communities and build the capacity of local Aboriginal health and community organisations to use social media. The project is delivered by GippSport (a Regional Sports Assembly), and is now commonly known as ‘Deadly Sport Gippsland’.

The project has predominantly focused on Facebook, as research has found that 70% of Aboriginal and Torres Strait Islanders in Australia own a Smartphone and 61% of indigenous Australians in regional areas (44% in remote areas) use Facebook on a daily basis, compared to 42% of adult Australians nationally.

Implementation: A targeted social marketing strategy was developed to include YouTube videos, Facebook content and social media advertising that has involved use of tags and key words to prompt community members to engage with health messages. A dedicated Deadly Sport Gippsland website with calendar events and health blogs has also been established with links back to social media.

Establishment of networks has included linking with local Aboriginal sports committees and community health organisations to encourage and coach them in the use of social media in order to increase their reach to Aboriginal communities. Sporting events, photos and interviews with local people have also been used to increase engagement with health message content.

Outcomes: This project has demonstrated the impact of social media for health promotion by attracting over 2,200 followers, engaging up to 1600 people each week and producing over 140 videos with up to 3,500 video views a week.

Feedback through community surveys and interviews identifies people have made healthy behaviour changes as a result of the social media content and that they have spoken to family and friends about these health campaigns. Networks and partnerships with local health and community organisations have been strengthened with greater awareness in the community of events and services evident from attendance numbers. Social media has also provided a platform to promote local role models.

Conclusion: Sport is an effective vehicle for engaging people in social media health campaigns. Social marketing is an efficient, current and relevant way to reach communities to promote healthy lifestyle messaging that can be replicated in any setting in Australia.

Slides | Paper
Russell Roberts
Meet the editors, Australian Journal of Rural Health
Abstract

Thinking about publishing research on rural and remote health?

Want to know more about peer review and the pathway to academic publication?

Interested in becoming involved with the journal as a reviewer or in some other capacity?

Meet the editors of The Australian Journal of Rural Health in a special session designed to clarify publishing procedures and improve your chances of being published in our journal and others.

Editor in Chief Russell Roberts and Associate Editor Jeff Fuller will be available to discuss the editorial policies and priorities of AJRH and answer your publishing questions.

New and established authors are welcome!

Now in its 25th year of publication, AJRH provides research information, policy articles and reflections related to health care in rural and remote areas of Australia. Since its inception, AJRH has contributed significantly to the publication of research reports and expert opinion on rural and remote health.

Slides
Louise Robinson
Delivering an integrated system of care in western New South Wales
Biography

Louise Robinson graduated from the University of Sydney as a physiotherapist and has lived and worked in western NSW for the past 22 years. Louise has worked in both the public and private sectors, in a range of clinical and leadership roles. However, her interest lies in working with care providers to redesign how care is delivered to better meet the identified local needs. Louise commenced as the Program Manager for the Western NSW Integrated Care Strategy in October 2014. The Western NSW Integrated Care Strategy aims to transform existing services in the region into an integrated system of care that is tailored to the needs of our rural communities, and improves access to care and health outcomes, with a particular focus on closing the Aboriginal health gap.

Abstract

Introduction: Western NSW (WNSW) is one of the most vulnerable regions in Australia with a fractured service network and poor health outcomes. A strategy to transform current services into a patient centred, coherent system of care is well into its third year with WNSW Local Health District (LHD) leading the way as a NSW Health Integrated Care Demonstrator Site. A range of district-wide and locality-based integrated care initiatives are being implemented to better connect providers to improve health outcomes for the region.

Methods: The WNSW Integrated Care Strategy is being implemented using a collaborative partnership approach between the LHD, the Western Primary Health Network, and Bila Muuji Aboriginal Health Services. The vision of the strategy is: To transform existing services into an integrated WNSW system of care that is tailored to the needs of our rural and remote communities, and improves access to care and health outcomes, with particular focus on closing the Aboriginal health gap.

A key element of the strategy was the establishment of local demonstrator sites to test new models of care at a locality level. Local Leaderships Groups were established at each site and tasked with developing and implementing locally led integrated models of care tailored to their identified local health needs. Features of the demonstrator site models of care include:

  • GP-led multi-disciplinary team based care
  • standardised risk stratification process to target identified cohorts
  • comprehensive assessment to address medical and social care needs
  • shared care planning
  • health and social care coordination
  • multi-disciplinary case conferencing.

Results: Over two and a half years the strategy has:

  • established a Health Intelligence Unit providing a ‘one-stop-shop’ for health care data, analysis, advice and support
  • established nine local demonstrator sites focusing on chronic disease management, the first 2000 days of life and dementia.
  • strengthened the connection between care providers in a locality
  • appointed local Health and Social Care Coordinators based in primary care
  • development of risk stratification criteria
  • introduced primary care based multidisciplinary case conferencing.

Early analysis of the enrolled cohort is indicating an improved health journey, improved health outcomes and a reduction in acute care utilisation

Discussion: A key objective of the strategy was to develop sustainable models of care that are easily and rapidly transferable to other sites and localities. We consider the learnings from our experience in transforming our local health system transferable to other contexts, with suitable tailoring to local funding, delivery and accountability environments.

Slides | Paper
Jennie Roe
Pathways to integrated health care in southern New South Wales
Biography

Jennie Roe has extensive experience in health and social services, across non-government agencies and the public sector (including as a senior executive in the Australian Government). Her varied experiences include driving high-profile primary health care reforms (including the establishment of Medicare Locals for the Commonwealth Department of Health), developing and managing health programs and projects, leading significant population health initiatives, working as a health policy consultant, managing community services for a national NGO, teaching undergraduate health promotion and community development, and working in a British general medical practice setting. Her skills and interests centre on population health, primary health care, chronic disease prevention and management, working with vulnerable communities, and health data and informatics—all of which build on her early roots in nursing and community health promotion. Jennie also has a long-standing interest in women’s health consumer advocacy and she takes a keen interest in promoting greater awareness of prevention, early detection and living positively with chronic conditions.

Abstract

The world of rural health is formidable, affected as it is by the tyranny of distance, workforce challenges, more social disadvantage, poorer health problems, and less access to the range of services that urban residents have come to expect – and, therefore, a greater need to travel outside the region for specialist health care.

The HealthPathways initiative aims to facilitate integrated and coordinated health care across the region, through clear care and referral pathways. Our HealthPathways program is a four-way collaboration between the two primary health networks and two public health/hospital networks that straddle the largely rural south-eastern corner of NSW and the ACT, which includes the region’s only tertiary referral hospital in Canberra. Almost one-third of all surgical procedures performed in ACT public hospitals are on NSW residents.

HealthPathways provides an online tool for primary health care teams, to help guide patient assessment and management and appropriate referral to specialist and allied health and community services. The ‘pathways’ aim to help connect consumers with the right care, in the right place, at the right time and with the right provider. The clinical and referral pathways are developed and agreed by general practitioners, hospital clinicians and other professionals involved in local patient care and support services; thus the HealthPathways methodology is also a useful engagement strategy to promote communication and teamwork amongst local primary care and specialist providers.

The underlying premise behind HealthPathways is that the use of locally-agreed condition-based guidelines: (1) increases GP knowledge, (2) reduces inappropriate referral to specialist services, (3) improves pre-referral work-up and (4) enhances the accuracy of referral information to facilitate efficient triage. Further, the HealthPathways approach can also be used to target particularly intractable health services issues, such as clinical services affected by excessive wait times, and adjustments to local primary care services to support consumers while waiting for specialist assessment.

This presentation will showcase the impact of the HealthPathways initiative in the two years since it was launched in the region in April 2015, including the pathways development process, usage and reach amongst clinicians, impact on local service provision, as well as achievements, challenges and lessons learned.

Slides | Paper
Michelle Rothwell
Piloting a novel multidisciplinary telepharmacy medication review service in a rural community
Biography

Like you, Michelle Rothwell is passionate about providing safe and equitable healthcare for rural patients. Michelle is an experienced clinical pharmacist based at Atherton Hospital on the Cairns Hinterland in Far North Queensland. Michelle has the responsibility for medication management for two large rural hospitals and ten rural and remote sites. Michelle implemented the first pharmacy telehealth rural outpatient model of care in Australia which was presented at the 13th National Rural Health Alliance conference.   Michelle has a strong interest in research and her latest project is ‘implementing and evaluating a telehealth post-discharge and high risk medication management service’ funded by the Allied Health Professional Office of Queensland. Current roles include Rural Advisor to the Society of Hospital Pharmacists (SHPA), Chair of the SHPA Rural and Remote Advisory Group and chair of the Rural Director of Pharmacy Services Advisory Committee of Queensland.

Abstract

Aims: The main aim of this novel collaborative model of care is to decrease medication misadventure by providing a telepharmacy medication review service, to rural patients in their home, via a nurse with an iPad. The objectives of the pilot study were to discover if this collaborative hospital outreach medication review (HOMR) model of service delivery was feasible and to evaluate pharmacist intervention activity.

Methods: Twelve patients took part in the study which was set in a rural town with the pharmacist based in a rural hospital 19 kilometres away. Patients considered at immediate or high risk of medication misadventure were eligible and were identified by the community nurse on home visits using a standard risk assessment tool. If identified as at immediate risk of medication misadventure the nurse would phone the pharmacist to request an opportunistic medication review; if identified as high risk a medication review was arranged for within a 5 -7 day period. Videoconferencing equipment was a computer with a ‘Cisco Movi’ camera for the pharmacist and an iPad for the nurse and patient. The HOMR was conducted as per the Monash HOMR methodology and according to SHPA standards of practice for clinical pharmacy services.

Relevance: In Australia, studies show the percentages of hospital admissions due to medication related problems range from 5.6% in the general population and 30.4% in the elderly population, also that patient medication adherence is as low as 50–60% and that 59% of adults do not reach the minimum level of literacy required to understand health information. This collaborative model of care provides rural patients with greater access to a pharmacist and has the potential to decrease emergency department visits and hospital readmissions. The telepharmacy component could be utilised world-wide.

Results: All twelve patients were comfortable with the use of the technology and patient feedback indicated satisfaction with the method of service delivery. Seven patients were male and five were female with an average age of 81.5 years. The average number of medications per person was 12.83 and a total of 59 pharmacist interventions occurred of varying type.

Conclusion: Preliminary data from the pilot study indicates collaborative telepharmacy HOMR’s are an acceptable and effective service delivery model for rural communities. This exciting new model of care could have many implications for the future of rural pharmacist service delivery and could certainly be replicated to a world-wide context.

Slides | Paper
Deborah Russell
Health workforce turnover in remote Indigenous communities—who stays, who goes?
Biography

Deborah Russell is a Research Fellow at Monash Rural Health, Bendigo and came to academia with a background as a rural general practitioner. Her specific academic interests include rural and remote health services research (models of care, understanding and measuring access to health care) and health workforce supply, distribution, recruitment and retention. Her PhD ‘The patterns, determinants and measurement of rural and remote primary health care workforce turnover and retention’ positioned her as an emerging leader in her field. Her publications have significantly influenced current thinking about rural medical workforce retention methodology and rural workforce policy more broadly. Deborah remains passionate about improving equity of access to health care resources, currently having important roles on an ARC grant ‘Assessing the impact and cost of short-term health workforce in remote Indigenous communities in Australia’ and in the rural stream of the MABEL CRE in medical workforce dynamics.

Abstract

Aim: Health workforce geographical maldistribution is a persisting global issue linked to inequitable access to health services and poorer health outcomes for rural and remote populations. Anecdotal reports suggest that the primary health care (PHC) workforce in remote NT Indigenous communities is frequently characterised by undersupply, high turnover, low stability and high use of short-term (agency) staff. A lack of reliable quantitative studies limits evidence available to guide workforce policy improvements. This study seeks to quantify current resident PHC workforce supply, turnover and retention in remote NT communities with a predominantly Indigenous population.

Method: Analysis of NT Department of Health 2013-2015 payroll and financial datasets. Main outcome measures: staff headcounts, annual turnover rates, 12 month stability rates, 12 month survival probabilities, median survival, and ratio of agency nurse full time equivalent (FTE) to number of nurse positions in each remote clinic

Results: In 2013-2015, 53 remote health clinics were staffed by NT Department of Health personnel. Most clinics were small, with a median of 2.0 NT Department of Health employed nurses, 0.6 Aboriginal Health Practitioners, 2.2 other employees providing or supporting PHC. On average, there was an additional 0.4 FTE agency employed nurse also providing PHC in each centre. Few communities had a resident doctor.

Mean annual turnover rates were extremely high, irrespective of whether turnover was defined as no longer working in any remote clinic (66%) or no longer working at a specific remote clinic (128%). Stability rates were low, with less than a fifth of nurse and Aboriginal Health Practitioner employees still working in a specific remote clinic 12 months after commencing. On average, staff in remote clinics stayed less than 6 months. A substantial proportion of nurse positions were filled by agency nurses.

Conclusion: Health services in remote, predominantly Indigenous NT communities are small and currently experience very high nurse and Aboriginal Health Practitioner turnover, low 12 month stability rates and considerable use of agency nurses. Further, there are substantially fewer Aboriginal Health Practitioners providing care in these remote communities than the available positions. These staffing patterns, also found in other remote settings in Australia, not only contribute to a lack of continuity of care for vulnerable remote Indigenous populations with complex health care needs but incur higher direct costs for providing primary care services, thereby compromising both long term service sustainability and population health outcomes. To address these deficiencies it is imperative that investments in implementing, adequately resourcing and evaluating staffing models which stabilise the remote primary care workforce occur as a matter of priority.

Slides | Paper
Deborah Russell
Improving rural health: research activity can build capacity and make a difference
Biography

Deborah Russell is a Research Fellow at Monash Rural Health, Bendigo and came to academia with a background as a rural general practitioner. Her specific academic interests include rural and remote health services research (models of care, understanding and measuring access to health care) and health workforce supply, distribution, recruitment and retention. Her PhD ‘The patterns, determinants and measurement of rural and remote primary health care workforce turnover and retention’ positioned her as an emerging leader in her field. Her publications have significantly influenced current thinking about rural medical workforce retention methodology and rural workforce policy more broadly. Deborah remains passionate about improving equity of access to health care resources, currently having important roles on an ARC grant ‘Assessing the impact and cost of short-term health workforce in remote Indigenous communities in Australia’ and in the rural stream of the MABEL CRE in medical workforce dynamics.

Abstract

Aim: Since 2007 a longitudinal evaluation of Elmore Primary Health Service (EPHS), as a single-entry point, comprehensive, multidisciplinary rural primary health care service, has been undertaken. The aim of this study was to assess whether the presence of this ongoing research activity has fostered a culture which contributes indirectly towards improved service performance, capacity building within its workforce, and improved patient satisfaction.

Method: This mixed-methods study included review and critical appraisal of documented quantitative data collected throughout the duration of the study, and analysis of recorded and transcribed qualitative data obtained through face-to-face interviews with EPHS staff.

Results: The process of conducting a comprehensive longitudinal study indirectly affected EPHS and the Elmore community. Initially research activities were sometimes perceived as intrusive and somewhat demanding because of the level of detail required. However, as the study progressed, data collection with analysis and feedback came to be accepted as a routine and necessary part of the annual cycle of activity within the service. The research process progressed from a stage of formal initiation and apprehension, through one of regular acceptance, to one of full-integration of a research culture as a necessary part of daily service activities.

Research findings indirectly benefited EPHS performance, as EPHS management increasingly valued the empirical evidence to inform accreditation and forward strategic planning, including grant and other funding applications. As clinical staff came to better understand what the statistics and quantitative data meant, they were able to modify individual practice. The research also helped inform the expansion of EPHS to becoming a ‘networked’ model, simultaneously improving service accessibility and increasing practice viability. Research was also a good selling point for recruiting new staff, especially doctors, who were referred to published evidence of EPHS excellence. As an indirect result, the service became sought after by registrars and medical students. Practitioners, in turn, gained greater confidence and professional satisfaction. Patients of EPHS and the broader community also experienced greater confidence in the quality of the services available, as research evidence was published in practice newsletters, available on the EPHS website and in the wider media when EPHS was shortlisted and subsequently successful in a range of awards.

Conclusion: This study suggests significant indirect associations between both research processes and research outcomes and the development of a research culture within EPHS which resulted in a number of organisational benefits relating to efficiencies in service delivery, staff recruitment, enhanced service viability and accessibility, and increased patient satisfaction.

Slides | Paper
Vanessa Ryan
Geographic health workforce distribution from 1986: have policies made a favourable difference?
Biography

Vanessa Ryan is a Lecturer in Interprofessional Education based at Flinders Rural Health SA (FRHSA) Flinders University, Adelaide. Vanessa has worked as a rural clinician and academic in rural South Australia for over a decade. She has worked in post graduate and undergraduate education and has enjoyed work as a rural clinician in acute, general practice Aboriginal health and midwifery. Vanessa holds Degree’s in Nursing and Midwifery and a Masters in Primary Health Care. She is currently enrolled in a Masters by Research looking at Aboriginal women’s successes in medicine. Her other research interests include rural medical workforce, maternal and newborn health and Aboriginal health and wellbeing. She lives in the rural coastal town of Normanville with her husband, their seven-year-old son and Milo the dog, where they spend any spare time they have surfing and enjoying the outdoors.

Abstract

A range of policies have been initiated over the years to address geographic health workforce maldistribution. These include rural exposure through clinical placement, rural education, rural scholarships and rural practice incentives. Although evidence suggests that rural clinical education has a positive impact on attracting health professionals to rural practice, the effect on long term retention is not so clear. It is also not clear whether the apparent success of individual programs and initiatives has translated into a system wide impact of better geographic distribution. This research uses Census data from 1986 to 2011 to demonstrate how the geographic distribution of medical practitioners, nurses and allied health professionals has changed, and to examine why particular distribution patterns may persist despite (or even because of) rural workforce policies.

It is possible that rural clinical education to obtain an initial professional qualification may need supplementation of access to tailored and ongoing professional development that supports rural and regional career pathways. If career paths are aligned with local health service needs then the chances that health professionals will stay in, or return to, rural practice throughout their careers are likely to be enhanced. Thus far, approaches to address these issues tend to have a narrow focus. Rural clinical education that is followed by access to tailored professional development (based on local and regional health service needs) could be part of a suite of strategies that form a more integrated approach to optimising the rural health workforce and associated health service provision that can be supported by policy. The success of such an integrated approach will depend on policy guided leadership and professional and education systems to go beyond traditional health professional education, and to engage with rural communities and broader community development interests.

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Vanessa Ryan
A yarn about how Aboriginal academics are changing the future
Biography

Vanessa Ryan is a Lecturer in Interprofessional Education based at Flinders Rural Health SA (FRHSA) Flinders University, Adelaide. Vanessa has worked as a rural clinician and academic in rural South Australia for over a decade. She has worked in post graduate and undergraduate education and has enjoyed work as a rural clinician in acute, general practice Aboriginal health and midwifery. Vanessa holds Degree’s in Nursing and Midwifery and a Masters in Primary Health Care. She is currently enrolled in a Masters by Research looking at Aboriginal women’s successes in medicine. Her other research interests include rural medical workforce, maternal and newborn health and Aboriginal health and wellbeing. She lives in the rural coastal town of Normanville with her husband, their seven-year-old son and Milo the dog, where they spend any spare time they have surfing and enjoying the outdoors.

Abstract

In 2015, Flinders Rural health SA (RHSA) held a strategic planning day where it was overwhelmingly realised that there was a gap in our teaching and research team. Despite great intent and effort FRHSA needed to do more to recruit and retain Aboriginal students into health professions. Consequently, the decision was made to employ rurally based Aboriginal Academics and Researchers from local communities into the FRSA teaching and research team. In September 2016 this vision became a reality when three Aboriginal people have been employed to provide education, support and mentorship to other Aboriginal and non-Aboriginal students which is culturally safe and appropriate.

Bringing a plethora of skills, knowledge, experience and enthusiasm to their roles, all three staff members have a key role to play the future direction of FRHSA. New to the world of academia this journey has been a steep learning curve for the organisation and the new staff members.

This presentation will take you on a journey as you listen to the yarn that describes this experience.

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