Paul Tait is the Content Editor of the Guidelines and Technological Innovation arm of the Decision Assist Project. His major interest is using technology to increase access to evidence based medicines information for primary care clinicians. The design and development of the palliAGEDgp smartphone app provided a wonderful opportunity to combine his clinical skills with his passion for technology. Paul edits the quarterly Decision Assist Augment Newsletter and writes regularly for the online resource CareSearch. His second job is as a pharmacist within the Southern Adelaide Palliative Services. He is also a keen photographer.
In 2013, the Australian Government funded the national Decision Assist project to improve the delivery of palliative care and advance care planning services to individuals aged over 65 years, through engagement with health professionals working across primary care.
CareSearch (Flinders University) as a Decision Assist consortium partner was responsible in developing the palliAGEDgp smartphone application (app) as a project deliverable. The app was developed to support general practitioners (GPs) in the provision of palliative care to older Australians living in a residential aged care or community setting. A desktop version was also created, acknowledging some GPs may prefer access through their office or home computer.
It was released through the Apple, Android and Windows app stores on 30 April 2015 and promoted nationally, with uptake in both rural and metropolitan settings. Rural GP access to the information on the app was strengthened with palliAGEDgp’s online-offline capacity allowing the app to be used anywhere in Australia - even in areas where there is limited internet coverage.
As at 31 August 2016, there had been 3,542 downloads of the app. In addition, there are over 44 visits to the online palliAGEDgp site are made each day.
This study aimed to evaluate how GPs and other specialist physicians, with an interest in palliative care, use the palliAGEDgp app, with the intention of using feedback from users to further improve their virtual within-app experience.
An online survey was developed by a multidisciplinary team. The survey asked about general demographics of the participant, their experience in using apps in the work context and their personal experience with the Decision Assist palliAGEDgp app. GPs and specialist physicians from around Australia were invited to complete the online survey. We used a variety of methods to reach this audience including newsletters and email distribution lists.
This presentation will discuss how the palliAGEDgp smartphone app can improve access to clinical support at the bedside, increasing the threshold of referral of dying patients to hospices, ambulance services and emergency departments. Based on the challenges we experienced, we provide recommendations for the development of smartphone technology, as a way to extend the reach and distribution of projects for community-based healthcare providers.
Shaun Tatipata is an Aboriginal and Torres Strait Islander man with family connections in Cape York, Torres Strait and South Australia. Shaun has worked in Aboriginal and Torres Strait islander health for over 16 years and is currently the Assistant Manager – Programs at The Fred Hollows Foundation’s Indigenous Australia Program (IAP).
Shaun trained as an Aboriginal health worker in 2001 and since graduating he has gained experience delivering primary health care services and implementing outreach programs in both the Aboriginal community controlled health sector and with the Northern Territory Government. Shaun’s interests include strengthening service coordination through improved leadership and governance; and advancing the Aboriginal and Torres Strait Islander health practitioner profession.
Background: Eye care is but one of the many specialist health care services provided within Aboriginal Community Controlled Health Services (ACCHS) and remote community health centres. Achieving positive eye care outcomes for these visiting services requires pro-active collaboration and two-way learning. Gaining and maintaining this stakeholder engagement can be challenging, but is a fundamental aspect of health system strengthening.
Aim: To support eye care improvements in the Katherine region of the Northern Territory, two Non-Government Organisations (NGOs) have been working together over four years to strengthen links and facilitate regional collaboration. This presentation shall identify processes that were constructive.
Methods: Upon feedback from the ACCHS, and observation of coordination challenges, key stakeholders articulated the need for intentional work to support collaboration.
This information was considered:
The regional eye care system was strengthened by:
Results: Eye care service delivery and access increased and patient pathways improved. Stronger relationships developed, communication strengthened and engagement with eye care by ACCHS increased. This system-level improvement was also noted as a positive trend in stakeholder-rated performance, gauged via an Eye Care Systems Assessment.
Discussion: Improved coordination, integration and strategic alignment of projects was achieved using participatory methods. Taking a strengths-based approach, the various challenges for eye care (e.g. competing health priorities, accessing data, waiting lists, patient access barriers) were viewed as opportunities for improvement that were achievable by working together. A shared work plan articulated the “common vision”, prioritised activities, set targets, and listed responsibilities. This was developed following structured conversation which invited individual perspectives then considered these in light of the broader stakeholder perspective. Helpful processes included an Eye Care Systems Assessment, focus-group guided enquiry, a polling process called ‘dotocracy’, and critical reflection. Importantly, these structured approaches happened on an existing platform of collaboration and trust between the stakeholders.
Relevance and conclusion: Celebrating achievements, embracing challenges and engaging widely were important aspects. The approach and tools are potentially helpful to apply in other regions, not only for eye care but for other specialty areas that must integrate with primary and tertiary care to achieve outcomes.
Sandi Taylor is a Kalkadoon, Ngnwun and Jirandali woman from north-west Queensland. She is an experienced community development practitioner and has acquired and demonstrated, over a thirty-year work period, a strong social justice ethos. This ethos aligns to the facilitation of building, affirming and validating personal and community empowerment, which is the corner stone to strengthening and sustaining personal and community social and emotional wellbeing. Sandi has had the opportunity to work within diverse community settings, with different employer organisations across various industries within Queensland. These experiences have enabled her to contribute and/or add value to exciting and challenging state-wide and/or regional initiatives in the public and community services sector. Her contribution to supporting and enhancing Aboriginal health and, in particular, primary health care training extends back to 1994-95 when she was employed as the Administrator to establish the first community controlled health training organisation in Queensland. Sandi and her small dedicated staff worked in consultation and partnership with five Aboriginal and Torres Strait Islander Health Services (AICHS Brisbane, Kalwun Health Service, Kambu Medical Centre, Goondir Health Service, Yulu-Burri-Ba Aboriginal Corporation) to establish the Aboriginal and Torres Strait Islander Corporation for Health Education and Training, ATSICHET. (VTEC Approved initially to deliver the Certificate III in Primary Health Care). In 1995-06, Sandi was recruited as the Training Coordinator for a new regional Indigenous health organisation, Apunipima Cape York Health Council, located in Cairns. Apunipima’s primary role at that time was to advocate for improved health service delivery within Aboriginal remote communities in Cape York Peninsula. Here, she was employed to facilitate the development and implementation of a range of health training initiatives for Indigenous people within the region. The initial course development targeting environmental health training. Since then, she has contributed to the sector through building the foundational capacities of local community Health Action Groups in Cape York. As a member of a research team, she has reviewed substance misuse and sexual assault programs, including domestic and family violence programs across different regions of Queensland. In recent times, she has worked to support the professional development of 90 social and emotional wellbeing workers in Far North Queensland. Sandi is enjoying balancing her life so that she can work towards becoming a fitter, healthier murri woman whilst at the same time contribute to supporting individuals and communities reach their aspirations and wellbeing goals.
Social and emotional wellbeing (SEWB) needs to sit in the epicentre of government and community driven policies, programs, and service delivery. It is imperative that bureaucrats, researchers, managers, and practitioners within the community services and the health sector aspire to value and understand the complexities associated with the disconnect and connect challenges facing Aboriginal and Torres Strait Islander peoples as they navigate through their life journey to build, maintain and sustain optimum wellbeing and quality of life.
Only when this understanding and knowledge is valued and embedded in the service systems, programs and deliverables will there be an improvement to health disparities, as true partnerships between Indigenous and non-Indigenous stakeholders and communities can walk and work together to create and generate collective impact on Closing the Gap.
Aims: To develop a medication management practice guideline to support quality care for rural clients and nurses in the community with a focus on palliative care.
Methods: The development of the guidelines included a sequential mixed methods design which involved the following steps; 1. Gathering of vignettes from practice situations, 2. An Interprofessional collaboration forum, 3. Literature review and a draft guidelines prepared by the project team based on the literature, 4. An online survey for community and district nursing working in rural areas, 5. Semi-structured interviews with rural general practitioners, pharmacists and consumers and/or their carers, 6. Revision of the guidelines based on findings from the surveys and the interviews, 7.Revision of the guidelines based on stakeholders opinions and obtaining endorsement of guidelines by key local organisations.
Results: The guidelines were developed for nursing staff involved in caring for adult clients receiving palliative care in rural areas. A total of 13 principles underpinning the guidelines with an explanation of what each principle were included. The main principles were; information resources, medication administration, medication orders and supply, syringe drivers, dose administration aids, medication storage, medication disposal, risk management and adverse events, transport of medications and cytotoxic medication administration.
The establishment of the guidelines led to a few recommendations to positively change the activities of the organisations regarding medications management. Examples of these recommendations were creating online educational resources addressing specific aspects of medications administration such as syringe drivers and cytotoxic medication handling and disposal.
Relevance: Rural community and district nursing practices form an integral part of delivering health services to palliative care clients. Provision of palliative care in the rural community has its unique challenges such as; varying perceptions of palliative care, professional issues and challenges of providing care in the community and system barriers. Medication administration is a key responsibility of community nursing staff assisting palliative care clients in their home. However, there is lack of clarity around their roles and obligations in the Australian rural context. Specific issues such as medication administration roles and responsibilities, medication disposal and ensuring accurate records of clients are not clearly defined by health service organisations. The formation of these guidelines addressed those needs.
Conclusion: Engaging multiple stakeholders to draft the proposed medication guidelines resulted in identifying the scope of the proposed guideline. The development of these guidelines has the potential to promote the quality use of medicines in the rural community.
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.
Daniel Terry (BN MntlHlth PhD RN) has an interest in the acculturation and retention of international medical graduates in rural and remote contexts. He has a background in nursing and a Masters of International Health. He is a research fellow and has worked as a research assistant for the University of Tasmania and Deakin University. He has been involved in many projects concerning the health and wellbeing of rural migrant communities; and he is currently undertaking a number of research projects related to chronic ill health and rural health workforce.
Relevance: Recruiting and retaining physicians in rural communities remains problematic internationally. One solution throughout rural United States (US) is the implementation of the Community Apgar Program (CAP). Just as an Apgar score quantifies resources and capabilities of newborns, the CAP strives to serve the same purpose. It quantifies important resources and capabilities of rural communities that impact physician recruitment and retention. The CAP enables healthcare providers to identify and appreciate individual community solutions, while providing explicit insights regarding health workforce planning.
The implementation of the CAP internationally was first achieved in the Hume region of rural Victoria in 2015-2016. This international collaboration provided an analysis of the strengths and challenges that certain communities encounter, while establishing the uniqueness of each community, including what each had to offer physician.
Aims and methods: The aim of this latest study was to undertake an international comparison of key resources and capabilities of rural communities that impact physician recruitment and retention, and to provide valuable insight into augmenting recruitment and retention approaches in Australia and the US. To achieve this, Victorian data was statistically analysed and compared with data from two US states. These two states were selected as they share a number of geographical and community similarities with rural Victoria.
Results and conclusions: The findings indicate there are international parallels that positively impact physician recruitment and retention. These factors include a good perception of quality – a community’s reputation for providing quality medical care; having adequate transfer arrangements due to limited sub-specialist availability; and having an adequate allied health staff workforce to undertake ancillary health care within rural communities. Other similarities were identified as challenges that impact recruitment and retention of physicians. These factors include spousal satisfaction, in terms of local community living, education and employment opportunities; and the adequacy or existence of electronic medical records in rural settings.
The CAP it has offered health services internationally the opportunity to develop strategic plans specifically tailored for their community, while confidentially sharing best practices, obstacle elimination, and facilitating greater networking opportunities with other services. In addition, the international comparison has also identified shared trends and themes that directly impact rural communities in both countries, and may highlight key factors that are experienced in other rural communities elsewhere. This process has developed a more robust evidence based platform for the advocacy of key issues at the community, state, national and international level.
Rosalie Thackrah completed a PhD at the University of Western Australia in 2016, which looked at culturally secure practice in midwifery education and service provision for Aboriginal women. She also has postgraduate qualifications in anthropology and education and has taught, conducted research and supervised students for many years at UWA and Curtin University. In partnership with colleagues at Curtin’s Centre for Aboriginal Studies, she developed a new core unit on Indigenous health for nursing and midwifery students, which won the Neville Bonner Award for Indigenous Education from the Australian Learning and Teaching Council in 2010. In the same year she was invited to Jonkoping University, Sweden to lecture and run workshops on cultural issues in health. Rosalie is co-editor with Kim Scott of a textbook titled “Indigenous Australian Health and Cultures: An introduction for health professionals”, which has been widely used in Australian universities.
The 2016 Indigenous-led Close the Gap Progress and Priorities Report identified “deliberate or accidental racism in Australia’s hospitals, and other health services” as contributing to ongoing health disparities. Calls for health care providers to work collectively to effect systemic change require heightened awareness of issues confronting Aboriginal communities, and opportunities to interact and build relationships. In 2011, Universities Australia recommended that Indigenous cultural competence be identified as a graduate attribute. There is an expectation that graduates with cultural capabilities will be better equipped to interact with, understand and provide culturally safe care to community members.
Health professional training programs now routinely include content on Indigenous populations, although there is considerable variation across universities and disciplines as to how content is taught. Furthermore, little known about its impact on students and whether they become the future change agents required to address institutional racism.
This paper draws upon completed doctoral research with midwifery students exploring the impact of an innovative Indigenous health unit introduced into a common first year for health science students at a Western Australian university. It focuses on initial and sustained attitude change and the impact of cultural immersion experiences on student learning. Themes relate to the power of exposure to dispel stereotypes and challenge assumptions; the role of reciprocity, trust and respect in relationship building; exposure and disquiet; and dilution of impact over time.
Findings revealed that a well-designed unit, conceived with substantial Aboriginal input and which privileged Aboriginal voices in the classroom, can enhance knowledge and shift attitudes in a positive direction. Remote clinical placements demonstrated a profound effect on student learning by providing opportunities for interaction and observance of cultural protocols.
Conclusions draw attention to the optimisation of student receptivity to Aboriginal content in programs, the need to consolidate and maximise gains made following intensive instruction, and increased opportunities for remote clinical placements. Exposure to Aboriginal people in classrooms and communities, relationship building that arises from these connections, and self-reflection generated in the process, all contribute to better prepared, culturally competent graduates. But is this enough to address institutional racism identified in health service delivery? More likely is that it is an essential component of a complex task which must also focus the lens on health practitioners and administrators within organisations. However, new graduates can play a vital role in expediting this process.
Jenny Thompson is a senior clinician and manager for the Strategy and Reform Directorate of the WA Country Health Service (WACHS). Jenny has an extensive background in clinical service delivery, health-related leadership and management, learning and development and service reform in country WA. Senior roles have included: clinical, education and policy roles; rural health service clinical operational management; rural small hospital and community health program leadership; state-wide rural health service development; and the planning, development, management and evaluation of a suite of primary health care service reform projects. Jenny is particularly interested in the delivery of consumer-centred care across the health continuum and health service reform to achieve integrated, multiagency and interdisciplinary service models to meet the health needs of rural communities. Improving health equity; through expanding people’s access to services through technology, partnerships and workforce development has been a long-held aspiration. As Program Manager for WACHS service reform, Jenny has led the development of partnerships with the WA Primary Health Alliance and the non-government sector to both develop and implement clinical services using telehealth to increase access to quality care for rural consumers; and the development and implementation of the WACHS Chronic Conditions Prevention and Management Strategy.
Context: 2008-2012 ‘diabetes complications’ was the leading cause of potentially preventable hospitalisations for Wheatbelt and Great Southern adults (20%); with a non-Aboriginal rate significantly higher than the State rate.
Regional capacity for diabetes education is minimal, resulting in consumers travelling long distances to access metropolitan based services or worse still, not getting the care and support required, resulting in ongoing poor/deteriorating diabetes health and management.
Process: Service gap locations were identified through data analysis and regional consultation. Partnering with Diabetes WA, in March 2015 the Diabetes Telehealth for Country WA Service commenced. The telehealth diabetes education service integrates with WA Country Health Service and non-government organisation services across regional WA. The service is delivered via videoconference (or phone if required), and addresses gaps in diabetes education and clinical support for consumers and increases regional capacity through provision of professional development for Diabetes Educators, Aboriginal Health Workers and generalist health staff in the prevention, treatment and management of diabetes.
Delivering timely triage, assessment, individual education sessions, referral to other services and direct links to local diabetes educators, the service can be provided at home and outside of traditional business hours to support consumer needs. Professional development sessions are delivered in the workplace.
Trialled in the Wheatbelt and Great Southern the service has progressively expanded. With an ‘every door is the right door’ approach referrals range from self-referral through to allied health, nursing staff and GP referrals.
Analysis and lessons learned: Lessons learned have been applied to subsequent telehealth service development. Flexibility to support tailoring of the service to the specific and unique requirements of each region is integral. Working closely with health professionals and private practices to demonstrate the triage process with referral back to existing services on the ground, ensuring private business models are supported, has been key to service acceptance. Building trust and establishing shared care roles via a virtual multidisciplinary team has resulted in GP and health professional acceptance – with 56% of referrals coming from GPs.
Outcomes: The service is now available across all seven WACHS regions. Since commencement there have been over 741 occasions of service, with 54 referrals for Aboriginal people. Over 31 hours of health professional upskilling has been delivered. An external evaluation is being finalised. Initial indications are $120,000+ service delivery savings for WACHS whilst saving consumers over 113,000 travel kilometres, with over 90% of consumers saying that using telehealth saved them time and money.
Michelle Thompson was instrumental in helping to establish the Rural Health Alliance Aotearoa New Zealand and was appointed its founding Chief Executive in September 2013. She is an experienced chief executive and senior manager who has provided services to a range of health sector organisations including the New Zealand Rural General Practice Network, the PHO Alliance, General Practice New Zealand, Compass Health, Southern Cross and Kowhai Health Trust. Michelle has also held management roles with Victoria University and the Reserve Bank of New Zealand. Michelle lives on a farm in Waipukurau, Central Hawkes Bay, running cattle, a few sheep and some alpacas - the latter not for eating.
Encouraging the “rural proofing” of policy has been a goal of the Wonca Working Party on Rural Practice for many years, examples of “rural proofing” in action are however few and far between.
Rural New Zealand has experienced a period of significant strain due to weather events and global market challenges. In response government, industry bodies and communities initiated a series of programmes to raise awareness around mental health issues and to increase capacity in services.
The Ministry of Health and Ministry for Primary Industries jointly funded the Rural Health Alliance Aotearoa New Zealand (RHAANZ) and Dairy New Zealand to create increased capacity in Rural Support Trusts, communities and health providers to recognise and treat people at risk of suicide.
The programmes developed were seen to be different in process and content to the usual activities in mental health treatment and this illuminated the need for “rural proofing” a new approach to mental health issues in rural communities.
The presentation will illustrate the process utilised by RHAANZ to develop a rural framework for mental health initiatives and the outcomes achieved by that project, we will present the current status of mental health research in rural New Zealand and discuss the initiatives that have been developed to address the level of need.
Participants will be able to see the process for “rural proofing” this particular policy and be able to translate this process into their own country or community setting.
Paul Thornton was born in the Australian Capital Territory and raised in Ballarat, Victoria. He currently lives in Geelong, Victoria. Paul has worked in many areas helping people as a psychologist: the Central Highlands Education Department, Ballarat Specialist School, Ewing House School for the Deaf, Centacare working with young people who are at risk of developing psychosis, Grampians Psychiatric Services as a community case manager, Barwon Health Hospital Admission Risk Program Complex Needs Care Coordinator, Private Psychology and now at Wathaurong Health Service. He is an AHPRA registered psychologist and psychologist supervisor and has worked with both the Australian Psychological Society and Victorian Department of Health and Human Services in determining best practice guidelines for management of clients with complex psychosocial needs. He has worked at Wathaurong Aboriginal Cooperative since July of 2010 in the clinical role as a psychologist. Additionally he has been employed as the Fresh Tracks Project Coordinator since July of 2014. During this time he continued to develop his understanding of Aboriginal culture and the influence culture has on health. An objective of Paul's current role as Fresh Tracks Project Coordinator is to provide an assertive outreach model of care to the Wathaurong Aboriginal Cooperative’s community. Clients are identified to have significant issues that impact on their ability to access and engage in services both at Wathaurong and in the mainstream community. Clients are identified to have or be at risk of developing chronic disease and/or deteriorating mental health needs.
Project overview: ‘Fresh Tracks’ is a Victorian Koolin Balit funded project that aims to support Aboriginal clients experiencing the combined impacts of chronic and complex illness and psychological distress. Staff at Wathaurong Aboriginal Cooperative in Geelong, Victoria, identified an increasing presentation of mental health issues in their clients that were compounding other health issues. Consequently an assertive outreach care coordination model was established to engage clients in psychological supports by working in collaboration with them, their families and external stakeholders to provide interventions focused on Social Emotional Wellbeing (SEWB) principles.
Implementation: Social Emotional Wellbeing principles defined by the Australian Indigenous Psychologists Association underpin Wathaurong’s assertive outreach model to address client’s psychosocial needs. Clients are proactively followed up and then assessed using a psychometric tool (Kessler 10- K10) to ascertain their level of psychological distress. Communication is encouraged through the use of a ‘chatterbox’ tool that engages clients in conversations they might not normally have about their connection to community, culture, family, land and ancestry and how these inter-relate with physical and mental well-being. All therapeutic sessions are conducted on Wathaurong Country.
Outcomes: Approximately 120 clients have engaged with the Fresh Tracks project since it was established. Numerous referrals have been facilitated for clients to attend specialists, health services, legal, housing, education and financial services. Improved K10 scores can be demonstrated in the majority of participants and anecdotal testimonials from clients show they feel their overall health has improved, as has their connection with family, culture and community.
‘Fishing for Answers’ (a targeted activity within the project) has been particularly successful in engaging clients on Community Based Orders (CBOs) who are required to attend a behavioural change program. While undertaking land management activities as part of their CBO, clients work alongside the Wathaurong psychologist and participate in individual and group sessions to discuss their mental health, any anger issues and their connectedness with people and the community. Fishing for Answers has gained support from the Regional Aboriginal Justice Advisory Committee and the Victorian Department of Justice and won a Leadership Innovation Award for the work undertaken with clients in the justice system.
Conclusion: The Fresh Tracks approach of culturally informed, assertive outreach care coordination support, based in an Aboriginal Community Controlled Health Organisation, has demonstrated significant benefits for clients’ health and wellbeing, for the organisation and for the local service system.
Kim Tracey is the Clinical Nurse Consultant for the Goldfields Renal Service. She has been working as a nurse in nephrology for the past 15 years in both metropolitan and regional hospitals in Western Australia. For the past six years she has led a team of renal nurses and Aboriginal health workers to provide renal specialty services to Kalgoorlie and the surrounding Goldfields region, which is the largest region in Western Australia. Her mission in the Goldfields Regional Renal Service is to provide a comprehensive chronic kidney disease healthcare service, including prevention, health promotion, education, case management and tertiary care for Goldfields renal clients that is closer to home. She has also managed the Kalgoorlie Dialysis Unit during this time, where she has developed and successfully implemented a learning program and mentored new graduate nurses to train in dialysis. She is currently studying for a Masters of Nursing Nurse Practitioner in Nephrology and is a member of several professional organisations, including the Renal Society of Australasia and the International Society for Peritoneal Dialysis. In her free time Kim enjoys camping, in any place that is by the ocean, catching up with friends, playing squash and walking her two Labradors, Derby and Tash.
The Goldfields Renal Service (GRS) was established in 2010 by the Western Australian Country Health Services (WACHS) to address a growing need within the Goldfields community and provide access to specialist renal services closer to home. The program serves the Goldfields, the largest region in Western Australia (WA), and home to approximately 59,638 residents; within this total 12% are Aboriginal people (Rural Health West, 2014).
The GRS has acquired many successes since implementation; also, it has experienced challenges such as the tyranny of distance, cultural barriers and socio-economic disadvantaged clients.
The program provides local and earlier intervention in regards to client’s kidney failure, individual client care planning, regular client follow up and increased education in regards to all dialysis options, this has increased home therapies clients from 7 in 2010, up to 18 currently. This equates to 39% of dialysis clients in the Goldfields now on home dialysis therapy, which is over the WA Renal Network benchmark of 35% and is the highest for any regional area in WA (Dept. of Health, 2008).
Earlier and individualised interventions have been evidenced in the literature to promote improved outcomes such as reduced patient mortality rates, increased numbers of patients selecting home dialysis therapy, decreased hospital admissions and decreased costs of care following initiation of dialysis therapy (Johnson, et.al 2012, Johnson, et.al 2013).
The establishment of regular outreach clinics to remote areas such as the Ngaanyatjarra Lands has improved the ability to build relationships and allowed clients to attend clinics with family and significant others improving collaboration between relevant stakeholders.
A visiting nephrologist familiar with local culture and community has enhanced the client’s journey through understanding and awareness of challenges faced by local clients. Over 89% clients for 2015/2016 have been referred to the GRS at least 6-12 months prior to the initiation of dialysis.
Co-ordination with a visiting vascular access surgeon to the Goldfields has enabled formation of pre-emptive fistulas, grafts and insertion of peritoneal dialysis tubes. This has enabled home therapies clients to reduce time spent in metropolitan Perth from 3 months to approximately 2 weeks.
Increased numbers of clients from the Goldfields are now being referred for kidney transplantation, 6 have been transplanted in the past three years including two Aboriginal clients.
As further evidence of the GRS success WACHS has begun to implement plans for similar renal services in other WA regions based upon the current Goldfields renal model.
Department of Health, Western Australia (2008). Chronic Kidney Disease Model of Care. Perth: Health Networks Branch, Department of Health, Western Australia. http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/CKD_Model_of_Care
Johnson, D; Atai, E; Chan, M. et.al. (2013). KHA-CARI Guideline :Early chronic kidney disease : detection, prevention and management. Nephrology. 18(5):340-350. Doi: 10.1111/nep.12052
Johnson, D. & Atai, E. (2012). Education Strategies. CARI Guidelines. www.cari.org.au/CKD/CKD%20early/ckd_early_ckd.html
Rural Health West (2014) Goldfields Population and Health Status http://www.ruralhealthwest.com.au/docs/outreach-in-the-outback-docs/goldfields-regional-needs-analysis-final-060513.pdf?sfvrsn=2
Pippa Travers-Mason began her career as a clinical pharmacist in Sydney before completing her first Masters in Public Health, and a subsequent Masters in Education. She currently resides in Cairns and divides her time between a clinical role as an accredited consultant pharmacist with the community controlled health service at Yarrabah, and as clinical services specialist (teaching role) for NPS MedicineWise, which takes her to primary care clinics around the far north to update GPs on best practice in quality use of medicines and diagnostics. She also provides coaching and support to Aboriginal students completing bachelor and higher degrees through Deakin University. She has a passion for bridging the evidence practice gaps by massaging the multitude of evidence-based guidelines into practical, simple solutions for clinicians and their patients.
Medicines burden can add another whole layer of complexity to some of our most vulnerable people, especially those with low health literacy or multimorbidity. Commonly encountered adverse effects of some medicines, numerous or very large tablets, miscommunication, confusion over brand substitution, and complex dosing regimens all contribute to the degree of concordance with recommended therapy.
Since late 2012 a home medicines review program featuring a collaborative approach has been successfully incorporated into a regional Aboriginal community in North QLD. Aboriginal health worker input is core to the success of the program which has been welcomed by the local community. During this time we have performed over 700 comprehensive reviews, looking holistically at the whole person; their condition(s), health literacy, ability to manage and concordance with prescribed therapies, adverse effects, concerns and personal preferences. Some of these stories we would like to share with you.
Identification of clients comes from the whole of clinic, and are channelled through our team of GPs. Our team based approach involves an accredited clinical pharmacist visiting the client in the community always accompanied by an Aboriginal Health Worker. Patients are often seen with their carers and/or family present, and even in groups where requested – flexibility in service delivery is paramount. Following this discussion the health worker and pharmacist are able to follow up on specific requirements to assist the client in their own health care journey. Accompanied visiting, though not part of a traditional HMR model has multiple benefits including increased trust, credibility, empowerment and team building; as well as ensuring that any cultural, family or social sensitivities are taken into consideration. This allows for a more comprehensive picture of our patients to be obtained and therefore more tailored solutions to be offered.
The additional benefits of an in-clinic pharmacist include the ability to refer to clients notes for additional information, the ability to directly enter reviews into clinic software ensuring information is up to date and accessible, as well as the opportunity for any urgent follow up to be provided.
In addition to the written ‘reports’ provided into the patients file, regular timeslots are booked for discussion of each individual case with the referring team including doctors and any other clinical staff involved in their care to ensure all relevant detail is discussed and the most appropriate plan can be formulated.
A holistic approach is taken to ensure that the complexities of managing a patient with multimorbidities, are taken into consideration and a lot of effort is put into reducing the medicines burden as much as possible. Do you or someone you know need to see the ‘medicines lady’ for a yarn?
Our success lies in the flexible and collaborative approach, individualising the service to meet the needs of each client and their family, delving into their personal health goals and providing as much detail in the education as required in a form that is easy to understand. This supports personal ‘buy-in’ to the shared decision making model, building better therapeutic relationships. We aim to debride the medicines list wherever possible and empower clients to take control of their journey.
clinic staff for the common goal of improving the health outcomes of the community, one person at a time.
Short case studies illustrating the benefits to patients and clinic staff of the HMR program will be included in the presentation (co-presented by an Aboriginal Health Worker); both the clinical and social/cultural aspects will be discussed as this is a holistic service.
A tale of collaboration and a whole of clinic approach to improving the health of the community one person at a time through maximising medicines management, and minimising needless misadventure.
Avinna Trzesinski is a Senior Research Officer at the Australian Indigenous HealthInfoNet, based at Edith Cowan University in Western Australia. The HealthInfoNet is a free to access web resource that contributes to ‘closing the gap’ in health between Indigenous and other Australians by developing and maintaining the evidence base to inform practice and policy. A member of the team since 2011, Avinna’s primary research responsibility is on the Australian Indigenous Alcohol and Other Drugs Knowledge Centre project. Avinna has a Bachelor of Science (Health Promotion) from Curtin University and is currently undertaking a Masters of Public Health at University of Western Australia.
There is rising concern in Australia about the prevalence of foetal alcohol spectrum disorder (FASD), and the impact that this condition is having on families and communities. Of particular concern is the affect that FASD has in Aboriginal and Torres Strait Islander communities, and there has been much attention given lately to the prevalence of Aboriginal and Torres Strait Islander people with FASD in the justice system.
Issues raised by those working in this area note that more information is needed to inform prevention strategies and services. This presentation will demonstrate how the Australian Indigenous Alcohol and Other Drugs Knowledge Centre (Knowledge Centre) can supports those working to reduce the harms of FASD among Aboriginal and Torres Strait Islander people by providing the knowledge base to inform policy and practice.
The AOD Knowledge Centre is a free web resource that offers comprehensive, culturally appropriate information on alcohol, illicit drugs (including kava), pharmaceuticals and volatile substances. Coverage includes: reviews and background information; a searchable bibliography; a collection of health promotion resources and practice guidelines, programs and projects, organisations, and courses and training. The AOD Yarning Place, an online networking forum, allows people with an interest in Aboriginal and Torres Strait Islander health and substance use to share information, ideas and knowledge.
A specific section on FASD facilitates access to timely and relevant information; assisting practice and policy at the local, state and territory, and national level. This presentation will cover the key features on the FASD portal, including information about:
User surveys of the Knowledge Centre have consistently shown that the FASD portal is an excellent resource for our users, with feedback indicating:
It is with these statistics in mind that we would like to disseminate information about the FASD portal, raise awareness about its value for anyone working in this field, and encourage the use of the portal.
Tarah Tsakonas is a Senior Policy Advisor for the Victorian Government Department of Health and Human Services. Part of the Medical Workforce team, Tarah works in rural medical workforce policy and training programs. Tarah has worked in various aspects of rural health, including the implementation of a national telehealth project, developing national education programs for rural GPs and broader rural priority skills campaigns. She has recently been involved in research on rural health workforce capacity issues, including lifting accessibility constraints for rural GPs in undertaking mental health training and current postgraduate research on the accessibility of regional sexual and reproductive health services has expanded her focus on addressing disadvantage.
The Victorian rural hospital system is very reliant upon general practitioners as Visiting Medical Officers (VMO) for the provision of medical services and in particular general practitioners with procedural or advanced skills. The role of general practitioners is a key factor in ensuring the health of rural communities; however the ability to attract medical practitioners to rural areas is proving to be difficult and necessitated different approaches by Commonwealth and State Governments. The training and development of general practitioners is within the remit of the Commonwealth. However, with implementation of some Commonwealth programs and initiatives incentivising and encouraging a career in rural practice, there continues to be shortages of medical practitioners in rural and regional Australia.
While the provision of primary health care, including the education and training of general practitioners is a Commonwealth responsibility, Victoria Department of Health and Human Services recognises the important complimentary role of the general practitioner in the Victorian public health system, particularly in the delivery of public and community health programs and providing procedural services in rural hospitals. The Victorian Department of Health and Human Services funds a number of training programs that support the development, recruitment and retention of a skilled general practice workforce for rural and regional Victoria, one of which is the Rural Community Intern Training (RCIT) program.
The RCIT program aims to encourage medical graduates to consider a career in rural practice, and in particular general practice, by providing intern training positions in smaller rural health services and general practice; the core rotations are predominantly undertaken in the larger regional hospitals. Furthermore, participation in the RCIT program in Victoria provides a pathway into the Victorian General Practitioner – Rural Generalist program.
An intern from the RCIT community based intern program has exposure to a wide range of experiences that mirror the practice of a rural general practitioner both within the hospital system and community settings. The program is designed to create a strong basis for a rural medical career whilst also developing skills transferrable to any setting or practice.
The RCIT program began with the Murray to Mountains intern program in 2012 and was subsequently expanded across the state in 2015. A total of 30 intern positions are available across five region specific programs; this will increase to 35 in 2017. The program is attracting wide interest, especially from graduates of rural origin. The five RCIT programs are:
A three-year evaluation of the RCIT program will commence in October 2016 and an interim report is due in early 2017. Early evidence suggests that approximately 65 per cent of interns completing the RCIT program have remained in the region, with many expressing strong interest in career general practice.
Doug Turner is an associate lecturer in Aboriginal health with the Flinders University Rural Health South Australia (FRHSA) and works from the FURSA Barossa Valley Campus facilities at Nuriootpa. Doug has a life time working and cultural knowledge of remote Aboriginal communities in the central regions of Australia. Doug’s earlier years were spent in the southern Flinders Ranges in South Australia on his mother’s country. Doug has a tertiary background in environmental management and secondary education, and Aboriginal community development. Doug’s current role with FRSA is to seek out possible and achievable educational pathways for young Aboriginal students to develop a career within medicine or other health areas. Flinders University is seeking to encourage and support Aboriginal youth within our community to engage in study at Flinders to study medicine, nursing and allied health. Doug also teaches both the Flinders and Adelaide University medical students about the Aboriginal health issues in mainstream Australia. He also provides an Aboriginal cultural immersion experience for these students on country as well as tutorials relating to the importance of country and culture to Aboriginal health and wellbeing. Doug’s strong connection to the Aboriginal community supports the endeavours of FRSA in achieving authentic and strong relationships with Aboriginal communities to build better health and research outcomes.
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.
Georgina Twomey is the National President of the Australian College of Pharmacy (ACP), she is a community pharmacist and pharmacy owner, and a member of Rural Pharmacists Australia (RPA). She graduated from the University of Tasmania in 2005 where she also completed her honours project on The Contaminants of Illicit Methamphetamine. Georgina was the inaugural recipient of the IMS Young Pharmacist Innovation Grant through ACP. She is now based in Cairns where she is the General Manager of a group of 10 pharmacies. She is the first female National President of the ACP and is a passionate advocate for community and rural pharmacy.
Communication between pharmacists and other health professionals involved in patient care is seen as vital to improve management of health conditions and assisting patients with their medicines. The My Health Record opt-out trial, conducted for six months by the North Queensland Primary Health Network from April to October 2016, is predicted to see significant benefits in patient continuity of care provision from Mackay to the Torres Strait.
The My Health Record system will enable live and streamlined access to patient health records in general. The Electronic Transfer of Prescriptions (ETP) and the Prescription Exchange Service (PES) for managing ePrescriptions will form essential components for prescription and dispense records. These digital records will facilitate communication of critical medicines-related information to both hospital and community pharmacy for enhanced continuity of care.
This presentation will provide an overview of the benefits and challenges of the use of My Health Records during the opt-out trial, the improvement of patient safety, and the current effectiveness of the system from a pharmacist perspective.
Jinnara Tyson is an Aboriginal health worker on the Aboriginal Children’s Therapy Team of Wellington Aboriginal Corporation Health Service. Jinnara is an Aboriginal enrolled nurse who graduated from her studies at TAFE Western in 2014. She grew up in Weilmoringle, a remote community 100km north of Brewarrina, NSW. She attended Saint Scholastica’s Sydney as a boarder from year seven to twelve but always knew that at the completion of her school she wanted to head back to rural NSW and work in healthcare and nursing. Jinnara spends the start of her working week doing immunisations and injections, assisting GPs and completing health checks in the clinic. She then transitions into a community setting with our paediatric allied health team and assists with case management and screening for speech pathology, occupational therapy and psychology. Jinnara has a special interest in coordinating care for children in out-of-home care and integrating health care services for vulnerable families. Jinnara is currently studying at Charles Sturt University to be a registered nurse.
As a Commonwealth funded, paediatric, allied health team servicing the Aboriginal population in our community, we would like to share our service delivery models and workplace partnerships that make this multidisciplinary allied heath team a success.
We service birth to eight year old Aboriginal children for speech pathology, occupational therapy and psychology. Each discipline works in collaboration with our Aboriginal health workers (AHWs) to provide a comprehensive family centred and culturally relevant service.
A cohesive partnership between our AHWs and allied health clinicians has proved essential to our overall service delivery. This key philosophy contributes to successful client outcomes by assisting in client engagement, attendance at appointments, culturally relevant parent education and goal setting.
We have established key roles and responsibilities guiding this partnership through policy and position descriptions which builds the positive working relationship for joint assessments, home visits, therapy sessions, case planning meetings and outreach screening programs. All these tasks require on the job upskilling and sharing of information with your colleague.
AHWs share ideas on wider social and family issues and ideas on what will work best for the family. Clinicians share information on the specifics of their discipline to build the knowledge base of the AHWs in relation to allied health. This sharing of information and upskilling of each profession increases the knowledge of the whole team but most importantly benefits the child.
This case study demonstrates the successful working partnership;
Anna was referred to the program for all three services. The AHWs completed an initial screening on Anna and completed an intake with her mother. This included speech pathology and occupational therapy screening with a detailed parent interview. This step was crucial to engagement into the service. It was identified at the initial meeting that the mother had a hearing impairment and a signing translator via video link was organised for subsequent appointments. The AHWs also provided transport for the family and linked them in to services, including Mission Australia, to assist with other family goals. They organised a case conference with the school, and all allied health staff and external agencies involved. This team approach meant that the service could be coordinated and culturally engaging for Anna and her mother.
This case study and other clients accessing the program benefits from the cohesive partnership between the AHW’s and allied health clinicians.