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A

Owen Allen
The forging of men
Biography

Owen Allen is a career rural physiotherapist of some 36 years. He spent 15 years from 1993 to 2009 on rural health committees and boards, including the Board of the National Rural Health Alliance. From those years, Owen concluded that the source of healthy community is robust empathetic leadership, an enzyme for whole of community integrity and discourse. From 2001 to 2008 Owen worked with Dr Farvadin Daliri OAM on an arts-based youth leadership program and saw that the performing arts can be a fantastic access to ethics and leadership training. In 2008 Owen established Phoenix Functions as a vehicle for exploring the role performing arts could play in leading rural community social discourse. Meanwhile, in his physiotherapy practice he was exploring innovative fun ways for bringing older people to exercise for strength, mobility and balance. In 2011, he found a passion in dance theatre through a convergence of the role of performing arts in community conversations, and extending the physicality of the older person. Since then he has facilitated community dance training in Atherton, which culminated in the first public performance of six rural men in September 2017, 'The Forging of Men'. He most recently presented and performed solo at the new BOLD Festival, Canberra, March 2017.

Abstract

Physical theatre falls within the contemporary/dance theatre genre. Facilitation models for designing physical theatre productions can optimise physical capabilities, listening and expression, teamwork, collaboration, vulnerability, courage, emotional management, and social engagement as an inclusive environment. In performance physical theatre defines courage in authentic display and a contribution to social discourse.

The Forging of Men used a combination of a directed, and a facilitation, collaborative model to test the principles of an inclusive facilitation model of performance design. Six rural men and a career theatre maker designed a 30-minute performance whose conceptual elements ranged from the evolution of the human to the making of modern man, breakdowns in the form of domestic violence, and possibilities for restoration. Emotionally the production ranged from the serious to the humorous, tender to angry violent, despairing to accountable and adult.

Performed on 23 September, The Forging of Men has provided a template for working with beginners from specific need or broadly inclusive groups in any remote and rural communities. It has inherent value for the players and the discourse for any topical issue confronting a community.

The poster will include images from the design rehearsals, performance and interviews with performers and audience, and reference to a video clip documentary of the project.

References: Powell, J., CEO CALM, Reported in “Depression and the fragility of the strong, silent male” Opinion, The Guardian, 8 Feb 2015.

Eden Ambrose
Evaluating oral health literacy of rural teens
Biography

Ethan Zappala, Thomas Meath and Eden Ambrose are dental student researchers whose project focused on evaluating oral health literacy in rural teens. Through providing appropriate oral health education for young adolescents in a farming community, they have been actively involved in the implementation of the award-winning Rural Engaging Communities in Oral Health (Rural ECOH) project. This focus on oral health in rural teens is showcased in the video available at https://www.youtube.com/watch?v=YR0p4w6zYds  Eden Ambrose is a final-year dental student studying at James Cook University. He is currently enjoying clinical training in Mackay, Queensland. Coming from regional Queensland, Eden has a particular interest in dentistry in regional and rural areas where dental services and health education are less accessible. Eden is also interested in preventative dentistry and health care, seeing the great importance of prevention and its effect on overall health and wellbeing. Outside of his dental studies, Eden has great interest in creative arts and music, as well as physical fitness.

Abstract

Background: This research aims to explore the oral health literacy of rural-dwelling adolescents in North Queensland. Health education interventions carried out during early adolescence have been shown to have long lasting effects on the development of good oral health behaviours into adulthood; oral health is fundamental to overall systemic health. However, to date, most studies surrounding these topics haven’t included adolescents. Furthermore, the literature surrounding rural Australian adolescents is scarce and this gap is addressed in this study.

Aims of study: To evaluate the oral health literacy level of rural grade 8 students at Ingham State High School in North Queensland.

Methods: This mixed methods study involved 30 rural students (aged 13-14) who received oral health education. A modified survey was developed using themes from existing tools. Implementation of visual components within the survey compensated for varying literacy levels amongst rural adolescents. Additionally, focus groups with the students informed the quantitative survey data.

Results: Participants were found to have varying knowledge surrounding oral hygiene and prevention of oral disease. Results demonstrated participants having knowledge on how and how often to carry out oral hygiene, however not understanding the reasoning to do so. One example of this is the 100% of participants reporting to brush morning and night with toothpaste however only 57% being aware of the benefits of fluoride toothpaste. Survey results suggest that 13% of participants reported of the dentist making them nervous. The focus group data however indicated that all participants were nervous depending on the dental procedure. The participants reported of having above average dental attendance, 93% attending the dentist in the past 12 months. Data indicated the most common reason for dental appointments was for a dental check up and restorative work. Toothache was also reported consistently amongst focus groups as a reason to visit the dentist. Evidence suggested the participants oral health knowledge was reasonable, however, their oral health behaviours required improvement.

Conclusions: The evaluation suggested main points delivered during the oral health promotion were received well. This indicates that teens have the ability to obtain and learn basic health information. It is hard to determine whether this will parallel to the appropriate health care decisions. As oral health literacy involves both the ability to obtain information and apply it, it is difficult to draw conclusions about the adolescents’ oral health literacy levels. Whether or not these positive oral health behaviours will be adopted is a significant opportunity for further research.

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Lyn Byers
Remote Primary Health Care Manuals—by the user, for the user
Biography

Lyn Byers is a nurse practitioner in the specialty of remote area nursing, as well as a midwife and mental health nurse. She has worked in remote central Australian communities since 2001 as the resident Remote Area Nurse/Midwife, as well as outreach mental health services. Before coming to central Australia she worked in small country hospitals and bush clinics in country Victoria. As well as her clinical work, Lyn sits on the Board of CRANAplus and the Australian College of Nurse Practitioners. She is a graduate of the Australian Institute of Company Directors and is passionate about delivering high-quality health care in remote areas. She currently chairs the editorial committee for the Remote Primary Health Care Manuals, which guide and support remote area practitioners in their day-to-day clinical work.

Abstract

This paper illustrates a collaborative process for developing a suite of clinical guidelines, the Remote Primary Health Care Manuals (RPHCM). These manuals are produced with extensive input from health professionals with the ethos of ‘by the user for the user’.

The remote setting is unique with disproportion representation of Aboriginal and Torres Strait Islander people, a high burden of chronic diseases and lack of services. Access to clinically relevant guidelines tailored to this population and context is crucial to provision of quality health care. The RPHCM are a suite of five manuals designed to support evidence based best practice in primary health care centres across remote Australia. The suite has been developed using a unique multi-disciplinary framework to cover a range of areas of clinical importance for the remote context.

Development of the guidelines draws on practitioners from many diverse fields. Individual guidelines are reviewed by experts in the field to ensure consistency with current best practice. Secondary reviewers, front line clinicians working in the remote context, look at the completed guidelines for relevance and practical application to the remote context.  A multi-disciplinary editorial committee oversees the entire process, ensuring the RPHCM guidelines are evidence based and contextually relevant to remote primary health care clinics.

Continual review by users, has resulted in the RPHCM suite being clinically relevant and culturally credible guidelines. They are embedded into health service systems and local legislation. They have a strong reputation among users as an essential tool to support evidence based practice in remote primary health care services. The process used to develop and review the RPHCM guidelines provides a framework for other jurisdictions looking to develop contextually and clinical relevant guidelines.

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Helen Chambers
A world of rural health through literature
Biography

Helen Chambers (BSc, DipEd) is a Research Officer/Database Manager with Monash Rural Health. She uses her skills in database management for research and data analysis. Helen has been responsible for the RURAL bibliographies database for Monash Rural Health for the past 10 years. This database is available online through INFORMIT. Her skills with Leximancer have been used to analyse the RURAL database, to inform us of the changes in rural health in the research literature. Among the research projects that have been highlights of Helen’s research career, is a Victorian Public Healthcare Award received with Latrobe Community Health Services (2013)—Optimising healthcare through e-health and communications technology (Gold Winner) “Mobile Wound Care”. Helen has been involved with the ARHEN student survey working groups, studying the qualitative responses of allied health undergraduates to their rural placements. Currently she is involved with tracking studies of Monash University medical graduates, nursing and allied health students, studying the outcomes of their rural immersion placements into their eventual principal place of practice. Helen is also Managing Editor of the International Journal of Evidence-Based Healthcare.

Abstract

Background: The RURAL bibliographic database is an extensive collection of journal articles (n=36616) written since 1944 to 2015. The publications are retrieved on an annual basis and selected for their relevance to rural health, the provision of services to rural geographies, the health concerns of rural patients and the education of health practitioners to work in rural areas, their recruitment and retention.

Objective: To identify the type of content published and detect title changes over time in the RURAL bibliographic database using Leximancer.

Method: Leximancer is a tool that uses semantic mapping to develop concept maps from natural language. The text-mining features of the program were used to visualise the changes in focus, in the written literature, of rural health. Titles from the period 1944 through to 2015 were included.

Results: The major rural health themes identified were the provision of care and services to rural and remote communities (59.2%), the provision of nursing and medical education in rural environments (16.6%), the study of risk factors in the population (11.1%), the study of issues relating to the status of women, the aged and children in rural areas (8.1%),the management of hospitals and clinical access (5.7%), the treatment of cancer and chronic disease for patients in regional areas (3.7%). A timeline of changes in the focus on these concepts, indicates that from 1970-99 nursing and medical education programs dominated the research literature, with a shift in 2000-2009 to community, women’s status, children and older populations.  Most recently, 2010-2015, the focus has developed around the treatment of chronic disease, cancer and diabetes in rural patients.

Conclusion: Leximancer provides an innovative tool for the visual appraisal of a large dataset, which in this example, demonstrates changes in research for the provision of health services to the rural population. This change is consistent with the need for sustainable development initiatives to integrate appropriate science and technology to improve rural health.

Fiona Crawford-Williams
Variations in survival by geographical location for Australian individuals with colorectal cancer
Biography

Fiona Crawford-Williams is a postdoctoral research fellow in the area of regional health and mental health at the University of Southern Queensland. Her research interests are in the areas of health promotion and health behaviours. Fiona completed a Bachelor of Psychology (Honours) at the University of Adelaide in 2010, before working as a drug and alcohol support worker providing a 12-week motivational interviewing program. She completed a PhD in public health at the University of South Australia in early 2016. Her PhD research focused on alcohol consumption during pregnancy and the use of health education documents in antenatal care. Due to an interest in this area she currently serves on the Capacity Building Committee of FASD Research Australia, a Centre of Research Excellence based in Perth. At the University of Southern Queensland Fiona is currently involved in a collaborative research program with Cancer Council Queensland, which aims to build regional resilience in cancer control. The focus of this research program is improving outcomes for cancer patients in non-metropolitan areas of Queensland. Specifically, Fiona’s research interest is in improving psychosocial support and quality of life for regional cancer patients through public health interventions.

Abstract

Background: Colorectal cancer (CRC) is a significant public health issue worldwide. In Australia, CRC is the second leading cause of all cancer death and has the second-highest incidence of all types of cancers. However, with screening and early detection, early stage CRC is easily treatable. Research has demonstrated that particular societal cohorts experience significant disadvantages in CRC care in terms of preventive approaches, access to timely treatment, reception of the most up-to-date treatments, psychosocial support, and specialist care. In particular, those residing in rural and remote areas generally experience the greatest level of disadvantage in terms of these aspects of care. The extent to which geographical disparities exist in CRC survival has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival.

Methods: The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and examining geographical variations in survival outcomes.

Results: A total of seventeen research articles, and nine grey literature reports met review criteria. Despite differing methodologies and inconsistent approaches to geographic classification between studies, there appeared to be a general trend indicating that survival from CRC is significantly poorer for individuals residing outside of metropolitan areas. However, this effect is likely to be moderated by a range of factors such as age, gender, socioeconomic status, health insurance, and Indigenous status rather than occurring linearly with increasing distance from metropolitan centres. The majority of studies were state-specific and limited data was available at a national level.

Conclusions: Overall, despite evidence of disparity in CRC survival across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of rural and regional Australians.

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Hannah Dolling
Close the Gap on Indigenous smoking: a rural community best practice approach
Biography

Hannah Dolling has a Bachelor of Health Science and a strong passion for health, fitness and the outdoors. Since graduating from university she has worked in different positions within various organisations, gaining further experience in the field of outdoor education, community health and within the education settings. Hannah grew up in the Victorian high country, and since returning home she has also set up and continues to work in her own business as a nutritionist, which she enjoys greatly. She sees clients for one-on-one consultations and facilitates group education sessions on various nutrition and health topics with a passion for going back to basics and getting creative in the kitchen. She is always up for a challenge, and enjoys work that encompasses further learning around community health and wellbeing that strives to assist all to better health.

Abstract

Objective: The State Government has committed to improving Aboriginal health through the Koolin Balit initiative, demonstrating the precedence in addressing preventable health concerns within Aboriginal Torres Strait Islander (ATSI) communities. In order to close the life expectancy gap, the startlingly high rate of tobacco use in Indigenous populations requires immediate attention, as this is a leading cause of preventable deaths within ATSI people. Non-Indigenous Australian smoking rates are reducing significantly compared to ATSI rates, identifying a prominent gap is present.

Method: Inclusion of a database search with peer reviewed journals and descriptive initiatives over the past 10 year period, additionally service mapping of the local area, ATSI community members and other health service providers surveyed, interviewed and evaluated to gather relevant local level data. Greater Shepparton has the second highest population of ATSI people outside of metropolitan Melbourne, highlighting the need to use this data to create and implement a best practice model and evaluation toolkit to provide continual monitoring and accommodating as required.

Results: The project is current and will be complete by December 2016. However preliminary evaluation has identified there is a concerning lack of education on the long term health implications, utilisation of quitting support and understanding of the preventable diseases associated with tobacco use. This has been highlighted through a trial quit program recently applied at a local men’s detox centre and prison facility. Further supporting the notion of a local culturally sound approach to ATSI smoking cessation is paramount.

Conclusions/potential use of research: Evaluations thus far, identifies the immediate requirement for long term funding and a community Best practice model for implementation within the local ATSI community, including specific educational training for Aboriginal Health Workers (AHWs), as there is high tobacco use rate within the profession. Tobacco use requires ongoing government funding and a priority for every local health service in areas heavily populated by ATSI people, such as Greater Shepparton as previously there have been insignificant successful long term funded initiatives post pilot studies. All of which we endeavour to combine to create the best practice culturally sound model that is accessible, feasible and appropriate to the local communities. Additionally with the inclusion of various culturally trained health services and professionals, to roll out an ATSI smoking cessation roadshow model targeting the various gaps and barriers identified.

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Brad Elliott
Clinical and economic advantages of a PoCT laboratory in rural medical practice
Biography

Dr Brad Elliott is a general practitioner working in the rural community of Ingham in North Queensland. He achieved a Bachelor of Biomedical Science (Griffith University) in 1998 and his MBBS in 2002 from the University of Queensland. He worked at The Royal Brisbane and Women’s Hospital from 2003 to 2006 and then moved to Ingham in 2007. He was awarded his RACGP in 2009. Dr Elliott became a Practice Principal in 2012 at Hinchinbrook Health Care. In 2013, with the help of mLabs, he introduced a point-of-care laboratory to his practice. He has been at the forefront of this technology, being the first to introduce PoCT Influenza swabs to a category M laboratory in the country. He has seen firsthand the massive benefits that this area offers primary care in the rural setting and is perfectly situated to perform this study into the benefits that are achieved via a PoCT Laboratory.

Abstract

Introduction: There are many obstacles to setting up and running a successful rural General Practice in Australia.  This study will look at the impact of setting up a PoCT laboratory in such a rural practice in Far North Queensland.

Method: This study will evaluate the success of the PoCT laboratory by way of clinical and economic outcomes. The clinical outcomes to be assessed are:

  1. use of Tamiflu to treat Influenza and the benefits of positive influenza identification
  2. rates and outcomes of HbA1c testing in established diabetic populations
  3. use of CRP in acute presentations in clinical practice.

The economic outcome will be analysed by net profit achieved by the PoCT laboratory.

Results

Clinical outcomes

  1. Correct identification of influenza allows successful treatment, appropriate quarantining, and improved antibiotic stewardship.  After the introduction of PoCT Flu testing in the practice Tamiflu scripts increased by ~500% within the year, all appropriately prescribed to diagnosed influenza patients.
  2. By monitoring, responding to information, and then reducing HbA1c levels, the risk of complications associated with diabetes can be reduced.  The ratio of HbA1c tests compared to the diabetic population is 0.68 in Australia.  Utilising the PoCT laboratory, the practice has achieved a ratio of 1.38 per diabetic patient.  This has translated into an improvement in control of patients’ diabetes, each year a further 5% of our total diabetes population have moved into the ≤7% HbA1c cohort.
  3. CRP test volumes for chronic disease management have remained steady since the introduction of the laboratory, but CRP tests for acute presentations has steadily increased as our doctors gain familiarity with it:
  • 2012 – PoCT 0
  • 2013 – PoCT 121
  • 2014 – PoCT 378
  • 2015 – PoCT 729

This provides opportunity for targeted antibiotic stewardship whilst maintaining patient satisfaction, regardless of whether a script is provided.  The practice has seen a decrease in associated antibiotic prescribing from an average of 39.8% in the 3 years before the PoCT Laboratory to an average of 31.3% in the 3 years following its implementation.

Economic outcome

Net profit per financial year:

  • 2013/14 - $28,130.36
  • 2014/15 - $20,797.00
  • 2015/16 - $29,756.20

Conclusions: PoCT Laboratories have a significant role to play in both clinical and economic performance of rural general practice. PoCT offers undeniable clinical advantages with acute and chronic disease management, community preventative health and antibiotic usage.

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Clinton Gibbs
Influenza vaccine coverage and practices in rural NSW aged care facilities
Biography

Clinton Gibbs has worked in health promotion, Aboriginal health and a number of public health roles in rural NSW over the last 10 years. He has a Masters of Public Health and a Graduate Diploma in Indigenous Health Promotion. He is a proud Murrawarri man and father of six. Clinton has recently traded in the dry heat and muddy waters of western NSW for the coastal breezes and salt waters of Port Macquarie.

Abstract

Aims: In 2015 the Western NSW Local Health District (LHD) Public Health Unit (PHU) undertook a survey to assess influenza and pneumococcal vaccine coverage and practices in aged care facilities (ACFs) within Far West and Western NSW LHDs, and their preparedness in the event of a case/outbreak.

Methods: ACFs were recruited through mail, email and phone contact. ACFs could submit their survey using a Survey Monkey link, secure fax or via email. PHU staff entered the emailed and faxed surveys onto Survey Monkey and analysed collected data.

Results: A total of 54 (73% of Far West and Western NSW LHD ACFs) ACFs participated in the survey and reported that 90.3% of residents and 49.3% of staff received the 2015 influenza vaccine. 2015 influenza vaccination rates were slightly lower in residents from public facilities (85.8%) compared to private (91.1%) facilities, but higher for staff (60.3% vs. 46.7%, respectively).  Only 11.1% of residents had received pneumococcal vaccine in the last 5 years; however, status was either listed as unknown or not reported for 74% of residents, and we did not assess to number of residents eligible to receive the vaccine to provide a reliable denominator. Recurring barriers to vaccination reported by ACFs included: staff/resident misconceptions, staff refusal, access/cost, allergies, previous negative experiences and needle fear. ACFs applied a wide range of vaccine ordering and administration practices and most agreed that they would use recommended procedures in the event of an outbreak.

Conclusions: The 2015 influenza vaccination rate for residents of Far West and Western NSW LHD ACFs was generally high and uptake appeared lower for privately operated ACF staff. Staff vaccination rates were similar to rates found in other studies of Australian residential aged care workers and health care workers. The estimated pneumococcal vaccination rate is unreliable as we are unable to determine the number of residents that met the prescribed eligibility criteria for vaccination. There is a need to address gaps in administering and recording influenza vaccinations of ACF staff and to promote outbreak prevention and response procedures. Annual surveys can be used to evaluate and adjust public health services and campaigns for the prevention of influenza in ACFs.

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Jane Harte
Safety behaviour and mental health in farmers: trends and implications
Biography

Assoc Prof Jane Harte is a senior researcher attached to the Agricultural Health and Medicine Unit of the Institute for Agriculture and the Environment at the University of Southern Queensland. She has a particular interest in rural and remote mental health and has worked in research and education throughout northern Australia for around eight years. She is also currently coordinating a longitudinal medical education project with the Griffith University Medical School, where she holds an adjunct academic title. Jane’s interest in medical education spans over 20 years, during which time she has worked in undergraduate medicine, postgraduate professional education and incentives to practice rurally. When not working in acadaemia, Jane consults as an organisational psychologist into the mining, defence and higher education sectors.

Abstract

Intentional and unintentional mortality is higher among agricultural communities within Australia compared to other industries. Agriculture ranks as one of the most dangerous industries in Australia, with vehicles, farm equipment and animals contributing to the high work-related injury rate, moderated by lesser occupational health standards and performance. This paper overviews our investigation of the overlap of psychological distress with safety behaviours among agricultural workers. Self-identified agricultural workers were recruited at field days held in Kingaroy, Kingsthorpe, Warwick and Charleville (Queensland) between 2013-15. They completed a health and lifestyle assessment initially developed by the National Centre for Farmer Health (including the Kessler Psychological Distress Scale - K10), modified for delivery by medical students supervised by rural health practitioners. Specifically we looked at the use of personal protective equipment [PPE] and the relationship between this variable and reported psychological distress. The overall low level of reported compliance with PPE among these agricultural workers is concerning. Data trends indicated a relationship between the low use of PPE in relation to agricultural industry environmental hazards of handling chemicals, using machinery and sun exposure, and psychological distress among farmers. On-farm seat belt and helmet use is particularly concerning, considering the predominance of vehicle-related accidents causing deaths on farms and in rural communities. Notably, compliance with these safety measures was poorest among those reporting greater psychological distress. The results to date are discussed here in relation to their implications in addition to what might have precipitated these findings, and finally, how safety might be improved in the agricultural industry.

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Rebecca Irwin
Patient Assisted Travel Schemes: are they actually assisting rural Australians?
Biography

Dr Rebecca Irwin recently graduated from the Australian National University and is currently an intern at Maitland Hospital in NSW. Rebecca has an interest in rural and remote medicine, interprofessional education and survey-based research. Review of the Patient Assistant Travel Schemes was conducted by a group of Australian National University medical students in 2016.

Abstract

Aims

1. Review the State and Territory- based Patient Assisted Travel Schemes (PATS).

2. Highlight current issues and develop key recommendations to improve the PATS.

 

Methods: Literature review and point in time analysis of the PATS in Australia. Search strategy included PubMed, the Australian Institute of Health and Welfare database, the Australian Bureau of Statistics database and Hansard publications. Broad search terms included: Patient Assisted Travel Schemes, Government review, Policy, Issues and Recommendations. Only English language papers were included.

 

Relevance: PATS aim to provide equitable access to essential healthcare services for the 30% of Australians living in regional, rural and remote areas. Specifically, travel and accommodation subsidies are provided for non-metropolitan residents to access specialist health services that are not available within their local area. Given the limited provision of specialist medical services in rural and remote regions of Australia and the increasing prevalence of chronic diseases, it is paramount that PATS function effectively.

 

Results

Issue 1: Non-uniform Principles of Eligibility. Eligibility criteria for distance, eligible medical services and escorts differ considerably between the State and Territory PATS.

Issue 2: Non-uniform and Inappropriate Travel and Accommodation Benefits. Travel and accommodation financial reimbursements can differ between the State and Territory PATS. The current schemes do not make optimal use of air transport. The financial reimbursement for accommodation is considered inadequate across all States and Territories.

Issue 3: Lack of Promotion and Complexity of the Application Process. There is a lack of awareness of PATS among health professionals and clients. There is varying degrees of promotion of the schemes among the State and Territories. The application process is unique to each State and Territory PATS and often involves multiple forms for both health professionals and clients to complete.

 

Key recommendations

Recommendation 1: Simplification and Nationwide Uniformity. We propose that current eligibility criteria are simplified and standardised across States and Territories.

Recommendation 2: Promotion and Accessibility. We recommend nationwide standardisation of PATS branding, application forms and materials to ease promotion and education of both patients and clinicians.

 

Conclusions: In order to ensure equitable provision of medical services to patients from rural and remote regions, it is necessary to harmonise the current eligibility criteria and to provide uniform levels of financial support across jurisdictions. Furthermore, all States and Territories must adequately promote the PATS and simplify the application processes to facilitate accessibility.

Akil Islam
Current traits and trends of rural generalist medicine in Australia: a secondary analysis of ACRRM Fellows using the MABEL dataset
Biography

Akil Islam is a rural GP practising in Mareeba, Far North Queensland. He completed his medical training at the University of Western Australia in 2009, and FRACGP in 2017. He is an academic registrar of ACRRM with research interests in rural workforce issues and rural medical education, and is associated with James Cook University under this role. He also involved with medical education at James Cook University.

Abstract

Aims and objectives: A shortage of rural general practitioners and challenges in rural retention contribute to the rural-urban health disparity in Australia. The Australian College of Rural and Remote Medicine (ACRRM) offers post-graduate general practice training (FACRRM) that claims to be broadened and nuanced for the added demands rural healthcare. This approach, known as rural generalist medicine is gathering international acceptance. It aims to provide rural communities with doctors for their specific health needs, who can work within and outside of traditional primary care roles. However, whether this innovation in medical training affects the distribution and retention of doctors in rural areas of Australia has not been established. This project analyses the Medicine in Australia: Balancing Employment and Life (MABEL) dataset to answer these questions.

Method: MABEL is a cross-sectional longitudinal study from 2008-2016 and contains extensive demographic, occupational and geographic information annually on 1200-1500 Australian doctors. STATA14 was used for the secondary analysis.  The geographic distribution of GP Fellows under the Modified Monash Model (MMM) was compared between those holding FACRRM and Fellows not holding FACRRM. Further analysis will include more detailed descriptive statistics; logistic regression to identify variables that impact on rural practice.

Results: The annual FACRRM cohort varied between waves, but was over 200 per year. Geographical distribution analysis shows increased distribution of FACRRMs compared to non-FACRRM fellows in rural areas > MMM 3. The difference was maximal in MMM 4 regions. This was statistically significant. Key descriptive statistics comparing gender split, age distribution, hospital work and procedural work between FACRRM and non-FACRRM general practice fellows will be presented. Subgroup analysis will also be demonstrated.

Conclusions: It would appear that rural medicine Fellowship is leading to most FACRRMs preferentially working in rural and remote areas. There are key differences in the composition and work practices of FACRRMs. Further analysis will contribute to the evidence base and informing the discussion on establishing a National Rural Generalist Pathway.

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Mary King
Three linked resources promoting quality care in rural and remote practice
Biography

Mary King (CNE MHStPHC; MHStCCAH; GradDipVocEd; GradCerteLearning; BA (Sociology); CertIV TAA;RN) is the Nurse Educator – Rural and Remote/Program Manager of the Pathways to Rural and Remote Orientation and Training (PARROT) Program based in the Rural and Remote Clinical Support Unit, Torres and Cape Hospital and Health Service, Cairns. She has worked in primary health care settings since 1989, including nine years in remote areas and six years in the Northern Area Health Service/Office of Rural and Remote Health. The main focus of the roles has been the development of primary health care services in rural and remote communities, with workforce development and appropriate orientation, education and training the priority. Mary has spent the past eight years focusing on the development of learner centred education and training programs in rural and remote and primary health care service provision. This has included research on the most effective and efficient way to deliver orientation and training to the rural and remote workforce, input into the development of The Chronic Conditions Manual (previously known as the Chronic Disease Guidelines) and the development of learner resources for rural and remote and primary health care staff. Mary is on the steering committee for the development of the Rural Generalist Nurse Training Pathway sponsored by the Qld Statewide Rural and Remote Clinical Network and provides technical and resource development support to rural and remote educators across Queensland.

Abstract

The Primary Clinical Care Manual (PCCM) is the principal clinical reference and policy document for health professionals in rural and remote Queensland, where it is supported by legislation, education, training and support for staff. Providing evidence based clinical care guidelines where health professionals may be working in isolation from immediate medical support, the PCCM also provides the authority for appropriately trained and endorsed rural and remote health professionals to engage in advanced practice by administering and supplying medications which would otherwise require a doctor’s order.

The Chronic Conditions Manual (CCM) is developed as a clinical practice manual for the prevention and management of common modifiable lifestyle related chronic conditions. The CCM provides a simple, easy to read standardised tool to inform clinical practice. It consolidates national and international evidence based best practice as well as nationally recommended age related early detection health checks for children and adults. The manual also includes current national recommendations for modifiable lifestyle behaviours and is endorsed by leading local, statewide and national clinical networks, as well as leading specialists and clinicians in their fields.

The Pathways to Access Rural and Remote Orientation and Training (PARROT) program has been developed for the multi-cultural, multidisciplinary health team.  It supports education, orientation and training of all health care workers in rural, remote and primary health care settings. It provides support and learning from pre-recruitment right through to professional development for staff in the provision of acute primary care and ongoing care in chronic disease prevention, detection and management. PaRROT is available as a free online training program with access to supporting resources including workbooks, links to other resources.

The Rural and Remote Clinical Support Unit (RRCSU) takes pride in the work invested and the standards maintained by these three initiatives that are specifically aimed at rural and remote health care and which address the spectrum of patient presentations encountered by rural and remote practitioners. The PCCM has a circulation of over 4,000 copies down the entire eastern seaboard of Australia, the CCM has been eagerly adopted and distributed by both individuals and Primary Health Networks, and PARROT is accessed nationally and internationally.

The RRCSU will showcase the structure, content and function of these initiatives, the links between them, and how they can improve quality and safety for rural and remote health services.

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Firstname Lastname
Topic of poster
Biography

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Abstract

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Poster | Paper
Matilda Low
Physical Activity Leader Program for people living in rural communities
Biography

Matilda Low is a passionate and motivated Health Promotion Officer employed by the Western NSW Local Health District (WNSWLHD). Matilda grew up in Sydney, where she achieved a Bachelor in Health Science majoring in Health Promotion and a Masters of Public Health. She is currently involved in both local and state projects focusing around tobacco control, healthy eating, food security and physical activity. Matilda is enjoying her time in Dubbo as the lead of the Physical Activity Programs across the WNSWLHD. The program was nominated as a finalist in the recent WNSWLHD Living Quality and Safety Health and Innovation Awards for 2016. Matilda volunteers her time as a PHN community council member and enjoys soccer and athletics. She hopes that her work will have a lasting effect on the community. She trusts that the healthy choices the people of greater NSW make today will enable future generations to thrive.

Abstract

Physical activity opportunities for beginners or aged participants are hard to come by when living rurally. Access to physical activity opportunities such as exercise classes in rural settings are limited by the sparse population compared to more metropolitan areas. When private businesses do run exercise programs they are often at a cost that can prohibit attendance.

With a population struggling with obesity and sedentary lifestyles the Physical Activity Leaders (PAL) program was developed. The PAL program aims to address this issue by increasing access to exercise groups run by trained leaders to provide evidence-based, safe community exercise at low cost, targeted at smaller towns.

The PAL program focuses on the prevalence of preventable diseases in disadvantaged communities by increasing participation in PAL groups. This is no easy feat with a sizable region encompassing a dispersed population.

By developing this Program through the Capacity Building, Health Promotion has created a system that develops personal skills, increases access, builds supportive environments and delivers a sustainable model of service delivery. This model delivers training and programs at far lower cost to the LHD than other options such as employing fitness leaders or training leaders externally. It also supplies a no-cost service to participants.

Training is conducted at various locations every year across the district by qualified trainers free of charge. Once trained these new facilitators go back to their communities to run classes. Health Promotion is there to provide assistance if needed.

The training is fully funded to allow for greater access. Leaders are also provided with providing volunteer reimbursements such as fuel cards, accommodation and first aid certificates. Trainings are continuously evaluated and improved to become participant and leader centred.

The PAL Program works locally and collaboratively with health services and volunteers enabling local solutions. These classes offer communities fun exercise suitable for all abilities. PAL programs empower individuals to manage their own health while strengthening communities. They seek to prevent avoidable chronic disease, injury, falls and social isolation whilst improving health and wellbeing.

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Tessa McCormack
Point-of-care testing for sexually transmissible infections: translating a trial into routine practice
Biography

Tessa McCormack (BMedSc, MPH) has spent the last two years working at the International Centre for Point-of-Care Testing, and was involved in several of the point-of-care testing programs running at the centre, including programs for acute, chronic and infectious illnesses. Tessa was the Coordinator of the ACE Program, an international point-of-care testing model for diabetes management, which operates in rural and remote Indigenous communities in seven countries. She also served two years as the Secretary of the WONCA (World Organization of Family Doctors) Special Interest Group on Global Point-of-Care Testing. Tessa was involved in the initial preparation and rollout of TTANGO2, a NHMRC-funded program introducing point-of-care testing for sexually transmitted infections in remote areas of Australia. Tessa is currently studying a Doctor of Medicine at the University of Notre Dame in Fremantle, WA.

Abstract

Background: The TTANGO randomised controlled trial (2013-2015) evaluated whether use of a molecular point-of-care (POC) test for chlamydia and gonorrhoea could improve the timeliness of treatment in 12 remote Aboriginal communities in Western Australia, Far North Queensland and South Australia. Preliminary results show that use of POC tests by Aboriginal primary care staff substantially reduced the time to treatment compared with standard laboratory testing, the POC tests had very high sensitivity and specificity and were found to be highly acceptable to patients and health service staff.

Aims: Through funding from NHMRC and the Australia Government, the second phase, called ‘TTANGO2’ involves translating POC testing into a routine program and expanding to 33 Aboriginal primary care services. In addition the program will integrate POC testing into sexual health continuous quality improvement (CQI) activities.

Methods: We established a translation framework based on; (i) community engagement and consultation, (ii) POC testing, training and quality management, and (iii) STI CQI activities. A transition workshop was held with health services in November 2015, and participants provided feedback on POC training models and operational aspects and STI testing and management processes. The findings from the workshop, along with acceptability research from the trial, informed the second phase. TTANGO2 is a partnership between Aboriginal health organisations, government, laboratories and researchers.

Results: Program expansion began by engaging a wide network of health services and stakeholders providing them with opportunities for input into the program implementation. To date, 16 primary care services have joined TTANGO2 with the remaining expected to join in the next 9 months. A comprehensive training system was developed and is being delivered in flexible and novel ways. A robust quality management program was designed in collaboration with the Queensland Paediatric Infectious Diseases Laboratory and the National Serology Reference Laboratory to ensure analytical quality and a software system for electronic transfer of results was developed. Sexual health CQI indicators were selected and a CQI working group is being established.

Conclusions: Year one has been productive and the framework has provided a solid basis for translation of the trial. The remaining 3 years of the project will continue to rely on the framework to build the capacity of health services and staff to take ownership of the program, continue POC STI testing as standard practice and integrate POC into their sexual health program.

Peter Merrilees
Clinical and economic advantages of a PoCT laboratory in rural medical practice
Biography

Peter Merrilees is the Medical Business Unit Manager at Point of Care Diagnostics Pty Ltd. He has a strong background in the health and medical industries with over 20 years’ experience, most of it specifically focused on point-of-care testing (PoCT). Peter has a Bachelor of Science (Biotechnology) from RMIT and a Graduate Certificate of Business Administration from the Australian Institute of Business where he is working towards his MBA. He has served on several industry working groups, including the IVD Australia PoCT Working Group and the AACB HbA1c Working Group. Peter is passionate about point-of-care testing and was instrumental in designing, establishing, and now in managing the mLabs point-of-care laboratory network.

Abstract

Introduction: There are many obstacles to setting up and running a successful rural General Practice in Australia.  This study will look at the impact of setting up a PoCT laboratory in such a rural practice in Far North Queensland.

Method: This study will evaluate the success of the PoCT laboratory by way of clinical and economic outcomes. The clinical outcomes to be assessed are:

  1. use of Tamiflu to treat Influenza and the benefits of positive influenza identification
  2. rates and outcomes of HbA1c testing in established diabetic populations
  3. use of CRP in acute presentations in clinical practice.

The economic outcome will be analysed by net profit achieved by the PoCT laboratory.

Results

Clinical outcomes

  1. Correct identification of influenza allows successful treatment, appropriate quarantining, and improved antibiotic stewardship.  After the introduction of PoCT Flu testing in the practice Tamiflu scripts increased by ~500% within the year, all appropriately prescribed to diagnosed influenza patients.
  2. By monitoring, responding to information, and then reducing HbA1c levels, the risk of complications associated with diabetes can be reduced.  The ratio of HbA1c tests compared to the diabetic population is 0.68 in Australia.  Utilising the PoCT laboratory, the practice has achieved a ratio of 1.38 per diabetic patient.  This has translated into an improvement in control of patients’ diabetes, each year a further 5% of our total diabetes population have moved into the ≤7% HbA1c cohort.
  3. CRP test volumes for chronic disease management have remained steady since the introduction of the laboratory, but CRP tests for acute presentations has steadily increased as our doctors gain familiarity with it:
  • 2012 – PoCT 0
  • 2013 – PoCT 121
  • 2014 – PoCT 378
  • 2015 – PoCT 729

This provides opportunity for targeted antibiotic stewardship whilst maintaining patient satisfaction, regardless of whether a script is provided.  The practice has seen a decrease in associated antibiotic prescribing from an average of 39.8% in the 3 years before the PoCT Laboratory to an average of 31.3% in the 3 years following its implementation.

Economic outcome

Net profit per financial year:

  • 2013/14 - $28,130.36
  • 2014/15 - $20,797.00
  • 2015/16 - $29,756.20

Conclusions: PoCT Laboratories have a significant role to play in both clinical and economic performance of rural general practice. PoCT offers undeniable clinical advantages with acute and chronic disease management, community preventative health and antibiotic usage.

Cassie Moore
Looking over the farmgate: resources to assist rural communities tackling mental health
Biography

Cassie Moore is the Senior Program Manager for Primary Health Care with the Royal Flying Doctor Service Victorian Section. Cassie is responsible for the delivery of all primary health care programs in Victoria, including Rural Women’s GP service, Mobile Eye Care, Flying Doctor Telehealth and the Flying Doctor Dental Clinic. She is a qualified health promotion practitioner and has just completed her Master’s in Public Health and Health Management. Having lived and worked in rural and remote Australia, Cassie has experienced firsthand the difficulties faced by communities to access the care they need. This real-life experience has ignited a passion in Cassie to reduce inequalities in health experienced by rural communities. This passion and experience has allowed for her to bring a community-centred approach to the management and service planning work she does with the Royal Flying Doctors Service in Victoria. She has a special interest in health literacy and evaluation and enjoys the challenges of rural health.

Abstract

A drought response initiative was developed to target farming communities in rural North West Victoria impacted by drought. A collaborative steering committee was formed, adopting a multifaceted approach to engage rural communities in proactively approaching mental health. The initiative encouraged local responses including: the funding of local community events and gatherings; training workshops for local champions; and the development of a suite of resources.

The resources intended to make contact details for crisis services easily accessible; promote ways to protect mental health; provide a call to action for communities to look out for their neighbours; and encourage a local response. To assess whether the resources have achieved this, there has been an evaluation of the resource development process, the response from community members and suitability of the resources for rural communities.

The collaborative group worked together to ensure that the resources were functional and relevant to deliver the key massages. An iconic rural artist was approached to develop the resources so that the design would appeal to rural communities. The suite of resources developed included a fridge magnet that doubled as a photo frame, with key contact details for crisis services; a to do list which included suggestions on how to look after your mental health; and a postcard with two tea bags attached to encourage individuals to “have a cuppa with a neighbour…it could make a difference”. The resources were distributed in a number of ways including a household mail out of the magnets and availability of all resources at community events and training workshops.

The evaluation adopted both quantitative and qualitative methods to ascertain if the resources have been effective in engaging the communities and delivering the health messages. The resources were distributed to over 10,000 households and reached 5800 community members at 48 community events across the region. There was a high demand for the resources to support events, with one community designing their event around the resource, offering a photo booth for families to take photos to use in their magnet photo frame.

The collaborative process of developing resources to engage a wide portion of the region was challenging, however the response from the communities has demonstrated that the approach was both effective and suitable. This is also reinforced by the collaborative group being approach to reproduce the resources to target additional areas in Victoria, such as Gippsland to support dairy farming communities.

Lara Motta
Point-of-care testing for diabetes management in Papua New Guinea
Biography

Lara Motta joined the Flinders University International Centre for Point-of-Care Testing in January 2012 as a research assistant, after completing her Honours year with the Centre and winning the University medal in 2011. Lara is the International Programs Coordinator for the ACE (Analytical and Clinical Excellence) Program, an international point-of-care testing model for diabetes management, which currently operates in rural Indigenous communities in four countries. Lara was Secretary of the WONCA Special Interest Group on Global Point-of-Care Testing from 2013-2014. Within Australia, Lara assists with training device operators and supervising quality testing for point-of-care testing field programs, including the national QAAMS Program and the Diabetes Management Along the Mallee Track program. Lara is also an associate investigator in TTANGO2 (Test, Treat and Go), an NHMRC Partnership Project investigating point-of-care testing for sexually transmissible infections in rural and remote Australian Aboriginal communities.

Abstract

Introduction: Estimates from the latest IDF Atlas report a diabetes prevalence of 12.9% in Papua New Guinea, with 507,900 known diabetes cases and a further 265,000 undiagnosed. The first PNG Diabetes Clinical Practice Guidelines (2012) recommend regular HbA1c testing for monitoring glycaemic control. However, in 2012, HbA1c testing was only available at the Port Moresby Hospital, requiring diabetes patients from Morobe Province to travel over 300 kilometres by plane or boat to have an HbA1c test. In 2013, in partnership with the local Government and National Department of Health, point-of-care testing (POCT) for HbA1c and urine ACR was introduced to four Morobe health services under the ACE Program, an international POCT model for diabetes management.

Aims: To introduce POCT for diabetes screening to reduce the number of undiagnosed patients and improve diabetes management in Morobe Province.

Methods: Patients attending diabetes clinics accessed HbA1c and urine ACR POCT as part of the quality-assured ACE Program. Patients who had repeat HbA1c testing during 2013-2016 were assessed to determine their change in glycaemic control.

Results: 1504 HbA1c and 621 urine ACR tests were performed on 1096 patients. 44% of patients (n=480) had diabetes. Their mean HbA1c was 9.4%. A third of patients (n=154) had repeat HbA1c testing and their mean HbA1c fell significantly from 9.2% (first measurement) to 8.6% (most recent measurement). The average time between tests was 16 months. The number of diabetes patients achieving target glycaemia (HbA1c ≤7.5%) nearly doubled (from 35 to 64), while the number of patients with poor or very poor glycaemic control (HbA1c >8.5%) decreased by a third (from 84 to 61). At one clinic where screening was a particular focus, 64% (n=43) of patients screened were newly identified with diabetes. The mean HbA1c in these new patients who had repeat testing (n=13) fell significantly from 10.5% to 8.5%. A trend towards increasing HbA1c with worsening kidney function was observable in diabetes patients who had HbA1c and urine ACR testing in the one visit (n=301). The mean HbA1c was 9.2% for diabetes patients with normoalbuminuria, 9.5% for patients with microalbuminuria and 9.8% for patients with macroalbuminuria. Quality control for both HbA1c and urine ACR met the recommended performance goals for these tests.

Conclusion: POCT has promoted change in clinical practice by facilitating greater accessibility to HbA1c testing. It is likely that, due to its success, the program will be extended to health services in neighbouring communities.

Thomas Meath
Evaluating oral health literacy of rural teens
Biography

Ethan Zappala, Thomas Meath and Eden Ambrose are dental student researchers whose project focused on evaluating oral health literacy in rural teens. Through providing appropriate oral health education for young adolescents in a farming community, they have been actively involved in the implementation of the award-winning Rural Engaging Communities in Oral Health (Rural ECOH) project. This focus on oral health in rural teens is showcased in the video available at https://www.youtube.com/watch?v=YR0p4w6zYds Thomas Meath is a fifth-year Bachelor of Dental Surgery student at James Cook University. He was born and educated in Cairns. He has a passion for rural and remote health, which is evident through his final year clinical placements in  Cape York, the Torres Straits and the Solomon Islands.

Abstract

Background: This research aims to explore the oral health literacy of rural-dwelling adolescents in North Queensland. Health education interventions carried out during early adolescence have been shown to have long lasting effects on the development of good oral health behaviours into adulthood; oral health is fundamental to overall systemic health. However, to date, most studies surrounding these topics haven’t included adolescents. Furthermore, the literature surrounding rural Australian adolescents is scarce and this gap is addressed in this study.

Aims of study: To evaluate the oral health literacy level of rural grade 8 students at Ingham State High School in North Queensland.

Methods: This mixed methods study involved 30 rural students (aged 13-14) who received oral health education. A modified survey was developed using themes from existing tools. Implementation of visual components within the survey compensated for varying literacy levels amongst rural adolescents. Additionally, focus groups with the students informed the quantitative survey data.

Results: Participants were found to have varying knowledge surrounding oral hygiene and prevention of oral disease. Results demonstrated participants having knowledge on how and how often to carry out oral hygiene, however not understanding the reasoning to do so. One example of this is the 100% of participants reporting to brush morning and night with toothpaste however only 57% being aware of the benefits of fluoride toothpaste. Survey results suggest that 13% of participants reported of the dentist making them nervous. The focus group data however indicated that all participants were nervous depending on the dental procedure. The participants reported of having above average dental attendance, 93% attending the dentist in the past 12 months. Data indicated the most common reason for dental appointments was for a dental check up and restorative work. Toothache was also reported consistently amongst focus groups as a reason to visit the dentist. Evidence suggested the participants oral health knowledge was reasonable, however, their oral health behaviours required improvement.

Conclusions: The evaluation suggested main points delivered during the oral health promotion were received well. This indicates that teens have the ability to obtain and learn basic health information. It is hard to determine whether this will parallel to the appropriate health care decisions. As oral health literacy involves both the ability to obtain information and apply it, it is difficult to draw conclusions about the adolescents’ oral health literacy levels. Whether or not these positive oral health behaviours will be adopted is a significant opportunity for further research.

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Rebecca Presser
Close the Gap on Indigenous smoking: a rural community best practice approach
Biography

Rebecca Presser is an Aboriginal women from North Eastern region who has worked in the community services sector for the past 15 years. Her work experience has spread across Aboriginal employment, education and health. Rebecca has a Diploma in Community Services and Youth Work. She is very passionate about working and advocating on behalf of her community on a range of issues that affect their spiritual, health and emotional wellbeing. Rebecca provides an overall holistic service to all of her clients and ensures that she sees and listens to all aspects of her client’s life.

Abstract

Objective: The State Government has committed to improving Aboriginal health through the Koolin Balit initiative, demonstrating the precedence in addressing preventable health concerns within Aboriginal Torres Strait Islander (ATSI) communities. In order to close the life expectancy gap, the startlingly high rate of tobacco use in Indigenous populations requires immediate attention, as this is a leading cause of preventable deaths within ATSI people. Non-Indigenous Australian smoking rates are reducing significantly compared to ATSI rates, identifying a prominent gap is present.

Method: Inclusion of a database search with peer reviewed journals and descriptive initiatives over the past 10 year period, additionally service mapping of the local area, ATSI community members and other health service providers surveyed, interviewed and evaluated to gather relevant local level data. Greater Shepparton has the second highest population of ATSI people outside of metropolitan Melbourne, highlighting the need to use this data to create and implement a best practice model and evaluation toolkit to provide continual monitoring and accommodating as required.

Results: The project is current and will be complete by December 2016. However preliminary evaluation has identified there is a concerning lack of education on the long term health implications, utilisation of quitting support and understanding of the preventable diseases associated with tobacco use. This has been highlighted through a trial quit program recently applied at a local men’s detox centre and prison facility. Further supporting the notion of a local culturally sound approach to ATSI smoking cessation is paramount.

Conclusions/potential use of research: Evaluations thus far, identifies the immediate requirement for long term funding and a community Best practice model for implementation within the local ATSI community, including specific educational training for Aboriginal Health Workers (AHWs), as there is high tobacco use rate within the profession. Tobacco use requires ongoing government funding and a priority for every local health service in areas heavily populated by ATSI people, such as Greater Shepparton as previously there have been insignificant successful long term funded initiatives post pilot studies. All of which we endeavour to combine to create the best practice culturally sound model that is accessible, feasible and appropriate to the local communities. Additionally with the inclusion of various culturally trained health services and professionals, to roll out an ATSI smoking cessation roadshow model targeting the various gaps and barriers identified.

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Lizzi Shires
“They liven the place up!” Tasmanian rural general practice medical student placements
Biography

Lizzi Shires is Co-Director of the Rural Clinical School, University of Tasmania, based on the north-west coast of Tasmania. She has a particular interest in encouraging and developing a ‘rural pipeline’ for rural students to postgraduate training opportunities in rural areas. Lizzi works closely with GPs to develop student placements. She sits on the policy board of FRAME, the Federation of Rural Australian Medical Educators and the board of the Tasmanian workforce agency. The research interests of the Rural Clinical School include tracking projects for rural students and rural doctors and delivering health services in rural areas. Lizzi has worked as a general practitioner for 20 years in England and Australia, with particular interests in chronic disease management, public health, and education.

Abstract

Tasmanian rural GP supervisors value medical student placements because they enjoy the interaction with enthusiastic young people of different backgrounds. GP supervisors also feel that medical student placements increase their own learning. When asked about support for their role as GP supervisors, the most frequent response was that the current program, of academic detailing provided by visiting academics to each rural practice, is working well.

The University of Tasmania (UTas) has a five-year undergraduate medical program. Rural GP placements (in practices outside of Hobart and Launceston) occur during years three to five. As part of a continuing professional development (CPD) activity established for GP supervisors of medical student at UTas, two qualitative questions were asked: “What do you enjoy most about teaching medical students in your practice?” and “How could you be assisted and supported in this activity?”. Fifty GPs from 19 rural practices participated in the CPD activity, which was 70% of UTas rural teaching practices.

Thematic analysis of the qualitative survey responses showed that sixty per cent of the rural GP supervisors enjoyed teaching medical students because they enjoyed the interaction. Sixty per cent of rural GP supervisors felt that they also learned themselves during medical student placements. GP supervisors also valued teaching as part of their role (10%) and enjoyed seeing their students learn and develop (20%). Thirty per cent enjoyed teaching about the role of the rural GP and felt it could encourage young future doctors to work in rural areas.

The most frequent response to the question about assistance and support for rural GP supervisors of medical students, was positive comments about their current role and level of support (36%). Administrative logistical support and individualised collegiate academic support were both highly regarded. The next most frequent comment regarding assistance and support was from 16% of GPs who would like to hear more feedback from students about their placements. UTas provides student feedback to practices as grouped data in de-identified form. There were a small number of rural GPs (5%) who were interested in higher education support such as formal teaching courses and assistance with research activity. Academic detailing will continue as the main form of rural GP supervisor support at UTas. Increasing student feedback to practices and providing flexible access to university learning programs for rural GP supervisors are recommended.

Sandra Saxton
Diversity and Inclusion addressing the barriers: a collaborative approach
Biography

Sandra Saxton has worked in the community sector for over 40 years, 20 of those at a senior level with a focus on aged care, planning, service development and provision. She is currently the Executive Officer of Lower Hume Primary Care Partnership (PCP), one of 28 PCPs across Victoria. PCPs are established networks of local health and human service organisations working in partnership to improve the health and wellbeing of their local communities. Sandra is committed to assisting agencies to work together with a strong belief that partners who collaborate can help each other achieve what they never could have done on their own. Sandra has a Bachelor of Social Science, Majoring in Welfare and Sociology and a Master of Management (Community Management).

Abstract

Aim: Diversity is a concept that recognises that each person is unique and has different beliefs, values, preferences and life experiences. For some people these differences may result in barriers to accessing or using services. To improve access to their in home aged care services by eligible people who are marginalised or disadvantaged and to improve the capacity of the service system to appropriately respond to their needs agencies across two local governments in regional Victoria collaborated on a joint Diversity Plan.

Methods: At the Lower Hume Primary Care Partnership (PCP) Service Development Collaborative in July 2015, members receiving HACC funding and required to develop a Diversity Plan supported the suggestion that they collaborate and develop one plan for the catchment. The rationale being that larger agencies with substantial resources would be able to work with and support agencies with less resources. Each agency took responsibility for a Priority this included liaising with other members on objectives, actions, timelines and measures. Agencies were supported by the PCP who provided the collaborative with detailed knowledge of the aged population within the catchment. This provided the rationale for the focus on the target groups identified in the Diversity Plan. Monthly reporting and discussion on the implementation of the plan was a standing item on the Service Development Collaborative agenda. It was at this meeting that agencies were able to communicate with one another if they wanted assistance and/or change a priority or an action.

Results: The collaborative maintained a strong focus on supporting improved access for Aboriginal and Torres Strait Islander peoples (Aboriginal) people with dementia, people from culturally and linguistically diverse communities (CALD) gay, lesbian, bisexual, transgender or intersex (GLBTI) people, people living in rural and remote areas and people experiencing financial disadvantage or are at risk of homelessness. The collaborative approach whilst having both strengths and weaknesses has enabled both systems change within service provision and improved access to the target groups. Evaluation of the plan is currently underway including an evaluation of the collaborative approach. The outcomes of the evaluation will inform and guide the 2016-17 diversity plan.

Conclusion: The collaborative approach when initiated by agencies and supported by the PCP has proven to be vital in initiating systems change and improved service access.

Melody Shepherd
Training and support for telehealth implementation in Queensland allied health services
Biography

Melody Shepherd is an Allied Health Team Leader at the Cunningham Centre, Darling Downs Hospital and Health Service. She has worked as an occupational therapist in regional and rural areas in Queensland, interstate and overseas for the past 16 years. In recent years she has focused on workforce redesign projects in Queensland Health and is a Calderdale Framework Facilitator. One of Melody's key projects is the development of an online telehealth education module for allied health professionals in response to the Allied Health Telehealth Capacity Building Scoping Project, a collaboration between the Cunningham Centre and the Allied Health Professions’ Office of Queensland.

Abstract

Background: Telehealth has considerable potential to expand allied health services into rural and remote areas that have previously received only infrequent outreach or required clients and their families to travel to access care in larger centres. System-level supports for the allied health workforce are required to progress the growth of telehealth services.

Methods: The Allied Health Telehealth Capacity Building Project scoping stage (2014-15) sourced information from the literature and through interviews and an online survey of key stakeholders and allied health professionals in Queensland and interstate. The project identified enablers and barriers for telehealth use, summary information on telehealth models and clinical applications for allied health professions and training and support resource gaps. The implementation stage (2015-17) is drawing on individuals with relevant clinical, technical, educational and service redesign expertise to address identified support needs of the workforce.

Results and outputs: Data was collected in the scoping stage from 52 interviewees and 128 survey respondents. Videoconferencing (synchronous telehealth) employed in a ‘dual clinician’ (health care provider at host and recipient sites) or ‘direct client care’ (provider at host site only) model were the most commonly reported forms of telehealth. Telehealth-supported delegation and telehealth-supported shared care or skill sharing are forms of a dual clinician telehealth model. Limited knowledge, training and confidence with clinical and service redesign required for telehealth were the primary barriers to implementation. Adapting clinical tasks, functions and programs for delivery via telehealth was regarded as challenging, particularly for the ‘hands-on’ professions. Capacity building strategies identified for development, implementation and evaluation in 2015-17 include:

  • production of an online, on demand, flexible inter-professional training program covering service topics including technology, managing risk, and funding and activity reporting, as well as 13 profession-specific, clinical scenarios with interactive links to telehealth resources, and a resource library containing examples and templates for telehealth referral pathways, activity reporting, etc
  • an allied health telehealth network including a presentation series featuring clinicians showcasing their telehealth services
  • a comprehensive telehealth evaluation resource guide.

Conclusion: Allied health telehealth capacity development needs to extend beyond skills training in the use of equipment to how to adapt the clinical service design for this method of delivery. Training, resources and collaboration are in demand by health professionals who need practical and clinically-relevant guidance to integrate new technologies into their practice.

Evelien Spelten
Bridging the gap: rural palliative care support for dying at home
Biography

Dr Evelien Spelten is Senior Lecturer Public Health at La Trobe’s Rural Health School. Her research interests in health sciences are driven by curiosity and by the aspiration to connect research and practice. Her move in 2013, from metro Amsterdam in the Netherlands to rural Mildura in Australia, sparked an interest in rural health and wellbeing. She is an experienced higher degree research supervisor and researcher. With a background in organisational psychology, she has worked in several health-related areas. Her areas of expertise are: circadian rhythm research, psychosocial oncology, and midwifery and perinatal care. She has significant publications and research reflecting this expertise. Her passion is not so much on bridging the gap between research and practice, but more on ‘making the connection’ and on thus contributing to increased equity. Connecting also involves encouraging (regional) students to undertake graduate research work, to contribute to the knowledge base of their profession. Through supervision and as a researcher, Evelien is involved in various regional research projects, e.g.: violence against health care workers, palliative care for terminally ill patients, collective community impact to improve rural health and wellbeing, cyber bullying and rural male adolescents’ gender identity development.

Abstract

‘It is not that I fear death, I fear it as little as to drink a cup of tea’ (Ned Kelly 1854-88, Bushranger)

One can only imagine what the emotional rollercoaster of knowing that you are living on borrowed time would be like. Once reality sets in and end of life planning begins in earnest, one of the many considerations would be how it will be and where it will be.

Most people approaching their end of life want to do so with dignity intact and surrounded by those they love, in their own home. It should be the familiar surroundings, sounds, smells and warmth that encircle those approaching end of life and not the white walls, buzzers sounding, pumps beeping and other patients with their mortal complaints.

In Mildura, a small country town in Victoria, information from Sunraysia Community Health Services (SCHS) suggest that, despite the wish to die at home, around 70% of palliative care patients end up dying in a hospital bed. One of the barriers is that families do not feel supported to make dying at home a reality. As a response to the reality that these days only 14% of Victorians do die at home, SCHS is trialling a palliative after-hours trial to facilitate patients who choose to die at home.

The WHO defines palliative care as: ‘an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”

The after-hours service will run over a period of six months. The trial is staffed with experienced, knowledgeable and supportive staff who will work in close collaboration with other local care providers.

In the rural context, one of the challenges of offering an after-hours service is limited resources: funding and adequate palliative care staff. It is anticipated that staff flexibility will be one of the main drivers behind the success of the trial.

La Trobe University and Monash University are evaluating the trial. This project intends to capture a picture of what support is requested and offered. Experiences of care providers, family, and carers will be presented at the conference.

Olivia Stapleton
A practical and innovative model for managing chest pains in rural/remote hospitals
Biography

Olivia Stapleton has been a registered nurse since 1996. Before that she was a primary school teacher since 1981, where she taught all levels of primary school grades for 15 years, before deciding to do nursing. She has aways had a passion for teaching and nursing and applied to do both after doing HSC. The first offer she received was for teaching, hence she took that path. Olivia's heroine is Vivian Bullwinkle, sole survivor of the massacre at Bangka Island during the war. She uses Vivian as her role model and hero. Vivian Bullwinkle had incredible strength of willpower to overcome adversaries during her entire life. She became heavily involved in establishing goals in nursing education. She helped to improve the salaries and working conditions for all nurses. Olivia workw in a small hospital in the north-east of Victoria, in Alpine Health Bright. It is a wonderful place to work with a wonderful team but they mostly work with two nurses on during all shifts. The Urgent Care is busy as it is a tourist town all year round, plus it has an ageing population. Olivia has become involved in improving education in Urgent Care in the rural setting, mostly with doctors on call via telephone link or telehealth video, after hours and on weekends. This lead to the creation of their Acute Coronary Syndrome protocol. The nurses want to get to the point of being able to thrombolise a patient without a doctor, as the nearest catheter laboratory is five hours away by road transport and over an hour away by air. Olivia is committed to educating the nurses and leading the team.

Abstract

Introduction: A hospital in a rural/remote setting can be staffed with two nurses and with on call general practitioners (GPs) available by phone or telemedicine. This ‘on-call’ system necessitates decisive action by the nurses who were seeking a practical and innovative model of care for chest pain presentations, to identify and treat suspected acute coronary syndromes (ACS) in high-risk patients, or before discharging the patient with low risk of heart disease. Based on a model from South Australia, the ‘Hume Algorithm for the management of patients with chest pains or suspected acute coronary syndromes’ (‘Hume Algorithm’) was developed and has become a living document, and has been introduced to 35 centres in the Hume region.

Method: Nurses sought help from other rural/remote settings. Dr Philip Tideman, Director, Integrated Cardiovascular Clinical Network Country Health South Australia, had developed an ACS protocol in his region to assist nursing and medical (General Practitioner and trainees) staff to have a practical process for early assessment of patients who presented with chest pains.

Dr Tideman’s model was further developed for our region by Professor Leslie E Bolitho (AM FRACP), Mark Ashcroft, (former Health Service Manager Alpine Health) and Olivia Stapleton (Associate Charge Nurse Alpine Health). Dr Jeffrey Robinson (Medical Director Alpine Health) worked with Professor Bolitho to formalise the ‘Hume Region Management of Chest Pains or Suspected Acute Coronary Syndromes’.

Similar to other like-sized small rural health services, our rural Multi-Purpose Service (MPS) is staffed according to current Nurses’ requirements. This means that most often, nursing staff caring for inpatients, also provide care for urgent care presentations with the support of a GP on call via the phone and / or through a telehealth consultation to a larger referral health service. When a patient presents with chest pains, the RN can follow the ACS protocol through one of the three pathways after assigning an emergent triage score and assessing with general observations including a 12 lead ECG. It is a pragmatic pathway because at times, a single registered nurse is conducting the assessment. This use of the ACS pathway enables immediate treatment with nurse initiated medications, and further, with GP telephone advice, on-going treatment and medications, as per the ‘Hume Algorithm’.

We are intending to go the next step in this process of acquiring digital ECG machines to link our larger regional hospitals with the smaller rural health services. The 12 lead digital ECG will be able to be read by specialist physicians in real time, who will then provide guidance to the locally based nurses and doctors with respect to potential thrombolysis treatment in the event of an acute myocardial infarct. Once thrombolysis occurs the patient can be transferred to a regional centre or to a tertiary hospital for further treatment.

The pathways enable treatment by the nurses on site whilst awaiting transfer out to the nearest regional or tertiary hospitals.

Results: The ‘Hume Algorithm’ has provided nurses a systematic and structured approach to patients presenting with chest pains thereby reducing the risks of discharging patients that may have higher risk acute coronary syndrome.

Conclusions: ‘The introduction of the ‘Hume Algorithm’ has provided a consistent guideline for the early and timely management of patients with chest pains. The longer term aim is to improve patient care and reduce cardiovascular morbidity and mortality in the rural setting.’ (Leslie E Bolitho AM MBBS FRACP FACRRM FACP FRCPI (Hon) MAICD)

For nurses in our rural setting, we feel we have clear and thorough guidelines to facilitate better decision making and to initiate the care required. The protocol is dynamic to allow for the evolution of management between the pathways to manage chest pains and acute coronary syndromes presentations.

Jennifer Stirling
Arts therapy: changes to systems through alternative health and wellness program
Biography

Jennifer Stirling graduated from La Trobe University Melbourne, Australia, with a Bachelor Degree in Occupational Therapy in 1991. Her career commenced working in metropolitan public health in Melbourne Victoria spanning 26 years, including community health and mental health services, oncology, acquired brain injury, rehabilitation services, acute and sub acute health services at various health organisations. Jennifer relocated back home to central Victoria to work in  community health services at Maryborough District Health Service in 2009, bringing with her extensive work experience and knowledge, which enhance local community health services in the region. Since returning home Jennifer has continued education in therapeutic arts, through The Melbourne Institute of Creative Arts Therapy in Fitzroy Melbourne. Jennifer graduated with a postgraduate diploma in Creative Arts Therapy in 2014 and Masters of Therapeutic Arts in 2016. This new career path using arts modalities for counselling, complements well with her skills in occupational therapy interventions, and has provided the region with access to innovative mental health and wellbeing programs for young adults with mental health issues, and people with chronic health conditions. Jennifer has embraced her local community request for alternative health services operating from the purpose-built wellness centre funded by the local community. Jennifer is passionate about providing high-quality holistic health services for the local rural community with some of the highest rates of chronic physical health conditions and mental illness than other regions in the state of Victoria.

Abstract

Maryborough District Health Service (MDHS) in Central Victoria is committed to providing a broad range of health and community services supports, to all people living in our catchment area, predominantly servicing Central Goldfields Shire and parts of the Pyrenees Shire. Our Allied health professionals provide a comprehensive range of services and support to groups and individuals with a wide range of health conditions. Our staffs are currently working collaboratively with Grampians Partners in Recovery (GPIR) to provide coordinated service supports to our shared clients with mental illness and their families living in the catchment area. Both services work closely with each community in its region to build partnerships that will improve the health and wellbeing of the local population. 

Mental health and wellbeing is considered an essential component of a person’s overall health and well being. An individual’s wellbeing is a combination of mental health, physical wellness, social factors and perceived security and support.  We support people to address any of these life’s challenges and to build healthy relationships.

Following community consultations and fundraising over several years MDHS Wellness Centre was officially opened in August 2015. We currently offer service supports from our Wellness Centre, including Arts Therapy, Mindfulness Meditation, Tai Chi, Exercise programs, and daily drop in counseling services. People who attend the Wellness Center programs have access to all our other community services available from MDHS.

The Arts Therapy program is an innovative new project developed by our qualified Occupational Therapy staff, which has been running successfully since an initial pilot project commencing in August 2015, supported by a GPIR Innovation fund. We provide an evidence based recovery model to participants of the Arts Therapy program to achieve optimal health and wellness, and positive outcomes for our clients’ and their care givers.

An evaluation of the current Arts Therapy program has indicated clients and their care givers have achieved the following; a safe and supportive environment, working through concerns and challenges, better developed emotional coping skills and emotional regulation, renewed understanding of personal meanings, self discovered inner resources, increased self esteem and confidence, achieving relaxation and stress management strategies, making connections with like minded people, acceptance of self and personal ways of being and other practical skills.

All participants indicated a desire to continue the program and there has been an increase in referrals for the program since commencing in August 2015. The Arts Therapy program meets national objectives by providing service supports to people with persistent mental illness who have complex needs. Through systems change we are filling the gaps identified in service delivery for people with mental illness in our region.

This presentation/poster will reflect on the implementation of Arts Therapy and share key learning’s from the project and promote a stronger awareness of mental health issues in our region. We have broken down the barriers by being visible and present to the wider community and been active agents of systems change.

Maree Stallard
The provision of culturally secure services in rural and remote Western Australia
Biography

Maree Stallard is Sector Development Manager at the Western Australian Network of Alcohol and other Drug Agencies (WANADA), the peak body representing alcohol and other drug education, prevention, treatment and support services in Western Australia. WANADA is an independent, membership driven, not-for-profit organisation that takes a whole of community approach to alcohol and other drug issues. Having lived and worked in regional and remote communities across Western Australia, Maree brings a unique perspective to the WANADA team and to her role, supporting program initiatives that aim to develop the capacity of the alcohol and other drug sector. Capacity building of the alcohol and other drug sector is a strategy that improves the ability of workers, services and the broader system to achieve better health and social outcomes. A diverse background in nursing, education and management across a range of community services settings, has made Maree ideally placed to work with the alcohol and other drug sector to build capacity. This work includes supporting WANADA’s member agencies to achieve accreditation against the WANADA Standard on Culturally Secure Practice. Supporting accreditation against the Standard contributes to WANADA's vision for a human services sector that significantly improves the health and wellbeing of individuals, families and communities impacted by alcohol and other drugs.

Abstract

Providing culturally secure services is a way to ensure that all Australians have access to safe and effective services. The Western Australian Network of Alcohol and other Drug Agencies recognises the role that culturally secure practice plays in delivering successful outcomes. To support the alcohol and other drug sector to deliver culturally secure services an accreditation standard was developed. This standard is the first to focus on cultural security and has since been implemented by services across Western Australia including in rural and remote regions of the Pilbara, Kimberley, Mid West, Goldfields, Great Southern, South West and Wheatbelt. For the purpose of the standard the term ‘cultural security’ is applied broadly and in a way that is relevant to the culture of the consumer group accessing the service. This broad application can include cultural groups such as Aboriginal and Torres Strait Islander people, youth, women, culturally and linguistically diverse, injecting drug users and the GLBTQ (gay, lesbian, bisexual, transgender and questioning) communities.

The poster presentation will highlight some of the health and social benefits of culturally secure standards for rural and remote areas of Australia and outline the history and development of the standard.

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Brodie Thomas
Rural Australian paramedics’ experience of occupational violence
Biography

Brodie Thomas is a paramedic with Ambulance Victoria (AV) and is currently studying a Master of Applied Science degree through La Trobe University. He was born and raised in the country town of Mildura, Victoria, studied paramedicine at La Trobe University in Bendigo and then returned to Mildura to work as a paramedic. After finishing his graduate program at AV, Brodie began a postgraduate masters degree with La Trobe through a desire to continue his professional development and to give back his profession. He has a passion to conduct research that is both relevant and useful for all paramedics. Paramedics in the Mildura region are regularly faced with unique challenges posed by rural communities, as they respond to some of the most remote and isolated areas in Victoria, often travelling in up to a 100km radius to small farming communities and national parks. Mildura is also currently in the throws of an ice epidemic with a marked increase in violence and suicide. Violence towards paramedics is the subject of Brodie’s current project. By interviewing paramedics about occupational violence he aims to bring context to the current data and discover areas to aid in the prevention and minimisation of this issue.

Abstract

Occupational violence is a serious issue with potentially devastating consequences for individuals, families, organisations and communities. Healthcare employees are regarded as one of the highest recipients of occupational violence and up to 80% of paramedics have encountered violence at work. In Australia paramedics have the highest occupational injury and death rate of all occupations and occupational violence accounts for a significant amount of the injuries to paramedics.

Comparisons between rural and urban paramedics in Australia are not often reported, especially within the subject of occupational violence. Although it has been established that paramedics in rural locations are often isolated and have less resources than urban paramedics.

Occupational violence can impact on both physical and psychological health; from short-term effects such as bruising or feelings of anger and fear through to long-term effects such as broken bones, depression and permanent disability. Occupational violence may also affect the finances and career of individuals by taking time off work due to illness or injury, reducing job satisfaction and their commitment to an organisation.

In victoria where this study is being conducted, the ambulance service has made a significant commitment towards caring for the psychological wellbeing of paramedics in both rural and urban locations. The utilisation and benefit of these services in the context of occupational violence however is not known.

There have been very few qualitative studies conducted on paramedics facing occupational violence and studies exploring personal insights in this area have previously been flagged for further research.

In this study, paramedics who have been involved in a violent incident are being interviewed. They are invited to talk about the event and any ensuing issues as well as their views regarding risk factors and opportunities for prevention. Eligible paramedics will be invited to participate in a one-hour individual interview in order to create each case.

With this study we want to provide context to the current state of occupational violence towards paramedics in Australia and to gain a greater understanding of occupational violence risk factors and opportunities for violence prevention. We will have the opportunity to investigate the specific experiences of rural paramedics and how their unique environment has impacted their journey through occupational violence.

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Sarah Venn
Targeted children’s health workforce and service planning: the Australian Early Development Census
Biography

Sarah Venn is the Health Workforce and Services Planning Manager at Health Workforce Queensland. Sarah is a registered nurse and has 19 years’ experience in the health industry working in clinical, project and program management positions within the public, private and not-for-profit sectors. Sarah’s project management role provides the opportunity for first-hand consultation with rural communities all over Queensland and she enjoys working with individuals and organisations that advocate for and work towards sustainable health services and workforce solutions. Her experience working in health policy and planning as well as education and training, has directed her ongoing passion for working innovatively and strategically to improve health outcomes in rural and remote communities, including addressing the inequity of access to vital services and resources. In her spare time, Sarah enjoys being a mum of two and attempting house renovations.

Abstract

PHNs have been tasked with understanding the health care needs of their communities through analysis and planning, including addressing gaps in primary health care services. A service mapping exercise can identify gaps in a region’s health service delivery but prioritising which local communities receive an injection of services, and matching those services to the specific needs of the region’s population, is more complicated.

Health Workforce Queensland (HWQ) recently conducted a service mapping analysis for a Queensland PHN, including identification of gaps in services for children and young people. With negative experiences early in life linked to disadvantage and ill health throughout the life course, early childhood intervention needs to be a major healthcare priority.

As part of the service mapping exercise, HWQ extracted data from the Australian Early Development Census (AEDC) online Data Explorer tool to enable prioritisation of communities and matching of services to each PHN community. The AEDC is an Australian Government initiative that provides a ‘local area’ snapshot of a child’s development during the first year of school across five domains: physical health and wellbeing; social competence; emotional maturity; language and cognitive skills; and communication/general knowledge skills. Data from the 2009, 2012 and 2015 census years were extracted for each local community, including the community’s percentage of developmentally vulnerable children across the five domains.

A methodology was developed to identify communities to target including those with a percentage of developmentally vulnerable children consistently greater than the Queensland or PHN average. Employing this methodology, a subset of at-risk PHN local communities were identified; these were further classified as having either high and persistent vulnerability (across the three census years) or moderate-high vulnerability, dependent on the consistency of their scores across the three census years.

The use of this methodology using AEDC data could help guide policy makers and service planners in identifying vulnerable populations and, at the domain level, specific population-based tailoring of the primary health care workforce and services. Investing in Australian children’s health care needs can reduce economic outlay across numerous areas, help shape children’s wellbeing, and substantially impact the future adult’s trajectory, whilst having a significant impact on the greater population.

Caitlin Vayro
Farmers aren't seeking help for mental health: their partners tell us why
Biography

Caitlin Vayro is a PhD candidate from the Institute for Resilient Regions at the University of Southern Queensland. Caitlin's research focus is mental health help-seeking in farmers. Specifically, the factors that prevent and facilitate mental health help-seeking intentions and behaviour in farmers.

Abstract

There are many stressors that impact on farmers and recent research has found that Queensland farmers’ rate of suicide is twice that of the general population (Arnautovska et al.,2014). It is reported that mental health help-seeking behaviour is lacking in farmers. Seeking help for mental health is seeking services from a health professional for distress or mental health issues (Rickwood & Thomas, 2012). Farmers’ partners reportedly have a role in the help-seeking of farmers, such as facilitation and support, and may also be able to offer insight into their mental health help-seeking behaviour (Doherty & Kartalova-O’Doherty, 2010; Kolves et al., 2012). There is an urgent need to identify factors specific to farmers that make mental health help seeking difficult, including those outside their awareness.

The research presented is part of a program of research exploring the barriers and facilitators of mental health help-seeking in farmers from regional Queensland. The present research draws on semi-structured interviews with 10 partners of farmers, where the farmer resides in Queensland with farming as their occupation. The interviews were analysed drawing on the techniques of Braun and Clarke (2006). Several key factors were identified as having the potential to directly or indirectly influence mental health help-seeking, including the weather, mental health literacy, stigma, health services, farming lifestyle and ‘culture’, finances and coping mechanisms. Further, the key role partners play in the farmers’ help-seeking processes was also identified. This paper discusses these factors from the farmer’s partners’ perspective.

The findings from this research advance the understanding of the factors that influence the mental health help-seeking of farmers, by including additional insight from a source close to the farmers. The implications of this research include that interventions could be developed and provided to reduce the barriers and reinforce or strengthen the facilitators of mental health help seeking in farmers, including factors that farmers themselves may not be aware of.

Vanessa Vidler
The provision of culturally secure services in rural and remote Western Australia
Biography

Vanessa Vidler is Project Officer and Quality Manager at the Western Australian Network of Alcohol and other Drug Agencies (WANADA), the peak body representing alcohol and other drug education, prevention, treatment and support services in WA. WANADA is an independent, membership-driven, not-for-profit organisation that takes a whole of community approach to alcohol and other drug issues. WANADA developed the Standard on Culturally Secure Practice, an accreditation standard that is internationally recognised and endorsed by JAS-ANZ, as part of its work to support and enhance quality processes for alcohol and other drug services. Cultural security is an essential requirement of the Standard, which can be applied in various community service settings. Vanessa now works to support alcohol and other drug services to undertake service improvement activities and to achieve accreditation against the WANADA Standard on Culturally Secure Practice. In 2015, Vanessa completed a secondment in the Pilbara region of WA, and has provided support visits to health services throughout the state. This work has provided Vanessa with valuable insight into how the Standard can be applied. Vanessa holds a Master in Nutrition and Dietetics from Edith Cowan University, which closely aligns with WANADA's vision for a human services sector that significantly improves the health and wellbeing of individuals, families and communities impacted by alcohol and other drugs.

Abstract

Providing culturally secure services is a way to ensure that all Australians have access to safe and effective services. The Western Australian Network of Alcohol and other Drug Agencies recognises the role that culturally secure practice plays in delivering successful outcomes. To support the alcohol and other drug sector to deliver culturally secure services an accreditation standard was developed. This standard is the first to focus on cultural security and has since been implemented by services across Western Australia including in rural and remote regions of the Pilbara, Kimberley, Mid West, Goldfields, Great Southern, South West and Wheatbelt. For the purpose of the standard the term ‘cultural security’ is applied broadly and in a way that is relevant to the culture of the consumer group accessing the service. This broad application can include cultural groups such as Aboriginal and Torres Strait Islander people, youth, women, culturally and linguistically diverse, injecting drug users and the GLBTQ (gay, lesbian, bisexual, transgender and questioning) communities.

The poster presentation will highlight some of the health and social benefits of culturally secure standards for rural and remote areas of Australia and outline the history and development of the standard.

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Cassandra Whatley
Capturing all ages: health promotion approaches in central west Queensland
Biography

Cassandra Whatley has always had a passion and awareness of rural and remote health, stemming from a childhood growing up in rural regions of the Northern Territory. To supplement her interest, Cassandra moved to Brisbane for university, graduating with a dual degree in Health Sciences (Nutrition) and Creative Industries (Media Communications) from QUT in 2010. Through her studies, Cassandra discovered a strong interest in both human behaviour and associated behavioural changes. With her passion for nutrition and preventative health in mind, she furthered her studies and completed a Graduate Diploma in Public Health, majoring in Health Promotion, in 2012. Since 2013, Cassandra has worked as a Health Promotion Officer for North and West Remote Health in Longreach, servicing 17 remote communities in Central West Queensland. The role involves coordination and delivery of a range of programs and initiatives targeting region-specific socioeconomic and cultural groups across all ages: from early years to adults. Ensuing funding changes in 2015, Cassandra mostly delivers these programs as a sole practitioner using limited resources and a high level of strategic planning. Cassandra values the importance of developing strong partnerships and using innovative, multidisciplinary approaches to address the demanding preventative health needs of rural and remote communities.

Abstract

A variety of approaches are required by Health Promotion workers in rural and remote areas, to increase reach and access to services, with one of the major disadvantages being large distances between towns and major city centres. Different tactics work for different communities and groups. A variety of age groups and cultural groups are also targeted, hence a multifaceted approach is required.

Health Promotion in Central West Queensland consists of a very limited team across the organisations. The region is vast and caters to about 17 communities and their surrounding properties. One of the major challenges faced by workers in this area has been the inconsistencies in funding, quite often resulting in a reduction in valuable resources, including qualified staff. Partnering with internal and external health professionals and allied health staff, across the disciplines, has been useful and will continued to be a strategy used. However, there is the realisation that health promotion cannot be solely driven by these staff members due to restrictions in their own work capacity and inconsistencies in health promotion knowledge and practices. Therefore, a strategic approach is needed by those remaining in the field to upkeep effective service delivery. Consistency with communities has been found to be a key driver of successful program delivery and engagement from key stakeholders.

This poster showcases some of the key health promotion programs and initiatives delivered in Central West Queensland, which are culturally appropriate and capture a range of target groups from Early Years to Adults. Programs are designed to improve health literacy and promote healthy lifestyle behaviour change, as well as focus on capacity building and creating supportive environments. Results from a Health Literacy Questionnaire conducted throughout the Central West region will be included as part of the strategies moving forward. The presentation will include how key partnerships are formed and maintained for effective service delivery across the region. It will also highlight the challenges encountered in this health promotion space and the strategies used to overcome these, with their evaluations and room for recommendations.

Tara Williams
Tackling complex social issues through system change: a descriptive case study
Biography

Tara Williams is a registered nurse, Lecturer and Campus Lead in the La Trobe Rural Health School at La Trobe University, Mildura, Victoria. She is actively involved in the local community as a board member of Sunraysia Community Health Services and Mildura Base Hospital Community Advisory Board. In 2015, Tara completed the Northern Mallee Leaders Program and has a Graduate Diploma of Health Service Management and a Master of Public Health. Her thesis used case study to explore how cross–sector collaboration is strengthened using a collective impact approach. With a breadth of knowledge across acute, primary, community and higher education, Tara brings a diverse approach to curricula development and delivery as a nurse academic. Tara has a particular interest in improving educational outcomes and improving workforce delivery in rural areas.

Abstract

In 2015 something had to change. Located in north-west Victoria, the town of Mildura had fallen to the 3rd most socio-economically disadvantaged LGA in the State. The community recorded the second highest rate of domestic violence; double the average number of teen pregnancies; and drug use and possession was twice the recorded average in Victoria. Despite significant investment of resources and a strong history of working in partnership, many of the community’s vulnerable people were still falling through the cracks. The current system wasn’t working and something had to change.

Within the existing system of fragmented service delivery, there is a growing trend recognising and promoting the importance of working in collaboration. Intersectoral or cross-sector collaboration has been posed as an effective approach in which government, business and civil society can work in partnership to bring about large scale societal change. Collective Impact is one systems-based framework which supports communities to develop adaptive problem solving towards deeply entrenched and complex social issues. It recognises that large-scale social change comes from collective community effort rather than isolated policies, organisations and programs.

Mildura is a rural town who has adopted a Collective Impact in an effort to mobilise the entire community to work collectively to lay the foundations for change. The Hands Up Mallee project aims to address the many and varied influences which directly impact a person’s opportunities and choices, including families, education, policy, services, sporting and cultural opportunities.

This research uses case study methodology to describe the perceptions of cross -sector partners involved in the process of introducing a Collective Impact into their community.

Data was collected through semi-structured interviews and archival records and analysed using thematic analysis.

The current literature suggests why intersectoral collaboration is an important investment for improving health systems, however lacks published research about how to make it happen. This project aims to address this gap by describing the process one rural community used to introduce a collective impact framework. Outcomes of this case study have the potential to inform service providers and policy makers about the benefits and challenges faced when introducing a collective impact into rural communities. Findings may also identify the ways meaningful collaborations can be achieved and strengthened for improved system design and delivery of health services to rural areas.

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Ethan Zappala
Evaluating oral health literacy of rural teens
Biography

Ethan Zappala, Thomas Meath and Eden Ambrose are dental student researchers whose project focused on evaluating oral health literacy in rural teens. Through providing appropriate oral health education for young adolescents in a farming community, they have been actively involved in the implementation of the award-winning Rural Engaging Communities in Oral Health (Rural ECOH) project. This focus on oral health in rural teens is showcased in the video available at https://www.youtube.com/watch?v=YR0p4w6zYds  Ethan Zappala is a James Cook University dental student enrolled in his fifth and final year of study. He is currently undertaking placement in the public sector in rural north Queensland. Growing up in a country town within north Queensland, Ethan developed a passion for a career as a health professional. With his rural upbringing, he has a particular interest in rural and remote health.

Abstract

Background: This research aims to explore the oral health literacy of rural-dwelling adolescents in North Queensland. Health education interventions carried out during early adolescence have been shown to have long lasting effects on the development of good oral health behaviours into adulthood; oral health is fundamental to overall systemic health. However, to date, most studies surrounding these topics haven’t included adolescents. Furthermore, the literature surrounding rural Australian adolescents is scarce and this gap is addressed in this study.

Aims of study: To evaluate the oral health literacy level of rural grade 8 students at Ingham State High School in North Queensland.

Methods: This mixed methods study involved 30 rural students (aged 13-14) who received oral health education. A modified survey was developed using themes from existing tools. Implementation of visual components within the survey compensated for varying literacy levels amongst rural adolescents. Additionally, focus groups with the students informed the quantitative survey data.

Results: Participants were found to have varying knowledge surrounding oral hygiene and prevention of oral disease. Results demonstrated participants having knowledge on how and how often to carry out oral hygiene, however not understanding the reasoning to do so. One example of this is the 100% of participants reporting to brush morning and night with toothpaste however only 57% being aware of the benefits of fluoride toothpaste. Survey results suggest that 13% of participants reported of the dentist making them nervous. The focus group data however indicated that all participants were nervous depending on the dental procedure. The participants reported of having above average dental attendance, 93% attending the dentist in the past 12 months. Data indicated the most common reason for dental appointments was for a dental check up and restorative work. Toothache was also reported consistently amongst focus groups as a reason to visit the dentist. Evidence suggested the participants oral health knowledge was reasonable, however, their oral health behaviours required improvement.

Conclusions: The evaluation suggested main points delivered during the oral health promotion were received well. This indicates that teens have the ability to obtain and learn basic health information. It is hard to determine whether this will parallel to the appropriate health care decisions. As oral health literacy involves both the ability to obtain information and apply it, it is difficult to draw conclusions about the adolescents’ oral health literacy levels. Whether or not these positive oral health behaviours will be adopted is a significant opportunity for further research.