Andrew Panckhurst is a member of the New Zealand Telehealth Forum, an organisation formed under the umbrella of the Ministry of Health to drive a cohesive national approach to telehealth in NZ. The Forum aims to educate clinical, policy and funding organisations and to encourage their active support for and involvement in telehealth initiatives. Andrew also runs the NZ Telehealth Resource (www.telehealth.co.nz) centre, which was set up in 2015 to provide independent, hands-on practical support and advice to organisations implementing telehealth solutions. Andrew also works at Mobile Health who run New Zealand's only mobile operating theatre, which undertakes low-risk elective day surgery in 24 rural and remote communities. Andrew has a commercial background but has developed a special interest in the technical aspects of telehealth.
The NZ Telehealth Forum (NZTF) is a group established under the Ministry of Health to promote the use of telehealth in the provision of health care within New Zealand. In practical terms its focus is providing leadership, strategy and direction for telehealth in NZ. The NZ Telehealth Resource Centre (NZTRC) was formed in 2015 through a partnership with Mobile Health and (NZTF). The goal of the NZTRC is more grass roots, providing support, guidance and resources for people who want to set up or improve a telehealth service in NZ. In 2017 the dual identities have merged into a single public identity, brand and website. This creates a single coordinated unified voice promoting telehealth within New Zealand. The work done by these organisations will be outlined, as well as a snapshot of where telehealth is at in 2017 in New Zealand especially what is happening in rural New Zealand. While there are some wonderful examples there is still some way until a wide range of services are universally available. The nationwide broadband initiatives for urban and rural are well under way, and the positive impact of these and other projects will be reviewed. Professional bodies are cautiously supporting the changes to support the new models of care, but legislation does provide some challenges especially in prescribing. Other challenges including interoperability will be discussed.
Annette Panzera is the A/Director of Health Policy at Catholic Health Australia (CHA). Annette moved to Canberra in 2015 to CHA however spent five years in north Queensland (Cairns) prior to that working on various projects focusing on regional health workforce planning, Aboriginal and Torres Strait Islander research, health service strengthening and clinical redesign. She held roles at both James Cook University and Queensland Health during this time. Before returning to Australia in 2010, Annette worked at the Organisation for Economic Co-operation and Development (OECD) in Paris for ten years, concentrating on international health, education and social policy development. She has also worked as a consultant at the World Bank.
Aims and rationale: Funding streams for Aboriginal Medical Services are often provided at a program level rather than in response to population health needs that don’t take into account workplace fatigue, overtime and sick leave. To address this problem, this workforce exchange program aims to support Apunipima’s health service delivery to its remote communities through additional health workforce resources from CHA member health service providers (hospitals and aged care) to fill gaps created by unfunded backfill and areas of workforce shortage. The exchange element provides clinical upskill training opportunities for Apunipima Aboriginal Health Workers in CHA member hospitals.
Methods: The workforce exchange placements, both in respect to CHA clinicians working in remote communities and Aboriginal Health Workers participating in clinical training placements in CHA member hospitals, will be continuously evaluated throughout the duration of the project. An evaluation framework is currently under development in association with Australia Catholic University that reflects shared, realistic objectives and uses a collaborative formulation of criteria and indicators for annual self-assessments, including assessment of the processes as well as the outcomes is an essential feature of the partnership.
Relevance: Access to quality aged and palliative care services can be challenging wherever you reside in Australia; however, there is an acknowledged gap in service delivery of culturally appropriate aged and palliative care services for the communities of Cape York.
Results: Members of Catholic Health Australia in partnership with Apunipima and its affiliates have so far commenced several projects targeted at increasing access to aged care services in Cape York including developing a service model that delivers culturally appropriate palliative care to the communities of the Northern Peninsula Area Regional Council; working with the community of Hope Vale to support aged care service delivery; and supporting the development of an appropriately trained aged care workforce throughout Cape York.
Conclusions: As this project recently commenced in late 2016 it is premature to discuss conclusions but the foundational principles of the project are that working together with full community engagement requires a relationship built on trust and integrity: it is a sustained relationship between groups of people working towards shared goals. Apunipima and CHA have begun a journey of collaborating together and with other relevant stakeholders towards closing the substantial gaps in health outcomes between Aboriginal people in Cape York and other non-Indigenous Australians.
Roz Pappalardo is known throughout Australia for her prolific music and songwriting career, most notably with independent champagne folk act, women in docs, and her solo work as a strong roots musician. She has recorded approximately 10 albums, winning various songwriting, self-management and music business awards for her efforts. She heads up iconic music venue Tanks Arts Centre in Cairns, Tropical North Queensland, where she programs high-profile national and international music acts. Roz works tirelessly in her community, giving voice to the voiceless and telling stories of the many who don’t have the opportunity to do so. Working on the Soldier’s Wife project has been more than a blessing for Roz—it’s been necessary and she’s proud to stand beside her songwriting family to tell such important stories.
In years gone past, songs were the form of documenting our stories—telling the stories of those who had gone before, our histories, our tragedies and our hopes. And music accompanied, being the one thing that could transverse those feelings that could sometimes not be voiced. This is at the very heart of The Soldier’s Wife.
The past 30 months has seen a small group of Queensland songwriters go on a truly remarkable songwriting journey—to tell the stories of women whose partners have served in conflict over the past 60 years. To tell the stories of soldiers’ wives and their families and of their personal sacrifice.
The songwriters have talked to almost 100 women—aged from 25 to 104 years old. From varying backgrounds and conflicts, from remote and regional areas to inner cities, their personal journeys all have similar themes of love, of loss, of existence and most of all of resilience.
The artists use their voices and their muse to hold legacy to these stories and to share them on stage. These are not just stories of incredible women—they are stories of our history and of the new generation.
Carol Parker is a physiotherapist by training and currently works part-time at the Collaborative Health and Research Centre (CHERC) at Bendigo Health in Victoria whilst studying for her PhD. During her time at CHERC she has participated in many health projects but has been involved in the cancer and/or palliative care area for the past two years. Last year she experienced personally some issues with after-hours palliative care and is keen to help with improving the current system where possible.
Background: The Loddon Mallee Region is one of eight Department of Health regions in Victoria and encompasses 26% of Victoria. The current population of the region is older than the Victorian population overall with 17% over 65 years. In 2011, 2012 and 2013 the average annual number of palliative care appropriate deaths in the listed catchment area was 904 people.
Living in remote and regional Australia invariably means a choice of fewer services, longer waiting lists and travel to metropolitan centres for medical treatment.
All specialist community palliative care services within the LM region currently support clients and their carers during business hours by providing support and symptom management plans to help pre-empt issues that might occur after-hours. However if and when an after- hours palliative care emergency occurred carers had little option but to present at emergency departments, incurring distress for all involved.
Aim: This project aimed to identify, pilot and evaluate preferred models for after-hours support to palliative patients at home with complex overnight needs in a small, medium and large regional and rural catchment area.
Method: A desktop analysis of palliative care models in primary and community sectors including a review of geographical, workforce and funding barriers and enablers was completed.
Stakeholders, including carers and consumers were engaged in focus groups or 1:1 interviews in a small, medium and large regional and rural area of Central Victoria.
Ambulance protocols, home support packages and other appropriate usable tools were reviewed.
A preferred after-hours palliative care model appropriate for a small, medium and large health service was piloted and evaluated.
Outcomes: Baseline situational analysis
We optimised the after-hours palliative care approach in the Loddon Mallee region, hence supporting palliative clients to be cared for, and to die, in their place of choice.
We strengthened end of life networks in each of the three pilot sites (small, medium and large regional and rural catchment area
We integrated relevant and appropriate existing support tools into the after-hours model
We identified appropriate end of life education for patients, carers and the community
Kelly Paterson is the Senior Physiotherapist (Paediatrics) at Royal Darwin Hospital (RDH). She coordinates physiotherapy care for paediatric inpatients and outpatients in all clinical areas, including orthopaedic, respiratory, developmental and neurological conditions. Kelly’s areas of interest (her “soapboxes”) are culturally safe treatment and awareness of clubfoot; accessible developmental services for remote Indigenous infants; and the need for access to physiotherapy in management of respiratory conditions in remote areas. With paediatric allied health colleagues at RDH, Kelly initiated and introduced the “Watch Me Grow” program, providing standardised screening of urban high-risk infants for developmental outcomes in 2014. Unfortunately infants living in remote areas of the Northern Territory have no equivalent access to developmental screening. With support from RDH Paediatric services, Kelly is working to reduce this service gap by introducing telehealth follow-up for high-risk infants using the General Movements Assessment (GMA), a highly evidenced screening assessment sensitive to neurological outcomes. This unique approach to developmental screening (combining telehealth with developmental assessment) is itself in it’s infancy, and Kelly will report at the 14th National Rural Health Conference on the progress, outcomes and obstacles to date.
The General Movement Assessment (GMA), also known as “Prechtl’s Assessment”, is a highly evidenced low cost developmental screening tool. It is used to identify neurological impairments in high-risk infants, including preterm and low birth weight.
It is well established that preterm and low birth weight infants are at increased risk for sub-optimal motor, behavioural and cognitive developmental outcomes compared to their term peers.
The Northern Territory (NT) has the highest rate of preterm births; the lowest national average birth weight and the highest incidence of both low birth weight (LBW <2500g) and very low birth weight (VLBW <1500g) births in Australia. Aboriginal Australian mothers have an even higher rate of preterm births and the highest rates of VLBW births in the country.
Unlike their urban counterparts, high-risk infants from remote Top End communities currently do not receive routine Allied Health screening due to lack of capacity of remote service providers. A myriad of service access and funding issues contribute to this gap. In response, Royal Darwin Hospital (RDH) is introducing a protocol to screen high-risk remote-based neonates.
The introduction of a GMA protocol, which includes Telehealth, will offer early identification of neurological impairments in remote Aboriginal high-risk infants. This will facilitate early access to intervention and further investigations. Eligible infants will be offered GMA according to an evidence-based protocol prior to discharge from the inpatient nursery, with follow up GMA conducted via Telehealth from their closest community clinic with Telehealth capacity. Access to this gold standard screening and thus early intervention will minimise the burden of travel and cost to both families and service providers.
As part of the protocol roll out a number of additional objectives will be addressed including: barriers to participation in video assessment and Telehealth for remote Indigenous infants, collating insights and feedback from families and health professionals, and collection of data relating to assessment outcomes, referral rates and access to early intervention services. A preliminary cost benefit analysis of the protocol will also be completed.
It is anticipated that implementation and review of this protocol will result in improved access to services and guide policy changes regarding routine care and assessment of high-risk remote Aboriginal infants.
Doris Paton has a PhD in Philosophy (Education) (2010), a Master of Education (Aboriginal Education) (2003), a Graduate Diploma of Education (Secondary) (1995), a Bachelor of Arts (Social Science) (1993) and a Certificate IV in Training and Assessment (2012). She is a Gunai//Monaro Ngarigo woman, a wife, mother and grandmother living and working in Gippsland. Doris is Chair of CEAHEG, the Centre of Excellence for Aboriginal Health in East Gippsland Ltd, an organisation of Elders and Community members working to promote Health careers to Aboriginal young people in East Gippsland. Doris’ role in reclamation and revival of Aboriginal languages over many years includes: Office Bearer for Victorian Aboriginal Corporation for Languages (VACL); Woolum Bellum (KODE) School in the development of “Nambur Ganai” CD, an educational tool of Koorie language, (specifically the Ganai language) in the Latrobe Valley; curriculum development and assessment framework for the Victorian Qualifications Authority (VQA) and Victorian Curriculum and Assessment Authority (VCAA) accredited “Indigenous Languages of Victoria”; and executive roles on the Federation of Aboriginal and Torres Strait Island Corporation of Languages (FATSIL), focused on the protection and preservation of indigenous languages and cultures across Australia. Doris was the recipient of a number of awards, including GippsTAFE Staff Excellence Award; Wurreker Award for exceptional practice in Indigenous Education and Training; Parks Victoria Regional Achiever Award. She delivers customised Cross Cultural Awareness Programs in Gippsland.
Research to “Identify the Barriers to East Gippsland High School Students Becoming Health Professionals” was conducted in East Gippsland secondary schools in 2013 by the East Gippsland School for Aboriginal Health Professionals (EGSAHP), with support and funding from the Monash University School of Rural Health East Gippsland. EGSAHP is the trading arm of the Centre of Excellence for Aboriginal Health in East Gippsland Ltd.
There is a lack of qualified Aboriginal workers in all health professions in East Gippsland, apart from Aboriginal Health Workers. Only one doctor has come from the local Aboriginal Community, and a few nurses.
There is a significant gap between the health of Aboriginal and non-Aboriginal people in East Gippsland. In efforts across Australia to "Close the Gap" and improve health outcomes for Aboriginal people, it is widely acknowledged that Aboriginal people are more likely to engage with the health system if they have access to culturally appropriate services and Aboriginal health professionals. When they do they are more likely to be open to advice and support about healthy lifestyle choices and to seek health interventions and access follow-up support services and treatment as needed.
The EGSAHP research sought to identify barriers to school student awareness and interest in the health professions and ascertain views on what strategies might be helpful in encouraging local students, particularly Aboriginal students, to consider health professions as a potential career.
The EGSAHP research project involved an extensive literature review to ascertain barriers to Indigenous participation in tertiary education, particularly health professions, as well as interviews and consultations with students and parents from East Gippsland.
98 parents/ carers and students in East Gippsland (from Lakes Entrance and Bairnsdale Secondary Schools) were interviewed and surveyed. Of these, 44 were Aboriginal parents or carers reporting on 42 students, and 11 were Aboriginal students. The Aboriginal parents and carers as well as a small number of Aboriginal Elders were interviewed face to face. Other research participants responded by written survey. Feedback and discussion sessions were also held.
The research results formed the basis to a two day conference held in the region to consider future action, and from this a series of activities and programs have evolved that CEAHEG are delivering or coordinating to support local Aboriginal school students to complete their schooling and go into health profession training.
Dr John Pawlovich is currently the Director of the Rural Education Action Plan in British Columbia, and a Clinical Associate Professor in the Department of Family Practice at UBC as well as the Medical Director for Carrier Sekani Family Services. He completed his medical degree in 1994 at the University of British Columbia. He then went to Chilliwack where he completed a two-year family practice residency. He has worked in many rural and remote sites across Canada. Over the last twenty plus years an interest in aboriginal health evolved with a focus of bringing innovative primary care and specialty services onto reserve to reach the people most in need. Using new technology such as telehealth from his home office in Abbotsford, British Columbia, Dr Pawlovich is able to connect to multiple remote aboriginal communities to help provide the daily primary care they deserve and need. He continues to make monthly visits to northern aboriginal communities to ensure the closeness of his relationship to the people remains strong. In 2009, the College of Family Physicians of Canada honoured Dr Pawlovich with the Reg Perkins Award as British Columbia’s Family Physician of the Year.
As with many other indigenous populations, First Nations communities in British Columbia Canada remain extremely disadvantaged in access to high quality, timely and culturally sensitive primary care services that meet their individual community needs. First Nations people in British Columbia suffer some of the worst burdens of chronic disease and fall at the bottom of just about every social determinant of health. Health issues are increased for those living in rural and remote areas due to limited access to services, geography, mistrust and poverty.
In north central British Columbia Carrier Sekani Family Services was created to reassert First Nations control of justice, health, child and family services, all of which have been negatively impacted by colonization. For over 25 years, Carrier Sekani Family Services (CSFS) has been working to offer holistic wellness services to 11 member First Nations extending over an expansive geographical area of 76,000 square miles.
This presentation will focus on Carrier and Sekani First Nation efforts to develop a sustainable, high quality and community-based model of primary care service delivery. Through discussion that will include personal stories and data from a comprehensive evaluation, we will provide insight into CSFS primary care model including lessons learned/challenges, successes and recommendations for policy shifts to improve primary care service delivery to remote and semi-remote Aboriginal communities.
Specifically we will address how the model has created:
Theatre can play a vital role in influencing discussions in the community. One dark aspect that costs our communities both lives and millions of dollars is domestic violence, and yet the issue continues to grow as a silent and shameful destroyer of lives.
Driven by community demand, Creative Regions has developed two resources to address this issue—a verbatim theatre production titled ‘It All Begins With Love', and a children’s picture book called ‘My Big Bear Story'. Join our session to hear more about these projects and discover how the arts has the capacity to help tackle your local beasts.
Nicholas Place trained at Melbourne University and is in his 30th year of Social Work practice, spent across a variety of fields including child protection, family support and counselling, and mental health. Having managed a range of teams across the mental health services continuum, he has had a broad exposure to consumer and practitioner experiences of specialist mental health services delivery. Nicholas is employed by South West Healthcare (SWH) in rural south west Victoria. He has managed SWH’s Primary Mental Health Team from its conception in Victoria in 2001, and has been a key driver of the development of primary mental health service delivery in Victoria. Nicholas’ commitment to collaborating with other organisations to further develop early intervention programs is evident. He has collaborated with his ‘local’ University Department of Rural Health (UDRH), that is currently auspiced by Deakin Rural Health, on a number of projects, including the qualitative research that informed the South West Mental Health Mapping Project, and more recently Screening for Gambling Disorders among patients of mental health services (the subject of his conference presentation). He has been a Primary Health Care Research, Evaluation and Development Recipient, researching depression and chronic disease management.
Assessment and screening for Gambling Disorder (GD) among clients of mental health services is available in major centres around Australia along with best practice CBT based therapies to support people seeking to overcome problems with their gambling. Such services are not generally available in rural and remote communities, so this initial pilot study is unique in that it was designed to screen for and assess prevalence of GD in participating populations in rural South Western Victoria and provide early intervention and referral to best practice treatment for those clients being identified as having moderate to severe gambling problems.
Participating clinicians from Primary Mental Health Teams (PMHT) running clinics in South Western Victoria estimated that they would treat around 450 new and continuing clients with mental health problems in their clinics during the course of the pilot study. If clients respond affirmatively to the cue question, ‘is your current mental health problem related in some way to a problem with gambling?’ they would then be screened for GD using the Problem Gambling Severity Index (PGSI). Following screening and assessment, clients would be offered access to support and Cognitive and Behavioural (CBT) based treatment provided by an initial team of qualified clinicians trained in the use of CBT in the treatment of gambling disorder.
This paper provides early outcome data from a six month screening and intervention pilot study conducted in rural Victoria between September 2016 and March, 2017. The study involved PMHT clinicians (psychologists, mental health nurses, social workers and counsellors) screening their clients for GD over a six month period using an initial screening question along with a follow up assessment using the Problem Gambling Severity Index (PGSI) for all clients who responded positively to the initial screening question.
Jenny Preece worked as a generalist community nurse and sole practitioner from the Dorrigo Multipurpose Service in NSW for 15 years, servicing the farming community of the Dorrigo Plateau. This experience provided the platform for a passionate interest in rural health and the unique challenges associated with equity and access to health services for rural communities. After working with the Health Education and Training Institute Rural for six years, Jenny joined the Agency for Clinical Innovation in 2013 to establish the Rural Health Network. The primary focus of the Network is to identify and showcase platforms for sharing rural innovation and to progress ground up priorities as identified by the rural Local Health Districts.
Multipurpose Services (MPSs) are unique health care facilities that provide a combination of health services including acute care, emergency, primary health and residential aged care to meet the needs of small rural communities. There are currently 60 MPS in operation across rural NSW with more in the planning stage.
MPS are accredited under the National Safety and Quality in Healthcare Standards (NSQHS) as they provide hospital services. However, although the majority of care provided in in MPS is aged care MPS are not required to meet Aged Care Standards1 as is the case with Residential Aged Care Facilities. To review the NSQHS, a consultancy was undertaken in 2014 to identify gaps between the NSQHS and the Aged Care Standards and revise the NSQHS in the following areas:
The Agency for Clinical Innovation have developed Principles of Care for Living Well in MPS from these findings to support staff in providing care for residents of MPS; not as patients in hospital, but as residents living in their home.
The Principles are accompanied by a Toolkit to enhance quality of life and lifestyle for people who call MPS home. The Toolkit comprises:
Expressions of Interest were sought in September 2016 for up to 20 MPS to work together and learn from each other through a series of Action Learning Sets; followed by a Plan Study Do Act (PDSA) improvement Cycle to implement the Principles as prioritised through individual Self-Assessment. MPS who implement the Principles will demonstrate they are meeting accreditation requirements.
This presentation will explore the methodology undertaken in developing the NSW Living Well in MPS Principles of Care and Toolkit, and showcase the Collaborative implementation approach underway across NSW in 2017.
Reference: Australian Aged Care Quality Agency. Pocket Guide to the Accreditation Standards. Parramatta NSW: Australian Aged Care Quality Agency; 2014. 56 p.
Dr Robyn Preston is a lecturer in the discipline of General Practice and Rural Medicine, College of Medicine and Dentistry at James Cook University. As a member of the Anton Breinl Research Centre for Health Systems Strengthening her research interests include socially accountable health professional institutions, community participation in health and collaborations between the community sector and health professional schools. She enjoys teaching medical students about rural, Indigenous, community and global health as well as research methods. She has been a member of The Training for Health Equity Network (THEnet), a collaboration of health professional schools aspiring for social accountability, since 2009 and feels privileged to work with inspiring researchers from across the globe.
Background: Flinders University (FU) and James Cook University (JCU) are founding members of the Training for Health Equity Network (THEnet), an international community of practice involving eleven socially accountable health professional schools that align their training, research and service with the needs of underserved populations. An important strategy of THEnet schools involves integration of the social mission into many elements of medical education. However, socially accountable health professional education assumes that learners understand the social mission of their school and the social accountable curriculum as it was intended to be understood. Currently, scientific evidence to substantiate this assumption is lacking. It is important for schools addressing the workforce shortage in underserved areas to understand student perceptions of this mission.
Aims: The aim of this study was to describe how learners at socially accountable medical schools perceive and engage with the social mission of their school. Developing a robust understanding of learners’ perceptions may inform curricular development.
Methods: This qualitative study draws on the results from two Australian medical schools that participated in the international study Accounting for Learners’ Perceptions of Social Accountability in THEnet Schools. A mixed convenience and purposive sample of domestic, final year undergraduate medical students were recruited (n=14) to participate in semi-structured interviews. Interviews were transcribed in full and analysed using abductive coding in a grounded theory framework.
Results: The participants of JCU perceived the schools social mission to prepare graduates with an understanding of social justice, social inequity, health workforce shortages and health disparities in disadvantaged communities. While initially their career intention may not have been to practice rural medicine over half the participants reported developing a genuine interest in rural, Indigenous and tropical medicine during their rural and remote clinical placements. Participants reported agreeing with and seeing the value of JCU’s social mission.
The majority of FU participants studied medicine with intent to practice in rural or remote regions which was reinforced by a curricular focus on cultural awareness, social accountability and diversity. The clinical placements reflected the schools social mission by exposing interested students to rural and remote clinical contexts. Those participants not interested in rural practice while agreeing with and valuing the school mission did not change their career intention.
Conclusions: Learners at both medical schools understood and valued, or grew to value, the social mission of their schools however clinical experiences in underserved settings alone did not necessarily change their career intentions.