Marion Hale has worked in improving health equity in the Tasmanian and Australian community for the last 25 years. Marion’s career has spanned crisis support, counselling, community development, policy development and population health. In 2012 Marion was elected to the Board of the International Network of Women Against Tobacco (INWAT) and in 2015 became the President of INWAT. Marion joined DEN after an extensive period working in government policy and health programs, as well as community development work. Marion has a particular passion for the promotion of smoke-free pregnancy, and was awarded a Churchill Fellowship in 2012 to study smoke-free pregnancy programs internationally. Marion is on the Alcohol Advertising Review Panel and Smoke Free Tasmania and works hard to make the world a more equitable place. Marion is currently a national educator with NOFASD Australia and leading their project Shine—a joint project between the drug Education Network and NOFASD Australia.
There is a mountain of evidence that shows us how potentially damaging even small amounts of alcohol can be in pregnancy. Women have a right to be given accurate, evidence based information about alcohol risks … so why doesn’t this happen? Why do we still hear that women are told … a couple of drinks is ok … by their health care providers?
In Australia’s alcohol marinated culture, it’s almost impossible for people trying to conceive, pregnant and breastfeeding women to avoid alcohol. Its critically important that we support people to make safe and healthy choices and protect their babies from alcohol. We all have a role to play.
This paper will examine what Tasmanian women know, think and feel about alcohol use in pregnancy through sharing the results of a state-wide research project undertaken with University of Tasmania. We will unpack these results and make meaning about through suggesting ways we can improve our communication with pregnant women, so the critically important message gets through. No Alcohol is the only risk free choice for pregnant and breastfeeding women.
Jessica Hammersley is a lecturer in nursing for the University of Tasmania and a registered nurse at the Royal Hobart Hospital, specialising in the area of oncology. After completing a Masters in Nursing (neuroscience), her passion for caring for patients experiencing cancer in rural areas has become her area of focus, and heavily influenced her chosen topic for her Honours research thesis (Comprehensive Child and Adolescent Health Journal, published 2018). Her main areas of research lies with the lived experiences of oncology patients, in particular paediatric patients.
The experience of paediatric cancer can be traumatic for children and their families. Living in rural, remote, and regional areas can add to the complexity of care and potential effects on this patient group. Children with cancer who live in rural, remote, and regional settings may be required to travel large distances and spend long periods of time away from home and their ‘normal’ life during phases of treatment and illness. This can lead to further disruption of family life and to the child experiencing new routines and, eventually, difficulties adjusting to life after cancer. The island state of Tasmania is recognised as being, rural, remote, and regional. For Tasmanian families who have a child with cancer, accessing both community and hospital-based services for medical treatment can involve complex travel arrangements. Patients may need to travel over a body of water to specialist mainland centres to receive vital treatment. This study was conducted to explore the experiences of children with cancer and their families in Tasmania from the perspective of healthcare professionals (HCPs).
Using interpretive description, as described by Thorne, this qualitative study involved semi-structured interviews with six HCPs who worked in the area of paediatric oncology. HCPs’ identification of the need for individualized care for each child and family was notable. The overarching theme identified was ‘How a family copes with having a child with cancer is individual … but it’s also very hard.’ The five key themes that informed the overarching theme are: (1) The child living with cancer; (2) separation and isolation; (3) financial impact; (4) navigating care systems; and (5) emotional and psychosocial wellbeing. A process of normalisation of cancer was described by participants and reflects how children’s cancer treatment becomes a routine experience for a child. Our findings show that children living in rural, remote, and regional settings may have different experiences in comparison to those living in large centres. The impact the geographic location has on children with cancer affects the child and their family and needs to be explored further.
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Lindy Harkness is currently the senior health programs advisor for RFDS Central Operations, based in Adelaide. A registered nurse, with a Masters in Health Science (Health Management) Lindy started with RFDS Central Ops in May 2017 and is involved in many programs with RFDS. She has various additional certificates in child health, midwifery, immunisation, sexual and reproductive health, and has experience working in community health as a women’s health nurse in regional SA and in hospital settings both in the more traditional sense and in running a nurse-run immunisation service at the Women’s and Children’s Hospital in Adelaide, then converting it to a GP service and subsequently setting up other GP services (co-located with emergency departments). Lindy also has over 10 years' experience as a director of care in large aged care facilities, and has worked for a few years as a director of nursing in a regional NSW public hospital. One of Lindy’s programs at Central Operations was to distribute 100 AEDs to remote stations in South Australia, where there are medical chests.
Background: Cardiac arrest occurs in over 25, 000 Australians every year. In the event of cardiac arrest, CPR alone has low rates of effectiveness. However, when provided in combination with defibrillation, survival rates increase significantly—reported to be up to 30%. Defibrillation needs to be administered quickly in the event of cardiac arrest, ideally within 3 minutes, but this is often not possible in rural and remote areas where there are limited health facilities.
A contributor to cardiac arrest can be chronic heart disease (CHD). Australians in remote areas are 1.6 times more likely than those in major cities to be hospitalised for, and 1.3 times as likely to die from, CHD. Indigenous Australians are overrepresented in these statistics. This is further demonstrated in demand for our emergency aeromedical retrievals, via which 112 patients per week, or 16 patients per day, are transported to receive definitive care in a tertiary hospital.
Aim: Responding to these research findings and interest from our communities, we commenced national roll-out of portable Automated External Defibrillators (AEDs), funded by corporate giving from a national partner. The primary aim of this AED project, the first of its kind in Australia, is to reduce the number of people who die from cardiac arrest in remote and rural Australia by improving access to AEDs for first responders.
Method: Over two years of retrieval data was analysed to identify the locations most commonly attended in response to a patient experiencing cardiac arrest, along with national data relating to prevalence of CHD. We mapped these locations, and combined with local knowledge from our service managers, identified the best locations for provision of an AED.
Results: Remote and rural locations in South Australia were identified as a high priority, and are the first for roll out of the portable AEDS through this program. It was determined that this program would most optimally be delivered in line with our medical chest program, which provides medications to approved custodians in areas where pharmacies are not easily accessible. To date, 80 AEDs have been provided in remote and rural South Australia, along with a self-developed training program to ensure people in those communities are confident to use the AEDs.
This presentation will briefly explore the research that lead to the development of this program; the partnership approach leveraged to purchase the AEDS; the implementation methodology; and, results of the first year, including case studies.
Andrew Harvey is the CEO of the Western Health Alliance Limited, which operates the Western NSW Primary Health Network (www.wnswphn.org.au). He was previously CEO of the Darling Downs South West Queensland Medicare Local Limited. Andrew has held economic and community development management roles in local government in Australia and New Zealand. Andrew has a Bachelor of Agricultural Science from the University of Canterbury in New Zealand, is a Graduate of the Australian Institute of Company Directors and has a Graduate Certificate in Management from the AIM Business School. Andrew is the non-executive Director of Westhaven Ltd, a Dubbo-based Disability.
A contemporary Australian health system must be characterised by partnerships with consumers. Partnering with consumers is about healthcare organisations, healthcare providers and policy makers actively working with consumers to ensure that health policy, information, systems and services meet their needs. Recognition of the need for a more active role for consumers in healthcare is gaining momentum.
Currently in Australia, emphasis is being given to the role consumers and communities can play in the governance of PHNs and local hospital networks, with some accompanying investment in recent years to provide governance training. However, there is a considerable way to go in harnessing the role consumers can play as agents of change in the health system. According to Alison Trimble, 2018 (King’s Fund, UK )“Consumers are renewable energy and the secret ingredient to transformational change within the health and care system”. Collaborative practice underpins co-design and is essential to implementing current health reforms in Australia.
The King’s Fund,(an independent charity in the UK) have developed a program Collaborative Pairs which is designed to support the development of the mindset and practices that underpin the culture of shared leadership and partnership and, specifically, joint clinician-consumer approaches to program and service development. The program consists of five one day sessions undertaken over a five month period to enable pairs to work on a shared work challenge in between sessions.
The Consumers Health Forum of Australia in collaboration with Western NSW Primary Health Network (PHN)and three other PHNS and the Australian Commission on Safety and Quality in Health Care (ACSQHC)are implementing Collaborative Pairs as part of a National Demonstration Trial in Australia. As one of the largest rural and remote PHNs in Australia, Western NSW PHN is well placed to test the program in a rural and remote context.
This paper will provide an overview of the Collaborative Pairs Program, the model being implemented in the National Demonstration Trial with a specific focus on Western NSW. The challenges and opportunities of delivering a world class innovative program in a remote location will be discussed as well as the need to build capacity of both consumer and clinical leaders to work together in rural and remote Australia. The importance of collaborative practice and the ways that it is being practiced, supported and integrated in Western NSW as compared to other more urban sites will also be discussed.
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Brett Hayes is the WA Wheatbelt Regional Specialist Palliative Care Manager. He manages a service that covers 155,000 square kms and includes 22 country hospitals, 8 nursing posts and 12 aged care facilities. However the majority of the palliative care work is in the community setting, providing palliative care for those at home. Brett worked in neurosurgery, cardiothoracic and oncology, before moving to the WA Wheatbelt Country Health Service, becoming the region's Specialist Palliative Care Manager in 2013. Brett’s Christian faith has helped him develop a desire to help others. This led him to palliative care, believing that those at the end of life have a particular need for compassion, support and kindness, and that health professionals working in palliative care have the unique privilege to help those who are often at the most vulnerable points of their lives. He is passionate about palliative care and believes that everyone has the right to the very best we have to offer.
Aims: The WA Country Health Service (WACHS) TelePalliative Care in the Home service aims to provide care and support, via telehealth, for patients who wish to die at home during the terminal stage of life. Initially successfully established and trialled in the Wheatbelt region of Western Australia, the service is now been delivered in a number of WACHS regions.
Methods: Since commencement in 2016, the service has trialled a number of different approaches to providing palliative care support via telehealth. In the initial phase of the Wheatbelt service, video conferencing technology was downloaded onto patients own ICT devices; however evaluation highlighted access to pre-existing technology within the home as a barrier preventing further patients accessing the service. As such, a number of regions now provide loan devices, allowing a greater number of patients access to the TelePalliative care service.
Relevance: Terminally ill patients living in country WA, who wish to die at home face additional challenges in accessing appropriate palliative care services. Large geographical distances make it difficult to assure patients and carers that they will have access to regular medical and nursing support during the terminal stage of life. Telehealth can be utilised to overcome this barrier, thus increasing the number of patients assisted to die closer to (or within) their home.
Results: Four regions of WA are now delivering the TelePalliative Care in the home service. To date, a total of 45 of patients have accessed the service, with 81 occasions of service delivered. Patient satisfaction with the service has been measured in the Wheatbelt region, indicating that 66% of patients were very satisfied with the service (n=27). Clinicians delivering the service have highlighted the value of providing in home support to patients, many of whom wouldn’t have been able to leave the home due to poor health.
Conclusion: The TelePalliative care service provides improved equity of access and quality of service for terminally ill patients living in country WA. Additionally, provision of a TelePalliative service can reduce the number of patients referred into, or requiring emergency transport to a regional or metropolitan health service. The service will continue to be rolled out across WA, with additional consideration given to establishing a 24 hour TelePalliative service, enabling regions to comply with the WA Health Clinical Services Framework 2014-2024.
Klara Henderson started her career as a management consultant in strategy, IT and project management, before focusing on health issues for those in low- and middle-income countries. She has a PhD in health policy and economics on Timor Leste. Klara has worked with organisations such as WHO, the World Bank, Gavi, UNAIDS and the Coalition for Epidemic Preparedness Innovations on the front line in Ghana, Kenya, PNG, India and Thailand, and conducted health evaluations and authored numerous publications, including on access to health in low-resource settings. She has been a member of ADI’s Program Committee since 2014, and the CEO since January 2018. Klara is also an adjunct lecturer at the University of Sydney, School of Public Health.
Papua New Guinea is Australia’s closest neighbour with epidemiology common to that of tropical developing nations. Life expectancy in Papua New Gaines is two decades less than in Australia; infant mortality ten times greater and maternal mortality thirty times that of Australia. World Health Organisation ranks Papua New Guinea as having the lowest health status in the Pacific region on the United Nation Human Development Index.
The population is overwhelmingly rural and remote, with 87 per cent of the population living in small, relatively isolated communities with limited agricultural industry. As in Australia and other nations, health and health care access is limited in rural and remote communities contributing to these health outcomes.
Australian Doctors International (ADI) is an Australian not-for-profit organisation that provides outreach services to remote rural areas of New Ireland and Western Provinces of PNG. The model of health care provided to address the access issues in these Provinces is to conduct remote integrated health patrols with a volunteer doctor working with local health staff forming a patrol team to visit rural and remote health centres and aid posts. The model aims to provide services and build capacity of the health system of rural communities.
The Western Province of Papua New Guinea is the least resourced region of the nation. To support local services, ADI was able to mount 83 days on patrol, visiting 43 villages, holding 121 clinics. When not patrolling, volunteer doctors have worked at the Catholic Health Service clinic in Kiunga. Through this service, public health education is provided locally to the community and school children. Patrol and Health Service clinics offered the opportunity for case-based learning for local health staff and group learning after clinic hours.
The challenges for Australian Doctors International in Western Province are those of all organisations attempting to address the health needs of rural and remote communities, whether they be in developed or developing nations. The solutions being explored by ADI in Western Province are as those being utilised in other rural and remote communities. Despite the contextual differences between rural PNG and rural Australia, lessons in one context are valuable in the other. Preventative and population health approaches are the next dimensions for ADI to expand engagement with the remote communities. The resources, experiences and professionals of Australian rural health services are welcome to strengthen these efforts. The potential health dividends in Papua New Guinea are great.
Danny Hills is a registered nurse. He has worked extensively as a clinician, manager, educator and researcher in rural and metropolitan settings in mental health and wellbeing, patient safety and clinical governance, ageing and aged care, and health services and workforce development. Dr Hills has extensive experience investigating the prevalence, predictors, prevention and consequences of workplace aggression in care settings, from smaller scale qualitative and mixed methods research through to national epidemiological studies. His work in this area is currently focused on disseminating the results of the Workplace Aggression Experiences of Victorian Nurses and Midwives study, conducted from May to December 2017.
Aims: Workplace aggression remains an intractable feature of clinical practice across the health and care sectors. Nurses, midwives and other frontline carers are at high risk of exposure to aggression at work, occasionally with fatal consequences. There is contention in the literature about the relative risks of exposure to workplace aggression in non-metropolitan compared to metropolitan care settings. Drawing on the results of a large mixed methods study of workplace aggression experiences of Victorian nurses and midwives, this presentation aims to highlight differentiating factors for clinicians working in non-metropolitan settings, which have emerged from both the quantitative and qualitative findings of the study.
Methods: The Workplace Aggression Experiences of Victorian Nurses and Midwives study initially utilised a cross-sectional survey design. Over 1200 respondents provided self-report estimates of exposure to aggression from external sources (patients, relatives/carers and others) and internal sources (co-workers), as well as their responses to incidents of aggression. Exposure rates were compared across Australian Standard Geographical Category (ASGC) classifications for respondents’ main workplaces. Almost 600 respondents provided unsolicited comments on their experiences and additional, in-depth interviews were conducted, which provided very personal accounts of the sources, impacts and consequences of aggression at work.
Relevance: Understanding the differences between rural and metropolitan settings is important, particularly in relation to key issues of concern, which can be critical determinants of decision-making about continuing to provide patient care or remaining in the profession.
Results: Differences in prevalence across the geographical classifications of main workplaces were detected, although these were not statistically significant. Qualitative findings provided particularly important insights, however. For nurses working in regional and rural areas, raising ‘unpleasant’ workplace issues could cause much deeper problems, especially where people working for or associated with local health and care services all know each other, and their privacy could not be maintained. As alternative employment options are often non-existent, only avoidance strategies can be used. Additionally, access to security and legal services in regional and rural services can be quite restricted. Thus, the notions of ‘risk’, ‘safety’ and ‘security’ for non-metropolitan clinicians can be considerably more complex than for clinicians working in metropolitan settings.
Conclusions: Workplace aggression in the health and care sectors is a major work health and safety, and public health concern, especially in non-metropolitan settings. More targeted and effectively operationalised legislation, policy, incentives and penalties are required to prevent or minimise the likelihood and consequences of this truly wicked problem.
Dr Kirsten Hogg manages the scientific and medical content at Andrology Australia (The Australian Centre of Excellence in Male Reproductive Health). Kirsten has a background in medical research (reproductive biology), and for the past 12 months has been involved in public health research activities examining views and behaviours of health professionals and consumers in tackling men’s health. This evidence-based approach allows Andrology Australia to develop information resources for health promotion and education that meet the needs of patients and doctors alike. Andrology Australia is funded by the Australian Government Department of Health and administered by Monash University.
Introduction: Disparities between men’s and women’s health still remain and the health experiences of men living across Australia can differ widely. As part of a nationwide study on how men seek health information, we stratified responses by post-code to define men’s health information seeking behaviour in a regional setting.
Methods : Males aged 18 years and over took part in an anonymous online survey on their current and preferred methods of accessing information about general, minor, serious and private health concerns. Men’s experiences and preferences for obtaining information about their health were also collected through two Focus Group sessions held in a regional area of Australia.
Results: One hundred and eight responses to the online survey were collected from males living in regional Australia, with 95% living in inner or outer regional areas. The mean (±SD) age was 55 (±16) years, with distributions across age groups (10%, 18–30 years; 27%, 31–50 years; 33%, 51–65 years; 30%, over 65 years). Multiple methods of accessing information were used by men, including GP/specialist (95%), online search (62%), pharmacist (69%) and wife/partner (59%). Around one in three males aged 18–30 years did not seek any information about minor, serious or private health concerns. Men aged 31–50 were most likely to seek information for all types of conditions. One in three men over 50 said they did not seek information on private health concerns. Primary reasons for this was “not being worried about it”, or “not feeling comfortable discussing it”. Themes emerging from the Focus Groups (n=35, ages 22–86 years) included men’s preferences for accessing their GP, a feeling that men ‘deprioritise’ their health, the need to have reliable, evidence-based information from reputable online sources, as well as feedback on their preferences for receiving health messaging.
Conclusions: The results presented here indicate that men living in regional areas are generally interested in their health and for the most part seek information when they have a health issue. The data collected from the survey and feedback from the Focus Groups will provide direction on our future communication approaches with a lens on the preferences and views of men living in regional Australia.
Dr Aaron Hollins has a focus and passion for the health of rural, remote, Indigenous and tropical populations. As Senior Lecturer, General Practice and Rural Medicine, James Cook University, he supports the training and education of GP registrars and medical students in Far North Queensland. Aaron tells bad dad jokes, will only drink good coffee, prefers the fourth Doctor Who, and works at a stand-up desk.
Introduction: The causative agent of Q fever, Coxiella burnetti, is found in a wide variety of animals and does not require direct animal-to-human contact for infection. Q fever is contracted by inhaling contaminated dust particles or bacteria shed from infected animals.
Q fever has traditionally been associated with rural workers in primary production, abattoirs and veterinary occupations; however cases linked to non-traditional sources are increasingly reported. The diversity of clinical symptoms and range of severity at presentation often leads to Q fever being misdiagnosed or not reported.
Early identification, appropriate treatment and follow-up following acute Q fever are essential for the health and wellbeing of patients. Serious long-term complications occur in 5% of all acute Q fever cases yet there is no Australian guideline or global consensus on what follow-up should be provided to patients.
Aim: This study explored the knowledge of Q fever, Q fever vaccination and usual clinical follow-up practices among rural general practitioners.
Relevance: Rural practitioners are likely to have patients present with Q fever and assume responsibility for managing their short and long-term care. However there is little known about Australian rural general practitioners’ knowledge of Q fever and Q fever vaccination.
Method: Far North Queensland rural general practitioners were invited to complete an anonymous survey either online or in hard copy. Descriptive analysis about knowledge of Q fever, recommendations for vaccination, post graduate education on Q fever and follow up practices was undertaken (IBM SPSSv22) on 16 responses (16/52, 31% response rate).
Results: Nearly all respondents were aware of the traditional sources (contaminated livestock and soil) of Q fever and at-risk occupations (farmers, veterinarians, abattoir workers) requiring vaccination. Less obvious sources of infection (wildlife and domestic pets) were not as well recognized. Most respondents would consult with an Infectious Disease or Public Health colleague. Appropriate follow-up practices were described by a small number of respondents: treatment with doxycycline (n=4), follow-up over a period longer than one year (n=2), specific cardiac follow-up (n=3).
Conclusion: This study identified a range of self-reported usual clinical practice and follow-up (if any) of Q fever cases by rural general practitioners, including consultation with a specialist. The lack of consensus found in this study reflects differing opinions about the best practice of Q fever management. These results further highlight the need for the development of evidence-based Q fever management guidelines.
As the Executive Director of Research, Primary Care and Strategic Services at Carrier Sekani Family Services and Adjunct Professor at the University of Northern British Columbia, Travis Holyk is a leader in developing and administering innovative health and social programs that continue to have a positive and lasting impact in First Nations communities. Through his diverse training he is able to merge health administration with knowledge acquisition and translation. In addition to administering physician and nursing services provided to 11 First Nations spanning a geography of 76,000 square kilometres, his current portfolios also include research, program development and quality assurance, thereby ensuring that all programs and services meet their intended outcomes. He guides services towards an interdisciplinary approach to wellness, using varied funding arrangements and technology to address complex health needs of rural and remote populations.
In north central British Columbia, First Nations communities remain extremely disadvantaged in access to high quality, timely and culturally sensitive services. Those living in rural and remote areas are at greater risk of burden from chronic disease due to limited access to services, geography, poverty and system mistrust. Carrier Sekani Family Services (CSFS) provides services over a large geographic area, servicing 11 different First Nations in a region encompassing 76,000km2. It is often a challenge to maximize services to remote areas, where funding structures and population size results in less than full time availability of many professionals in each community. This makes it difficult for program professionals to build strong relationships with other professionals and to liaise regarding mutual clients.
Integrated care is a philosophy that fits well with Indigenous views of holistic health and provides opportunity for positive health outcomes. CSFS identified integrated care as a path to transition services from a fragmented approach of providing health and social services, to a process that emphasizes partnerships and team-based practices with community partners. The challenge for our organization was translating a philosophical concept that health providers subscribed to into a tangible system of care that would work in rural settings. This presentation will outline the CSFS model of care, specifically outlining the role of integrated care and technology in addressing the determinants of health – thus improving outcomes. We will provide tools developed to assist staff in care planning, discuss our informed consent process and the Terms of Reference that provides a road map for practitioners to understand their role on the Integrated Team. Patient and practitioner satisfaction as well as data from chronic disease management will be used to support our discussion.
Dr Diane Hopper is GP and Medical Director at the Aboriginal Health Service in Tasmania.
This presentation will present on Tasmanian Aboriginal Health Services’ delivery of comprehensive primary health care. General practitioners (GPs) and registered nurses (RNs) are supported by Aboriginal health workers (AHWs). The health workers provide an important link between clinical practitioners and the community.
AHWs provide clinical staff with family information and back ground that may not been in the patients notes. They also support patients to attend appointments by providing transport and support at appointments. AHWs also home visit patients to follow up nonattendance at appointments, provide emotional support and encouragement to the patient.
A Launceston AHW and GP complete monthly home visits to clients identified as high risk but for whom barriers exist, inhibiting their access to health care. The home visits have been hugely successful in supporting the patients to attend clinical appointments at the AHS and specialist services. The AHW has been successful in gaining access to the patients which the GP would otherwise not have had.
Health practitioners within Tasmanian Aboriginal Health services, access internal referral pathways including midwives, child health nurses, counsellors, child psychologists, paediatricians physiotherapists and diabetes educators. Staff also refer patients to outside services not provided internally.
As an example of how the comprehensive primary care model works in practice the presenters will discuss the approach of the (Launceston) Aboriginal Health Service in managing hepatitis C treatment.
There are strong connections between clinical services and heritage and cultural programs for clients accessing Tasmanian Aboriginal Centre programs and the AHS. The palawa kani language and rrala milaythina-ti, Strong on Country programs have supported connections and improved social and emotional wellbeing outcomes for patients.
The palawa kani name of the project, rrala milaythina-ti, means strong in country. The title of the project captures the links between our community, our country, and the emotional and social wellbeing of each of us and all of our community.
There are many celebrations throughout the Tasmanian Aboriginal community calendar supporting connections to community. The putalina Festival, Preminghana camp and Generation Cup provide community with opportunities to be together and for some these events provide contact with family members from around the state they may not see at any other time of the year. These events are opportunities for health staff to deliver health promotion programs in a social environment.
Kim Houghton manages the Regional Australia Institute’s policy and research portfolio to ensure the Institute’s work has practical application and supports a better policy environment and more vibrant regional economies. Having worked on regional economic development in Australia for almost 20 years, Kim has a passion for engaging, motivating, informing and connecting regional leaders from business, community and government.
Health services are more than a critical part of living in rural Australia, they make a significant contribution to rural economies. Analysis by the Regional Australia Institute shows the scale of the economic contribution to rural areas from the complementary sectors of health care and social assistance. Service provision in these vital areas is through a mix of public and private providers, and covers a span of occupations from low wage entry level jobs to highly skilled professionals. Health care and social assistance services typically account for 10–16% of a regional workforce and 18-20% of high income jobs in regions. Job vacancy rates are high and growing—increasing 19% over the last two years in regions. National projections are for another 86,000 healthcare and social assistance jobs in regional Australia by 2023. Analysis of the nature and economic significance of these jobs is presented in this paper, and we discuss the importance of attraction and retention of this diverse workforce to the prosperity of rural and regional communities.
Christine Hunter, Senior Project Officer, commenced with WA Country Health Service (WACHS), Aged Care Directorate in 2013 with responsibility for integrating aged care services into mainstream health and for improving equity and access to services for older people living in rural and remote Western Australia. For the last five years Christine has worked in the Aged Care Directorate, planning, developing, implementing and evaluating aged care projects across WACHS, including the development of an innovative specialist geriatric video consultation service to older people in regional, rural and remote communities in WA. The role has also comprised primary responsibility for aged care policy review, development and implementation in WA Country Health, including identifying training gaps in access to accredited, culturally appropriate education and training programs for unregulated health workers. Prior to becoming a project officer, Christine trained as a physiotherapist in the United Kingdom in 1979, immigrating to Australia in 2002. She has worked within the aged care, subacute, acute and community settings in public health and non-government organisations both in the United Kingdom and in Australia. A total of 36 years’ experience has encompassed roles that focus on delivery of quality care to older people.
Partners in Health is about a collaborative relationship between the Country Primary Health Alliance (WAPHA) and Country Health Service (WACHS). It explores:
- how a learning gap in aged care become evident and the subsequent call to action from the two agencies to address this.
- where collective impact was demonstrated through the development of on-line learning modules with the in-kind expertise provided through WACHS and the input for community home care through the Primary Health Network.
This journey began with a need being identified in 2017 for Aged Care Unregulated Health Workers(UHW) to obtain competency in medication management in community and residential aged care.
WACHS as the largest providers of Aged Care within country WA approached the WA Primary Health Alliance (WAPHA) seeking funding to support the purchase of eLearn Australia and agreement to work collaboratively in customising the E learning modules for the aged care sector in rural and remote areas.
Agreed contract deliverables included:
- support provided to facilitate the implementation of the UHW online module with interactive content and assessment in a safe learning environment.
- the improvement of UHW skills and competency when assisting with medication administration. Compliance being required with the National and Safety Quality in Healthcare Service Standard 4 and Aged Care Accreditation Standard 2.7.
This agreement between WACHS and WAPHA was founded on the principle that the E-learning was available for all NGO aged care providers within WA and that there was the establishment of a working group (WACHS, WAPHA and NGO) to cover a trial period over three regions of Great Southern, Kimberley and Wheatbelt. These regions were chosen due to number of Multi-Propose Service (MPS) facilities (Great Southern), the number of small residential facilities both Government and NGO (Wheatbelt) and high degree of remoteness (Kimberley).
The working group supporting the E Learning modules consisted at various stages of WACHS user experts within clinical nursing, allied health, staff development, community /hospital pharmacy with a balanced lens on community and residential care.
Following the trial and satisfactory evaluation within these three regions it was agreed the E Learning would progress to all the seven regions across county WA.
Further to be explored in the paper Partners in Health will be the collective learning around the valued resource of collaboration in creating a Better Together! culture in the system.
Heidi Hutchesson is a final year Bachelor of Occupational Therapy (Honours) student at the University of South Australia. Heidi grew up in a small rural community in South Australia and throughout her life has enjoyed being a member of sporting clubs. Heidi has always been interested in rural health and how rural communities can work together to address some of the health disparties impacting on rural people.
Introduction: Suicide rates in rural populations throughout Australia are alarmingly high, almost twice as high as city counterparts. In rural communities, football clubs are often seen as the ‘hub’ of the community and are being explored as an avenue to deliver mental health and wellbeing promotion to their members and supporters. For programs to be created effectively for rural communities, it is crucial to identify what might help or hinder implementation.
Aim: To explore perspectives of the barriers and enablers for promoting mental health and wellbeing through local rural South Australian football clubs.
Method: This qualitative descriptive study included 12 individuals who are senior members of 10 rural football clubs affiliated with the South Australian National Football League. Recruitment occurred through email contact with club secretaries and presidents. Semi-structured interviews included open-ended questions and explored mental health and wellbeing issues experienced by football club members, previous involvement of clubs with mental wellbeing programs, and potential enablers and barriers they can identify for future programs. Interviews were transcribed verbatim and analysed thematically.
Results: Data collection has been completed, and analysis is currently in progress. Preliminary analysis has identified that football clubs require more support for their players’ mental health and wellbeing, with majority discussing recent instances of suicide impacting their communities. Participants recognised that football club provide members with health-related benefits in addition to football, including socialisation, opportunities to discuss life’s challenges and a regular commitment of their leisure time.
Some barriers identified by participants include limited available time and getting people to attend and enablers identified include the football club being a ‘hub’ for the wider community and relevance of content to individuals and their community. No football clubs had mental health and wellbeing programs, however mental health fundraiser rounds were initiatives being run by some clubs. Participants recognised the importance of such programs for their community’s wellbeing.
Conclusion: This study will help to inform the development of a mental wellbeing program to be delivered via rural football clubs with consideration given to the potential enablers and barriers which may impact on engagement and effectiveness.
Dr Nerida Hyett is a Lecturer in Occupational Therapy in the La Trobe Rural Health School at La Trobe University, Bendigo. Her research is focused on consumer and community participation, and she has expertise in applying participatory research methods that transform community health and wellbeing.
Introduction: Co-design is an increasingly popular method of service improvement in health and social services. Co-design involves service end-users in the front-end design. The purpose of co-design is to use multiple sources of knowledge to transform services through increasing service acceptably and accessibility, and tailoring services to user expectations and needs. In rural and regional Australia, co-design methods of service and community development are particularly important because of service and resource shortages and high levels of unmet need. Additionally, co-design methods have great potential in rural communities because of high levels of social capital and volunteer participation. In this project we use co-design to explore how to address the major issue of exclusion of children with disability from mainstream primary schools.
Aim: The research aim was to trial a method of co-design in a regional setting to create an online education package to support inclusion of children with disability in mainstream primary schools.
Method: The co-design method involved a series of six workshops over eight-months. Participants (n=12) including parents, teachers, education support staff, and allied health professionals, engaged in creative activities and group reflection and deliberation to design the package. The package outlines a collaborative team-based approach to supporting two children with disability attending mainstream primary school; one child with National Disability Insurance Scheme (NDIS) funding and the other with no NDIS funding.
Co-design participation was evaluated using process and outcome evaluation methods. Process evaluation included a survey method and qualitative analysis of group discussions. Outcome evaluation was completed through thematic analysis of individual semi-structured interviews.
Results: Co-design was effective for supporting participants to collaborate and share knowledge and experiences. The online learning package designed by participants is accessible and acceptable for the range of people who support children with disability to participate in mainstream school. Challenges of the method were difficulties relating to scheduling, and time and resources required for intensive design work and effective deliberations. Study findings include several strategies for managing group dynamics and influences of power on group decision-making.
Conclusion: Co-design methods of service and community development can be highly effective in rural and regional settings. Process and outcome evaluation findings relating to the co-design method provide direction for improving applications in other settings. Research findings demonstrate how participation-based methods can address significant health and social challenges impacting Australian rural and regional communities.