Introduction: The severity and frequency of weather-related disasters are likely to increase because of a warming climate. The catastrophic flooding that occurred in the Northern Rivers in 2017, and again in 2022, has worsened social inequalities. For people with disability, however, the effect can be especially profound. In this presentation, we explore the experiences and mental health impacts of flood-affected people with disability and carers of the Northern Rivers, six months after river flooding in 2017.

Methods: A cross-sectional survey was conducted of flood-affected communities in Northern Rivers. Binary logistic regression models were used to investigate associations between the mental health of people with disability and carers and their exposure to the flood, and inductive content analysis was used for qualitative data.

Results: Of 2,252 respondents, there were 164 people with disability and 91 carers. Both of these groups had an increased likelihood of having their home flooded, having essential services such as health care and social services disrupted, and experiencing disproportionate negative mental health outcomes following the flood. After taking sociodemographic factors into account, carers and respondents with a disability respectively had two and three times the odds of reporting probable post-traumatic stress disorder compared to other respondents.

Conclusion: Our findings show the profound impact and systemic neglect experienced by people with disability and carers during and after the 2017 flood event in the Northern Rivers. There is a need for greater investment in preparedness, and this is amplified in areas such as the Northern Rivers where disasters are likely to occur again and where the most socioeconomically marginalised populations reside.

Introduction: Recruitment and retention is often subsumed as a single issue in research addressing rural health workforce. Globally, strategies have been introduced to improve the recruitment and retention in underserved areas. Research analysing these identifies personal and professional factors as influencing recruitment and retention. Much of this research is quantitative and does not distinguish between factors promoting recruitment or retention. Additionally, there is a dearth of knowledge about international medical graduates (IMGs) who comprise a significant part of rural workforces in Australia.

Methods: We conducted semi-structured interviews with nationally-trained doctors (NTDs) and IMGs who had started working within south-east New South Wales, Australia, within the last 10 years. We aimed to explore the participants’ experiences prior and upon entering rural practice, the significant influences on their career to date, and how these may influence their retention. We analysed interviews thematically with each interview coded by two researchers and regular meetings to discuss and formulate an emerging conceptual framework.

Results: Our framework focused on how doctors developed connectedness through rural medical practice. Connectedness occurred across personal, professional and geographic domains at different sociorelational levels, with significant variance between NTDs and IMGs. An additional two domains were identified related to the variance, the dissonance between their expectations and lived experiences, and holistic multifaceted connectedness across all domains.

Discussion: Our study highlights the narratives, expectations and experiences of both NTD and IMG doctors entering rural general practice and proposes a determinant of retention is interconnectedness. Connectedness is a critical component to both groups of doctors in rural practice, however NTDs and IMGs described different needs. When a doctor’s connectedness is mainly derived from a rural location and transverses personal, professional and geographic domains, the likelihood of retention is increased. Understanding the differences in enablers and barriers to retention in both the NTD and IMG cohorts may allow for nuanced recruitment and employment practices, with particular attention afforded to strategies addressing the need for connectedness.

Background: In Australia, around 60,000 people will have a stroke annually. In rural and remote Australia, there are significant barriers to accessing acute stroke treatment. The incidence of stroke is 20 per cent greater in rural areas. The distance needed to travel for assessment and treatment typically excludes patients from being eligible for emergency treatment such as thrombolysis. The Australian Stroke Alliance (ASA), partnering with over 30 national agencies, is committed to establishing equal stroke care for all Australians, regardless of location.

Aims: The education platform of the ASA will work with established rural and remote communities, Indigenous communities and organisations, training organisations and universities within a culturally adaptive governance framework to educate the next generation of stroke champions.

Methods: Partnering with rural and remote healthcare workers, clinicians, first responders and identified community champions, the ASA will provide the necessary education and tools firstly for prevention of stroke, including to address risk factors for stroke. Secondly, the ASA aims to ensure all people at risk of stroke are aware of the signs of stroke and the importance of acting swiftly. Education will continue into the pre-hospital stroke workflows, including clinical assessment of stroke and urgent brain imaging, conducted on scene at the rural or remote site, with advanced novel stroke imaging devices and telehealth support from specialist neurologists. This will allow for early treatment of stroke, drastically improving the outcomes of stroke, allowing more patients to return home free from disability. Lastly, utilising telehealth, the ASA will deliver post-stroke care, with allied health and rehabilitation specialists providing care for patients in their homes.

Results: The development of a robust education platform, in partnership with existing rural and remote education organisations, will optimise primary prevention of stroke, rapid stroke recognition, early treatment with access to specialist care on the ground and the continuation of care after discharge from hospital. This will reduce stroke incidence, morbidity, mortality and will foster the new generation of stroke leaders, in particular, Aboriginal and Torres Strait Islander peoples.

Conclusions: Stroke is a public health emergency. With stroke rates expected to rise at an alarming rate, we need a drastic change in our approach which starts by supporting the rural and remote workforce and communities that care for stroke patients. To treat patients safely and effectively, we need purpose-built education streams, early stroke imaging and access to specialist care.

Background: The demand for community-based palliative care is increasing as more palliative care clients are preferring to die at home. In rural areas, while nurses comprise the largest health professional discipline providing palliative and end-of-life care, only 1.1% work in a designated palliative care role. Studies report rural nurses feel professionally and emotionally unequipped to work with palliative care patients.

Aim: The aim of our research is to build a greater understanding of the professional development needs and workforce issues of rural nurses working in community-based palliative care in Australia.

Methods: We conducted a survey of community-based nurses in Gippsland, Victoria, Australia. Health service managers distributed a link to an electronic questionnaire to eligible staff (N=165). We developed a 123-item Palliative Care Skills Matrix Questionnaire to identify rural nurses’ knowledge of providing community-based palliative care around six practice standards. Descriptive data analysis was used to identify strengths, consolidations or gaps in knowledge and practice. Binary logistic regression examined associations between nurses’ characteristics and knowledge gaps and consolidations.

Results: Overall, 122 nurses (response rate = 74%) completed the questionnaire; 93% were female, 87% worked as registered nurses and 58% had >5 years’ palliative care experience. The majority of items (77%, n=95) were identified as strengths across all six palliative care standards. ‘Developing a care plan’ and ‘Transition with and between services’ were the only two practice standards with 100% of items rated as strengths. Gaps and consolidations emerged in four practice standards and using clinical tools. These included items around pain, symptom and emergency management. In items around psychosocial and supportive care, gaps and consolidations were found in using carer and client assessment tools, working with children, referral to an Aboriginal liaison officer, seeking volunteer support, sourcing respite options for carers, accessing an interpreter and implementing appropriate follow-up for a carer with a high bereavement risk. Factors significantly associated with knowledge gaps included lack of palliative care training, fewer years of clinical experience and being in an enrolled nurse role.

Conclusion: The data generated in this study can be used by managers and health service administrators to plan targeted professional development programs that have the potential to address the identified knowledge and skills gaps.

The perceived capabilities and confidence of returning to study, undertaking online postgraduate education coupled with financial commitment and the geographical impediment to further education were identified as key challenges to nursing staff formalising their skills and practice with specialist qualifications. To address the identified gap in specialist palliative-care-educated nurses, the Gippsland Regional Palliative Care Consortium and Palliative Care South East partnered with the Australian College of Nursing (ACN) to develop the course ‘Transition to Specialty Palliative Care’. By responding to the identified challenges, this unique partnership has provided a hybrid model of education to support access to nurses living in regional and outer suburban areas.

The Transition to Specialty Palliative Care course is for registered nurses working in a community or acute setting wanting to advance their palliative care knowledge. It is a supportive bridge for those who may wish to pursue postgraduate study but have not progressed the aspiration yet.

The pilot program was run over seven sessions (each six weeks apart) in a face-to-face format. Mentoring and support for participants was provided from leaders across the palliative care sector. The face-to-face sessions were complemented by an accredited online component coordinated by ACN. Completion of the course rewards one subject toward the Graduate Certificate of Professional Practice. Further study options are available for individuals who wish to advance their education, with the goal for participants to complete a postgraduate qualification following the initial program.

Evaluation of the program illustrated a high level of interest with feedback identifying the original hypothesis of returning to study was challenging for many nurses. A supported program with peer support and mentoring from senior nurses enabled individuals to advance their studies in a positive, assisted environment as an introduction to further postgraduate studies.

Introduction: In 2019–20 an external evaluation was undertaken of the Australian Government’s Rural Health Multidisciplinary Training (RHMT) program. The aim of the RHMT program is to increase the recruitment and retention of health professions working in rural and remote Australia through the 19 Rural Clinical Schools and 16 University Departments of Rural Health (UDRHs).

Methodology: The evaluation used a mixed-methods design that included interviewing over 980 stakeholders in semi-structured interviews, focus groups and roundtables, written submissions from peak and professional bodies, two electronic surveys (Multidisciplinary Health Workforce Survey; RHMT program staff survey), and review of longitudinal workforce data, program reports and expenditure data.

Results: The evaluation found strong evidence of the positive impact of longer-term rural placements on rural workforce outcomes for medical students, however an absence of research into the impact of undergraduate rural placements for both nursing and allied health students. While a requirement of the program is that universities should provide placements in RA2–5 regions, in 2018, only 27% of long medical placements and a third (31%) of nursing and allied health placements were in RA3–5 locations. Between 13% and 25% of allied health and nursing students had a rural background.

The workforce survey found that longer placements of over 20 weeks resulted in increased rural work outcomes for nurses and allied health graduates after controlling for rural background.

The evaluation also found that UDRHs had developed strong academic networks in local communities and, in recent years, have demonstrated significant innovation in creating and sustaining allied health service-learning placements and student-led clinics that directly support the health of rural communities. Students expressed high levels of satisfaction with these rural placements and valued the breadth of clinical exposure, opportunities to have ‘hands on’ experience and individualised teaching they receive through the RHMT program.

However, the evaluation also identified the lack of graduate allied health positions in rural and remote Australia, which is an ongoing challenge to the conversion of these innovative rural experiences to future rural work.

Discussion: This evaluation identified strategic opportunities underpinned by the evidence generated through the RHMT program, to nuance future training models to improve health workforce outcomes. The Australian Government announced an investment of a further .3 million over four years to expand the RHMT program. This paper will present the evaluation findings and recommendations.

In rural and remote locations across all Australian states non-radiographer X-ray operators (XOs) who have no formal radiography qualification, can be licenced under State Radiation Control legislation to perform a limited range of plain radiography examinations. The licencing of XOs provides rural and remote patients with access to medical imaging services that would otherwise be unavailable without travelling long distances, often at substantial cost. The benefit of improved service access, however, should not come at the cost of lesser-quality radiographic services for patients. It follows that the education and ongoing support of XOs should be of a high standard.

In seeking to provide high-quality training to XOs across Queensland, the Cunningham Centre began a collaboration with the University of Newcastle’s Department of Rural Health in 2017, sharing online educational resources for the introductory XO course. This training is supplemented by face-to-face workshops at the completion of the online component. Despite the challenges of differing licence conditions and target course participants, the collaboration has been highly successful, demonstrating a willingness to overcome local legislative and professional practice variations.

Even with improved online educational resources, XOs were still concerned about a perceived lack of support. XOs felt alone. At the same time, financial and staffing resources at the Cunningham Centre were stretched and COVID-19 meant that travel was, at times, impossible. It was important to find a more sustainable way to provide ongoing support and guidance.

With only a small team based at the Cunningham Centre, courses rely on the statewide network of local radiographers to provide ongoing support and guidance to XOs within their own community. As such, the Cunningham Centre has sought to actively foster these relationships through the introductory course, various communication platforms and in-services, and plans to provide further support and training to radiographers to ensure that XOs remain well-supported.

Videoconferencing tools have also been utilised to conduct the annual training and assessment workshops remotely, which has allowed the Cunningham Centre to continue to provide support and training using minimal resources and without the need to travel. This training has been well-received.

The Cunningham Centre and XOs in Queensland have already benefited greatly from embracing collaboration and change, perhaps especially in challenging circumstances. This serves to promote ongoing collaboration and innovation and raises prospects of a national curriculum and standard for XO education.

Background: Poor health outcomes continue to exist for people living in rural and remote Australia and are influenced by shortages of nurses and midwives in these communities. Many nurses and midwives who have worked in rural and remote areas have significantly enjoyed their work and benefited personally and professionally from those roles. However, these stories and their voices are frequently not heard. Webinars have been used with some success to educate student nurses about cultural issues and is more recently becoming a preferred format for academic and professional discussion and exploration.

Methods: A series of webinars have been created based on a structure of interviewing a panel of rural and remote area nurses and midwives to showcase their stories for live participation through professional and academic networks across Australia, and for later distribution as a recording, aiming to encourage others to work in rural and remote areas. Each panel is to provide insight from a variety of participants ranging from early career nurses and midwives to educators and managers. The interviewer for each webinar was selected based on a similar background of positive working experiences in rural and remote nursing. Social cognitive career theory and appreciative inquiry informed the questions being asked. Each webinar addressed specific issues unique to rural and remote nursing and midwifery.

Results: Webinars have been professionally created with technical support and a group of rural and remote nurses and midwives with insight into issues and requirements of these communities and their workforce needs. Webinars will be conducted monthly from July to November 2021.

Conclusion: Feedback will be obtained after each webinar from participants and viewers of the webinar and analysed for impact.

Background: The COVID-19 pandemic necessitated introduction of alternative methods for healthcare service delivery. This was facilitated by the rapid introduction of temporary Medicare Benefits Schedule (MBS) item codes for professional attendances via telehealth delivery, alongside existing codes for face-to-face delivery, in March/April 2020. To understand initial impacts of the pandemic on the number of services provided, and the uptake of telehealth delivery methods, Cancer Australia examined MBS services data for January to June 2020.

Methods: We examined MBS items for Standard GP Attendances (such as initial symptom presentations) and Specialist Attendances and Consultant Physician Services (which may include consultations with surgeons and radiation and medical oncologists). Both total monthly services and relative contributions by delivery type (videoconferencing, telephone and in-person consultations) were examined.

Results: From January to April 2020, the total number of services for Standard GP Attendances increased by 32 per cent; remaining relatively stable in May and June. Telehealth delivery consistently comprised around one-third of monthly services between April and June.

Notably, the number of Specialist and Consultant Physician services decreased by 24 and 11 per cent respectively between March and April 2020, with telehealth delivery contributing 30 and 40 per cent of these services respectively in April. Although total services increased in May and June for both groups, relative proportions of services provided by telehealth delivery decreased to 12 and 25 per cent respectively in June.

Across all three groups, telehealth delivery was largely by telephone, with monthly services provided by videoconference only one per cent of GP Attendances and between 2 and 6 per cent of services for Specialist/Consultant Physician Attendances.

Conclusion: Telehealth can support continuity of cancer care by offering choice, convenience and safety for patients and clinicians, and may provide opportunities to reduce rural–urban disparity in cancer care. Despite initial reductions in services in the early pandemic, the overall uptake of telehealth delivery methods during April to June 2020, indicates the potential to utilise this approach to minimise impacts of reduced access to services.

Uptake of telehealth services may have helped to moderate the scale of reported reductions in cancer referrals and possible delays in cancer diagnoses, which could lead to more advanced disease at diagnosis and ultimately poorer patient outcomes. To understand the nuances of the utilisation of telehealth, more specifically in cancer care, Cancer Australia is undertaking further analysis of changes throughout 2020 by provider speciality type and population characteristics including age, remoteness and socioeconomic status.

Background: Antimicrobial stewardship (AMS) programs promote the appropriate use of antibiotics and slow antibiotic resistance. There is an absence of specific strategies to support rural and regional (rural) hospitals to deliver AMS programs. The aim of this research program was to develop an action plan for enhancing AMS practices in the rural setting.

Methods: Strategies or approaches for the delivery of AMS programs in rural hospitals were identified through key informant interviews with AMS innovators. Focus groups with health professionals with day-to-day AMS responsibilities explored the contemporary barriers and enablers for rural AMS programs. The interview and focus group transcripts were analysed using the framework method. Antibiotic prescribing patterns in rural hospitals were compared to those in major-city hospitals through analysis of the 2014–16 National Antimicrobial Prescribing Survey (NAPS) data.

Results: Key informant interviews with 15 participants from various professional disciplines generated three recommendations to better support AMS programs in rural hospitals: use hospital accreditation to drive direct resource allocation; provide greater support to develop AMS network arrangements; and refinement of traditional roles within AMS programs to create new partnerships. The focus groups, involving 22 participants from various professional disciplines, identified six contemporary factors unique to the rural setting that impacted on AMS program delivery: a culture of independence and self-reliance by local clinicians; personal relationships; geographical location of the hospital influencing antibiotic choice; local context (such as resistance patterns); inability to meaningfully benchmark performance; and lack of resources. The NAPS analysis (n=47,876) highlighted that, compared to major-city hospitals, inappropriate antibiotic prescribing was higher in rural hospitals for cellulitis (25.7% v 19.0%, p=<0.001), high-risk infections such as Gram positive bacteraemia (12.6% v 6.5%, p=0.004) and empiric therapy for sepsis (26.0% v 12.0%, p<0.001).

These findings were synthesised to create an action plan for enhancing AMS practices in rural hospitals, including to:

• adopt a true one-health approach with coordinated initiatives and messaging between acute, primary, aged, dental and veterinary care and the community
• develop shared resources to improve antibiotic prescribing in commonly encountered infections such as cellulitis
• evaluate existing rural AMS programs in Australia to define the organisational conditions and intensity of input required to foster practice change.

Conclusions: An action plan for enhancing AMS practices in rural hospitals was formulated through a program of interlinked research. The action plan requires strong collaboration between researchers, communities and clinicians in the various sectors where antibiotics are prescribed.

Background: An analysis of the National Antimicrobial Prescribing Survey (NAPS) data indicated that antibiotics for cellulitis were more often inappropriately prescribed in regional and remote hospitals compared to major-city hospitals (25.7% v 19.0%, p=<0.001). Given that antibiotic therapy for cellulitis is well-established, this represented an evidence–practice gap. Additionally, deficiencies existed in the information provided to patients about cellulitis.

Objective: To improve the appropriateness of antibiotic prescribing for cellulitis by implementing a cellulitis management plan developed through a collaboration between three Victorian regional or rural (rural) health services.

Methods: An adult lower limb cellulitis management plan, incorporating advice on antibiotic prescribing and a patient leaflet, was co-designed by three rural Victorian health services. Adults with ICD-10-AM codes for lower limb cellulitis or erysipelas admitted as inpatients of the three hospitals between 1 May and 30 November 2019 (baseline) and 1 March and 31 October 2020 (post-implementation) were included. Patients were excluded if they were admitted to ICU during their admission. Antibiotic prescriptions on Day 1 were assessed using the NAPS appropriateness definitions. Patient satisfaction with the information provided to them about cellulitis while in hospital was captured via a phone call after discharge.

Results: Overall, 29% (37/127) of patients with lower limb cellulitis were commenced on the cellulitis management plan. The overall appropriateness of antibiotic prescribing at Day 1 was similar in the baseline and post-implementation groups (79% and 82% respectively). In the post-implementation group, there was a non-statistically significant increase in antibiotic appropriateness when the cellulitis plan was initiated (88% v 79%, 95% CI -5.6% to 19.8%, p=0.20). The proportion of patients who were satisfied with the information provided to them about cellulitis was 100% (22/22) for those who received the cellulitis leaflet and 78% (46/58) in those who did not receive the leaflet (95% CI 4.8% to 34%, p=0.02).

Implications for practice: Cross-organisational collaborations present unique challenges, particularly in rural health services where resources and staffing structures can vary considerably. This study showed that a collaboration between three independent rural health services can conceptualise, design and implement shared resources. The provision of patient-centred information on cellulitis remains important to optimise care and increase patient satisfaction.

Background: The COVID-19 pandemic has presented unprecedented challenges for policymakers and public health researchers. Policymakers are challenged to make decisions based on emerging and often conflicting evidence; while researchers must rapidly generate and synthesise high-quality evidence to facilitate decision-making.

The 45 and Up Study is Australia’s largest longitudinal study of health and ageing, with over 267,000 participants recruited between 2006 and 2009. In response to the pandemic, and supported by a New South Wales (NSW) Government COVID-19 grant, the Study established new collaborations with researchers and policymakers, and a rapid research methodology to facilitate timely collection of data to guide policy.

Methods: COVID Insights invited a sub-cohort from the Study to participate in five short online surveys throughout 2020–21. The research was developed collaboratively with research and policy partners. Survey themes were informed by extensive consultations with key public health and research stakeholder groups in NSW to align data collection with information needs. Survey topics included the impact of the pandemic on healthcare access, household finances, mental health, COVID-19 prevention and attitudes toward/uptake of COVID-19 vaccines. Results were rapidly analysed and disseminated to stakeholders to inform decision-making.

Results: COVID Insights recruited a diverse cohort of 32,117 participants, mean age 70 (range 56–96), with 10% from outer regional/remote areas, 13% from the most socioeconomically disadvantaged communities and 9% from culturally/linguistically diverse backgrounds. Preliminary results from mid-2021 are presented here, focusing on participants in regional and remote areas.

Of participants in regional and remote areas, 93% reported overall excellent to good quality of life. Despite this, 22% reported their mental health was worse because of the pandemic. Almost 9% reported missed or delayed access to health care.

By June 2021, 74% of participants in inner regional and 66% in outer regional/remote NSW had had at least one dose of the COVID-19 vaccine. Reasons for not yet being vaccinated included waiting for an appointment (35% inner regional and 31% outer regional/remote), waiting for a different brand (28% inner regional and 29% outer regional/remote) and not considering it a priority (18% inner regional and 23% outer regional/remote). Detailed analyses of the impact of the pandemic will be available for presentation at the conference in August 2022.

Conclusions: COVID Insights illustrates the capacity of a large longitudinal study to develop a responsive approach to generating evidence, adapting to changing contexts and evolving information needs.

Background: The 45 and Up Study was designed as a resource to enhance population health research. Through routine surveys and data linkages, the study collects important data to support research into health and ageing and supports evidence-based policy, practice and planning.

Methods: Between 2006 and 2009, New South Wales (NSW) adults aged ≥45 years were randomly sampled from Medicare Australia. Residents living in rural and remote areas, and those aged ≥80 years, were oversampled. All residents in remote populations were invited. The final cohort of over 267,000 included 10 per cent of the NSW population in the age group. Over 128,000 participants from regional and remote communities (~93,000 from inner regional areas and ~30,000 from outer regional and remote areas) completed the first study questionnaire and consented to their survey data being linked with a broad range of other data sources for health research (such as Medicare, pharmaceutical, hospital, cancer registry). Participants are contacted every five years for follow-up surveys which include core questions to identify changes in socioeconomic factors, health, functional status, health behaviours and lifestyle, and new questions responding to data gaps and environmental changes such as the COVID-19 pandemic. Participants also support sub-cohort research including biospecimen collections and surveys on socioeconomic and environmental factors (SEEF) including information on sexual orientation, faith, social support, financial hardship and healthcare access.

Results: The 45 and Up Study data has formed the basis of over 400 publications, been used by research and government organisations across Australia and 18 countries, enabled research that has informed policies and programs including the COVID-19 response, the Premier’s priorities on green space, vaccination policy and guidelines, smoking in common areas of buildings policy and informed development of the Severe Chronic Disease Management Program and for Primary Health Network Needs Assessment planning.

Some studies have focused on differences between farm residents, rural non-farm and urban counterparts. Astell-Burt et al reported lower incidence of Alzheimer’s in rural participants and Depczynski et al found lower cancer incidence in farm residents, however farm men had twice the odds of being diagnosed at later stage of colorectal cancer and there were differences in cancer care received by farm residents. Age, distance, income and health insurance factors contributed to differences in non-surgical care between groups.

Conclusions: There is enormous opportunity for additional research into variation across rural Australia in access to care, physical and mental health, the impact of the COVID-19 pandemic and health outcomes.

Introduction: A National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders in Australia was released in 2018 with 70 recommendations to guide implementation. It aims to provide consistency and equity in the diagnosis of autism spectrum disorders (ASD) in Australia. The guideline is yet to be translated into practice and evaluated in a rural community.

Rural and remote communities face significant challenges in accessing skilled professionals and support services. Families in these communities are often required to travel significant distances to access services for diagnostic evaluation, resulting in increased time and cost associated with autism diagnosis.

This study investigates whether the guideline recommendations can be effectively implemented with children under the age of five in western New South Wales using a novel telehealth model and existing community resources. A diagnostic model is being trialled that includes telehealth services from a developmental paediatrician and local allied health intervention. The process and outcomes will be evaluated against the guideline.

Methods: Action research with mixed methods is being utilised to develop, implement and evaluate a model of ASD assessment for young children who attend an established developmental clinic with a speech pathologist and social worker at Mudgee Community Health Centre. Quantitative and qualitative data will be gathered and analysed including length of time taken from identification to diagnosis, cost to families, distance travelled, number of recommendations met and the experience for families and clinicians. The financial sustainability of the model will be examined.

Results: This study will be in progress at the time of presentation. It is anticipated that preliminary quantitative and qualitative data can be shared and the establishment and implementation of the model discussed.

Outcomes: This research is imperative in addressing unanswered questions about translation of guideline recommendations, particularly in rural communities where unique service system barriers are present. The development and evaluation of an innovative model may lead to better outcomes for children and families in rural communities. These findings may be able to be translated to other rural communities.

Suicide Prevention Australia, the national peak body for suicide prevention, collaborated with people with lived experience of suicidal behaviour, service providers and researchers to develop Australia’s first national framework for suicide prevention in the workplace.

Suicide is a public health issue in Australia, particularly for those living in rural and remote regions who face a disproportionately higher suicide rate than people living in major cities. Australians living in rural and remote areas experience additional suicide risk factors and stressors and have limited access to appropriate support services.

Suicide prevention: a competency framework (the Framework) provides a starting point for employers, staff, volunteers and the community to ensure they have the skills and confidence to intervene when someone is in distress. It is designed to provide organisations with the knowledge and education to respond appropriately to people experiencing suicidal thoughts and behaviours at work. We want to ensure every person who needs support can access a consistent, high-quality and safe standard of care.

The Framework builds on the evidence found in literature, current organisational policy, practice and procedures. It also takes into account a variety of industry feedback around ‘what works’ regarding the knowledge and skills needed across suicide prevention and postvention.

Suicide Prevention Australia developed the Framework to address the gap in the knowledge and attributes of Australia’s diverse workforce in the suicide prevention sector. This Framework will influence and inform workplace policy and practice, service and systems changes in the workforce and the broader community to support the health and wellbeing of all Australians.

The Framework aims to build capability by ‘bridging social distance’ through application of the specific needs and requirements of a workplace and the roles within it.

The presentation will include an overview of how organisations have implemented the Framework to build capacity and capability when it comes to recognising suicidal thoughts and behaviours in the workplace.

Suicide Prevention Australia, the national peak body for suicide prevention, partnering with service providers, people with lived experience of suicidal behaviour, consumers, clinicians and accreditation experts to develop Australia’s first accreditation program for suicide prevention.

Research highlights that the suicide rate in Australia’s rural and regional areas is approximately 40 per cent higher than in major cities. People experiencing distress describe limited access to appropriate services in regional and rural towns and a disconnected system that is ill-equipped to support their needs.

The Suicide Prevention Accreditation Program (Accreditation Program) supports organisations to implement safe, high-quality and effective suicide prevention and postvention programs in Australia. We are striving to ensure that every person who needs support can access a high-quality standard of care.

The Accreditation Program has demonstrated capacity and capability-building opportunities by ‘bridging social distance’ through online continuous quality improvement resources and templates. Providers of suicide prevention and postvention programs, at different stages of implementation or maturity, can participate in a self-directed accreditation program that will provide consistency in delivery and continuous quality improvement.

Examples from service providers undertaking the Accreditation Program will highlight the opportunities for meaningful evaluation through continuous quality improvement. Furthermore, the Accreditation Program strengthens the local knowledge of ‘what works’ in the prevention of suicide and support for communities impacted by suicide.

Background: In the remote community facilities of Queensland, there is a high turnover of registered nurses (RNs) and the question being asked is why they are leaving their workplace. This research study will focus on remote community areas where high turnover of RNs is an issue and explore the reasons why. The importance of the study is to investigate low workforce retention and what is needed for a sustainable workforce in the future.

Methods: This project will adopt a qualitative approach using interviews. Up to ten participants will be interviewed for this study, either in person or via Microsoft Teams, and will be recorded and analysed thematically. By doing this, research findings from this study will offer insight into RNs’ perspectives about retention in the remote healthcare setting. This outcome is particularly important because this field of study has limited research investigating this context.

Findings/results: The findings from this research will be used to inform strategies to retain RNs in remote areas.

Conclusion: To retain RNs, change within healthcare organisations is needed for a sustainable future within remote healthcare facilities. Fatigue, burnout and stress are the leading causes for RNs to resign and either move on or leave the nursing profession all together. As an ageing nursing profession population, it is paramount to look after our mental health wellbeing.

It is acknowledged that people who live in rural and remote areas have less access to specialist medical treatment and clinical trials compared to people who live in metropolitan areas. The Australian Teletrial Program, funded by the Medical Research Future Fund (MRFF) 2019 Rural, Regional and Remote Clinical Trial Enabling Infrastructure grant, will implement a scaled-up version of the Australasian Teletrial Model, particularly targeting people from MM3–MM7 postcodes. The program is in its first year of the five-year grant and will encompass public, private and academic clinical trials services, as well as general practitioners.

In late 2021, the federal government announced the implementation of the HELP for Rural Doctors and Nurse Practitioners debt reduction scheme, as a means of addressing the shortage of medical professionals throughout rural, regional and remote Australia. As part of the initiative, eligible health professionals (general practitioners and nurse practitioners) located in communities ranked three to seven according to the Modified Monash Model (MMM) for rurality may have up to 100 per cent of their Higher Education Loan Program (HELP) debt reduced, depending upon a variety of factors.

As the peak representative body for students across all sectors of rural health, the National Rural Health Student Network (NRHSN) feels compelled to highlight the ideas, concerns and perspectives of the future rural workforce of Australia. We surveyed our multidisciplinary student body to gain insight into the perceived strengths and pitfalls of the proposed program, as per the workforce to which it will be targeted.

A total of 253 results were collected from the qualitative survey distributed to our members, the majority of whom expect to enter the workforce in the next two years. The factors that students identified as inspiration to practice in regional, rural and remote communities were reflective of the current body of literature, with personal background and perceived superior quality of life being major influences. Similarly, the barriers identified by our student body for working in such communities were synonymous with those documented in the literature: impaired access to resources, specialty training programs demanding relocation to metropolitan areas and family/spouse commitments.

The issue of staff shortages in rural, remote and regional Australia is complex and rooted in issues surrounding staff support, education and access to resources. While the HELP debt reduction was unanimously perceived as a positive scheme, financial incentives can only be one piece of the puzzle. We extrapolated three major themes towards which ongoing efforts should be directed to further improve the retention of a health workforce throughout regional, rural and remote Australia: attractiveness, inclusivity and sustainability.

#SnapshotRuralVic is a social media campaign aiming to connect rural communities and provide opportunity for sharing stories and imagery supporting mental health and wellbeing. The project plan was initiated during a challenging time for many rural communities – as ongoing drought was followed by substantial and devastating bushfires across large areas of rural Victoria. The onset of the COVID-19 pandemic in early 2020 raised a new threat, adding new layers of social isolation and risks to livelihoods. The #SnapshotRuralVic campaign commenced in August 2020, as Victoria declared a ‘state of disaster’ and faced six weeks of strict lockdowns. Schools were closed, retail shopfronts empty, people were working from home, and mask wearing and physical distancing became part of everyday life.

#SnapshotRuralVic provided a silver lining to the dark cloud of COVID-19. By encouraging creativity and conversations about everyday experiences, #SnapshotRuralVic saw a diverse range of Victorians connecting through photography, videography and storytelling. The initial 10-week campaign encouraged participants to share everyday snippets of their lives – from crafting and cooking projects to walking the dog or enjoying the sunrise – combining to paint a unique virtual picture of Victoria during this time and socially connecting people in a positive and supportive way (regardless of physical distance).

The campaign was overwhelmingly supported by the rural community, with 100 per cent of survey respondents saying they had no hesitation in taking part: ‘Anything that promotes rural living and connects those that are feeling isolated has my full support’.

Clear benefits to mental health were identified: ‘… picked me up when feeling down and enjoying the positive and motivating pictures … some of, actually many of, the pictures posted boosted my mental state of mind’.

Benefits from #SnapshotRuralVic extended beyond a rural audience, with contributions helping to build understanding and connect rural and city audiences: ‘I had friends in Melbourne that were in lockdown and it was great because a lot of them visit country Victoria and our home and the areas around where we live and, for them, I think there was a great connection. That we were still here.’

This presentation will share insights about communications strategies used to promote the campaign and engage participation. Findings from an evaluation (using a combination of analytics, surveys and qualitative interviews) will highlight the benefits, challenges and learnings for future social media campaigns tailored to improve the health, wellbeing and safety of rural communities.

Background: Vaccine hesitancy is a barrier in reaching the level of herd immunity (approximately 80 per cent fully vaccinated) to enable the return to some form of normalcy in Australia. Whilst many rural and regional areas have been spared significant outbreaks of COVID‑19 in comparison to metropolitan areas, outbreaks have been witnessed particularly in workplaces such as abattoirs and aged care facilities. Intention to have the COVID‑19 vaccination amongst a regional population could vary due to demographics, sociocultural and educational differences, and when compared to metropolitan counterparts.

Objectives: This study aimed to assess intention to be vaccinated among attendees at two rural and regional COVID‑19 screening clinics located in Victoria. It also examined whether the intention changed if strongly recommended by a healthcare provider.

Methods: A cross-sectional study was conducted with adult residents of south-west Victoria who went through two differently located screening clinics during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. A seven-point Likert scale was used to collect responses on intention to have the COVID-19 vaccine and if it was strongly recommended by a healthcare provider.

Results: Among 702 total participants, more than two-thirds were females (481, 69%) and mean age (±SD) was 49 (±15.8) years. Motivation to take COVID‑19 vaccine across the two sites was 73–80 per cent, which increased to 78–86 per cent if a recommendation of vaccination was received from their healthcare providers. Intention to be vaccinated for COVID‑19 was higher among participants who had completed a bachelor degree or above (51% vs 34%, AOR 2.08, 95% CIs 1.27-3.41, p<0.01). Participants who reported that their financial situation had been negatively impacted due to the COVID‑19 pandemic were not motivated to take COVID‑19 vaccine (20% vs 29%, AOR 0.61, 95% CIs 0.40-0.93, p<0.05). There was no difference in intention to vaccinate with those who had reported comorbidities or experiencing stress.

Conclusions: Findings indicated that there was scope to improve awareness among the general community and workplaces. A role for ensuring those financially negatively impacted are advised of vaccination opportunities and benefits when connecting with any healthcare provider.

Background: To date, the direct impact of COVID-19 has been less in regional Victoria compared with metropolitan areas. Regional hospitals have initiated and continued community screening clinics for COVID-19 testing. Research examining psychological wellbeing and the effect of COVID-19 in regional settings of Australia is limited.

Objectives: To assess the extent of psychological distress, fear of COVID-19 and coping strategies among the attendees and health workers in COVID-19 screening clinics at two regional/rural Victorian settings.

Methods: A cross-sectional study was conducted with adult residents of western Victoria who went through the selected screening clinics during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale and Brief Resilient Coping Scale were used to assess levels of psychological distress, fear of COVID-19 and coping, respectively. Intention to receive COVID-19 vaccine was also assessed.

Results: Among 702 total participants, more than two-thirds were females (481, 69%) and mean age (±SD) was 49 (±15.8) years. One in five participants (156, 22%) experienced high to very high levels of psychological distress, one in ten (72, 10%) experienced high levels of fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher levels of distress (AOR 10.4, 95% CIs 6.25-17.2) and higher levels of fear (AOR 2.56, 95% CIs 1.41-4.66). Higher distress was also associated with having single or multiple co-morbidities, increased smoking (AOR 5.71, 95% CIs 1.04-31.4) and alcohol drinking (AOR 2.03, 95% CIs 1.21-3.40) and having higher levels of fear. Higher fear was associated with negative impact on financial situation, drinking alcohol (AOR 2.15, 95% CIs 1.06-4.37) and increased alcohol drinking, and having higher psychological distress. Medium to high resilient coping was associated with being ≥60 years old (AOR 1.84, 95% CIs 1.04-3.24) and those who completed bachelor and above levels of education.

Conclusions: People who had pre-existing mental health issues, co-morbidities, smoked and consumed alcohol were identified as high-risk groups for psychological wellbeing in regional Victoria during the COVID-19 pandemic. Conversely being female, aged over 60 years and living alone were not associated with increased stress, fear or lower resilience unlike previous studies. Specific interventions to support the mental wellbeing of these vulnerable populations, along with engaging healthcare providers, should be considered.

In April 2016, our local GP called a public meeting. Over one-third of the population came to hear of the difficulties she was facing as the only doctor in a town with a permanent population of roughly 1,000 people.

What we heard shocked us – the practice was facing closure as she was overworked and yet unable to make ends meet. To address these issues the Mallacoota Community Health Infrastructure and Resilience Fund Inc (CHIRF) was formed.

In 2018 CHIRF formed an alliance with the Remote Vocational Training Scheme (RVTS) and became the first town in a targeted-recruitment pilot strategy, to recruit, retain and train doctors to GP Fellowship in remote communities, via a supported model of remote supervision and distance education.

Adding the training program to the recruitment package enabled Mallacoota to find a new doctor who has been with us for three years now. Our doctor was the first of 14 who has been recruited to 18 of Australia’s hardest to fill locations, including six remote Aboriginal Medical Services.

The RVTS targeted-recruitment model has brought a more stable workforce and enhanced continuity of care to the participating communities, as well as providing career progression to specialist qualifications for the recruited doctors. There have also been numerous spin-off effects for the community which have enabled Mallacoota to expand both facilities and services.

Results from the pilot have revealed that the linking of high-quality vocational training to a specific remote location is an effective strategy to recruit and retain doctors to rural, remote and First Nations communities with high medical workforce need. The strategy has been most effective in locations such as Mallacoota where on-ground community-driven support fosters collaboration between partnering organisations.

Encouraged by these initial findings, the Australian Government is now providing additional salary support funding to enhance the market competitiveness and business viability of participating practices.

The story of what happened in Mallacoota, and how this led to our facilities and services playing an integral role in the survival of the community during the bushfires, is an example of how close community involvement with the medical system can lead to positive outcomes.

Lessons have been learned and challenges remain but, as a remote community, we have become more acutely aware of the substantial gaps that still exist within the health system and the further opportunities that exist for these to be resolved.

Background: Victoria experienced the largest number of COVID-19 cases out of all Australian jurisdictions in 2020. While research is emerging about the impact of COVID-19 on metropolitan health service workers, limited data exists detailing impacts on staff in rural and regional areas. The COVID-19 and Regional Health Staff Wellbeing (CReW) study, involving nine rural and regional health services in Victoria, aims to understand the impact of the COVID-19 pandemic on the wellbeing of staff, with preliminary data analysis exploring changes and adaptations required in work duties. This information is important to ensure the rural and regional context is considered when developing and implementing strategies to support the health workforce in the current pandemic and future public health emergencies.

Aim: To describe workplace changes occurring in rural and regional Victorian health services during the COVID-19 pandemic.

Methods: All permanent, part-time, casual and contracted staff (clinical and non-clinical) at nine rural and regional health services across Victoria were invited to participate in an anonymous online survey (open May to July 2021). The survey was developed in consultation with the participating health services to maximise the utility of the results. In addition to participant demographics and wellbeing measures, the survey included four questions about the impact of COVID-19 on the workplace. The survey will be repeated in six months to track changes as the pandemic response continues.

Results: Analysis of the 455 survey responses indicates that the majority (68.1 per cent) of staff in rural and regional health services experienced changes to work duties related to the COVID-19 pandemic. Despite varying numbers of COVID-19 infections across health service catchment areas, similar levels of work changes were reported by participants across regions. Changes in work duties were reported across all role types and were not limited to staff with direct patient contact.

Respondents reported changed work hours, role changes (including secondment or redeployment) and implementation of additional processes, such as enhanced cleaning procedures and screening of staff, clients and visitors. Practice changes were also required, including increased personal protective equipment use, working from home and providing telehealth services.

Conclusion: Rural and regional health service staff in Victoria have experienced changes in their work duties, regardless of their region or role. These findings highlight the importance of developing strategies to support all health service staff in rural and regional settings to enable them to continue to provide care for their communities during the current pandemic and future public health emergencies.

Introduction: Between 55 and 65 per cent of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets and/or fluids by a speech–language pathologist (SLP). The aim of this study was to quantify current adherence to prescribed texture modification for residents with dysphagia and explore the barriers to appropriate implementation in a rural aged care setting.

Methods: Meal texture audits (N=42) were conducted with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were facilitated with nursing and food preparation staff (N=11) to identify barriers to implementation.

Results: Mealtime texture audits identified that 54.8 per cent (n=23) of residents’ food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3 per cent (n=27) of meal trays contained foods that did not meet residents’ dysphagia management plans. Focus group data revealed seven major themes impacting the staff ability to implement prescribed texture-modified diets. Complex processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff, as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility.

Conclusion: There was low adherence to SLP-prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP-prescribed texture-modified diets including complex processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and inefficient paper-based menu systems. These should be made a priority for health services to ensure adequate dysphagia management.

There are significant workforce shortages under the National Disability Insurance Scheme (NDIS), particularly in the allied health professions. These shortages are further exacerbated in rural and remote areas and other thin markets. To address these shortages, innovation in service design is required to augment local services. The therapy assistant model is one such emerging model. Collaboration between an allied health practitioner and a locally based therapy assistant, including the use of telepractice, is a model that has great potential to increase timely access to therapeutic supports in rural and remote locations.

Based on the literature and a modified delphi approach, our research aimed to identify the aspects of therapy assistant models that are important in implementing it within the disability sector and differentiating it from a medical model of service delivery. We further investigated the delivery of a newly developed therapy assistant service to NDIS participants in four rural communities – Broken Hill, Deniliquin, Norfolk Island and north-west Tasmania – using a mixed-methods design including experience sampling, photovoice and qualitative interviews. A sustainability and cost-effectiveness evaluation were also undertaken.

This presentation will explore our key findings related to the development of a disability-specific therapy assistant framework, as well as the impacts and sustainability of a therapy assistant model of service delivery from the perspective of NDIS participants, therapy assistants, therapists and managers.

The major impact of this research is that the broader disability sector can build an evidence base to understand the successful application of the therapy assistant model which includes telepractice. This may increase therapeutic supports delivered to NDIS participants and their local support team in regions that are currently poorly served with traditional outreach models of service delivery. The research captures goal-oriented outcomes and participation in the community for NDIS participants as part of their engagement with therapy assistants. We will present practice frameworks, guidelines and business insights for upscaling the application of this model in many rural and remote locations.

Poor oral health can affect an individual’s quality of life and increases burden of disease. In Australia, dental caries is one of the most common chronic diseases in childhood which can impact overall general health and wellbeing throughout life. In regional and rural areas there are higher incidences of dental caries in children compared to those in metropolitan areas. Risk factors which impact oral health include lower socioeconomic status, lower social capital, high obesity and poorer access to dental services. Oral health is additionally influenced by lifestyle factors such as smoking, alcohol consumption, diet and poor nutrition. The issue of oral health is complex, affected by where people live and their circumstances, which then influences their ability to prevent oral disease.

This presentation outlines a multi-method approach undertaken by a rural health service to explore oral health and dental care in a rural area. The aim was to garner a baseline understanding of needs to then develop and prioritise relevant health promotion information and service improvement activities. The project involved electronic self-report surveys to community members and dental care providers. and focus group interviews with the health and community care workforce. Oral health students on placement at the health service assisted with data collection.

Overall, 139 community members and 17 dental providers completed an online survey, and 78 workforce members gave their opinion through interviews. Community respondents felt that people avoided going to the dentist mainly due to cost, time, service access, and sometimes shame, fear and anxiety. Dental providers thought more information and education is needed for the community for them to understand what they can access for free on Medicare for children.

Overwhelmingly, the workforce indicated oral health was the specific concern of the dental field, despite the many connections oral health has on overall and long-term health. This emphasised the need for dental care to be promoted as part of a whole-of-person health approach, alongside physical and mental health needs. Next steps are to develop oral health messages and education, and advocate for oral health to be included in public health plans across the rural area at a local government level. This multi-method approach has shown it is important to develop place-based understandings of the features of poor oral health to enable tailored responses to meet the needs and circumstances of the community.

Background: The demand for community-based palliative care is increasing as more palliative care clients are preferring to die at home. In rural areas, while nurses comprise the largest health professional discipline providing palliative and end-of-life care, only 1.1% work in a designated palliative care role. Studies report rural nurses feel professionally and emotionally unequipped to work with palliative care patients.

Aim: The aim of our research is to build a greater understanding of the professional development needs and workforce issues of rural nurses working in community-based palliative care in Australia.

Methods: We conducted a survey of community-based nurses in Gippsland, Victoria, Australia. Health service managers distributed a link to an electronic questionnaire to eligible staff (N=165). We developed a 123-item Palliative Care Skills Matrix Questionnaire to identify rural nurses’ knowledge of providing community-based palliative care around six practice standards. Descriptive data analysis was used to identify strengths, consolidations or gaps in knowledge and practice. Binary logistic regression examined associations between nurses’ characteristics and knowledge gaps and consolidations.

Results: Overall, 122 nurses (response rate = 74%) completed the questionnaire; 93% were female, 87% worked as registered nurses and 58% had >5 years’ palliative care experience. The majority of items (77%, n=95) were identified as strengths across all six palliative care standards. ‘Developing a care plan’ and ‘Transition with and between services’ were the only two practice standards with 100% of items rated as strengths. Gaps and consolidations emerged in four practice standards and using clinical tools. These included items around pain, symptom and emergency management. In items around psychosocial and supportive care, gaps and consolidations were found in using carer and client assessment tools, working with children, referral to an Aboriginal liaison officer, seeking volunteer support, sourcing respite options for carers, accessing an interpreter and implementing appropriate follow-up for a carer with a high bereavement risk. Factors significantly associated with knowledge gaps included lack of palliative care training, fewer years of clinical experience and being in an enrolled nurse role.

Conclusion: The data generated in this study can be used by managers and health service administrators to plan targeted professional development programs that have the potential to address the identified knowledge and skills gaps.