Background: To address the gap in culturally safe and accessible community rehabilitation services in remote communities, stakeholders in two Cape York communities co-designed and implemented an interprofessional student-assisted community rehabilitation and lifestyle service. Funding for the service was provided by the Northern Queensland Primary Health Network. The evaluation of this service aimed to explore the feasibility and acceptability of the service in the first 12 months (July 2019 – June 2020) from the perspective of all the stakeholder groups (clients, families, community organisations, allied health students and health staff).

Methods: Feasibility and acceptability was determined by occasions of service (OOS), referral rates, failure to attend (FTA) rates, student placement offers versus placements filled. One-to-one semi-structured interviews with 40 people representing all stakeholder groups explored stakeholders’ perceptions of the service.

Results: During the first 12 months, 783 OOS were provided to 46 clients. A total FTA rate of 14% was recorded trending down as the service became more established, 50% in the first month to 0% in month twelve. Placements for 29 allied health students (206 weeks) were offered, 15 (117 weeks) were filled. COVID-19 restrictions impacted both on student placements and reduced OOS from March to June 2020. Themes from interviews were analysed using a SWOT analysis. Strengths included cultural responsiveness, integration of care, reliability and continuity of service, and building community capacity. Weaknesses included reliance on student workforce, extra coordination between health professionals, role clarity and scope of practice. Opportunities included the funding model and stakeholder commitment to community needs. Threats included sustainable funding structures and attracting student workforce.

Discussion: This initial 12-month evaluation found the student-assisted community rehabilitation service to be feasible and acceptable. Acceptability indicators improved as the service developed and responded to client and community needs. Reciprocity between the service, clients and community organisations was highly valued. Adequately funded place-based co-design of health care and student training models can lead to feasible and acceptable service models for very remote and Indigenous communities.

An expanded role for pharmacists, although emerging in Australia, has been a priority for pharmacy associations internationally. ‘Expanded practice’, ‘extended practice’ and ‘full scope of practice’ are terms used to describe the extension of the pharmacist’s role. Expanded services are tasks usually provided by other health professionals (HPs) and offered in addition to pharmacists’ usual medication management services. Rural Australian community pharmacists have been frequently identified as being well-positioned to expand services to address adversities of healthcare access for rural and remote populations.

An ethnographic lens of rural culture was utilised for this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with pharmacists (12), doctors (8), nurses (4), allied health professionals (11) and stakeholder representatives (8). Thematic analysis using an inductive and deductive approach was guided by a multi-level lens of macro- (policy level), meso- (HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided aligned strategies to support the theoretical framework for the analysis.

Key findings at the macro-level included agreement that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. In addition, government support and funding provisions were needed for sustainability. The meso-level revealed an expectation that expanded practice would improve rural pharmacist recruitment and retention through improved professional satisfaction. Effective collaboration and coordination with other healthcare providers in a community was described as essential at the meso-level to ensure success and acceptability of expanded services. The importance of ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place, as well as capacity including time and space, were also identified at the meso-level. The micro-level highlighted the opportunity expanded service development presented to empower and engage consumers through rural community pharmacies.

As pharmacists internationally continue to expand their scope of practice, these results provide first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators across policy, health professional, consumer and community levels is needed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.

Background: Colorectal cancer (CRC) is the third most common cancer in Australia and second leading cause of death. With 90 per cent of CRC being potentially preventable with early detection, optimal National Bowel Cancer Screening Program (NBCSP) participation is critical for mortality reduction and cost-effectiveness. Currently, testing averages 44 per cent, significantly below the 60–70 per cent target. Participation is further reduced within rural communities, exemplifying CRC disease burden and mortality with increasing rurality. Western New South Wales (NSW) is no exception to this. While numerous barriers limited patient participation, the resounding facilitating factor enhancing NBCSP uptake is general practitioner (GP) endorsement. This research explored rural GP NBCSP experiences to elucidate circumstances unique to rural and regional communities which impact utilisation and access of preventive medicine resources.

Methods: Semi-structured interviews are being used to explore GP (~n=15-20) experiences with the NBCSP and preventive screening within western NSW. Participants are GPs currently practicing in western NSW with at least one year of regional practice experience. Interview questions explore GP experiences in NBCSP administration and preventive screening, common patient perceptions and how these conversations were navigated, barriers and facilitators for patient participation as well as recommendation to improve NBCSP uptake and facilitate GP endorsement. Interviews are audio-recorded for transcription and analysed using reflexive thematic analysis.

Results: Data collection and analysis is ongoing. GPs perceive a lack of public awareness and media promotion in the region, as well as limited health literacy as principal barriers in engaging western NSW residents with the NBCSP. However, GPs also identified that, following discussions of NBCSP participation, its requirements and potential benefits, most patients subsequently utilise FOBT testing, either through the NBCSP or privately purchased kits. Incorporating preventive screening discussion as part of regular ‘check-up’ appointments was found to normalise the topic and enhanced patient understanding of asymptomatic testing, increasing test uptake and positive result follow-up. Automated system reminders were identified as helpful to both patient and practitioner to ensure test completion.

Conclusions: This research will enable a more comprehensive understanding of the barriers and facilitators which impact patient NBCSP participation in this regional centre. Engagement of regional primary health care will facilitate the development of specific strategies to promote NBCSP endorsement by GPs and the multidisciplinary primary healthcare team within non-metropolitan areas. These strategies will aim to improve patient care and reduce the CRC disease burden within our rural Australian communities, bridging the health gap defined by postcode.

Aims: The Allied Health Rural Generalist (AHRG) Pathway was developed in Queensland Health between 2014 and 2018. Following successful evaluated trials, the Pathway was embedded in system funding and employment structures. The AHRG Pathway is an integrated service, workforce and training strategy that supports rural and remote health service outcomes. The Pathway includes: (1) early-career, designated training positions for nine allied health professions supported by postgraduate training in rural generalist practice; and (2) a leadership development program for senior allied health professionals (AHPs).

The purpose of this project is to examine the implementation and outcomes of the AHRG Pathway 2019–22 on:

1. workforce development and sustainability
2. training and development
3. service development and delivery.

Methods: This project employed a mixed-method, implementation-effectiveness hybrid design to evaluate the pathway using both retrospective and prospective data. Primary data sources included: (1) online surveys with AHPs involved in the AHRG Pathway (such as trainees, managers/supervisors); (2) online surveys with a matched cohort of rural AHPs without connection to the Pathway; and (3) follow-up semi-structured interviews and virtual site visits with focus groups. Secondary data included de-identified AHRG Pathway program documentation and payroll data used to compare longitudinal tracking of trainees/participants and matched cohorts.

Survey data were analysed using descriptive and non-parametric statistics and content analysis. Individual interviews and focus groups were recorded, transcribed and analysed to identify themes. Both survey and individual interview data informed questions asked of key contacts and focus group participants at the virtual site visits.

Results: Preliminary findings describing factors for engagement in the AHRG Pathway include interest in rural practice/career and professional development, and indicate challenges and enablers of success, including the key role of the professional supervisor and access to protected development time. Attraction and retention factors include workforce and service pressures.

Strategies used to address the methodological challenges of investigating small, dispersed rural and remote teams will be presented, including the use of virtual site visits and leveraging existing finance and payroll data.

Conclusion and relevance: The AHRG Pathway is being implemented in most state and territory health systems and the primary care sector nationally. Outcomes from this evaluation can guide decision-making on improvements and investment in the strategy.

Digital health is changing the healthcare ecosystem in Australia. Yet, the future of digital health is about people. COVID-19 led a seismic shift in the uptake of digital health. Consumers and providers now appreciate the critical role technology can play in supporting better health and wellbeing and its potential to ease pressure on the health workforce and reduce wastage and duplication in government spending. But there’s more to be done to realise the opportunities that digital health offers to ensure our health system is nationally connected and accessible so that consumers, including those in rural and regional areas, can access the care they need when and where they need it. This presentation will outline how the Australian Digital Health Agency is collaborating across the Commonwealth, across different tiers of government, with healthcare peaks and consumer groups and healthcare providers to drive uptake and connection – including work to develop the next National Digital Health Strategy and work to drive greater interoperability that facilitates the exchange of clinical information easily and securely to support continuity of care and better patient outcomes.

Informal care is most often provided by unpaid family members, with studies consistently demonstrating a significantly higher incidence of psychological disorders, levels of stress and poorer wellbeing in caregivers when compared to non-caregivers.

Limited social supports and formal services in rural areas, compounded by the pandemic and bushfires, have highlighted the importance of digital platforms in maintaining social connection and wellbeing. This mixed-methods study used quantitative surveys and in-depth interviews to investigate the relationship between online social supports and/or in-person social supports with depression and burden for older rural caregivers.

Regression analysis techniques were used to explore the relationships between online and in-person social supports and the experience of burden and depression in older rural caregivers. In-depth interviews then provided insights into the specific aspects of social support valued by caregivers in rural areas, providing useful considerations for the development of interventions to address known issues of isolation and depression for older caregivers in rural Australia.

Aim: Abortion is an essential healthcare service. In Australia, early medical abortion (EMA) is available up to nine weeks’ gestation and can be delivered via telehealth or face to face. However, there are a number of system, provider and patient barriers to integrating EMA into primary care in Australia, which leads to variability in the availability of EMA services, particularly in rural and remote areas. We undertook a study to determine how EMA service provision varies across the Australian primary care landscape.

Methods: We undertook a cross-sectional study of Pharmaceutical Benefits Scheme (PBS) dispensing data for females aged 15–54 dispensed MS-2 Step® between 2015 and 2019 in each Australian Bureau of Statistics Statistical Area 3 (SA3). Standardised rates of MS-2 Step dispensed were calculated for 2019 stratified by state and level of remoteness.

Results: In 2019, while dispensing rates of MS-2 Step were greatest in inner regional, outer regional and remote parts of Australia, at 7.2 prescriptions dispensed per 1,000 women, approximately 30 per cent of women across Australia lived in an area where no general practitioner (GP) provided EMA services, and 27 per cent lived in an area where no community pharmacy dispensed MS-2 Step.

Relevance: While rates of MS-2 Step prescriptions are higher in regional and remote areas compared to major cities, there remains a large proportion of areas where there is no GP or pharmacist provision, suggesting local access is limited in many rural and remote areas.

Conclusion: The higher dispensing rates in regional and remote parts of Australia may in part be explained by telehealth provision and by the lack of surgical abortion options in these areas. However, there remains a large proportion of areas where there is no local GP or pharmacist provision of EMA. Greater attention must be given to supporting local primary care providers, including GPs and community pharmacists, to deliver EMA in their own communities.

Aim: Ensuring access to contraception and abortion services is a priority of the National Women’s Health Strategy 2020–2030. Women in rural and remote areas often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Extending the scope of practice nurses using innovative nurse-led models and task-sharing could help to overcome some of the access issues. While such models exist in community health and family planning settings in Australia and internationally, they have not been developed or evaluated in general practice. The ORIENT study aims to increase access to LARC and medical abortion for women in rural and regional Australia, through implementing an innovative nurse-led model in primary care.

Methods: ORIENT is a five-year pragmatic, stepped-wedge, cluster randomised controlled trial. We will co-design, implement and evaluate a nurse-led model of care that includes contraceptive implant insertions and use of telehealth to support LARC and medical abortion. Thirty-two general practices will be recruited. Online training, educational outreach through academic detailing, and a virtual Community of Practice will be utilised to support implementation. The evaluation will include changes in rate of LARC and MS2Step prescribing, and a cost-effectiveness analysis of the intervention compared to usual care.

Findings: It is anticipated that broadening the scope of practice nurses to provide LARC and medical abortion services in general practice will increase LARC uptake and access to medical abortion for women living in rural and regional areas of Australia.

Relevance and conclusion: The ORIENT study will equip practice nurses with the resources, networks, knowledge and skills to increase the delivery of LARC and medical abortion in rural and regional areas. This has the potential to decrease unintended pregnancies and improve reproductive health outcomes for this priority population in Australia.

Background: Many small rural and remote hospitals do not have routine access to pharmacy services and medication management is undertaken by doctors and nurses. To support the quality use of medications, a virtual clinical pharmacy service (VCPS) was implemented to eight hospitals. The pharmacist uses the electronic medical record, electronic medication management and a wireless teleconferencing cart to provide medication reconciliation, medication review, patient counselling, advice on prescribing, and administration and staff education. The uptake of telehealth services is reliant on local healthcare staff who can be challenged by new models of care, technology, re-organised tasks and changes to processes.

Aim: To evaluate staff perspectives of a new virtual pharmacy model of care and identify potential areas for improvement.

Methods: Focus groups were conducted with doctors, nurses, allied health and pharmacists at each hospital via videoconference. The focus groups were held at least three months after the implementation, to provide adequate time for staff to attain a working knowledge of the service. Focus group discussions explored issues, benefits and barriers. Data was transformed using thematic analysis informed by Appreciative Inquiry to focus on the strengths of the service and identify further improvements.

Results: Fifteen focus groups were conducted between July 2020 and April 2021 with a total of 67 staff. The study identified key themes including benefits to patients through access to specialist medical knowledge, improved staff confidence and safety in medication management, and enhanced compliance with accreditation standards. Challenges identified included communication and coordination. Key factors for maintaining and scaling up the virtual services were identified and will be discussed.

Discussion: The VCPS brought a positive, collegiate culture regarding medication management. Healthcare staff felt the VCPS worked well overall and saw it as an efficient way to increase access to healthcare services for smaller rural and remote hospitals.

The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national peak body representing 143 Aboriginal Community Controlled Health Organisations (ACCHOs) nationally on Aboriginal and Torres Strait Islander health and wellbeing issues. Our membership operates more than 450 clinics which contribute to improving Aboriginal and Torres Strait Islander health and wellbeing through the provision of comprehensive holistic primary health care, and by integrating and coordinating care and services, including for disability.

The NDIS Ready: Aboriginal and Torres Strait Islander Market Capability Program (NDIS Ready) recognises the additional barriers ACCHOs face in registering and delivering services sustainably under the NDIS. In line with the National Agreement on Closing the Gap, NDIS Ready demonstrates the ability for government and the community controlled sector to work together in genuine partnership to develop the capability of the community controlled sector to deliver culturally appropriate disability services to their communities.

NDIS Ready is underpinned by four key initiatives, all designed to develop and promote the capability of ACCHOs and their communities to understand and sustainably deliver NDIS services:

1. NDIS Ready project officers situated in each jurisdictional affiliate
2. a targeted grant round
3. a communications Initiative
4. consultation through a series of Yarning Circles.

There are challenges for all ACCHOs in transitioning to and sustainably delivering NDIS services. However, for rural and remote ACCHOS, the challenges of delivering NDIS services to their communities are often exacerbated by their remoteness and the vastness of their service footprint. NDIS Ready is designed to support all ACCHOs and through its four initiatives will start to address the unique or additional challenges faced by rural and remote ACCHOs. This oral presentation will discuss:

• how the four initiatives of NDIS Ready can help address some of the challenges of NDIS service delivery for rural and remote ACCHOs specifically
• the importance of programs which improve the capability and sustainability of rural and remote ACCHOs and their communities, like NDIS Ready
• identifying and developing next steps to support rural and remote ACCHOs on their NDIS provider journeys.

Relevance and aims: In 2020, Queensland Health funded an initiative to develop a home-based model of care to safely reduce Torres and Cape Hospital and Health Service (TCHHS) episodes of in-hospital care in rural and remote areas of Far North Queensland. While home-based models of care have been established for years in many areas across Australia, the context within the region serviced by TCHHS required a customised approach given the unique community needs, geography and healthcare settings. This presentation provides details on the development of this model of care and provides insights for other healthcare services operating in rural and remote areas.

Methods: Initially a Steering Committee was established to oversee and design the required model of care. This committee was chaired by the Executive Director of Allied Health and included representation from nurses, allied health practitioners and Indigenous health workers from within the region. A decision was made early on to name the model of care Healthcare in the Home (HITH) to reflect the nature of work in providing alternatives to hospitalisation and empowering people to better manage their own care. The model is now embedded as usual care.

Results: Three sites were chosen according to their geography and ability to rapidly establish and support a broad range of community services: Bamaga, Cooktown and Weipa.

A HITH Coordinator role was initially established to assist in customising HITH for each site based on existing staff resources and specific health needs of the community. The HITH model of care commenced with establishment of a workforce of six allied health assistants (mostly Indigenous). Certificate IV training was provided twice in Cairns and a support clinician facilitated the learning. The workforce was arranged in pairs as a buddy system for each site.

Training was also provided for allied health teams at each site to facilitate competence and confidence in delegating work responsibilities to allied health assistants. The HITH model of care has now expanded to include allied health practitioners, nurses, health workers and administrative staff.

Indigenous allied health assistants and health workers have played a vital role in improving appropriateness of care, health literacy, cultural safety and compliance with care.

Conclusions: The HITH model of care can be customised to operate as an extension to existing health services in rural and remote communities.

Key Message: HITH is a viable hospital avoidance strategy in selected rural and remote areas of Far North Queensland.

Mental illness affects one in five (20 per cent) of Australians aged 16–85 in any year and almost half of all Australians will experience a mental illness in their lifetime. Around seven million people live in rural and remote areas and face unique challenges due to their geographic location, with often poorer health outcomes than people living in metropolitan areas. Therefore, rural and remote communities are more likely to struggle to access the right mental health support as fewer mental health services are available.

Telehealth has been a key enabler for access to services in rural and remote communities and crucially, as we have seen during the COVID-19 pandemic, in maintaining access to care while under restrictions (lockdown).

Video consultations are the next best thing to having a patient in the consulting room as they enable clinicians to observe and interact with patients in ways not possible over the phone. The May 2021 Medicare Benefits Schedule telehealth summary reported mental health consultations accounted for 18 per cent of all telehealth services (n= 203,000) and, of that, seven per cent were conducted by video.

During the financial year 2020–21 COVID-19 pandemic, the Video Call service delivered over one million consultations in total across Australia, with over 1,200 new mental health clinics onboarded across primary and tertiary health sectors. Mental health clinics currently account for 15 per cent of all clinics using our service.

Case study: headspace has been a huge adopter of video consulting to deliver essential services to young people in rural and remote communities. headspace has seen an increase in the number of young people accessing their services during the pandemic response, especially from rural and remote areas. During the period 1 January to 31 July 2021, headspace services undertook over 6,600 Video Call consultations. This has bridged the social distance gap for those clients in rural and remote locations and has kept young people connected to their mental health service provider.

The Healthdirect Video Call service has been a key enabler to ensure continuation of service delivery.

This presentation will further outline headspace’s use case in our service and show how this model can be used effectively by other service providers in the mental health sector, especially in rural and remote areas. It will outline clinician experience in the use of Video Call for delivering mental health services and feedback from rural and remote patients using telehealth to manage their mental health.

Background: It is well known that a high-quality, sustained health workforce contributes to a healthy population. However, health workforce retention continues to be an ongoing challenge for rural health. It is posited that improving a rural health practitioner’s capability could help to retain them working rurally for longer. With rapidly increasing access to, and use of, digital technology worldwide, there are new opportunities to build capability for those who are working in rural and remote areas.

Purpose: To explore important factors in building a health professional’s capability, including digital solutions to retain them longer in a rural location.

Method: In 2021, an evaluation of [name of platform], a popular digital platform that connects health professionals and organisations interested in rural health, asked members about the factors that impact on health workforce capability. Additionally, semi-structured interviews were conducted in rural NSW with 13 GPs and allied health professionals. Thematic analysis was used to analyse the data and themes identified were mapped to an overarching Framework.

Results: The ‘Framework for building Health Workforce Capability through using digital technology’ identifies elements of health workforce capability, cues to action, and benefits and barriers to using a technology solution to support rural health workforce capability. Whilst it could be assumed that low technology literacy would act as a barrier to the use of digital tools, this was not a significant factor in impeding participants’ willingness to adopt digital tools when social and professional networks weren’t available to them face to face. Capable people felt connected to others professionally and were recognised members of their community. They had access to education, training and supervision. Similarly, 56 per cent of the survey respondents said engagement with others on [name of platform] made them feel more capable in their role, suggesting this platform is an important part of the solution to building rural health workforce capability.

Challenges: That we understand what is needed in a digital or technology solution to help rural health professionals build or maintain their capability. To ensure rural health professionals are aware of digital for self-management when their rural circumstances prevent other forms of support.

Implications: The Framework may guide health workforce planners, HR professionals, policymakers and app designers in developing technical solutions. Understanding the factors that make up a health professional’s capability and the cues to maintain their capability may help to strengthen technical solutions to support health workforce capability.

Background and aims: The Parliamentary Inquiry into Health outcomes and access to health and hospital services in rural, regional and remote New South Wales (the Inquiry) is examining the provision and availability of health services in non-metropolitan areas. Reporting and recommendations coming out of the Inquiry, as well as the submissions and associated transcripts, constitute a rich source of data for those working to support rural health. This study identified key themes to determine how they inform key collaborative initiatives addressing health access and equity across regional, rural and remote New South Wales from a health workforce perspective.

Method: [Organisation] selected 81 pieces of the most relevant data from the Inquiry (70 submissions, five transcripts and six sets of supplementary questions). These submissions were largely made by advocates (organisations, unions, government, peak bodies) and consumer groups. The main issues or recommendations in each transcript were themed and counted.

Results: Amongst other key themes that will be reported, a desire for health system integration at the local, state and federal levels, to help navigate Australia’s often fragmented health system, strongly emerged from the transcripts. It is also a draft recommendation in the Primary Health Reform Steering Group. Fragmented approaches reduce health workforce capability and the capacity of the health system to provide continuity of care, which leads to untimely access to care, the delivery of poor-quality services, duplication and inefficient use of resources.

We will present insights into how integration of parts of the health system and levels of government can be achieved through existing initiatives, such as the innovative Collaborative Care program funded by the Australian Government. This is a community-centred approach to addressing primary healthcare challenges in remote and rural NSW that can be implemented more broadly.

Challenges: To break down healthcare silos to address remote and rural workforce recruitment and retention, workforce capability, health service financial sustainability and continuity of care.

To create a system’s view and increase collaboration between governments and local stakeholders. This relies on learning the lessons from approaches that aim to bridge the social distance.

Implications: A strong commitment to collaboration and innovation is central to addressing the problem of our complex and fragmented health service. If we are to create better access to health services for rural communities, we must play a strong advocacy role in relation to policy, strategies and approaches that aim to break down the siloed approaches.

The aim of this study was to evaluate the implementation and impact of widespread telehealth by all relevant departments and disciplines at Bendigo Health, during the COVID-19 pandemic.

Specific research questions explored were:

• What is the human experience (staff and patients) of widespread telehealth use?
• What triage criteria and business rules were used to support decisions regarding telephone, video or in-person consultations and why?
• What are the costs versus benefits of the scaled up telehealth service?

The COVID-19 pandemic significantly increased the use of telehealth, defined as ‘the use of telecommunication technologies for the purpose of providing a clinical consultation with a patient’. One of the main drivers of this change was the need to provide health care to our community while adhering to the ‘stay at home’ rules. This initiative and subsequent study has provided an opportunity to analyse what was learned from this experience and ascertain what changes we should keep in place.

For this study, questionnaires were developed for consumers, clinicians and administration staff.

Focus groups were also held via videoconferencing for both clinicians and administration staff to delve further into the lived experience and gain an understanding of issues that may impact upon sustainability of telehealth services.

We received responses from 468 consumers (303 telephone and 165 videoconference), 157 clinicians and 22 administration staff.

This presentation will discuss the findings from this initiative and share the learnings and recommendations developed as a result of this study.

The legacy of colonisation, assimilation policies, racism and victim-blaming approaches to health have created inequality in health for Aboriginal people that is reflected in their oral health status. Rumbalara Aboriginal Cooperative (RAC) provides health and community services, including dental services, to around 2,000 Aboriginal and Torres Strait Islander people living in rural Victoria. Despite the development of the emergency dental program into a comprehensive dental service, oral disease levels are of concern and access to care appears not to be meeting community need. The aim of this study is to consult the Rumbalara community about their oral health to understand their lived experiences with oral health and dental services and the barriers and enablers for oral health.

Methods: Using an Aboriginal and Torres Strait Islander knowledge framework and co-designed approach, this study consulted the Rumbalara community about their oral health. Following ethics approval from the University of Melbourne and engagement with the community, 20 Aboriginal people (aged 19–61 years) participated in digitally recorded semi-structured interviews and yarning circles in a setting of their choice. Transcripts were de-identified and returned to participants for verification prior to thematic analysis. A community mentor was involved in the study throughout to ensure cultural rigour and validate interpretation of the data.

Results: Themes emerging from the data included the importance of community-centred services, fear of dental treatment, shame, communication, trust and clinical dental experiences dominated by deficit perspectives.

Discussion: Experiences of dental care had often been related to pain driving attendance, resulting in experiences that multiply fear and anxiety. While community-based care was considered a strength, the approach to individual dental advice and care often resulted in increasing shame and diminishing trust. Increasing participatory approaches to delivering dental care may increase engagement and trust, and develop critical oral health literacy.

Conclusions: The study has identified important gaps in cultural and clinical understanding between the community and dental service providers. These findings will be returned to RAC and used to inform the delivery of oral health and dental services, and to develop oral health promotion programs at RAC and cultural safety preparation for student dental practitioners, to enable Aboriginal and Torres Strait Islander people to increase control over their oral health.

Each year, four primary healthcare nurses deliver health promotion activities to small towns and villages in an area spanning fourteen local government areas, and covering over 99,100 square kilometres. These small communities face numerous barriers to accessing health services and information – including isolation, lack of transport, poor internet access, higher than state and national levels of chronic disease, and low health literacy. Added to these challenges are those of recent drought, bushfires, mouse plague and the uncertainty of the COVID-19 pandemic. This program relies on the support and funding of our local primary health network.

In 2020–21, 1,545 people attended 215 health promotion activities in 59 towns and, of those, 176 identified as Aboriginal and/or Torres Strait Islander. These events lead to increased general practitioner (GP) appointments, increased health screening and improved access to services. We rely on meaningful community engagement and collaboration to deliver quality events.

Through trial and error, we have developed successful strategies and learnt the pitfalls in running community health promotion events. We use a variety of creative approaches to deliver important health messages.

We recently coordinated 14 comedy shows in 14 bushfire-affected communities – empowering communities to remain connected and to enjoy a laugh and meal. These events include important health messages and the opportunity to chat informally to trained staff. Communities talk about these events for months, and the feedback is positive.

On World Kidney Day in 2019, in a small community of a few hundred people, 62 rural women gathered to hear talks on the importance of screening for kidney disease. Forty health checks were completed and many women subsequently made appointments with their GPs to discuss their results. We also discussed cancer screening and the various financial supports available to rural people.

Feedback from a local GP, following a men’s night in a small community, confirmed GP appointments increased by over 30 per cent following our event.

We also deliver health activities in small rural schools, recognising that health messages, including oral health, are important for all age groups. Other topics we deliver include bush kids’ first aid, farm safety and cooking. Some of these schools have only a handful of children.

This unique program is delivered by local nurses and their partners, who are passionate about the health of their small rural communities. Through health promotion activities, important health messages reach rural people and are delivered in a way that is meaningful and responsive to community needs.

Background: There is increasing importance placed on efforts to ‘grow your own’ health workforce to build health workforce sustainability in remote/rural communities. Despite university activities to support this, opportunities for undergraduate remote/rural placements remain limited, especially for allied health/nursing students, with placements not always focused on rural lifestyle experiences. It has also been difficult to model the interdisciplinary health teams required in smaller communities. This prompted Health Workforce Queensland to implement a pilot immersion experience, GROW Rural (GR). GR is a unique co-designed program to facilitate three-day interdisciplinary immersion experiences for undergraduates. With a focus on interdisciplinary clinical experiences, rural lifestyle and networking, the program visits the same communities over three years.

Method: Networks established by a senior health practitioner were activated across three physically close communities in central Queensland: a mining community; a farming community; and an Aboriginal and Torres Strait Islander community. A planning committee was formed in 2017 comprising health leaders and community members to co-design activities for the first year. GR was promoted to students through social media networks. Student selections were based on written application and interview. Medicine, nursing/midwifery and allied health students were eligible. Following the first GR, two students were elected to the planning committee. Online evaluations were undertaken after each weekend, including an overall evaluation in 2019.

Results: There were 30 undergraduate student participants, 15 from medicine and 15 from nursing/midwifery and allied health. Overall student and community participant ratings at the conclusion of the three years were positive. Student ratings indicated that GR had promoted interest in rural practise and positively impacted rural practise intentions. Community ratings indicated that GR was viewed positively and had had an impact on student future rural career intentions. Other positive outcomes included some students organising university placements through GR networks. Of the 15 students who have entered the workforce as of July 2021, seven (47 per cent) were working rurally.

Conclusion: GR provided undergraduate health students a unique and positive glimpse into the possibilities of future careers as rural practitioners through an interdisciplinary immersion experience. Early conversion rates of students into rural practitioners were extremely positive. The impact on rural communities has also been positive and provided a mechanism to ‘grow’ the future workforce and showcase what their communities had to offer the future practitioners. The co-design approach has provided a unique method to facilitate a program supported by health students and the rural communities involved.

Attract, Connect, Stay (ACS) is a two-year philanthropically funded project. ACS addresses chronic rural health workforce shortages through the application of a strategy for rural communities to self-fund, establish and sustain a Health Workforce Recruiter & Connector (HWRC) position. The main outcome of the ACS project is the creation of a tested blueprint (instruction guide with tools and resources) for other Australian rural towns to utilise to create and sustain their own HWRC.

The HWRC’s role is to successfully attract health professionals (allied health, doctors and nurses) who are a ‘strong fit’ for rural health services (private/public, primary/tertiary) as well as for the local community. A core focus of the HWRC is to provide tailored support to newly recruited health workers and their family members with settling in, making social connections and to thrive in-place (including employment support for partners).

The HWRC was originally developed ten years ago in Marathon, a small rural town in Ontario, Canada. Since then, the position has been continuously funded and managed by a consortium of representatives from local health services, local government and business stakeholders. Outcomes from having a dedicated health workforce recruiter and connector include the successful attraction and retention of a broad range of health professionals.

In August 2021, after extensive community consultations followed by an expression of interest process, three local government areas in north-western New South Wales were selected to pilot the establishment of a HWRC position in Australia. Through a co-design workshop process, the three communities were supported to self-fund, establish and sustain a HWRC. The workshops focused on:

• developing a governance and management structure
• collecting baseline health workforce data
• establishing measures of success
• sustainability planning.

Once the positions were recruited, a digital network was established between the communities and the HWRCs to provide support and share learnings. In 2022, the project was extended into Victoria and elsewhere in New South Wales to test the applicability of the blueprint for other rural towns.

The blueprint was developed by the project implementation team using continuous quality-feedback cycles. An external evaluation was undertaken alongside the implementation to capture processes and mechanisms to support the refinement of the blueprint and measure the impacts and outcomes of both the blueprint and HWRC positions.

This presentation presents project findings, highlighting the effectiveness and that HWRCs are critical health workforce infrastructure. It presents rural communities with a way forward that engages the whole community and is strengths-based.

Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase healthcare access for school-aged young people (12–18 years) living in small rural towns (less than 5,000 people). Developed by the Bega Valley Medical Practice (BVMP), Teen Clinic began operating in 2015. It now operates in five other medical practices throughout coastal southern New South Wales and far-eastern Victoria.

Nurse-led Teen Clinics apply a free, early intervention approach to care coordination. Nurses serve as a soft-entry point to the medical practice where young people are triaged, screened and/or health education is provided. Support is provided for a wide range of medical and non-medical issues including sexual and mental health concerns. Nurses can refer patients to general practitioners and/or other providers as needed.

The Teen Clinics have been implemented over time and are at various stages of maturity, they present a significant opportunity to reflect on how context and time impact on delivery and performance of the care model, including youth and community buy-in.

Working with the six medical practices operating Teen Clinics, researchers from the University of New England and the University of Newcastle designed and undertook a process and outcome evaluation of the Teen Clinics. The evaluation was philanthropically funded by the Foundation for Rural & Regional Renewal with additional financial support by the BVMP.

The evaluation’s purpose was to ascertain: (i) community perceptions on the key deliverables and benefits of having the Teen Clinic service operating in their town and (ii) what is working best for whom, in which sites, why and when.

Data collection included: interviewing representatives from community groups, organisations involved with local youth and staff from the participating medical practices; and anonymously surveying youth concerning their access and user experience.

This presentation will focus on the key findings on community perceptions of the value of the Teen Clinic model in supporting young peoples’ health/wellbeing needs, how it works in different settings and the viability of replicating the model in other rural towns.

Introduction: Geographic isolation, limited availability of services and a heavy seasonal workload can all prevent farmers from actively prioritising their health, wellbeing and safety. However, we also know that farm men and women are interested in taking a proactive role and ownership of their own health, wellbeing and safety. The Farmer Health Assessment Tool (Farmer HAT) has been developed in collaboration with farmers and service providers as a way of overcoming these barriers – enabling farmers to identify their individual risks and empowering them to take control of their own health, wellbeing and safety.

Farmer HAT is a free, secure online self-assessment tool developed to promote a safe farming culture and healthy personal behaviours without leaving the farm. Farmer HAT can be completed by individuals or by farming groups to stimulate relevant discussions and promote collective action. Farmer HAT involves a series of questions about health, wellbeing, lifestyle behaviours and farm safety practices. Using a traffic light system, Farmer HAT provides rapid feedback and presents targeted information and resource material to address identified risks and improve personal health, wellbeing and safety practices – and ultimately (and important for farmers) support the health of the farming business. Users can save, download and print results and track their self-assessment results over time – showing improvement, maintenance or decline in health, wellbeing and safety indicators. Farming groups can also engage in the platform and discuss/take action on the group results through their nominated group leader. A pilot program and evaluation of Farmer HAT was recently conducted.

This presentation will provide further detail about the co-development of Farmer HAT with industry, demonstrate how the tool can be used and report findings from the evaluation of the pilot program.

Background: Using a collaborative and interactive approach, Gear Up for Ag™ was developed to provide young adults with evidence-based safety information about a range of agricultural health and safety topics. Partnering with the Ag Health & Safety Alliance (US), the National Centre for Farmer Health adapted the Gear Up program for use in Australia. Students participate in discussions and demonstrations about practical health and safety strategies, including correct usage of personal protective equipment (PPE). Students are empowered to adopt safe behaviours and practices and influence safe practices on the farm, at home and in their future workplace.

Aims: Gear Up for Ag™ aims to influence agricultural safety culture by engaging with students in a practical and interactive way, to build their understanding of common agricultural hazards, improve understanding and knowledge about their impact, and ways to mitigate safety risks.

Methods: Pre- and post-program surveys were developed based on Kirkpatrick’s four-level training evaluation model. Data was collected between February and June 2021 (n=120 students across eight rural Victorian locations). Data is collected using Qualtrics and completed as a classroom activity. The pre-program survey is completed two weeks prior to onsite delivery of the education session and the post-program survey three to six weeks after the session. This program has been assessed and approved as a quality assurance activity by Deakin University.

Results: Baseline data identifies the program is effectively reaching the target population – with over 73% of participating students currently assisting or working on farm, 77% reported working on farm before the age of 15 and 76% plan to work in agriculture.

Initial analysis of post-program surveys show improvements in student safety knowledge, attitudes and behaviours including: 96% of students have improved knowledge of farm hazards, 57% say that the program has influenced their own farm safety behaviours, 97% report improved understanding about why respiratory protection should be worn, with 76% now using a disposable P2 dust mask in appropriate situations, and 91% have a better understanding of how rollover protection devices on quad bikes can protect the rider.

Discussion/conclusion: The program – tailored to the needs of agricultural students – improves understanding and knowledge to positively influence farm safety behaviours and practices. This is central to decreasing the incidence of injury and fatality on Australian farms and building a workforce that understands the importance of their own health, wellbeing and safety on the farm and at home.

Introduction: The podiatry workforce has demonstrated skills in improving health outcomes and quality of life for people who have complications of diabetes such as neuropathic foot disease, foot pain and vascular impairment. Appropriate and timely management of these complications can prevent lower limb amputations. Rates of amputation are higher for people living outside metropolitan settings, yet these are precisely the areas where there are long waiting periods and podiatry services are limited. The primary aim of this study was to describe factors relating to recruitment and retention of Australian podiatrists. Secondary aims included describing the differences between podiatrists working in metropolitan and non-metropolitan locations.

Methods: This was a cohort study of Australian podiatrists using data collected between 2017 and 2020 through an online survey. Qualtrics® software was used to collect data and all participants provided informed consent. Variables known to impact recruitment and retention including age, primary work setting, number of working locations, exposure to regional/rural work and access to professional development were described. Univariate and multivariate logistic regression models were used to determine factors associated with location of work (as a pseudo-measure of recruitment) and leave direct patient care or the profession entirely (retention).

Results: There were 1,127 podiatrists (20 per cent of 5,613 registered podiatrists) who consented to participate in at least one of the survey waves. Podiatrists who grew up in a regional/rural area were less likely to work in a metropolitan location, yet podiatrists who undertook a regional/rural placement were more likely to work in a metropolitan location. Podiatrists who indicated they were planning to leave direct patient care within five years were less satisfied with opportunities to use their abilities, were less satisfied with their working conditions, were more satisfied with their working hours, had less personal accomplishment and less job satisfaction. Podiatrists who indicated that they were planning to leave podiatry work entirely within five years were less satisfied with opportunities to use their abilities, agreed they had a poor support network from other podiatrists, had less personal accomplishment, less job satisfaction and did not have access to annual leave.

Conclusion: Podiatrists identified professional burnout elements, poor connection with the podiatry workforce and feeling their scope of practice was limited as associated with a desire to leave direct patient care. These factors were similar for those that indicated that they would leave the profession all together, with addition of no access to annual leave.

Background: As treatments improve, cancer survivors are living longer and many continue to experience ongoing health concerns and late effects. Specialist-led post-treatment cancer care continues to be most prevalent; however, this places a high burden on the acute care system and has a focus on detection of recurrence or new cancers which may fail to comprehensively meet cancer survivors’ holistic supportive care needs. Specialist-led care delivered in acute care settings also presents a challenge for cancer survivors living in rural areas who must travel to major centres for medical appointments.

Aims: The present study aimed to engage with cancer survivors living in rural Queensland to gain their perspective on more effective ways to provide post-treatment cancer care. Further, the study investigated barriers and facilitators to different aspects of post-treatment cancer care.

Methods: Semi-structured interviews and focus groups were conducted with cancer survivors living in diverse rural and regional settings across Queensland, as well as local service providers including cancer nurses, community health workers, and peer-support group coordinators. Qualitative data were audio-recorded then transcribed verbatim and were analysed using thematic analysis techniques.

Results: Three major themes were identified including (1) information content and provision, (2) accessibility of services and (3) interactions with health professionals. Findings suggested that health information provision post-treatment was inconsistent particularly regarding diet and exercise; survivors’ individual needs and attitudes after treatment varied greatly; and that the quality of relationships with health professionals was a crucial aspect of satisfaction with care. A multidisciplinary care model involving general practitioners and specialist cancer nurses more heavily was preferred and may lead to better care provided closer to home. Telehealth options such as telephone support or video consultations were considered viable, but most cancer survivors did not value web-delivery models of care. Referrals to relevant community health services need to be tailored to meet individual needs.

Conclusions: The current findings have important implications for healthcare delivery as they identify gaps in the current provision of quality holistic cancer care post-treatment. The findings suggest that ongoing information and positive interactions with healthcare providers would facilitate improvements in satisfaction among rural cancer survivors. Importantly, suggestions for changes to cancer care which could better address cancer survivors’ needs were identified by a diverse group of cancer survivors and health professionals in local communities.

The Western New South Wales (NSW) Regional Training Hub (the Hub) partnered with the Western NSW Local Health District (LHD) and invited the Western NSW Primary Health Network and NSW Rural Doctors Network to collaborate on a comprehensive medical workforce description and analysis. The Western NSW Medical Workforce Analysis took over a year to complete, with the data collection completed by the Hub with input and assistance from the LHD. This analysis aimed to map the volume and distribution of medical professionals in the region, highlight areas of maldistribution or workforce shortage and model the workforce moving into the future.

To understand and communicate the nature of the workforce distribution across the region, a model was developed using a standardised approach. However, given circumstances in the western NSW region, which are not dissimilar to most rural areas, the evaluation team and the expert panel, through much consultation, developed an ‘adjusted head-count measure’ to standardise the variability of workload to a full-time equivalent (FTE) pro rata. This data was mapped against data sets including the Australian medical workforce data, NSW (total) medical workforce data and ratios, rural NSW (excluding metropolitan Sydney), and the northern NSW region.

The analysis identified the disciplines of priority shortage, as well as disciplines with no workforce resident in the region. Workforce was distributed unevenly across the region with a centralisation towards Orange and Dubbo and away from remote sites, which is now mapped and quantified for the first time.

There were a range of hurdles that needed to be overcome in gathering, collating, analysing and communicating the workforce data. This included the withholding of information due to privacy, difficulty collating accurate local data pertaining to western NSW and the nature of medical workforce in western NSW. In some instances, this information proved unattainable. The process was significantly impacted by the fact that the period for data collection coincided with the outset of the global pandemic (COVID-19).

Like any in-depth analysis, certain assumptions have been made and there are limitations and caveats related to the data and analysis. This presentation will focus on the challenges, including limitations, caveats and assumptions made to produce the report which provides a sound foundation on which to build collaborative work in improving medical workforce opportunities into the future. This work is instructive and helpful to other rural areas as they attempt to analyse their medical workforce for planning and other purposes.