Program
A PDF version of the program is now available here:
Keynote speakers
Lara Fuller
Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University, Victoria. As an academic general practitioner, her teaching and research interests are in curriculum design for rural medical education, learning in longitudinal integrated clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Margaret Garde
In 1985 Margaret Garde arrived in Portland, Victoria, to join her partner, now husband. Being the only female GP, and the youngest by at least 10 years, brought with it a sense of professional isolation.
The disciplines in which she worked included family planning, occupational health, Aboriginal health, public health, forensic medicine, adolescent health and mental health. Now she has a strong interest in teaching and supporting students and doctors who wish to live and work in a rural location, with a strong emphasis on giving them the preparation they need to feel confident and secure.
Thus followed the hosting of a string of medical students, John Flynn Scholars, and cousins, children of friends or anyone else who was remotely interested in medicine as a career.
As is now well recognised, none of these wonderful people returned to Portland to work.
In 2012 the opportunity to work in Portland’s GP SuperClinic presented and, together with this, the ability to host Deakin University students from a rural background who reside in Portland for their 12-month placement.
This, together with a visit from Paul Worley, the then National Rural Health Commissioner, provided the inspiration for our longitudinal rural vocational experience.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Christine Giles
Chris Giles is a senior executive with considerable experience leading and managing regional, rural and remote health services.
Chris has a strong clinical background as a nurse then midwife, which has proven very valuable in her recent executive roles. These executive roles include working in healthcare organisations in Western Australia, Victoria and Queensland.
Most recently, Chris has worked as the Chief Executive Officer of Portland District Health in south-west Victoria. Prior to this she spent three years living in the Torres Strait, working as a District CEO for Queensland Health.
Chris has a passion for finding solutions to wicked problems, often challenging the normal by finding innovative solutions to improve health service access and quality for rural and remote communities. Some of these solutions include extending scope of practice for clinicians, training cohorts of nurse practitioners and using technology such videoconferencing and electronic health records to overcome distance.
As a sideline, Chris is on the Board of the local catchment management authority, keen to ensure land and water resources are managed to ensure future generations can enjoy them as we do.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Stan Grant
Stan Grant is the International Affairs Editor for the Australian Broadcasting Corporation (ABC), a multi-award-winning current affairs host, an author and an adventurer.
Well known for having brought the former Prime Minister Malcolm Turnbull to tears when interviewed about Indigenous affairs on The Point, Stan’s keynotes are insightful, engaging, always professional and, at times, controversial.
Stan’s Aboriginal heritage has shaped his dynamic, resilient personality. Born in Griffith in south-west New South Wales (NSW) in 1963, Stan Grant’s mother is from the Kamilaroi people and his father is of the Wiradjuri.
Stan spent most of his childhood on the road living in small towns and Aboriginal communities across outback NSW. His father was an itinerant saw-miller who worked when and where he could. Stan moved so often he attended 12 different schools before he was in his teens.
The early travelling gave Stan a love of adventure and stories. He grew up listening to the tales of his grandfather and uncles and aunts. Despite poverty and an early sporadic education, the security of his family and the larger Aboriginal community gave him a strong platform for life.
After attending university, Stan won a cadetship with the Macquarie Radio Network, launching a career in journalism that has spanned more than 30 years and more than 70 countries. In that time Stan has travelled the world covering the major stories of our time from the release of Nelson Mandela, the troubles in Northern Ireland, the death of Princess Diana, war in Iraq, the second Palestinian intifada, the war on terror, the South Asia tsunami, the Pakistan earthquake and the rise of China.
Stan has hosted major news and current affairs programs on Australian commercial and public television. He has been a political correspondent for the ABC, a Europe correspondent for the Seven Network based in London and a senior international correspondent for the international broadcaster CNN based in Hong Kong and Beijing.
Returning to Australia in 2013, Stan continued to cover international events for Sky News Australia and reignited his passion for telling the stories of his own Indigenous people. He has worked as the Indigenous editor for The Guardian Australia, managing editor for National Indigenous Television and international editor for Sky News. In 2016 Stan was appointed as special adviser to the then Prime Minister Malcolm Turnbull on Indigenous constitutional recognition.
Stan has won many major awards including an Australian TV Logie, a Columbia University Du-Pont Award (the broadcast equivalent of the Pulitzer Prize) and the prestigious United States Peabody Award. He is a four-time winner of the highly prized Asia TV Awards including reporter of the year.
Stan has written The Tears of Strangers and Talking To My Country (Harper Collins), and has published numerous articles and opinion pieces for The Sydney Morning Herald and The Australian.
Stan Grant is passionate about justice and humanity. His years of international reporting have given him a deep understanding of how the world works. He is deeply immersed in the politics and history of Asia and the Middle East. He can link the importance of leadership and the impact of history and, above all, believes in the power and resilience of people.
Stan is married to ABC Sports broadcaster, Tracey Holmes, and has four children. He lives in Sydney.
Booked through: Celebrity Speakers www.celebrityspeakers.com.au
Mark Howden
Professor Mark Howden is Director of the Institute for Climate, Energy and Disaster Solutions at The Australian National University.
He is also an Honorary Professor at Melbourne University, a Vice Chair of the Intergovernmental Panel on Climate Change (IPCC) and the Chair of the ACT Climate Change Council. He was on the US Federal Advisory Committee for the Third National Climate Assessment, was a member of the Australian National Climate Science Advisory Committee and contributes to several major national and international science and policy advisory bodies.
Mark has worked on climate variability, climate change, innovation and adoption issues for over 30 years, in partnership with many industry, community and policy groups via both research and science-policy roles. Issues he has addressed include agriculture and food security, the natural resource base, ecosystems and biodiversity, energy, water and urban systems.
Mark has over 420 publications of different types. He helped develop both the national and international greenhouse gas inventories that are a fundamental part of the Paris Agreement and has assessed sustainable ways to reduce emissions. He has been a major contributor to the IPCC since 1991, with roles in the Second, Third, Fourth, Fifth and now Sixth Assessment Reports, sharing the 2007 Nobel Peace Prize with other IPCC participants and Al Gore.
Gabrielle O'Kane
Gabrielle O’Kane is Chief Executive Officer of the National Rural Health Alliance, the peak body for rural health in Australia. She is an Adjunct Associate Professor with the University of Canberra and Charles Sturt University. Gabrielle has extensive experience in the private and public health sector, which has contributed to her deep understanding of the need for collaborative partnerships to support the rural health workforce and achieve positive health outcomes for rural communities. She promotes solutions to the Australian Government to address the needs of rural communities and health professionals, through her position on many pertinent steering groups and committees.
Roland Sapsford
The Climate and Health Alliance’s new Chief Executive Officer, Roland Sapsford, has been working to respond to the challenge of climate change and the task of reducing emissions through public policy and activism for much of his professional life.
This work has ranged from being involved in New Zealand’s first study of the impacts of carbon taxes and work on energy efficiency and home insulation policy, through to getting solar panels installed on a local community centre and campaigning against major road projects.
Roland once completed four years of a medical degree and was a senior manager in public health for five years. He has also studied economics and systems ecology to postgraduate level, and has a strong commitment to Indigenous rights.
Rabia Siddique
Rabia Siddique is a history-making humanitarian, best-selling author and multi-award-winning international keynote speaker. She is a sought after transformational coach and mentor and speaks English, French, Spanish and Arabic.
Current work
Rabia’s powerful and engaging presentations on leadership, resilience, equality and diversity draw on her personal story of strength, courage and forgiveness, in addition to her legal, military and psychology training. Surviving a hostage crisis in Iraq, Rabia garnered global attention for making the British military accountable for silencing her about her ordeal and role as a military lawyer in releasing captured Special Forces soldiers. Standing up for justice in the face of public ridicule, Rabia’s brave action in suing the British Government for sexism and racism became a catalyst for policy change to ensure a fairer workplace for women and cultural minorities in the British military.
Rabia is an expert commentator, regularly appearing in newspapers and magazines, and on television, radio and online media in Australia and around the globe, including The Guardian, 60 Minutes and ABC television.
With her best-selling memoir Equal Justice also the focus of a feature film, she is now writing her second book.
Rabia is an Ambassador for 100 Women, Angelhands, Esther Foundation, Inner Ninja (mental health support) and Ishar (multicultural health service). She is a Board Member of the International Foundation of Non-Violence, Museum of Freedom and Tolerance, Wesley College and Calan Williams Racing.
Previous experience
Law: Rabia’s extensive career as a criminal, terrorism, war crimes and human rights lawyer has taken her to Europe, the Middle East, South America, South East Asia and Australia.
Military: Her military career includes serving as a British Army officer in England, Northern Ireland and the Middle East. Rabia was one of England’s first Armed Forces Employment Law Officers – a role which took her to Royal Military Academy Sandhurst where she ran equality and diversity training. Among her charges was Prince William, the Duke of Cambridge.
Keith Suter
Dr Keith Suter is considered one of Australia’s most influential global futurists and media commentators in national and foreign affairs. He has also held many strategic leadership roles. Dr Suter is an experienced, professional and awarded presenter renowned for explaining complex global and business issues in a way his audiences can digest and understand. He is in demand as an MC and conference facilitator. Keith’s tailored keynotes, workshops and facilitated sessions are entertaining, highly compelling and always captivating.
In 2019 Keith was proudly appointed as a Member (AM) of the Order of Australia (General Division), for significant service to international relations and to the Uniting Church in Australia.
Previous experience
Academic expert: Dr Keith Suter has achieved three doctorates. The first of these was about the international law of guerrilla warfare (University of Sydney), the second about the social and economic consequences of the arms race (Deakin University) and a third doctorate on scenario planning (University of Sydney).
Leadership roles: He has been appointed to many prestigious roles throughout his career, including Chairperson of the International Commission of Jurists (NSW), Director of Studies at the International Law Association (Australian Branch) and Managing Director of the Global Directions think tank. After 25 years, Keith recently retired from the role of Chairperson of the International Humanitarian Law Committee of the Australian Red Cross (NSW).
Global recognition: He has also been a member of the prestigious Club of Rome since 1993. The Club is ‘an informal association of independent leading personalities from politics, business and science, men and women who are long-term thinkers interested in contributing in a systemic, interdisciplinary and holistic manner to a better world. The Club of Rome members share a common concern for the future of humanity and the planet.’ The club has only 100 members, with Mikhail Gorbachev among them.
Keith is a Life Member of the United Nations Association of Australia in recognition of his service. At various times from 1978 to 1999, he served as the National President of the organisation and took on the roles of WA and NSW State President.
Strategic roles: Keith was the President of the Centre for Peace and Conflict Studies (1991–98) at the University of Sydney, and was a consultant on social policy with the Wesley Mission for 17 years. In addition, he served as a consultant for a number of other organisations with a focus on local and international issues. He is also an active member of the Australian Institute of Company Directors.
Media roles: He frequently appears on radio and television discussing politics and international affairs. He has been, for many years, the foreign affairs editor on Channel 7’s Sunrise program.
Renowned author: Among Keith’s many books are All about Terrorism: Everything you were afraid to ask, as well as Global Order and Global Disorder: Globalization and the Nation-State and 50 Things You Want to Know About World Issues … But Were Too Afraid to Ask.
Susan Wearne
Susan Wearne is a general practitioner (GP) and senior adviser to the Australian Government Department of Health and Aged Care regarding rural health and health professional education. She trained at Southampton University in England and completed general practice training in Northamptonshire and back home in Cheshire. She owned a practice in York, England, and worked at the Aboriginal Medical Service in Alice Springs and for the Royal Flying Doctor Service at Ayers Rock Medical Centre. She has extra qualifications in child health, women’s health, family planning, primary health care and medical education and now works as a GP in Canberra.
Susan is a Clinical Associate Professor at Australian National University and has published over 40 peer-reviewed articles on general practice and medical education. The fourth edition of her textbook Clinical Cases for General Practice Exams was published in 2019. She held educational leadership positions in the Northern Territory before taking on national roles for the Royal Australian College of General Practitioners and General Practice Education and Training. She works in the Health Workforce Division which manages general practice training and other programs that promote Australians’ access to qualified health professionals. She was medical lead for the soon to be released Australian National Medical Workforce Strategy.
Susan’s husband, Tim Henderson, is the eye surgeon at Alice Springs Hospital. Their daughter and her family live in England and their son works in Adelaide. Between flights home to Alice, Susan swims, makes clothes and enjoys the scenery on the lake as she learns to row.
Justin Yeung
Justin is a consultant emergency physician by training. He has had a number of leadership positions in WA Health – director roles in emergency medicine (Royal Perth Hospital, Albany Health Campus and WA Country Health Service) and medical services (Great Southern region of Western Australia). He is currently Medical Director of the WA Country Health Service Command Centre, which incorporates a number of 24/7 clinical streams in acute telehealth – emergency, inpatient medicine, mental health, obstetrics and midwifery, palliative care and acute patient transfer coordination. Justin splits his time between Perth and Albany, and still maintains clinical exposure working in the Emergency Telehealth Service and locums in regional Western Australia. To add some spice to the year, Justin has started postgraduate studies in health care leadership. He’s also an oft-stung beekeeper.
From humble beginnings as a limited-hours, weekend-only, single-doctor emergency consultation service for a handful of small country hospitals in Western Australia (WA), the WA Country Health Service Command Centre is approaching a 10-year milestone of providing specialist-led clinical consultation directly to rural patients using video-enabled technology. The Emergency Telehealth Service (ETS) has grown into a 24/7 virtual emergency department, managing more than 27,000 consultations in 2021. The range of clinical services available to support our regional clinicians using telehealth has expanded to include inpatient care (2018) and mental health (2019), obstetric and midwifery, palliative care and, most recently, transfer coordination (all commenced in 2022). We will present an overview of our 10-year journey, highlight areas of innovation and success, as well as outline challenges we have and continue to face.
Plenary sessions
Opening Session:
Julieanne Gilbert MP
Assistant Minister for Health and Regional Health Infrastructure, Queensland – Welcome to Brisbane
Emma McBride MP
Federal Member for Dobell, Assistant Minister for Rural and Regional Health
Plenary Session 1:
Russell Roberts
Australian Journal of Rural Health
Editor in Chief 2017–21 – AJRH 30 Years
Jason Waterford
HESTA Australia Ltd
Plenary Session 4:
Helen Haines MP
Independent Federal Member for Indi
Closing remarks:
Stephen Gourley
Deputy Chair, National Rural Health Alliance
Concurrent presenters
Stephanie Dale
For eight years, journalist Stephanie Dale has travelled the back roads of rural and remote areas of inland Australia, delivering a writing for wellbeing program to people in isolated communities. She called her initiative The Write Road and has delivered the program in partnership with Royal Flying Doctor Service, NSW Department of Primary Industries, Rural Adversity Mental Health Program, Australian Red Cross, NSW Health, local councils and others.
Stephanie has worked with more than 2,000 rural and remote Australians, including newly literate First Nations adults and farming communities experiencing extremes of drought, flood and bushfire. In 2016, she created an online writing program to connect isolated Australians.
Curious to understand the power of writing to heal, Stephanie has now traded the dust for bitumen and embarked on a PhD at the Queensland University of Technology, where she is investigating how people understand their wellbeing through writing. Her scholarship aims to shed light on the personalised connection human beings have with writing, and its relationship to and influence on their sense of wellbeing.
Writing is good medicine: understand writing for wellbeing
We are in the red dust country of Outback Australia. It is 2014. Twelve people – women and men, young and old – have driven in from the dust to attend writing workshops in an old wooden hall. None of these participants identifies as ‘a writer’. By day’s end residents in an isolated community have met their neighbours, in some cases for the first time. People who have known each other for decades have learned new things about each other. All have experienced renewed connection to self, even if just for a moment.
There is a vast body of evidence about the power of writing to heal. Thousands of studies, from randomised control trials to autoethnographies, have probed and explored and split hairs about the capacity of writing to deliver physical and mental health outcomes. While research shows writing is a powerful pathway to health and wellbeing, after four decades of mostly quantitative analysis, one key question remains: how? How does writing achieve health and wellbeing outcomes? Seldom have researchers ventured beyond speculation to investigate how writing works to improve and sustain mental and physical health and wellbeing, and the conditions required for it work.
I have spent eight years driving 200,000+ kilometres delivering writing workshops to rural and remote Australians. At the beginning of 2020 I was accepted by Queensland University of Technology to undertake doctoral research investigating the how of writing for wellbeing. Longitudinal, community-based, qualitative studies in the field are rare. This study is focused on participants from rural and remote areas of Australia.
The past 18 months have been a relentless and challenging time. For people in rural and remote areas, COVID-19 has enforced added burden to lives already reeling from isolation, drought, flood and fire. In 2018–19, Australia spent $10.6 billion on mental health care (AIHW, 2021) and this cost is rising (AIHW, 2021). We are a (mostly) literate society. Almost everyone has ready access to pen and paper. Is it possible, with public health awareness, that this everyday resource may help people navigate challenging times and perhaps, for some or even many, avert or alleviate a crisis?
This wellbeing scholarship is of interest to – and will benefit – rural and remote health professionals. By early 2022, I will be writing up the results of this salutogenic, phenomenological study. I welcome the opportunity to present the interim research results at the 16th National Rural Health Conference.
Emma de Courcy-Ireland
Dr Emma de Courcy-Ireland is a scientist and point-of-care network coordinator for the Flinders University International Centre for Point-of-Care Testing. Emma joined the Centre in 2020 and currently coordinates two point-of-care testing networks. One network, focused on acute care, includes 20 white blood cell count devices located within remote primary health centres across the Top End region of the Northern Territory. The second network was developed in response to the ongoing national infectious syphilis outbreak and facilitates a test-and-treat model using point-of-care lateral flow test strips.
Emma has a Bachelor of Biotechnology (Honours) and a PhD in protein biochemistry. She has more than 10 years of experience as a research scientist and a passion for working on projects that have real-world, translational outcomes that are end-user focused and address inequities.
Bridging the pathology gap: patient-centred point-of-care testing in rural and remote locations
Around 70 per cent of all medical consultations in Australia involve a pathology test request. However, pathology samples are tested by centralised laboratories which are often physically disconnected and distant from the site of patient care. This disconnection is known to cause delays in diagnosis and treatment, as well as loss to follow up if results are not communicated to the patient once available. People living in rural and remote communities are further disadvantaged by this centralised pathology structure by extended turnaround times, which can also amplify risks. For some clinical scenarios, the timeframe to obtain test results may be impractical and clinicians must err on the side of caution and arrange for the patient to be retrieved from the remote community – usually via aeromedical services – so the patient can be physically closer to diagnostic laboratory for testing.
To address these issues, several point-of-care testing (POCT) pathology initiatives have been successfully implemented in many rural and remote primary healthcare facilities around Australia. POCT enables rapid pathology test results to be available during the initial patient consultation, enabling on-the-spot decisions about patient care to be made and eliminating the need for follow-up visits to discuss test results. Many of the POCT networks in Australia are managed by academic institutions who provide innovative, flexible and responsive coordination of training, quality management and logistics that are practical for rural and remote health. These academic institutions are also able to evaluate and provide evidence on clinical, operational, analytical and economic outcomes through research. This evidence base has enabled POCT to be embedded into mainstream practice with various point-of-care tests now incorporated into clinical protocols within the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual.
To date, some examples of better outcomes include: improvements in glycaemic control for patients with diabetes, increased patient satisfaction and convenience, reduced loss to follow up for chronic disease management and more rapid initiation of treatment for sexually transmitted infections. For acute care, POCT has improved patient safety for acute presentations, enabled Aboriginal people with underlying health issues to move between communities and be safely monitored and assisted in the prioritisation of aeromedical retrieval services, and has provided rapid results to rule out unnecessary medical retrievals and thus produced significant cost savings. The success of these rural and remotely located POCT networks has led to international translation with POCT being used in isolated locations in low-resource countries.
Johanna de Wever
Johanna de Wever has worked in communications, policy and advocacy for more than 20 years in organisations including RANZCP, the Brotherhood of St Laurence, the Australian Drug Foundation and, most recently, the Society of Hospital Pharmacists of Australia (SHPA). Her work has included campaigns related to reducing opioid-related harm and improving the management of medicine shortages in hospitals, which resulted in federal legislative change in 2018.
Filling gaps in the ‘Better Access’ policy: counsellors in regional areas
In the first half of 2021, long waiting lists were reported in the media for psychologists and psychiatrists impacting mental health care. At the same time, multiple primary and secondary sources indicate that the counselling and psychotherapy professions are currently underutilised. A survey with 959 Australian counsellors and psychotherapists was conducted during October and November 2020. Surveyed psychotherapists and counsellors reported consistent available capacity to support people with challenges relating to self-awareness, behaviour change, relationship trouble, as well as grief and loss – all of which are recognised to contribute to protective factors and the prevention of mental health conditions. In addition, accredited counsellors and psychotherapists are able to provide evidence-based talking therapies to treat serious mental health conditions such as trauma or eating disorders.
Rural Australians are at a particular disadvantage when it comes to accessing health services given rural communities experience a shortage of many health professions. In contrast, the current counselling and psychotherapy workforce survey reports 33 per cent of practitioners were located in regional/rural/remote areas, indicating a significantly more accessible workforce than psychologists (16.8 per cent) or psychiatrists (15.6 per cent). Given that accessing counselling is generally accepted to be less stigmatising than seeking psychological treatment, as well as lower in cost, this presents an opportunity to support rural and remote mental health more effectively.
Mark Deady
Dr Mark Deady is a University of New South Wales (UNSW) Senior Research Fellow at the Black Dog Institute and the research lead within the Workplace Mental Health Research Program. He has over twelve years’ research experience in the field of mental health and substance use disorders. In this time, he has worked on a range of projects at a coronial, epidemiological and clinical level, completing his PhD at UNSW in 2015.
Dr Deady has extensive expertise in the development of digital interventions, online service delivery, clinical trial evaluation and workplace mental health. His primary research interest is in improving access to evidence-based prevention and early intervention through technology and the translation of research into practice, particularly in vulnerable populations including young people and high-risk workforces.
The Bush Fire Support Service: a multimodal approach to mental health service provision following a major disaster
Background: The Black Summer bushfires caused unprecedented levels of stress for those who responded to the crisis. In June 2020, as part of the National Bushfire Recovery Fund, the Black Dog Institute and University of New South Wales (UNSW) were funded to develop post-traumatic stress disorder (PTSD) and mental health services to support emergency service workers (ESWs) and their families affected by the bushfires. The Bush Fire Support Service (BFSS) was implemented to complement already existing health services.
Methods: The BFSS incorporates three core components:
- mental health training to local health professionals to increase skills and confidence to recognise responses to trauma in ESWs and their families, and provide appropriate referral
- a quick-and-easy online mental health assessment for ESWs and their loved ones
- a variety of free, evidence-based clinical and digital mental health support options are then made available, personalised to the results of the assessments.
These options include a tailored smartphone application for those with mild symptoms, a variety of integrated online and face-to-face referral options, and specialised clinical teams based at either the Black Dog Institute Depression and Anxiety Clinic or the UNSW Traumatic Stress Clinic, where users can access up to 12 face-to-face or telehealth sessions completely free of charge.
Results: Since the launch of the BFSS, there have been 43 general practitioner workshops completed. The website has had more than 37,000 unique website visitors, with 3,800 completing online assessment, and almost 200 starting clinical treatment. Almost 70 per cent of individuals receiving treatment for PTSD no longer meet criteria for PTSD upon completing the program, with sustained improvement at six months after finishing treatment. We are currently looking to evaluate the effects of the online tool, and the newly developed smartphone app has undergone pilot evaluation (N=72), with promising results.
Conclusions: An integrated service to offer trauma-based care to ESWs and their families following the Black Summer bushfires holds considerable promise. Aspects of evaluation and dissemination are considered.
Margaret Deerain
Margaret is the National Policy and Strategy Manager at Palliative Care Australia (PCA), the national peak body for palliative care. PCA represents all those who work towards high-quality palliative care for all Australians who need it and advocates for palliative care to be core business in aged care. PCA believes all older Australians should be able to access the palliative care they need, regardless of where they live. Margaret leads PCA’s policy work across a number of health and aged care areas including supporting palliative care provision in rural and regional Australia. Margaret has been actively involved in PCA’s ongoing engagement with the Royal Commission into Aged Care Quality and Safety’s outcomes. She has previously worked in roles in other health peak bodies and in the Australian Government Department of Health.
Palliative care as core business in aged care in the bush
In rural Australia, there is evidence-based research that identifies a reliance on non-specialist palliative care services to provide palliative care and, like most health sectors, there is a shortage of any medical specialists on the ground to provide health care, including access for our older people in rural and remote areas. This issue is multifaceted and, for aged care in particular, is a growing problem as our rural population ages and we consider that end of life is an individual, family and community experience, and part of the social fabric of the community.
Palliative Care Australia (PCA) submitted ‘Palli-8’ to the Royal Commission into Aged Care Quality and Safety, which was an eight-point plan to highlight key issues for the provision of palliative care in aged care and provide constructive solutions. By communicating these eight recommendations, PCA wanted to ensure the importance of palliative care would be reflected in the Commission’s final report, which was tabled on 1 March 2021. PCA had great success with submissions, with the majority of recommendations accepted. But where to from here to make palliative care core business in aged care and ensure that it bridges the social and geographical distance?
PCA has developed a strategic policy Roadmap that leads the way for palliative care when and where older Australians need to access it. It addresses the key elements including:
- a person-centred approach to palliative care in aged care
- clearly articulated aged care standards which include palliative care
- palliative care training for every health and aged care worker
- addressing the data gap relating to older Australians receiving aged care services
- ensuring equitable access for every older rural person and embedding access as part of our social fabric.
This presentation will focus on understanding the potential the PCA Roadmap has for adapting, addressing the needs and investing in holistic services in rural and remote areas. It will consider specific underserved groups, with a particular focus on Aboriginal and Torres Strait Islander communities. The Roadmap provides the opportunity for adaptability to different rural and remote contexts and forms part of the health solution for the future.
Pascale Dettwiller
Associate Professor Pascale Dettwiller holds a doctorate in pharmacy. She is the lead researcher in Aboriginal health for the University of Adelaide Rural Clinical School in Port Lincoln. She holds a part-time position as Regional Lead Pharmacist for the Eyre and Western region of South Australia (SA). She has extensive experience in research, both qualitative and quantitative. She was the inaugural Head of Pharmacy at Charles Darwin University in the Northern Territory (NT) and led the course successfully to full accreditation. Before moving to SA, her role was Director of the Rural Clinical School in Katherine for Flinders University. She developed a university–community partnership with the local Aboriginal community using co-design principles. Her research in the NT focused on women’s health and adherence to medicines. She is a member of many pharmacy organisations and remains a member of the Australian Pharmacy Council. She supervises many drug usage evaluations at the hospital, with the latest one on psychotropics in acute regional settings following on the Royal Commission into Aged Care Quality and Safety recommendations earlier this year. She is the Chair of the Lower Eyre Local Health Cluster (Primary Health Network), linking communities within the local health systems. She feels, as an academic, there is a unique privilege, a special opportunity and a gentle but constant duty to ourselves and to each other to pursue excellence, fun and social justice in all areas of scholarship!
Characterising psychotropics prescribing in regional South Australian hospitals
Background: The final report of the Royal Commission into Aged Care Quality and Safety, issued in 2021, highlighted the need for further investigation into the usage of antipsychotics, particularly indications not supported by the Therapeutic Goods Administration (TGA). A considerable body of work has been published in residential aged care facilities but little can be found in acute care, where prescribing may start with poor reviewing and transfer of care on discharge. There is an identified deficiency in studies regarding the use of antipsychotics in acute care settings across Australia.
Aim: This study aims to characterise the prescribing of psychotropic medications in acute regional hospitals in South Australia, and identify ‘off-label’ practices.
Method: A retrospective audit of medical records of patients admitted from March 2021 to September 2021 was implemented in five regional sites. Data was collected through an adapted version of the Australian Commission for Quality use of Medicines indicator for acute mental health care (2014). Data was collected for regular, PRN and on-discharge medications. Participants were identifed for inclusion by clinical ward pharmacists which reviewed patients‘ medical records.
Results: Preliminary data analysis of the five aggregated sites reflect demographics of ages from 22 to 92 years, and gender distribution of 65 per cent female and 35 per cent male. A segment of the sample included three per cent identifying as Aboriginal. The average length of stay was six days. Seventy-nine per cent of regular psychotropic prescribing indications were in line with TGA-approved indications. Meanwhile 41 per cent of prescribed psychotropic doses were consistent with electronic Therapeutic Guideline (eTG) recommendations. The most prescribed antipsychotic was quetiapine, while for benzodiazepines diazepam was most common.
Discussion: Suboptimal documentation of indications (20 per cent of charted orders documented) brings about the question of medication errors, non-evidence-based ‘off label’ use and medico-legal implications. Similar findings were evidenced from discharge summary documentations (64 per cent had a discharge summary). Australian practice guidelines also specifically recommend against the use of some ‘off-label‘ indications; for example eTG does not support the use of psychotropics for insomnia, due to limited supportive evidence and adverse effects, including increased risk of stroke and death in the elderly. Prescriptions of antipsychotics were characterised as ‘off-label’ in 20 per cent of charted orders and for the benzodiazepines the frequency of inappropriate prescribing was 22 per cent. No clear documentation could be found regarding discussion with patients about ‘off-label’ prescriptions and usage; no side effects or harm was identified in patient medical records.
Virginia Dickson-Swift
Dr Virginia Dickson-Swift is a Postdoctoral Research Fellow at the Violet Vines Marshman Centre for Rural Health Research located at the La Trobe Rural Health School in Bendigo, Victoria. She is an experienced public health researcher with over 20 years’ experience working in rural communities. Dr Dickson-Swift specialises in public health approaches to health and wellbeing challenges, oral health, qualitative research methodologies, sensitive research, ethics and working with vulnerable rural communities to solve local health issues
Access to community water fluoridation in rural Victoria
Introduction/background: People living in rural Australia have poorer oral health (OH) than those living in cities and OH status generally declines as remoteness increases. Internationally recognised as one of the most important public health measures, community water fluoridation is a population-based public health intervention that has the potential to ameliorate the socioeconomic and geographic determinants of poor OH. Currently around 90 per cent of Victorian communities have access to fluoridated water, with major towns and cities mostly fluoridated. The coverage outside of these areas remains patchy despite having the recommended population thresholds of over 1,000.
Objective: The aim of this study was to describe the water fluoridation status of communities >1,000 population in rural Victoria.
Methods: Using publicly available data on water fluoridation status, Australian Bureau of Statistics population data, Modified Monash Model (MMM) classifications, local OH profiles, municipal public health and wellbeing plans, Socio-Economic Indexes for Areas (SEIFA) indices and spatial population data, current service gaps in the provision of community water fluoridation for rural Victorians were identified.
Results: There are 193 rural Victorian towns with over 1,000 population that would qualify for community water fluoridation in line with Australian Government Department of Health guidelines. However, 71 (37%) of them do not currently have access to fluoridated water. Most of the towns without water fluoridation (n=63 or 88.8%) were classified as MMM5+. Twenty-one local government areas (LGAs) in rural Victoria have a SEIFA index lower than the average for regional Victoria (997). Of these 21 LGAs, 18 (85.7%) contain towns over 1,000 population that have no community water fluoridation.
Conclusion/implications: Despite government support for community water fluoridation as a key public health measure to address poor OH, many rural Victorian communities do not have access to fluoridated water. Identifying gaps in access to community water fluoridation is important for rural communities and local governments, who play a key role in the provision of supportive environments for health. The insights from this study can be used by local councils, service providers and community groups in policy and advocacy work to improve OH status for rural people.
Kathleene Dower
Kathleene is a radiation therapist tutor from the North Coast Cancer Institute in New South Wales (NSW). She is currently a novice researcher within the 2020 Rural Research Capacity Building Program at the NSW Health Education and Training Institute and a PhD student at Curtin University, with the project: Do multimedia formats of education and coaching improve the experience for breast cancer patients treated with deep inspiration breath hold and surface guided radiation therapy?
Co-design of virtual reality patient education based on previous patients’ experiences
Introduction: Left-breast cancer patients are offered standard deep inspiration breath hold (DIBH) with surface guided radiation therapy (SGRT) within the North Coast Cancer Institute (NCCI) Lismore and Mid North Coast Cancer Institute Port Macquarie (MNCCI-PM). While this technique reduces late cardiac side effects and minimises breathing motion for the patient, it is challenging for patients. DIBH is non-intuitive, requires high compliance and patient coaching which may lead to longer treatment and planning appointments. For a patient cohort, where up to 45 per cent can have clinical levels of anxiety related to, and persisting into, their radiation therapy treatment, DIBH can compound these issues.
NCCI Lismore is designing a virtual reality (VR) supported form of education, based on previous patient experience. Our current printed education is solely radiation-therapist-based. Here we explored the experience of patients with radiation therapy planning and treatment using DIBH to co-design the VR experience. The VR format will be investigated in a future clustered pilot study between the two sites, to gauge its impact on the patient experience.
Methods: Structured interviews were conducted with 23 women with left-sided breast cancer treated with DIBH and SGRT at NCCI and MNCCI-PM. Thematic analysis using a framework analysis approach will be applied to identify key themes.
Results: Interviews with 23 women were conducted between March and August 2021. Final analysis of the interviews and design of the VR experience will be completed by conference commencement. Preliminary analysis indicates four themes arising from the interviews: breathing practice; control over treatment; focus; and relaxation strategies. Most themes differ from topics covered in existing radiation-therapist-led education.
Discussion: The patient experience offers a point of difference from the clinician perspective. Incorporating a co-design process with patients has the potential to inform patient education and the design of a VR system to assist with training in DIBH. An increase of adherence and reduction of distress are possible effects associated with using this technique.
Heather Downey
Dr Heather Downey is Senior Lecturer in Social Work at La Trobe University, Albury Wodonga campus. Her social work practice experience includes a number of years with the Australian Government, Centrelink, working with drought-affected farmers and communities in the Murray–Darling Basin, before testing Australian Government Drought Reform Pilot measures in Western Australia. Heather’s PhD research explored ageing Australian farming couples’ retirement decision-making in the contemporary context.
The rapidly changing climate is resulting in more frequent and prolonged extreme heat events, periods of drought, bushfire events and rainfall variability. As a result, water has become increasingly an area of focus for Australian policy, with increased attention on the myriad ways people engage with water. Heather’s research concerns social and environmental justice in the rural context, particularly the economic, social, cultural, recreational and environmental meaning of water for all rural community residents. Water has significant implications for rural sustainability and livability, as well as individual and community health and identity.
Multidimensional meanings of water for a rural Australian river community
Introduction: In Australia, the impacts of climate change have resulted in water becoming a scarce natural resource and, increasingly, an area of focus for Australian policy. In Australia’s most complex river system, the Murray–Darling Basin (MDB), for example, water management policy has controversially aimed to balance the needs of the environment, agriculture and rural Australian residents through recovery of 2,750 gigalitres of water from irrigation farming. Consequently, many studies have explored the value of water in the context of irrigation farming, yet little is known about the recreational, cultural and environmental meaning of water for those who reside in Australian river communities, rather than on the land.
Aims: This proof-of-concept study aimed to contribute to redressing the balance in the Australian water debate that continues to privilege economic consequences, such as the commodification of water in the agricultural sector, over the voice of community members.
Methods: We conducted an anonymous online mixed-method survey in Mildura, a rural community in northern Victoria, Australia, in 2020. The survey focused on connections with the Murray River, recreational use, cultural meanings and water availability. We used the Statistical Package for the Social Sciences (SPSS) software to undertake a descriptive analysis of quantitative data to assess the recreational, cultural and environmental meanings of water for Mildura residents. Answers to open-ended questions were firstly analysed thematically using sociological lenses to examine the recreational, cultural and environmental meanings of water. Secondly, we conducted a deductive sweep of the data for any comments relating to the relationships between water and community, family and individual health.
Relevance: This study suggests that understanding the multiple dimensions of hydro-social relationships is critical to socially and environmentally just water management, and to community, family and individual health.
Results: Respondents privileged recreational meanings of water, including the importance of blue spaces to mental and physical wellbeing, over cultural and environmental meanings. Water availability was identified as an emotive issue.
Conclusion: This study adds a critical dimension to water management debates by privileging the community voice. The study highlighted that community members feel marginalised by the emphasis on economic consequences and the influence of the agricultural sector that impacts themselves, their communities and the environment.
Zelda Doyle
Dr Zelda Doyle is the rural research coordinator and epidemiologist for the rural clinical schools in the Sydney School of Medicine at the University of Notre Dame, Australia. She has a PhD in Ethics and Epidemiology from the University of Tasmania, a Master in Epidemiology from the London School of Hygiene and Tropical Medicine, and a Bachelor of Science with Honours from the University of Queensland. She has varied research interests including rural retention and workforce, regional and rural aged care, the impact of research ethics on long-term longitudinal studies, as well as supporting student projects in rural health. As part of her job she assists clinicians to develop, implement and analyse their own research agendas. She is also the current Chief Investigator on the Federation of Rural Australian Medical Educators final-year rural clinical school students survey.
In her spare time she sits on the board of one of the local aged care homes, assists in the running of the local village daffodil festival and rings church bells throughout the central-west of New South Wales.
Ten years of Notre Dame Sydney rural clinical schools: where are they now?
On the 10th anniversary of rural clinical school (RCS) graduates of The University of Notre Dame Australia (UNDA) School of Medicine, Sydney, this study takes a lens look at the location of practice of 1,100 graduates. The aim is to contrast metropolitan clinical school with RCS appointment of one year or greater and to determine if this has resulted in alumni practicing at an Australian Statistical Geography Standard (ASGS) determined rural, regional or remote location. It is anticipated that this quantitative analysis will typify the practice location of the UNDA medical graduate and determine if alumni demographics such as fee type, fellowship type and being educated in a UNDA RCS increase the likelihood of practice in a rural, remote or regional location. This will prove pertinent to the UNDA School of Medicine, Sydney, in gauging the extent that its RCSs have contributed to the provision of health care in rural Australia and to areas of workforce shortage.
Lauren Duckworth
Lauren Duckworth is the Manager of the Northern Territory (NT) Point-of-Care Testing (POCT) Program at the Flinders University International Centre for Point-of-Care Testing.
Lauren has a Bachelor of Medical Science and a Bachelor of Science (Honours) from Flinders University and has been working in the POCT field for seven years. She specialises in POC pathology testing research for rural and remote communities, specifically in the NT. Lauren’s interest in this area stemmed from her travels around Australia where she observed the challenges surrounding inequity of healthcare access faced by remote communities.
The NT POCT Program is a well-established field program that supports quality-assured POCT on the Abbott i-STAT and HemoCue WBC DIFF devices for the care of patients with acute and chronic health conditions. The NT POCT Program supports nearly 100 i-STAT devices in remote health centres across the NT, the Ngaanyatjarra Lands and the Kimberley region of Western Australia, and 20 WBC DIFF devices in the Top End of the NT.
Lauren and the rest of the NT POCT team recently won the 2021 Engagement Australia Excellence Award for Outstanding Engagement for Research Impact.
Bridging the pathology gap: patient-centred point-of-care testing in rural and remote locations
Around 70 per cent of all medical consultations in Australia involve a pathology test request. However, pathology samples are tested by centralised laboratories which are often physically disconnected and distant from the site of patient care. This disconnection is known to cause delays in diagnosis and treatment, as well as loss to follow up if results are not communicated to the patient once available. People living in rural and remote communities are further disadvantaged by this centralised pathology structure by extended turnaround times, which can also amplify risks. For some clinical scenarios, the timeframe to obtain test results may be impractical and clinicians must err on the side of caution and arrange for the patient to be retrieved from the remote community – usually via aeromedical services – so the patient can be physically closer to diagnostic laboratory for testing.
To address these issues, several point-of-care testing (POCT) pathology initiatives have been successfully implemented in many rural and remote primary healthcare facilities around Australia. POCT enables rapid pathology test results to be available during the initial patient consultation, enabling on-the-spot decisions about patient care to be made and eliminating the need for follow-up visits to discuss test results. Many of the POCT networks in Australia are managed by academic institutions who provide innovative, flexible and responsive coordination of training, quality management and logistics that are practical for rural and remote health. These academic institutions are also able to evaluate and provide evidence on clinical, operational, analytical and economic outcomes through research. This evidence base has enabled POCT to be embedded into mainstream practice with various point-of-care tests now incorporated into clinical protocols within the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual.
To date, some examples of better outcomes include: improvements in glycaemic control for patients with diabetes, increased patient satisfaction and convenience, reduced loss to follow up for chronic disease management and more rapid initiation of treatment for sexually transmitted infections. For acute care, POCT has improved patient safety for acute presentations, enabled Aboriginal people with underlying health issues to move between communities and be safely monitored and assisted in the prioritisation of aeromedical retrieval services, and has provided rapid results to rule out unnecessary medical retrievals and thus produced significant cost savings. The success of these rural and remotely located POCT networks has led to international translation with POCT being used in isolated locations in low-resource countries.