Background: COVID-19 was an unprecedented public health emergency, resulting in drastic preventive measures. The ongoing restrictions and lockdowns have had significant implications which may be disproportionately felt by regional communities whose economies rely on tourism. Regional Victorian towns, in particular, have been hard-hit by extended and frequent lockdowns and travel restrictions, which have affected mental health and social/emotional wellbeing considerably. Understanding the key issues for the community is key to tailoring strategies and plans to support them during restrictions, and to aid recovery efforts.

Methods: A qualitative investigation of the issues perceived to be most salient for regional communities. A convenience sample of 943 regional Victorians responded to open-ended questions in a mixed-methods survey distributed online and in hard copy format from May to August 2020 (spanning the first and second lockdowns in Victoria). Responses were analysed thematically.

Results: A number of prominent themes emerged.

• Community life – The cessation of local social opportunities (community events and organisations, local shows, sports and clubs, volunteering) was commonly reported, contributing to declining community connectedness. Many voiced concerns about resources available to facilitate their recommencement upon easing of restrictions.
• Local economy – The closure of businesses and resultant job and income losses were one of the most commonly reported concerns. In part this may be exacerbated by a loss of tourism, another highly prevalent response. Similar to other community-based events and activities, many were concerned about businesses’ ability to recover and long-term recovery.
• Following the rules – Although a decline in tourism was a key concern, a return to normal meant concern about ‘outsiders’ failing to comply with restrictions. People were concerned about both locals and tourists failing to follow the rules and increasing complacency as restrictions endured.
• Mental health – Concerns about declining mental health were common, with a perception that rates of decline had increased across the community. This may have been exacerbated by the decreases in community connectedness, diminished economies and higher unemployment.
• Border closures – Significant functional and emotional impacts were created by border closures restricting access to services, health care and family support.

Conclusions: This research provides insight into the unique experiences of regional communities during COVID-19 lockdowns. Findings suggest that tailored support is needed for regional businesses and organisations to navigate an unpredictable future. Social connection initiatives are required to ameliorate declining mental health in regional communities during lockdowns and in the longer term post-COVID-19. The translation of this research has informed responses during the ongoing impacts of COVID-19.

While consumer voice and person-centred care is not new, the involvement of service users in service design, research and evaluation is slowly gaining momentum. This focus on collaborating with people with lived and living experience of mental ill-health and suicide through co-creation processes are important steps through which we can improve the relevance, timing and appropriateness of service offerings. Simultaneously, involvement in research and evaluations of such services provides deeper insight into the mechanisms that ensure service offerings meet people’s stated needs. This presentation will focus on the model of co-creation of new knowledge. This model will be presented using case studies to explore the opportunities and challenges in applying this model to suicide prevention and mental health activities in regional Australia. Consumer workforce development needs will be discussed.

This is a mini-symposium session composed of a series of lightning talks from members of the newly established Regional Australia Mental Health Research and Training Institute. However, the talks have also been scheduled to synchronise with the other concurrent sessions.

Introduction: Women in rural, regional and remote Australia experience unique challenges when accessing maternal health and gynaecological services (services), compared to counterparts in metro areas. There is evidence to suggest that these challenges result in the inequitable access of services in geographically isolated areas. This inequity extends to the availability of the obstetric and gynaecology (O&G) workforce, with notable O&G workforce shortages in rural, regional and remote Australia.

While these challenges are widely acknowledged, there is paucity of data on: (1) the type and acuity of services; (2) the O&G workforce composition; and (3) the barriers that impede effective service delivery across rural, regional and remote Australia.

Methods: We are conducting a mapping research project that aims to: (1) map the geographic distribution of services, O&G workforce, levels of service and population demographics in rural, regional and remote Australia; and (2) explore the perspectives of consumers on the facilitators and barriers they face when accessing the services.

The mapping research project is being piloted in Western Australia as:

• an observational cross-sectional study of rural, regional and remote hospitals that provide services. Clinical leaders will complete an online survey that covers the following themes: available services, current and proposed models of care, proximity to relevant services and workforce data
• focus groups with Aboriginal and non-Aboriginal consumers and non-birthing partners to explore the barriers that affect service provision and access in rural and remote areas, and how services might be made more effective and consumer focused
• an online mapping platform that will highlight population demographics and consumer service utilisation data.

We hypothesise that the mapping research project will provide a comprehensive overview of services across rural, regional and remote Australia, identify current gaps, and provide valuable information on emerging workforce, models of care, population trends and barriers to effective service delivery.

Results: Preliminary qualitative data from the observational cross-sectional study, focus groups and the interactive online population and service mapping will be presented.

Discussion: Findings from the mapping research project will be fundamental for service and workforce planning as they will help identify current service and workforce gaps, and provide targeted recommendations to improve maternal health and gynaecological service delivery. The recommendations will also be made to the project sponsor, the Australian Government Department of Health, and they will help support future service and workforce planning, and facilitate steps towards achieving equitable access for all women.

Anxiety and depression are the most common mental health problems experienced by children and adolescents. Despite effective treatments, many young people do not have access to evidence-based care, due to long waiting lists, costs, limited professionals with child and adolescent expertise, and reluctance to see mental health professionals face to face. These problems are amplified for families in regional, rural and remote areas.

Digital mental health services are effective for children and adolescents, but the models of care best suited for regional and rural families are unclear. Bandwidth, network availability and general reluctance to use technological approaches limit the overall reach and efficiency of digital mental health services in regional and rural areas. This presentation will share insights into digital models of care that have worked for regional families, and will present data from one platform, the BRAVE Program, to highlight the potential of digital mental health. This presentation will also share insights from clinicians, young people and parents who have taken part in BRAVE in regional settings.

Digital mental health services are here to stay, but this presentation will highlight the importance of flexibility and choice in the models of care needed to ensure young people in regional areas receive the support they need.

To optimise birth outcomes, universal screening for gestational diabetes mellitus (GDM) by 75g oral glucose tolerance test (OGTT) is recommended at 24–28 weeks gestation and earlier for women with GDM risk factors. Women from regional Western Australia (WA) have increased risk for GDM compared to urban women, yet poor OGTT acceptability and non-adherence to pre-analytical laboratory standards results in significant underdiagnosis. Early pregnancy measurement of glycated haemoglobin (HbA1c) and implementation of tubes (FC) to stabilise OGTT samples may improve screening outcomes.

Prospective study

Participants: Twenty-seven regional WA clinics recruited 694 pregnant women, >16 years of age, without confirmed diabetes (2015–18). Clinicians reported maternal characteristics and GDM risk factors. Birth outcomes were recorded from hospital discharge summaries. Study HbA1c was offered early (<20 weeks gestation). Clinician requested OGTT results were corrected for estimated glucose loss due to pre-analytical glycolysis.

Outcome measures: Uncorrected and corrected GDM incidence; ROC curve optimal early HbA1c threshold for corrected GDM (≥90% specificity); and relative-risk for large-for-gestational-age (LGA) newborn.

Results: Pre-analytical glycolysis resulted in 62% underdiagnosis of GDM (uncorrected 10.8% v corrected 28.5% [20.8-29.5%], P<0.001) and underestimation of risk for LGA newborn (RR 1.12 [0.51-2.47]). Early HbA1c ≥38 mmol/mol (≥5.6%) was highly predictive (71.4% [47.8-88.7]) for GDM diagnosis in Aboriginal women (129) and increased risk overall (466 with HbA1c) for LGA newborn (RR 2.04 [1.03-4.01], P=0.040).

Validation and Translation: Kimberley Aboriginal Community Controlled Health Services (ACCHSs) implemented universal early HbA1c and FC-tubes for OGTT in 2017 and 2019, respectively. Preliminary analysis of ~1000 electronic medical records for Kimberley ACCHS antenatal patients (2018–21) showed 13.9% had an early HbA1c ≥38 mmol/mol and trend towards higher LGA newborn (22.7% v 13.6%, P=0.118). GDM incidence increased 2.5-fold after implementation of FC-tubes (37.4% v 14.8% standard-tube, P<0.001) with most GDM (77.5%) diagnosed at fasting OGTT sample. Concomitant increases in maternal booking BMI and LGA newborn in the FC-tube period (coinciding with initial COVID-19 restrictions) confounded birth outcome analysis (median [IQR] BMI (kg/m2) 26.5 [22.1-31.9] v 24.8 [21.0-29.8], P=0.001; LGA 16.7% v 10.0%, P=0.028).

Discussion: Universal early pregnancy HbA1c ≥38 mmol/mol likely identifies Aboriginal women with apparent prediabetes and elevated risk of LGA newborn. When glycolysis is minimised, universal fasting glucose at 24–28 weeks gestation identifies most GDM that develops later in pregnancy. Both approaches could lead to more comprehensive screening coverage, reduce the number of OGTTs and expedite management of hyperglycaemia to improve birth outcomes. The potential COVID-19-related increase in LGA newborn warrants national analysis.

Background/aims: The Rural Interprofessional Education and Supervision (RIPES) model is an innovative professional-entry clinical-placement model, developed in Queensland, to promote interprofessional education (IPE) and collaborative practice in rural healthcare settings. The RIPES placement model includes tailored and targeted IPE and interprofessional supervision activities, including joint client sessions, weekly skills sessions, work shadowing and peer learning. Participants in healthcare settings are trained and prepared to facilitate the RIPES placements. Students from two or more disciplines undertake placement concurrently, with an overlapping period of five weeks. This study explored student and clinical educator experiences with, and perceptions of, the RIPES model.

Methods: Five rural sites across Queensland (MMM 4 to 6 locations) implemented the RIPES model, with students from physiotherapy, dietetics, speech pathology and occupational therapy. Qualitative methods and participatory action research principles were employed in this study. Data collected through focus groups and interviews were analysed through a content analysis approach.

Results: Data were available from 24 clinical educators and 34 students. The RIPES model was found to be very complementary to rural healthcare service delivery. The placement experience facilitated skill development in IPE and collaborative practice in both students and clinical educators. It resulted in several unintended benefits such as producing ripple effects at participating sites, with most sites further embedding IPE and collaborative practice in their usual service delivery, post-placement.

Conclusions: The RIPES model was purposively developed for rural sites to promote IPE in student placements. Study findings indicate that the model not only fosters IPE in students, but also enhances IPE and collaborative practice among healthcare teams. It is anticipated that these changes will positively influence patient care at these sites.

Relevance: This study provides information on a novel, tried and tested IPE student placement model that is applicable and relevant to rural healthcare settings. The RIPES model and the study findings will be of interest to rural healthcare workers that seek to promote IPE, collaborative practice and client-centred care.

Background, rationale and aim: Torres and Cape Hospital and Health Service (TCHHS) provides public healthcare services across the northern remote area of Queensland, an area that spans 130,238 square kilometres. In 2017, 67 per cent of the 26,966 residential population identified as Aboriginal and/or Torres Strait Islander people. Services are provided from within four hospitals and 31 primary and community health services facilities.

While palliative care services are a well-established model of care across Australia, within Torres and Cape communities the same results are not being achieved due to unique community needs, geography and healthcare settings. Specialist consultation can be delivered through the provision of telehealth. However, specialist physical care can currently only be delivered in Cairns, resulting in patients not only having to travel long distances, but also being removed from their normal support systems.

This presentation aims to provide details on the development of a ‘pop-up’ model of palliative care and provides insights for other healthcare services operating in rural and remote areas.

Methods and relevance: The framework for a pop-up care model, is inclusive of palliative care principles, while encouraging and supporting flexibility and broad community engagement. It also supports the community to identify gaps and provides resources to assist communities to meet their needs. The principles of the pop-up model are that it functions in a coordinated approach only when it’s required (that is, pops up). The model is flexible, sustainable, owned and developed by the local community (not imposed by others) and tailored to meet community needs. It also importantly increases the knowledge and skills base in palliative care for communities and clinicians.

Results: Since the commencement of the project there has been extensive community consultation with both clinical staff and community stakeholders to identify areas of need and gaps within the current services. Gaps identified include access to education and the need for a specialised palliative care team. The project has now commenced education sessions to clinical staff and community members provided by PallConsult (funded by Queensland Health). It has been designed to boost the ability of local healthcare teams to deliver patient-centred palliative care, especially in rural and remote parts of the state.

Conclusions: The project team is currently developing comprehensive resources, processes and procedures, and project tools that support not only the successful implementation of this program but also a sustainable and flexible program that will serve communities for years to come.

Introduction: Sustaining the necessary recruitment and retention of general practitioners (GPs), particularly in rural areas, remains a challenge. Insufficient medical graduates are choosing a general/rural practice career. Prevocational medical training (between undergraduate medical education and specialty training) remains strongly reliant on hospital experience in larger hospitals, potentially diverting interest away from general/rural practice. This study evaluates a workforce strategy – the Rural Junior Doctor Training Innovation Fund (RJDTIF) – that enabled interns to experience 10 weeks in a rural general practice, aiming to increase their consideration of general/rural practice careers.

Methods: The RJDTIF supported up to 110 new places during 2019–20 for Queensland’s interns to undertake an 8–12-week rotation out of regional hospitals to work in a rural general practice. Participants were surveyed before and after the placement, although only 86 were invited due to disruptions from the COVID-19 pandemic. Descriptive quantitative statistics were applied to the survey data. Four semi-structured interviews were conducted, combined with open-ended responses in the surveys, to further explore their experiences post-placement, with audio-recordings transcribed verbatim. Semi-structured interview data were analysed using deductive, reflexive thematic analysis.

Results: In total, 60 interns completed either survey, although only 25 were matched as completing both surveys. About half (48%) indicated strong enthusiasm (pre-placement) for the experience. The two most common reasons for preferencing a rural GP term were experiencing training in a primary care setting (50%) and gaining more clinical skills through increased patient exposure (22%). The overall impact on pursuing a primary care career was self-assessed as much more likely by 41%, but much less likely by 15%. Interest in a rural location was less influenced by participation. Those rating the term poor or average had low pre-placement enthusiasm for the term. The qualitative analysis of interview data produced three themes: importance of the GP placement (hands-on learning, skills improvement and influence on future career choice); integration into the community; and improvements needed in the GP rotation.

Conclusion: Most RJDTIF participants reported a positive experience from their rural GP rotation, which was recognised as a sound learning experience at an important time with respect to choosing a specialty. Despite the challenges posed by the pandemic, this evidence supports the investment in programs that provide opportunities for junior doctors to experience rural general practice in these formative prevocational years, to stimulate interest in this much-needed career pathway. Focusing resources on those who have at least some interest and enthusiasm may improve return on the investment.

Background: To address rural health workforce shortages, improving access to health courses for those living in rural areas is critical. Student rural upbringing is a strong indicator for future rural health practice; however, the need to study at a metropolitan university is a barrier, particularly for mature-aged students.

Aim: To identify Australian university health course availability for those students living in rural, regional and remote locations (Modified Monash Model 2–7).

Methods: A quantitative design was used. Relevant websites were searched to identify courses in regional/rural locations and online for medicine, nursing and midwifery, allied health (physiotherapy, occupational therapy, speech pathology, optometry, podiatry, dietetics, pharmacy, psychology, social work) and dental. The Australian Health Practitioner Regulation Agency (Ahpra) website was searched for relevant courses; association websites were searched for non-Ahpra-registered professions. To confirm current course offerings, university websites were checked. The Monash Modified Model (MMM) website determined course rurality. Descriptive statistics were used for data analysis.

Results: Two medicine courses were available in MMM2 locations and three in MMM3 locations. Three dentistry courses were in MMM2 locations and one in MMM3. Oral health had two courses in MMM2 locations. Twenty bachelor degrees of nursing were offered in MMM2 locations, 17 in MMM3, five in MMM4, three in MMM5, one in MMM6 and nine had online offerings. Only one midwifery degree was in an MMM2 location and two were online. One nursing and midwifery double degree course was in an MMM2 location and two were offered online. A nursing and paramedicine double degree was offered in an MMM2 location. One graduate entry nursing degree was offered in an MMM2 location and one in an MMM5 location, with two courses offered online. For enrolled nurses articulating to bachelor degrees, one course was in an MMM2 location, two in MMM3 locations and one in an MMM5 location.

Some physiotherapy, occupational therapy, speech pathology and pharmacy courses were in MMM2 and MMM3 locations. Podiatry had two courses in MMM2 locations. No optometry and dietetics course were in MMM2–7 locations. Social work had courses in MMM2 and MMM3 locations, and online. Psychology had bachelor degrees offered online and in MMM2 and MMM3 locations.

Conclusion: Health courses available outside of metropolitan cities are predominantly in large regional centres and few disciplines have online courses. The gap in health courses in MMM4–7 locations, online or through flexible course delivery, limits access and participation for rural mature-aged students.

Aim: To promote engagement and design of maternity care stillbirth prevention resources for rural and remote health practitioners, to assist antenatal care decisions in limited-resource and/or remote maternity settings. Specifically, to adapt the Safer Baby Bundle (SBB) education and resource package to address issues facing rural and remote women, families and clinicians, to end preventable stillbirth.

Methods: The SBB is a national initiative recognising the government’s commitment to reduce late-gestation stillbirth (after 28 weeks) by at least 20 per cent. The SBB includes five elements of care that address smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping and timing of birth. Partnering with CRANAplus, we are piloting and evaluating the SBB educational materials (Masterclass and Webinars) to ensure relevance in rural and remote contexts. Consultation will explore priorities of rural and remote health professionals and families, including targeted co-design with Aboriginal and Torres Strait Islander communities.

Relevance: Stillbirth is a serious public health problem with wide psychosocial, emotional and financial burdens on families and service providers. Women in rural and remote settings experience an intersection of multiple social inequities and an almost doubled stillbirth risk. Experiences of poverty, service access and health literacy contribute to an increased risk of poor outcomes in pregnancy and birth. Furthermore, in remote areas, 65 per cent of women identify as Aboriginal and/or Torres Strait Islander, who experience the highest rate of stillbirth nationally (14.6 per 1,000 births). Data on causes of stillbirth in this population indicate that many are preventable with improved care and community awareness.

Results: SBB education has been implemented into existing CRANAplus Maternity Emergency Care and Midwifery Upskilling courses and in CRANAplus magazine for dissemination to remote and isolated health professionals. Further engagement to embed this with remote tertiary education providers has also been initiated. Piloting and consultation of the SBB Masterclass to rural and remote clinicians commenced in December 2020 and is ongoing. Initial feedback has identified key areas requiring adaption for rural and remote antenatal settings include variations of the DFM and FGR pathways to reflect low-resource capabilities and inclusion of additional infographics for low-literacy individuals.

Conclusions: This project promotes community engagement and co-design in resource development to benefit rural and remote health providers and communities. This project will encourage women in isolated areas to engage in discussion of risk-reduction measures with their providers and will provide tools to healthcare professionals to reduce preventable stillbirth.

In 2018 the Training Centre in Subacute Care WA (TRACS WA), Heart Foundation WA, Australian Cardiovascular Health and Rehabilitation Association WA (ACRA-WA) and Rural Health West were approached by WA Country Health Service (WACHS) to provide support and education for rural and remote health professionals working in heart health in Western Australia (WA). This was to address a specific need to increase confidence, knowledge and skills across all health disciplines in the area of cardiac rehabilitation and secondary prevention (CRSP) in WACHS. Following a needs assessment to identify topic areas and preferred style of presentation delivery, the collaborative group innovatively developed a program of monthly interactive telehealth CRSP professional development sessions. This novel approach provides outreach to time-poor rural clinicians to attend while having their lunch break, thus interfering less with clinical work schedules. The one-hour presentations are all recorded and available for viewing via the TRACS WA website.

Since August 2018 these interprofessional lunch and learn sessions have been provided to 463 clinicians, researchers and managers throughout WA. Participants have attended from 321 locations over the vast area of WA. Practitioners tune in from Kununurra in the north, Esperance in the south and some extremely remote locations. Multidisciplinary clinicians including nurses, physiotherapists, occupational therapists, social workers, clinical psychologists, exercise physiologists, dietitians, Aboriginal health workers and general practitioners participate. They work within public, private, acute care, primary health and Aboriginal health services. The professional development content is driven by clinicians and delivered by local and national experts. To date, 30 sessions relating to cardiovascular care have been delivered, including rheumatic heart disease, effect of exercise on CVD, medication compliance, medication side-effects, blood pressure, cholesterol, Heart Foundation resources and cardiovascular research.

Electronic surveys completed after each event show that access to professional development remotely using multimedia technology, supplemented with resources and opportunities for mentorship, enhances clinicians’ knowledge and confidence in the delivery of CRSP services. Significant outcomes are also noted by the interprofessional partnerships being formed between both rural and metropolitan health sites. These kinds of networks and communication channels have a positive influence on patient care by improving communication, connection and continuity of care. Results reflect the success of these sessions is due to the ease of access, relevancy of content and context to the clinician’s work environment. Interagency collaboration to deliver relevant, practical, evidence-based professional development sessions to rural and remote practitioners is highly appreciated and successful.

Background: In rural and regional areas, older adults face a number of accessibility issues when sourcing healthcare services, and have poorer healthcare outcomes and higher rates of potentially preventable hospital admissions. Paramedics have been identified as a key health profession in rural areas, able to engage with the community and proactively care for at-risk older people. There is, however, limited evidence regarding what the community sees as the current and potential role of paramedics in the lives of older rural-dwelling people.

Methods: A descriptive phenomenological analysis of data from semi-structured interviews with older people living in rural communities, as well as key stakeholders from health and ambulance services, was used to explore the current and potential role of paramedics in the lives of older rural-dwelling people.

Results: Interview participants from rural communities reflected on their lived experiences relating to ambulance utilisation in rural areas and the role of their local paramedic. Health and ambulance service stakeholders reflected on barriers and enablers to the potentially extended role of paramedics working with older people in rural communities. Three themes were identified: health professional availability, funding and hospital avoidance. A key finding was that, while paramedics may be well-placed to bridge the distance between older rural-dwelling people and health services, competing priorities present a challenge to engagement in ‘non-traditional’ roles within primary and preventive health care.

Conclusion: Paramedic engagement in ‘non-traditional’ pre-hospital activities, such as health education and primary and preventive health care, emerged as a potential area for development. A high level of trust placed in the local paramedic by older rural-dwelling people was evident, with rural paramedics likewise feeling a strong sense of responsibility to their local community members. Findings emphasise the importance of supporting older rural-dwelling adults, and indicate that novel approaches are required to overcome challenges associated with funding and shortfalls of healthcare professionals in rural areas.

The COVID-19 pandemic has brought into sharper focus many of the challenges that rural and remote communities face in the delivery of health services. The pandemic has disrupted medical workforce supply chains by restricting the immigration of international medical graduates and the movement of locums across state borders, and exacerbated an underlying tension in the sustainable supply of medical relief in both the private and public sectors and primary and secondary services.

The future-proofing our rural and remote medical workforce project was initiated as a response, by the Office of Rural and Remote Health (ORRH) in early January 2021, to an identified need to address the progressive decline of effective primary health care, largely based on traditional models of general practice, in rural and remote Queensland. The project commenced with a stakeholder roundtable, the establishment of a cross-sector reference group with key stakeholder organisations including the National Rural Health Commissioner, three focus groups and individual meetings with, for example, the Australian Government Department of Health, in order that issues were clarified and recommendations tested.

In June 2021, six key areas with accompanying recommendations were approved for release by the Director General. Queensland Health, and presented at the Rural Doctors Association of Queensland annual conference by the project’s medical advisers, Dr Ewen McPhee and Dr Konrad Kangru. The ORRH commenced implementing these recommendations with the medical advisers in August 2021.

This conference provides an opportunity to present to the participants an update on the implementation of these recommendations, with any early outcomes that show an improvement in supply of medical workforce to rural and remote Queensland.

Council identified in the early 2000s that there were increasing barriers to health service accessibility for the residents of the local government area (LGA) including attracting and retaining general practitioners (GPs) to an adequate level to service the community. Council proactively developed initiatives to address these barriers to achieve long-term sustainable health services for the wellbeing of the community.

1. In order to improve the experience of registrars living in regional areas and encourage permanent employment, Council provided grant-funded accommodation at a reduced rental rate.
2. In 2006, Council adopted the Doctors and Registered Nurses Attraction and Retention Incentives Policy. Funded by Council’s own resources, the policy aims to promote employment and residency within the LGA through cash and lifestyle benefit incentives.
3. In 2010, Council purpose-built a medical centre to accommodate 10+ GPs, registered nurses and visiting specialists; the centre is leased to GPs and specialists on a ‘walk-in walk-out’ model. The model assists recruitment of GPs by removing the need for upfront investment or buy-in to a business.
4. In 2011, Council opened an education centre located adjacent to the hospital. The facility repurposed the redundant retirement home. It was reconfigured to comprise offices, training facilities and short-term accommodation for medical locums and student work placements. Part of the facility has been developed into a family healing centre for which Council provides subsidised rent.
5. Council has funded, along with University of Wollongong and the Australian Government, an extension to the medical centre to establish a regional hub for medical students undertaking study placements.

Through these initiatives, levels of GPs and registrars have increased and the medical centre has been able to provide a range of specialist services to the local area.

Unfortunately, there are still a number of barriers to provision of adequate health services in rural and regional Australia. Medical practitioners tend to specialise in order to achieve higher remuneration, whereas a generalised knowledge base is usually required to serve the varying needs of rural communities. Relocation to the area and costs associated with opening and maintaining a practice are still not as attractive as the metro alternatives. Many feel that isolation from being the only GP in a town, plus work–life balance in these areas, are unattractive along with limited budgets and facilities.

Australia’s ongoing health workforce shortage necessitates the active adoption of strategies and practices to attract and upskill our future health workforce across all regions and skill levels, to ensure a sustainable supply of future health professionals to aid service delivery. This bears greater relevance to organisations providing services in rural and remote communities, which have historically witnessed shortages in their workforce owing to issues with retention of workers, migration of workers to urban settings, and a lack of youth interest and participation in the sector.

Conceptualised in 2020, the Health Gateway to Industry Schools project works in partnership with key government agencies and public and private sector training organisations, educational institutions and health service providers using a place-based, grow-your-own approach to health workforce development. The project partners with high schools across Queensland as ‘Health Gateway Schools’, that are actively involved in delivering nationally recognised vocational education and training (VET) in health at Levels 2 and 3 of the Australian Qualifications Framework.

The project aims at creating sustainable partnerships between Health Gateway Schools and local health service providers to engage students pursuing health qualification on a pathway that broadens the students’ awareness of career opportunities in health and promotes further engagement and participation to complement the local health workforce shortages. Approaches include developing experiential learning opportunities through work experience placements and traineeships, professional development support for teaching staff to draw industry relevance to classroom learning, and industry-endorsed resources to support learning and awareness on the range of in-demand career options within the health sector.

The project engages clusters of health employers across Queensland, with an emphasis on clinical and non-clinical roles across the broader health ecosystem – including hospitals, community health centres, Indigenous health, general practice, allied health clinics, pathology laboratories, radiology and imaging services, pharmacies, and mental health and oral health clinics.

Anticipated long-term outcomes of the project include:

1. A sustainable supply of a locally trained, work-ready workforce in regional centres.
2. Improved participation, retention and upskilling of youth to address regional shortages within the workforce.
3. Improved literacy on the range of roles and services in health, resulting in an improved uptake of health and allied services.

The success of the project is highly dependent on the participation of health service providers and employing organisations, with an approach that can be extrapolated and adapted to other states and territories based on the sector’s regional requirements.

The first 2,000 days of life is a critical period in the development of a child, impacting the health outcomes of individuals, their families and communities. Specialist child and family health services play an integral role in the identification, support and response for children and families with increasingly complex physical, developmental, psychosocial and behavioural health needs. The need to develop service models which effectively meet the healthcare needs of rural and regional communities, and address inequities currently experienced by populations outside large metropolitan centres, has been identified as a key priority both nationally and internationally (WHO 2007; Standing Council for Health 2012; NSW Health 2014).

The Tresillian Family Care Centres (FCC) model provides a family-friendly non-clinical environment from which a range of services are provided, including comprehensive assessment and interventions for early parenting challenges impacting on the health and wellbeing of children and their families. FCC teams of clinicians in rural and regional locations, embedded in the local service system network, provide a secondary level referral pathway utilising modes of delivery, including centre-based, home-visiting, group programs and telehealth with co-located perinatal mental health services, to decrease the stigma often associated with help-seeking. Supporting parents to navigate the service system to address multifaceted needs has emerged as a vital function of these services.

Tresillian has worked in partnership with NSW regional local health districts to adapt the service model to be tailored to the contexts of rural and regional communities. From three regional FCCs in 2017, NSW Government funding has enabled the establishment of an additional 12 FCCs in rural and regional communities (2018–22). Key to the service model is a ‘package of care’ concept, enabling a tailored response to address the unique needs and circumstances of each family and community. Partnerships with regional local health districts and integration into local service system networks has been integral to the model achieving a seamless service response for families in the early parenting period.

This presentation will describe the Regional Family Care Centres model, the joint governance and operational partnerships, implementation experiences and findings of a formative evaluation. The formative design has enabled progressive data analysis to be reviewed at regular intervals to inform service improvements and adaptations. Quantitative and qualitative data will be presented, including key outcomes measures introduced to enhance clinical decision making and inform further service improvement to improve outcomes for rural, regional and remote children and their families.

Aim: To determine if a validated esky reduced the number of cold chain breaches, met staff satisfaction and reduced waste when transporting vaccines.

Methods: This was a prospective study over a four-month period from a very remote district hospital. It examined the number of cold chain breaches when delivering vaccines from a district hospital to primary health care sites using a polystyrene esky versus a validated esky.

The hospital services nine clinics within the study area, which were divided into two study arms, the first receiving the current polystyrene eskies (n=5) and the second using the validated eskies (n=4).

A communication plan was developed to ensure clinic staff were aware of the study, knew where to direct enquiries, and how to return the validated eskies.

A data collection tool was used to record delivery, packing and return data, cold chain breach data, wastage cost, queries and issues arising.

Qualitative information was collected at the conclusion of the study through a survey of pharmacy and clinic staff members for the sites using the validated eskies.

Relevance: There are approximately 70 remote communities which rely on distribution from the study jurisdiction hospitals for vaccine supply. The current method of distributing vaccines in polystyrene eskies means breaches of cold chain (temperatures outside 2–8°C) are relatively common. This creates a number of risks to our health system, increases stress and workload for staff, and has financial impact. Since this research was undertaken, the findings have been implemented into the jurisdiction’s COVID-19 vaccination program.

Results: The validated eskies had zero cold chain breaches (16 deliveries) compared with two breaches (23 deliveries) in the polystyrene arm ($0 vs $10,823.85 of stock wastage). The validated eskies additionally reduced waste by decreasing the number of deliveries due to vaccine capacity in one esky and an implementation of a return to pharmacy process to re-use the esky. Overall, pharmacy staff were satisfied with the validated eskies, while clinic staff raised concerns relating to the weight and size of the validated eskies.

Conclusions: The validated eskies were successfully implemented for improved vaccine transportation. The communication plan informed staff of the change, and ensured each validated esky was returned for re-use. Utilising validated eskies resulted in less cold chain breaches, less waste and reduced overtime for staff. The increased size and weight of the validated esky used in the study requires risk mitigation and consideration of smaller sized validated eskies.

The ‘Allied Health Priorities across the Continuum of Care’ Project 2020–21 was sponsored to inform future workforce and service development across various settings of care including acute, sub-acute, regional, remote, community and primary health care and across all disciplines of allied health. The project produced four deliverables: analysis of strategic priorities, environmental scan and literature review, consultation across the workforce and development of recommendations to inform a pathway for allied health moving forward.

The extensive workforce consultation, framed as qualitative research, consisted of three methods: online surveys, semi-structured interviews and workshops. Data was analysed using a thematic analysis methodology. Overall, good engagement and representation across allied health disciplines and work units was achieved with 106 staff, working mostly in operational roles, being part of one or more consultation methods.

Participants acknowledged processes and resources in place that currently work well included areas of communication and engagement, referrals and handovers, models of care and current workforce. Staff visions pointed at identifying and addressing service gaps, reducing silos, workforce support and development, service-wide matters and equity for allied health within the service. Finally, participants identified strategies that would contribute to progress towards prioritised visions point at friendlier services for consumers, user-friendly systems for staff, workforce development, service development and recognition of allied health. The data was presented in the thematically analysed Staff Consultation Report.

The findings from deliverables 1–3 were integrated into a recommendations paper, with a Delphi group facilitated to review the recommendations – with 16 recommendations achieving consensus. These were all deemed feasible and to have significant impact by a panel of experts from across allied health disciplines and settings of care. The recommendations were grouped into five thematic areas for development. The recommendations paper, with a focus on the ‘friendly services for consumers’ was well-received by the health services consumer group.

These recommendations and the papers have great potential to inform future service and workforce development for allied health across the health service.

Access to coordinated and relevant health care is challenging in rural Victoria, particularly for children and young people in out-of-home care. In 2019, the Victorian Department of Health and Human Services, in partnership with Sunraysia Community Health Services, embarked on an aspirational 10-year project to improve health outcomes for children and young people in out-of-home care. The integrated area-based health system prescribes a multidisciplinary wraparound approach, aimed at reducing hospital admissions, improved experiences with safe medication use and improved health-related quality of life for this cohort of young people. The Rural Health School at La Trobe University was engaged to evaluate the first phase of a two-year trial in north-west Victoria, entering its final stage of data gathering before concluding in November 2021.

Integration of healthcare systems is a challenge at the best of times, particularly due to the range of different legislative requirements and frameworks to work within. While COVID-19 introduced significant disruption to integration, it also enabled behaviour changes of individuals, systems and organisations, inadvertently enabling innovation and agility. Application of a robust theoretical framework facilitated the identification and detailing of relevant capabilities, opportunities and motivational elements to behaviour (COM-B), structuring the theory of change analysis.

At the 18-month timepoint of the project, reflections on progress so far will include:

• stories from a range of policymakers, senior leaders and healthcare professionals who shared their experiences of the project
• populating six distinct indicators amounting to transformative systems change
• system readiness in rural Victoria regarding nuanced and sustainable integration in the complex environment of statutory service delivery for children and young people.

This presentation will discuss findings and ’embedded evaluator’ impressions regarding requirements for system change with the purpose to provide timely and coordinated health pathways for children and young people in rural Victoria.

Background: Despite the strong push by governments in Australia to ensure that inclusion is prioritised across all sectors, particularly in health, the gap between rural and urban health and wellbeing continues to persist for marginalised consumers. Rural health service providers hold powerful positions as representatives and knowledge-bearers of healthcare institutions. However, this is often unacknowledged and disregarded with providers un/intentionally preferring to reproduce deficit discourses of marginalised groups. Barriers such as these exclude consumers and need addressing prior to ‘doing’ inclusion work.

Aim: This presentation aims to refocus the gaze on those who wield power in institutions by exploring the narratives of rural consumers’ in/exclusive experiences when accessing health care.

Methods: Purposive recruitment was employed to ensure findings centred the perspectives of people often marginalised in Western frameworks of healthcare delivery including Australia’s First Peoples, immigrants and refugees, those who identify as gender and/or sexually diverse, people with disability/ies and young people. There were 119 rural consumers who participated in this study with 76 participating in individual interviews; 15 were interviewed as part of a small group of two to three people; and 28 participated in five focus group discussions.

Findings: Four in/exclusive practices were identified in this study: (i) the way language was used and/or the way care was communicated to them; (ii) assumptions and prejudice that manifest in various ways; (iii) how health is understood by consumers and their expectations when seeking and accessing health care; and (iv) issues related to the service that are not visible nor understood by consumers (for example waiting times, what services are available and cost of service).

Discussion: Although exclusion and inclusion manifest differently between and within consumer groups, these practices are commonly shared by consumers. They can make consumers feel either welcomed or excluded when seeking care, hence impacting their future experiences and/or access to health services. By identifying and addressing such practices, health services can begin to work on increasing and improving inclusion for all.

Relevance: Highlighting the perspectives and experiences of rural consumers of various cultural and social backgrounds challenge the dominant models of Western health care which often exclude, generalise and ignore patient needs. Rural health has a history of innovation and so by harnessing its strength through purposeful collaboration with rural consumers of diverse backgrounds, inclusion and access can be improved and tailored to the needs of the community.

The evidence is that, with the COVID-19 pandemic, strategies to reduce the associated risks of surgery and to accelerate recovery will be needed. So Enhanced Recovery after Surgery (ERAS) protocols should be promoted as the model of care (MOC). ERAS protocols are proven to reduce hospital stay, improve capacity and be safer, but may require adaptation to certain Australian criteria and conditions.

The addition of technologies such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation and the use of telemedicine should minimise hospital visits, reduce the risk of exposure to possible sources of COVID-19 and be relevant for other extreme events.

The ‘real world’ implementation study of the mHealth Recovery App in rural and remote New South Wales, which targets ERAS after knee and hip replacements, will be presented. This technology-enhanced MOC uses the inevitable wait time before surgery to get patients fitter, stronger and managing their current pain at home. Best International practice is that 15 to 20 per cent of patients should go home the same day as surgery. Seventy per cent are home by the next day. Currently length of stay is up to five days and patients have to either go to the hospital, GP or physiotherapy for ongoing care. Patients are keen to return home, stay at home and manage their rehabilitation with telehealth and in contact with their trusted clinical team and significant others.

Indigenous patients are at higher risk of complications, both with and without COVID-19, in association with these surgeries and will need a MOC that is tailored to their specific needs. Many other surgeries are suitable for this approach.

Widespread implementation of this MOC equals an estimated saving of 250,000 low-value bed days or name='abstractinsert' billion across Australia just for these surgeries.

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 &amp; 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.

Family and domestic violence is prevalent in Australia and occurs at a higher rate in Geraldton and Western Australia’s Mid West region. Family violence refers to violence between family members, typically where the perpetrator exercises power and control over another person. The most common and pervasive instances occur in intimate (current or previous) partner relationships and are usually referred to as domestic violence.

Geraldton’s Community, Respect and Equality Plan (CRE) follows the Our Watch Change the Story framework, which recognises that family violence disproportionately impacts on women and is based in gender inequality. Accordingly, the primary prevention of family violence requires the following actions:

1. Challenge condoning of violence against women.
2. Promote women’s independence and decision-making in public life and relationships.
3. Foster positive personal identities and challenge gender stereotypes and roles.
4. Strengthen positive, equal and respectful relations between and among women and men, girls and boys.
5. Promote and normalise gender equality in public and private life.

A survey of community attitudes and beliefs about family violence, the Local Community Attitudes and Experiences of Violence Survey, has provided important data about the attitudes and experiences of sub-populations within Geraldton, suggesting ways that messages need to be tailored for particular groups.

A three-year Healthway research intervention grant has enabled the WA Centre for Rural Health (WACRH) to develop, deliver, monitor and evaluate a targeted communications strategy which engages with various forms of media to promote population attitudes and norms that prevent family violence. Using a collective impact approach, a small team has worked across various segments of the Geraldton community to develop consistent and relevant messages. Interventions include bringing together a community of practice of communications officers from local businesses, industries, and service organisations to generate coordinated messages within their workplaces and outwards to their stakeholders, a consistent social media messaging campaign, working with local journalists to raise awareness and change the framing of family violence reporting in the media, and incorporating messaging in association with existing community campaigns such as sporting, arts and cultural events.

This presentation will report on the methods, challenges and outcomes to date of this primary prevention communication strategy.

The Start the Dream program is an enrichment program that has operated after school at a primary school in Geraldton since 2018. The need for the program was identified by the school principal, who recognised the need for additional wraparound, supportive and culturally welcoming enhancement activities to build academic skills, promote healthy relationships and reinforce social and emotional wellbeing in children who attend the school. A collaborative of organisations including a local Aboriginal Corporation, a not-for-profit community organisation supporting families, the school leadership team, and the WA Centre for Rural Health worked together to establish the program. It operates weekly throughout the year to support children at risk of falling behind academically or at risk of not attending school as a result of disengagement or learning challenges.

The program design and format were developed by university students on placement at WA Centre for Rural Health in collaboration with partner organisations. Over the past three years it has grown and evolved with the same community partners and a consistent strengths-based approach for each child. Over that period the on-the-ground coordination has been shared by occupational therapy and social work students working alongside young Aboriginal people gaining skills in program planning and coordination.

In 2021 a comprehensive evaluation of the program was conducted to investigate the processes and outcomes of the program. The collaborative processes contributing to the sustainability of the program were explored, voices of families of children and coordinators were noted, strengths and challenges of the program were identified, and recommendations developed. This presentation will provide a summary of the evaluation processes used in this study, and a discussion of the results in the context of community partnerships across multiple organisations with support from university students on rural placements. Learnings from this program will be unpacked and key drivers to promote sustainability for culturally responsive school-based programs will be shared.

People who are LGBTIQ+ are often unable to access safe, timely palliative care (PC) that meets their needs. A growing body of international literature on palliative and end-of-life care inequalities for people who are LGBTIQ+ shows that many people avoid, delay or defer accessing palliative care due to concerns about discrimination and non-recognition of their relationships, lives and identities. This is, in part, because people who are LGBTIQ+ who have faced discrimination in previous healthcare contexts are likely to carry these experiences forward into palliative care.

Geographical barriers mean that people who are LGBTIQ+ living in rural and regional areas, including far remote areas in Australia, likely face significantly different challenges than people who are LGBTIQ+ in metropolitan areas. This is related to reduced service provision and access, and increased stigma and discrimination.

LGBTIQ+ people also have concerns about their confidentiality and the lack of understanding of health professionals in rural settings.

Aim: This research aims to better understand the perceptions of barriers and enablers to effective PC access among healthcare professionals and LGBTIQ+ people, including those LGBTIQ+ people who reside in rural areas across Australia.

Methods: This research uses a mixed-methods approach. Data will be collected from a survey of a minimum of 500 healthcare professionals and LGBTIQ+ people living in Australia. Subsequent interviews with 10 LGBTIQ+ people will further elucidate survey responses. The research team will be analysing findings of LGBTIQ+ people and healthcare workers who identify as residing in a rural area and comparing this data to those living in urban areas.

Results: Descriptive analyses will provide data on perceptions of healthcare professionals, LGBTIQ+ people and LGBTIQ+ healthcare professionals about barriers and enablers to effective PC for LGBTIQ+ people. Data will be used by Australia’s peak body for LGBTIQ+ health, LGBTIQ+ Health Australia (LHA), to build an evidence base to support the development of e-modules for healthcare practitioners around LGBTIQ+ inclusive PC. The e-modules aim to build the capacity of the PC sector to respond to the needs of LGBTIQ+ people in a culturally inclusive way, with a nuanced understanding of what education might be required in rural areas.

The state government of Western Australia (WA) has enforced border closures within and into the state at various times since the beginning of the COVID-19 pandemic. Between March and June 2020, strict travel restrictions were imposed across WA’s Kimberley region to circumvent the virus entering the vulnerable, remote Aboriginal communities in the region. Kimberley health services face many unique challenges in care provision. During a pandemic, stretched services potentially struggle further to meet community and staff needs.

This project examined the key learning outcomes from the delivery of aged care and telehealth services amid these restrictions. Specifically, the research team explored the barriers and enablers to providing care, impacts upon staff delivering care, and effectiveness of providing care and preventing social isolation for the Kimberley’s older population during COVID-19.

Given the diversity of providers and workforce in the Kimberley region, the research team deemed the case-study approach the most appropriate and rigorous method to achieve the research outcome. To develop the case study, a convergent mixed-method approach was employed with quantitative and qualitative data collected concurrently and results blended to create a more complete, in-depth exploration of the research. Approximately 30 study participants completed a survey and/or interview with the research team.

The unexpectedness of pandemics such as COVID-19 means it is imperative to develop planned strategies that work effectively across sectors and service providers in the future. This project uncovered key elements of delivering care during health crises and better ways to provide culturally safe care to older Aboriginal Kimberley residents. The findings will assist in preparing for future pandemics among this and similar populations throughout remote Australia.

Background: Few Australian medical practitioners have postgraduate research qualifications or engage actively in research and many graduating doctors believe their knowledge of basic research skills is lacking. In developing a medical curriculum for our MD program, we took the opportunity to embed and integrate research and critical analysis (RCA) throughout the four-year postgraduate program with the long-term aim of developing research-aware doctors practising evidence-based medicine. As part of the RCA curriculum, all students conduct their own community-based research project during their 12-month placement in a regional or rural area of New South Wales, supported and mentored by RCA team members, fellow academics and clinical preceptors. Their research project aims to consolidate and expand upon their research and critical appraisal skills introduced throughout the RCA curriculum and also provide students with the opportunity to delve a little deeper into a health area of interest.

Aim: The aim of this presentation is to report on the success of the program in providing important research experience and skills, especially in the context of regional and rural health research.

Methods: An audit was undertaken of the medical student research projects, conducted over the past 10 years, to identify which areas of regional or rural health research had been investigated by the students and to gain a better understanding about which research methodologies had been employed.

Results: Between 2010 and 2020, around 800 students successfully completed the MD program and their individual student projects. During this time, the majority (70 per cent) of the projects undertaken aligned with the Australian Institute of Health and Welfare priority areas and approximately 20 per cent of them focused on regional and rural health-related topics.

Engaging in health-related research projects while on regional and rural placements has raised the profile of our students in their placement community and has also resulted in the translation of research findings into practice, such as development of patient information resources; changes to GP prescribing practices; and the increased up-take of interpreter services in a regional emergency department. Many of these projects have also resulted in scholarly publications and conference presentations.

Conclusions: Embedding RCA into a medical curriculum helps to ensure that graduating students have a sound foundation in their research and critical appraisal skills. In addition, regional and rural placements provide medical students with the opportunity to engage in research which is of benefit to their placement communities, as well as to themselves with regard to research capacity building.

Effective collaborative care has long been recognised as being beneficial in promoting positive health outcomes. While the lack of diverse health professionals, combined with limited access to comprehensive health resources, can make it difficult to provide more team-oriented care in rural and remote communities, many Aboriginal and Torres Strait Islander health contexts involve multidisciplinary teams that work closely together. This model of enhanced communication, collaboration and consideration of cultural factors improves access to local health care, provides better continuity of care to patients and increases professional job satisfaction through team-based practice.

This session will explore collaborative primary care models in Aboriginal Medical Services around Australia, including a coordinated network of general practitioners (GPs), nurses and allied health professionals supporting each other to deliver local services. It will highlight the benefits of collaborative models of care and outline how they could be implemented in rural and remote communities.

Learning outcomes:

1. Identify how collaborative care models can be established to optimise the quality of patient care in rural and remote communities.
2. Describe the role of collaborative care models in creating a rural health workforce to service the needs of a region.
3. Outline how allied health and other supports are vital to improve outcomes and maintain efficient health care while working closely with GPs in a healthcare team.

Background: Clinical guidelines are one tool to help translate research into clinical practice. Recently the Stroke Foundation, in partnership with Cochrane Australia, tested a world-first ‘living guidelines’ model to ensure new evidence is rapidly incorporated into recommendations. This continually updated guidance is available online so it can be accessed by stroke-care health professionals in any location.

Aims: To describe the living stroke guidelines and their acceptability, access and impact, with a focus on rural and regional care.

Methods: A mixed-methods evaluation of the living guidelines was undertaken focused on internal stakeholders (clinical experts, consumers and the project team involved in the development) and external stakeholders (end users). Traffic to the guidelines via the website was monitored via Google Analytics. Changes to care were measured by the National Stroke Audit, which involves retrospective case audit of up to 40 consecutive cases focused on recommended processes of care outlined in the guidelines. Acute hospital services are invited to participate in the audit if they admit over 40 annual stroke admissions, with some flexibility due to geographical reasons. Descriptive analysis was undertaken for 14 recommended audit indicators corresponding to the Acute Stroke Clinical Care Standard.

Results: There were 178 external stakeholder responses to an online survey. Sixty-nine per cent of end users reported increased trust in living guidelines, over half (57 per cent) reported they have increased their access of the guidelines and 65 per cent reported increased likelihood to follow the guidelines. Website analytics found a 292 per cent rise in unique page views (23,535 in 2016 to 92,327 in 2020) and a 222 per cent increase in users (16,517 in 2016 to 53,154 in 2020) of the guidelines page.

A total of 3,890 cases were audited: 425 cases were from outer regional services, 1,131 cases from inner regional services and 2,334 cases from major city services. Outer regional services were the poorest performing services. None of the 14 indicators from outer regional services or inner regional services were higher than major city services. Inner regional services outperformed outer regional services in 11 out of 14 indicators. There has been greater improvement in indicators in regional areas compared to large cities over time.

Conclusion: Living guidelines are well accepted and accessed, and provide an important tool for evidence-based care. However, indicators related to the Acute Stroke Clinical Care Standard remain lower in rural services compared to large city services.

Background: Stroke Foundation is a national charity that partners with the community to prevent, treat and beat stroke. We lead evidence-based education for stroke health professionals through provision of the Clinical Guidelines for Stroke Management (evolving into the world’s first living guidelines as the next generation of health evidence translation), the National Stroke Audit Program and InformMe (a dedicated website for health professionals working in stroke care).

Quality improvement activities have traditionally been face-to-face, a model which has limited reach and regional and remote inequities. The coronavirus pandemic (COVID-19) necessitated adaptation to an interactive digital format which led to the development of an innovative pilot program.

Aim: To improve stroke patient outcomes and reduce inequities in the provision of care through a national digital quality improvement program.

Methods: In collaboration with state and territory hospitals, specialist stroke experts and other expert organisations, we piloted a national digital interactive quality improvement program. The program utilised data and evidence from the National Stroke Audit and Clinical Guidelines for Stroke Management to support clinicians to identify barriers and gaps and provide effective improvements in quality of care. A secure webinar environment facilitated collaboration between sites and states, and a peer-to-peer model allowed opportunities for exemplary hospitals to share strategies for improvement.

Relevance: Leveraging off learnings from the pivot shift caused by COVID-19, a local stroke quality improvement activity has been transformed into an innovative, collaborative national program which is able to reach hospitals regardless of location in Australia.

Results: The pilot was launched in 2020 with successful delivery of 10 webinars for 1,200 stroke health professionals from over 200 sites nationally. Topics included discharge planning and ‘My Stroke Journey’, audit, living guidelines, stroke prevention, sexuality, delirium and best-practice smoking cessation.

Participant surveys showed that 93 per cent agreed the program would help improve national consistency in stroke care, 100 per cent recognised the training value for staff new to stroke, 91 per cent would recommend the webinars to others and 100 per cent were interested in future webinars.

Conclusion: Stroke Foundation’s pilot national digital interactive peer-to-peer program was an innovative and collaborative method of supporting and connecting stroke healthcare professionals from across Australia to drive quality improvement and improve patient outcomes. Building from the success of the pilot, we plan to embed this model into our stroke health professional education and scale the program reach to influence standards and consistencies in stroke clinical care nationally.

Australia must do a better job of meeting the mental health needs of regional and rural Australians.

Mental health is a silent health determinant in rural health and, with a reduction in stigma around mental illness, we’ve seen a widespread increase in help-seeking behaviour. We need to ensure there is a highly skilled mental health workforce to service this increase in demand.

Psychologists form the largest mental health workforce in Australia, and yet 82 per cent of psychologists are employed in major cities.

We will outline what is needed for government, health practitioners and policymakers to address the alarming rates of mental illness, suicide and self-harm in our rural communities.

These reforms will require structural reform, a national workforce plan and solutions, and an agile use of technology – such as telehealth – to meet the needs of rural Australians. These geographic pressures also require health practitioners to employ a multidisciplinary, coordinated, stepped-care approach to the delivery of services.

We must also look closely at the growing body of work around Aboriginal and Torres Strait Islander Social and Emotional Wellbeing models, and how this can be meaningfully embedded within our mental health system. It is vital we produce, attract and retain a culturally sensitive, literate and diverse workforce to truly meet community needs.

As a peak body, we are committed to improving the mental health and wellbeing of rural Australians, including targeted support for vulnerable groups. We are guided by evidence-based solutions and ‘whole-of-community’ action to create tangible reform where it’s needed most.