Aboriginal and Torres Strait Islander peoples are over-represented in terms of high dental needs and under-represented in the dental workforce, with only 0.5 per cent of the Australian dental workforce having Aboriginal and/or Torres Strait Islander backgrounds (DBA, 2020). It is essential that all dental and oral health professionals in Australia are able to provide healthcare services free from racism and culturally safe for all people receiving health care. The term ‘cultural safety’ first developed in Maori nursing practice in the 1990s (Papps and Ramsden, 1996) and is now part of all entry-to-practice and specialist accreditation standards in Australia. Without cultural safety, there is no clinical safety and ‘patient safety includes the inextricably linked elements of clinical and cultural safety’ (Ahpra, 2021). Cultural safety is a component of being fit to practice as a safe and effective health professional.

The purpose of cultural safety preparation in dental practitioners is to ensure that the health, self-determination and wellbeing of Aboriginal and Torres Strait Islander peoples is enabled and supported in all interactions with health practitioners and experiences of health care. The twofold purpose of this curriculum is to contribute to the development of new graduate dental practitioners with appropriate knowledge, skills and practice to provide culturally safe oral health care and to create a culturally safe educational approach which will support the development of an Indigenous dental workforce. This paper presents the Dental Aboriginal and Torres Strait Islander Cultural Safety Curriculum, commissioned by the Australian Council of Dental Schools, developed for Australia’s dental schools to support their ability to meet Ahpra accreditation standards.

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

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

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

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

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

A 2018 report analysed projections in population, health status and health workforce trends in rural and remote Australia, to determine the health status, health service needs and gaps in services over the next decade. Cancer, mental health and cardiovascular disease are predicted to be the most prevalent health concerns over this period, with those in rural and remote areas expected to be most impacted.

The report also found, over the next decade, there will be significant shortages of essential health services in rural and remote Australia. For example, in 2028, projections demonstrate there will be less than one-fifth of the number of general practitioners (GPs) in remote as compared to metropolitan areas (43 as compared to 255 per 100,000 population respectively); just one-twelfth of the number of physiotherapists (23 as compared to 276 per 100,000 population); and half the number of pharmacists (52 as compared to 113 per 100,000 population).

In addition, a follow-up report released in 2020 sought to specifically demonstrate the inequities in access to primary healthcare services currently experienced by those in rural and remote areas.

In the rural and remote context, where there are small populations spread across large geographical areas, it may not be realistic or practical for everyone to have access to permanent local services. However, the Australian Institute of Health and Welfare proposes that all Australians should have reasonable access to services, which it defines to be access within a 60-minute drive time.

It was found that 42,805 people had no access to any place-based primary healthcare services within this 60-minute drive time. Furthermore, when looking at the specific primary healthcare type, it was found that 65,050 Australians had no face-to-face access to a GP; 440,387 had no access to a nurse-led clinic; 142,269 had no access to dental services; and 106,848 had no access to mental health services within a 60-minute drive time.

These reports show that the greater the distance from city centres, the greater the disparity remote Australians face in access to health care, education and facilities. Acknowledging the tyranny of distance as a hurdle in healthcare provision to remote Australians, the presentation will explore the need for further research and collaborations to agree a definition of what is ‘reasonable’ access to health care for rural and remote Australians and how, through innovative service models, we can better ensure equity of access to services.

State and national oral health plans and strategies have identified higher levels of dental disease in rural and regional areas of New South Wales (NSW) and even higher disease rates in communities with a high Aboriginal population. Among rural and remote communities, there have been long-standing issues with access to dental care, including issues with dental and oral health workforce shortages, as well as little or no access to culturally appropriate care for Aboriginal people.

In 2014, the Poche Centre for Indigenous Health at the University of Sydney co-designed a new oral health service in collaboration with Aboriginal communities in rural NSW, following an invitation from local Elders to improve access to dental care for people in their communities. This required a sharing of power in the relationships between the university and community leaders that led to enduring trust and a service model that saw providers located locally. This replaced a costly traditional fly-in fly-out model with dental professionals from Sydney or Queensland delivering care episodically. It saw the inclusion of strong prevention strategies that were also co-designed with key community members.

The model has led to long-term change in oral health status, the development of related innovation in education and workforce models, as well as co-created research. These outcomes include a significant reduction in dental caries among children, the development of an Aboriginal Dental Assistant Scholarship Program which is in its seventh year of operation, and the development of a school-based fluoride varnish program which has led to urban and scalability pilots in other parts of the state and has influenced national oral health policy. The oral health service has been running successfully for seven years and continues to be led by the local team. Most importantly, this co-designed oral health service has challenged the traditional notions of the core business of universities and their relationships with Aboriginal Elders and community-controlled health services. The co-created research and related activities has led to over 23 peer-reviewed journal articles since 2016.

The presentation will outline the development of the service, the key treatment and oral health promotion components and its links to wider oral health workforce projects. We will also explore how this oral health program has been influencing policy and practice statewide and nationally in three areas: the use of teledentistry, school-based fluoride varnish programs and the installation of water fountains.

Background: Chronic health conditions (such as diabetes, cardiovascular and respiratory disease) are causes of high levels of preventable hospitalisations in Gippsland, Victoria. Limited progress addressing longstanding structural challenges including access to health services, service coordination and health workforce shortages, highlight the urgent need for new approaches to assist people to manage chronic health conditions.

This presentation outlines an approach piloted in far-east Gippsland. Developed jointly by Gippsland Primary Health Network and the Royal Flying Doctor Service Victoria, [email protected] aims to improve the health outcomes of people with chronic disease by enabling access to comprehensive clinical decision-making and care coordination within or close to home through remote monitoring.

Implementation: A bespoke model of care was developed that enables patients with chronic health conditions to undertake regular home-based monitoring and access comprehensive clinical decision-making and care coordination at home.

Using Lifeguard Health Networks digital platform, [email protected] allows real-time patient health provider connectivity via a mobile app for patients and a web dashboard/app for health practitioners.

Monitoring is mobilised through patients regularly reporting health-related information defined in monitoring templates. Developed by a clinical reference group, the suite of monitoring templates have predefined clinically significant thresholds for vital signs and patient-reported outcome measures (PROMs). Patient information outside a threshold generates an alert to the health provider, signalling deterioration and enabling timely intervention.

Outcomes: Seven health services are involved and 22 practitioners actively monitor patients via 17 monitoring templates. The project aims to involve 300 patients. An external evaluator is engaged and ethics approval gained. Data will be collected via patient and health service surveys, semi-structured interviews with patients, patients’ circle of care and health providers.

Short-term outcomes to be reported include:

• stakeholder engagement and user acceptability
• health service perceptions of capability to support chronic disease management through remote monitoring
• patient perceptions of changes in self-care capability and collaborative care approach enabled by remote monitoring.

Early insights include the:

• benefit of using a proxy/carer model to engage patients who otherwise would be unreachable
• importance of monitoring PROMs and vital signs to identify deterioration
• varying degrees of digital literacy amongst health providers
• importance of a team-based care approach within and across services to embedding a patient-centred model of care.

This approach offers rural health services an innovative approach to prioritising and responding to patients’ healthcare needs.

The COVID-19 pandemic changed the way we work, spend, live and learn. The impact was particularly felt in the health sector, where hospitals cancelled elective surgery, put on hold outpatient services and implemented new social distancing procedures and telehealth systems, to enable hospitals to increase bed capacity. For medical students, these factors meant significant disruption to their clinical placements, remote delivery of their education, cessation of international and interstate placements, complicated by significant travel restrictions and border closures. There were concerns that final-year students might be unable to graduate in 2020 due to this lack of clinical exposure.

As a result of this disruption, in late March 2020 we developed an innovative six-week ‘COVID-19 e-lective’ rotation, consisting of online modules, virtual clinical tutorials and a COVID-19 project, totalling the equivalent of 200 hours of work. This provided a learning opportunity for those students who were going to miss their planned clinical placement for 2020.

An evaluation was undertaken that found it to be very successful in meeting the students’ learning needs and alleviating concerns about disrupted placements. The impact of COVID-19 on interstate and international clinical placements continues to be felt in 2021. The rotation was revised and was undertaken by all Year 4 students to help expand and manage available clinical placement opportunities during 2021.

This paper describes the COVID 19 e-lective, its innovations, challenges, outcomes and future in the medical curriculum. This unique experience can be replicated at other institutions, amid the ongoing natural evolution of the pandemic.

Mentoring can be a critical aspect of goal setting and achievement career development for medical students and doctors in training, particularly during times of change. It is also reported as being an important tool in encouraging mental health and wellbeing when it is offered. In 2019, the online mentoring platform, Mentorloop, was rolled out across two regional medical training sites in rural New South Wales. This program was implemented in response to requests from the two groups that became the mentee cohort: medical students undertaking extended rural clinical placements and doctors in training at the two rural hospitals. The program had the dual goal of supporting career development and creating supportive social networks for the participants.

Over the past three years, the platform has enabled over 300 mentors (senior clinicians) and mentees (students and doctors in training) to engage in mentoring relationships based not only on proximity and discipline, but demographics, interests and cultural connection. Each year our number of mentees and mentors has grown as new students and doctors in training move to these communities and local senior clinicians return annually to re-commit to the program. Through this time, we have learned about the logistics of implementing a widescale and multisite program, how to promote authentic engagement and meaningful partnerships. Critical to the implementation of the project was knowing when not to use the full functionality of the platform, namely the choice to manually match mentors and mentees, rather than allow the program to automate this process. While this process was more labour intensive, we believe this work was central to high satisfaction scores and feedback from both mentors and mentees.

This presentation will review the implementation and ongoing evaluation of the project, and case studies of successful and unsuccessful mentoring partnerships. We will share lessons learned, lessons we’re still learning and our plans for the future of the program as we continue our aim to support the development of the rural medical workforce and promote mental health and wellbeing in our students and doctors in training.

End of life is an uncomfortable subject that most people would prefer to avoid, even though talking about and planning for end of life can provide people with greater choices, a better quality of life and can help with loved ones’ grief and bereavement.

A recent collaboration between WA Primary Health Alliance and a local government agency resulted in the roll-out of a range of community arts projects aimed at generating conversations about end of life. The interactive arts programs were designed to engage the community and challenge the stigma around end of life and ageing.

One project was an exhibition titled ‘Permission to Die’. The project began with community workshops to unravel jumpers to collect wool, which was then placed in small timber coffins around the community with instructions for how to crochet a ‘floret’. The florets were integrated within an installation that included a lined coffin made from reclaimed timber that viewers were encouraged to lie in.

The arts program used a Compassionate Communities approach that encouraged community and neighbourhood networks to play a stronger role in supporting people, their families and carers at the end of life, encouraging people to adopt an understanding that health is everyone’s responsibility, not just that of their doctors or health services.

In a rural community, informal support from friends, clubs, neighbours and community gives people the choices about where and how they would like to spend their time up to, and including, their dying moments. For rural residents this can involve the decision to return home after seeking curative treatment in metropolitan areas.

Caring at end of life can be isolating and a significant cause of isolation in seniors once a loved one has died. The project sought to demonstrate that being involved in a network of support can not only help to address isolation but be rewarding, provide meaning, purpose, and a sense of belonging for everyone involved.

Through the partnership with local government the project has had access to a greater range of existing networks, programs and resources, such as the Public Library and the Community Arts Centre. As the first line of connection to people where they live, local governments play an important role in contributing to the social wellbeing of communities. Local governments undertake critical functions that influence people’s sense of connectedness to their community, overall community wellbeing, and ultimately their resilience to hardship, including serious illness.

Introduction: The Australian healthcare system struggles to meet health needs in rural communities. The government response concentrates on increasing the availability of doctors with limited exploration of the potential contribution of other healthcare workers such as paramedics.

Australian paramedics are well-educated, nationally registered and plentiful. Paramedics practice in diverse contexts including communities and (remote) industrial settings, with about 25 per cent of paramedics working outside of ambulance services. There is currently a surplus of graduates exceeding jurisdictional service demand, which allows for the opportunity to deploy paramedics in new roles and settings.

Community paramedicine (CP) is an emergent field of practice where paramedics use knowledge, skills and clinical reasoning beyond an emergency response, thus contributing to preventive and rehabilitative health in communities. CP is a feasible and financially viable approach for addressing the growing demands on health systems. CP is increasingly accepted by healthcare providers and consumers and is recognised within paramedicine as one of the ways forward for the profession. Internationally and in some Australian jurisdictions, there exist very successful CP models. However, there is limited consistency across different jurisdictions in terms of collaboration, roles, education and governance.

Recently, due to the current surge of interest in CP, many reviews have been published with variability in quality and scope. As part of our work in developing an innovative CP-led multidisciplinary model of healthcare delivery in parts of Victoria, we are undertaking a review of reviews, to identify the current evidence on opportunities and challenges to implementing successful CP models.

Methods: A systematic search of the literature was undertaken to identify reviews of CP care delivery, education and governance. The literature was investigated for evidence on opportunities for CP, as well as challenges.

Results: The results summarised the evidence on opportunities and challenges for the implementation of CP care delivery, education and governance, in countries with advanced paramedic systems.

Discussion: To facilitate the wide-spread implementation of CP models and their place in future development of the paramedic profession, it is important to identify and manage unnecessary hurdles, and to streamline education and governance. We will discuss the results of the review within this broader context.

Introduction: People living in rural areas face considerable health issues, compared to people living in metro areas. On average, they have shorter lives and suffer from more diseases. Important contributing factors are lifestyle differences, geographic location, and a disadvantage in education and employment opportunities, as well as reduced access to health services, such as a specialist, general practitioner or hospital. This inequity between rural and metro health is a persistent problem.

Rural health consumers, patients and their carers, are an important stakeholder, but they are not systematically involved in the prioritising, improving and delivery of health care in rural areas. In research there is growing attention to co-designed or consumer-led research as this supports the translation, user acceptability and impact of research.

To enable the systematic involvement of rural health consumers, we have established Australia’s first Rural Health Consumer Panel (RHCP), for the improvement of rural health outcomes. This unique panel enables systematic involvement of rural health consumers and is modelled on successful international health consumer panels.

Methods: Rural health consumers are invited to join the panel for a period of two years. They are recruited through local rural networks. The panel is growing to around 5,000 health consumers. Health and wellbeing data are collected systematically from the panel participants, and members actively participate in research and education. The panel members will not just have an advocacy role.

The consumers on the panel:

• undergo a health assessment before they join
• complete general health surveys during their time on the panel
• are actively involved in the co-design of research projects
• are involved in education, for example in helping students learn to undertake clinical assessments.

Results:

• The systematic and long-term approach results in a longitudinal dataset on rural health and wellbeing from a consumer perspective. This is a move away from an ad hoc involvement of consumers in research.
• Through involvement in education, the panel actively shapes the next generation of healthcare workers and encourages a patient-centred approach.
• The panel helps set the agenda for healthcare improvement from a strong consumer perspective.

Discussion: The panel aims to be a driving force behind improving the health and wellbeing of rural healthcare consumers in Australia.

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.

Only 500,000 people live in Australia’s most remote locations, but they have disproportionate access to health services and, consequently, poorer health outcomes. There are often long waits to access services and, in some cases, people are unable to access the services they need.

Our research indicates lack of access to adequate telecommunications is still the main barrier to accessing telehealth for many of our rural, regional and remote people. There have been significant advances in satellite internet technologies and the Sky Muster Plus service has been shown to be adequate for telehealth via videoconferencing with a typical minimum speed of 25 Mbps download and 9 Mbps upload. The research has also demonstrated telehealth can be part of the solution to this long-term problem and supplement the services currently available in rural, regional and remote areas (St Clair & Murtagh, 2021).

Project partners, Simbani Research and Synapse Medical, have developed a pathway – the Telehealth for the Bush (TH4B) Trial – that connects doctors, specialists and nurse practitioners (NPs) to patients, in the same way ride-sharing companies connect drivers. Synapse Medical’s mobile phone app is a medical billing system which facilitates clinicians billing Medicare from their mobile devices and can also be used to connect healthcare providers and patients through telehealth appointments. NPs are highly qualified registered nurses, educated and authorised to diagnose and treat patients in collaboration with medical practitioners. NPs can provide in-person and telehealth consultations, access Medicare rebates, provide prescriptions and access to PBS medicines, order diagnostic tests and refer patients to specialists. National standards ensure NPs provide high-quality, patient-centred care working in similar roles to general practitioners.

The TH4B Trial (the technology combined with the NP pathway) has evolved to provide access to a wide range of health services for 42 patients over the last eight months. They have had appointments through the TH4B Trial and accessed telehealth-based health care that supplemented available services or provided services that were not available. Some of these patients have had more than one subsequent appointment with a specialist, others have had pathology and diagnostic imaging services provided and two have required surgery. One patient was linked into the public waitlist. They had their surgery within a few weeks.  For some, TH4B replaced services where there was no continuity of care or provided access to services that were unavailable to the patient.

Additional functionality has been added to the mobile phone app for this project. Referrals can now be made at the press of a button. Administration is reduced, Medicare billing is correct and health care is provided using a fast, compliant framework through this project trial. Patient data (subject to patient’s approval) will be uploaded to My Health Record, thereby improving data integrity for patients.

Using the theory of collaboration (Grey, 1989; Huxham & Vangen, 2004), this new model of service delivery may address gaps in health care for rural, regional and remote Territorians, including remote Aboriginal communities and cattle stations.

Background: There are 143 Aboriginal Community Controlled Health Organisations (ACCHOs) providing primary health care to Aboriginal and Torres Strait Islander communities across urban, regional and remote settings. One key role that many ACCHOs play is facilitating safe access to medicines for their clients.

Medicines management is the clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit, while minimising potential harm. This includes ordering, prescribing, dispensing, administering and/or stocking medicines. Strengthening medicines management in health services has been shown to improve safe and effective use of medicines. There is little evidence available regarding medicines management in Australian primary care services, including ACCHOs and general practices.

Aim: To analyse ACCHO medicines management activities across Australia in the context of ACCHOs’ models of care and the broader health system.

Methods: All ACCHOs were invited to nominate suitable participant/s to complete an online survey developed from a global medicines management literature review. Results were collated, coded and thematically analysed. Survey participants were invited to participate in follow-up in-depth interviews, for further analysis.

Results: Eighty-five participants completed the survey, including responses from 48 distinct ACCHOs – around one-third of all ACCHOs. Participants reflected ACCHOs’ diverse geographical distribution and range of practitioners. Twelve individuals participated in the follow-up interview.

Medicines management activities were heterogeneous across ACCHOs. Significantly variation was identified in the following themes: amount and type of medicines stocked, medicines management staff, medicines governance, and policies and procedures. Some themes varied depending on geographical remoteness and jurisdiction. The most common reasons to stock medicines were for emergency use, for acute conditions and improving client access. Around half of respondents (47 per cent) identified their ACCHO using a standard medicines list; all Northern Territory respondents reported a standard list, compared to 15.4 per cent of Queensland respondents. Medicines list governance was sometimes managed informally (n=15), while a similar proportion (n=13) had formal processes and/or used standard treatment guidelines.

Conclusion: Our findings reflect ACCHOs’ independent governance processes and the consequent variability in medicines management activities as determined by the priorities of the community. However, results also demonstrate the paucity of suitable guidelines and materials to support consistent and evidence-based medicines management activities for the ACCHO sector, including from mainstream Australian or international guidelines and literature. This research identifies an opportunity for ACCHOs to provide medicines management support and knowledge between organisations, which ultimately stands to improve health outcomes for Aboriginal and Torres Strait Islander people.

Background/approach: Since the advent of highly effective and tolerable treatments in 2016, Australia has made great progress towards eliminating hepatitis C (HCV) as a public health threat by 2030. To achieve HCV elimination targets, innovative interventions that support provider knowledge and skills are required, in particular for regional and remote services where access gaps may lead to delays in treatment initiation. A recent HCV mapping study has highlighted that rural and remote settings are frequently areas of high HCV prevalence but low treatment uptake. In response, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) has developed a comprehensive, incentivised virtual program to support eligible providers to develop the necessary skills to conduct HCV case finding within their own practice by increasing the identification of people for testing or follow up.

Analysis/argument: ‘Beyond the C’ has recruited 27 sites since September 2019 including three sites located in regional centres, nine in rural settings, one remote and one very remote. The virtual design of the project provided the ideal environment for supporting enrolled practices with their case finding and clinical auditing quality improvement (QI) activities. Additional key project components included providing access to online education and resources to support clinicians in these settings, as well as the identification of ‘HCV champions’ to take ownership of project components; data integrity, collection and extraction. The project aimed to embed sustainable QI skills enhanced by facilitated collaboration between practices, ASHM and local primary health networks.

Outcome/results: Enrolled practices are located in New South Wales, Victoria, Western Australia and the Australian Capital Territory and include Aboriginal Community Controlled Health Organisations and general practices. The use of videoconferencing through Zoom was employed to facilitate project support and communication between the general practice nurse consultant and the practices. Rural and remote practices have demonstrated high levels of enthusiasm in working with their data to improve the lives of people with HCV. Practices have identified that limitations of medical software and data extraction tools, under-resourcing, access to pathology, allocating time for clinical auditing and integrity of data are barriers to case finding.

Conclusions/applications: Inequitable distribution of healthcare resources is a contributing factor to poor treatment uptake in rural and remote regions of Australia. An individualised and incentivised approach to case finding is required to support services in these settings. Differences between practice needs, skills, resources and practice software functionality indicate the need for tailored support to ensure a sustainable model of QI is built at practice level.

Australian Government frameworks focusing on the needs of families with young children and rural and remote health have highlighted the need for the adaptation of innovative models of service delivery to address the unique contexts of different rural communities and their health needs. An international call to action to address the health outcomes gap for those living in disadvantaged regions, including those living in rural areas, has also been promoted in documents released by the World Health Organization (WHO), emphasising the need to adapt interventions and develop contextualised service models for lower resourced settings.

This presentation will describe a doctoral study exploring the extent to which an Australian metropolitan service model for specialist (level 2) child and family health services can be implemented in rural and regional areas. Consumers and other key stakeholders were engaged through Participatory Action Research (PAR) and a Modified Delphi Study to ensure the voices of parents and rural health professionals were heard, to inform the co-design of adaptations to a service model, enabling contextualisation to meet the needs of local communities and address the power differential that can occur between researchers and participants.

This presentation will report on the three phases of this doctoral research, all of which sought to utilise collaborative research approaches to facilitate co-design. The first phase was an initial PAR cycle in rural New South Wales to review service model fit for context; followed by a modified e-Delphi Study with an expert panel including parents of children living in rural and remote settings, together with academics and service planners. The results of the e-Delphi study identified 97 elements to be considered when adapting child and family health service models for rural community contexts. Through a process of thematic analysis, these elements were utilised to develop a draft framework to guide the adaptation of specialist child and family health service models for diverse settings, which was then tested with a second PAR group with another rural community.

Key themes were identified as the members of the PAR groups shared insights into the strengths, needs and priorities for their communities and the Delphi expert panel participants considered the broader application to other diverse community contexts. The research design and process will be described and research outcomes and subsequent local and organisational actions taken in response to the findings will be reported.

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.

As the World Health Organization (WHO) 2022 deadline to eliminate trachoma draws closer, the #endingtrachoma project has decided to invest and focus on the F and E within the WHO SAFE strategy – the facial cleanliness and environmental health components. Overall, our project works with and trains Aboriginal organisations who employ Aboriginal environmental health workers (EHWs), regional Public Health Units and the WA Health Environmental Health Directorate to develop a sustainable approach to reducing trachoma – through environmental health change in community. We work with remote communities to develop a community-driven Community Environmental Health Action Plan which identifies and plans for sustainable and realistic trachoma prevention strategies. Through this, we support locally identified projects in community such as the environmental health clinical referrals and the healthy homes project.

The healthy homes component is highly coordinated. We train EHWs to conduct home assessments and, within that, to identify risk factors within the house that cause disease. These assessments identify structural issues requiring maintenance to ensure functional health hardware but also provide a hygiene-related conversation. The EHWs provide free soap, light bulbs, mirrors at child height, coloured towels and towel hooks, shower roses and tap spindles, and have a conversation with the householder about the importance of hand and face washing. We have developed several tools to facilitate this conversation.

This presentation will briefly cover the healthy homes process but focus on the training and tools to support these visits and how the project promotes the importance of prevention within the SAFE strategy.

To bridge the social distance between health promoters and the farming community, new and innovative ways of working are required. Statistically, farmers have higher rates of skin cancer, noise-induced hearing loss, mental illness, suicide and cardiovascular disease. Farmers have self-reported worse mental and general wellbeing outcomes than non-farmers living in rural areas and are significantly less likely to access health services for their physical or mental health. Innovative preventive health techniques are needed to create effective communication to farmers. This paper describes an innovative use of engagement and co-production methods and digital media to engage this niche group of health consumers.

The Farmer Wants a Healthy Life (FWAHL) program aimed to reach farmers during their everyday lives using digital communication methods. The project was developed through a consultation process which engaged and empowered target audience members. Representatives from the local farming industry co-designed the initial development and identification of the FWAHL program’s methodology, including the content development process and the creation of a culturally and functionally appropriate advertisement strategy.

The resultant Farmer Wants a Healthy Life podcast series was launched in June 2021. The series’ first eight episodes focused on a range of topics including mental health, social and emotional wellbeing, men’s health, zoonotic disease and cancer. Dedicated pages on social media platforms are utilised to provide a cascade of appropriate information and resources. Metrics regarding utilisation of the pages are a significant component of the ongoing development and evaluation of the project.

There has been a growing evidence base for consultation and co-production in the creation of health promotion programs and interventions. This program illustrates the benefit of translating theory into practice when engaging with a niche target audience. As a result of the consultation process, the lived-experience insights provided by the target audience members involved influenced significant revision of the program. Changes included the format for engagement, adoption of digital media for messaging, and development and refinement of content, including prioritisation of topics and suggested speakers. The success of the program is largely attributable to the consultative and responsive program development, and the engagement of key stakeholders from the target audience. FWAHL is a positive example of translating evidence into practice, utilising digital media, and the value of engagement with consumers in the development of health promotion strategies.

Background: The onset of the COVID-19 pandemic has had a significant impact on the mental health and wellbeing of Australians and forced a rapid shift to alternative service models for many health services, while also managing substantially increased demand. Digital mental health services offer obvious advantages in such circumstances and have a strong evidence base for their safety and effectiveness. This paper explores views from rural and remote health practitioners about their use of digital mental health with clients, particularly in the wake of the pandemic.

Method: Data was collected as part of the activities of the e-Mental Health in Practice (eMHPrac) project, which is funded by the Australian Government to promote digital mental health in primary care. In 2021, eMHPrac surveyed health practitioners in a range of locations on their use of digital mental health with clients, perceived barriers, impact of COVID-19 and training requirements. eMHPrac also continued to collect annual data on user registrations and practitioner referrals to Australian digital mental health service providers.

Results: Numbers of new users and referrals to phone lines, web counselling services, forums and programs have risen between 30 and 90 per cent following onset of the COVID-19 pandemic, with some programs seeing an increase of over 300 per cent. Rural and remote health practitioners reported growing knowledge of the benefits of these tools and are much more willing to use and recommend them to clients. However, they also reported lack of time and skill to introduce the resources in sessions, issues with internet access and client digital literacy, and a perception that clients might not be receptive to recommendations or referrals to these resources. A follow-up survey will be occurring in early 2022 to identify continued trends or changes.

Conclusion: The increased use of digital mental health highlights the value of these options in facilitating rural access to mental health and wellbeing support, and in assisting to manage high demand for services. Rural and remote practitioners are keen to utilise digital mental health services with their clients, however they do require ongoing support to embed these options realistically within their practice. eMHPrac are currently monitoring and evaluating some innovative ideas for improving practitioner confidence in this area.

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

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

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

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

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

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