Program
A PDF version of the program is now available here:
Keynote speakers
Lara Fuller
Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University, Victoria. As an academic general practitioner, her teaching and research interests are in curriculum design for rural medical education, learning in longitudinal integrated clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Margaret Garde
In 1985 Margaret Garde arrived in Portland, Victoria, to join her partner, now husband. Being the only female GP, and the youngest by at least 10 years, brought with it a sense of professional isolation.
The disciplines in which she worked included family planning, occupational health, Aboriginal health, public health, forensic medicine, adolescent health and mental health. Now she has a strong interest in teaching and supporting students and doctors who wish to live and work in a rural location, with a strong emphasis on giving them the preparation they need to feel confident and secure.
Thus followed the hosting of a string of medical students, John Flynn Scholars, and cousins, children of friends or anyone else who was remotely interested in medicine as a career.
As is now well recognised, none of these wonderful people returned to Portland to work.
In 2012 the opportunity to work in Portland’s GP SuperClinic presented and, together with this, the ability to host Deakin University students from a rural background who reside in Portland for their 12-month placement.
This, together with a visit from Paul Worley, the then National Rural Health Commissioner, provided the inspiration for our longitudinal rural vocational experience.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Christine Giles
Chris Giles is a senior executive with considerable experience leading and managing regional, rural and remote health services.
Chris has a strong clinical background as a nurse then midwife, which has proven very valuable in her recent executive roles. These executive roles include working in healthcare organisations in Western Australia, Victoria and Queensland.
Most recently, Chris has worked as the Chief Executive Officer of Portland District Health in south-west Victoria. Prior to this she spent three years living in the Torres Strait, working as a District CEO for Queensland Health.
Chris has a passion for finding solutions to wicked problems, often challenging the normal by finding innovative solutions to improve health service access and quality for rural and remote communities. Some of these solutions include extending scope of practice for clinicians, training cohorts of nurse practitioners and using technology such videoconferencing and electronic health records to overcome distance.
As a sideline, Chris is on the Board of the local catchment management authority, keen to ensure land and water resources are managed to ensure future generations can enjoy them as we do.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.
Stan Grant
Stan Grant is the International Affairs Editor for the Australian Broadcasting Corporation (ABC), a multi-award-winning current affairs host, an author and an adventurer.
Well known for having brought the former Prime Minister Malcolm Turnbull to tears when interviewed about Indigenous affairs on The Point, Stan’s keynotes are insightful, engaging, always professional and, at times, controversial.
Stan’s Aboriginal heritage has shaped his dynamic, resilient personality. Born in Griffith in south-west New South Wales (NSW) in 1963, Stan Grant’s mother is from the Kamilaroi people and his father is of the Wiradjuri.
Stan spent most of his childhood on the road living in small towns and Aboriginal communities across outback NSW. His father was an itinerant saw-miller who worked when and where he could. Stan moved so often he attended 12 different schools before he was in his teens.
The early travelling gave Stan a love of adventure and stories. He grew up listening to the tales of his grandfather and uncles and aunts. Despite poverty and an early sporadic education, the security of his family and the larger Aboriginal community gave him a strong platform for life.
After attending university, Stan won a cadetship with the Macquarie Radio Network, launching a career in journalism that has spanned more than 30 years and more than 70 countries. In that time Stan has travelled the world covering the major stories of our time from the release of Nelson Mandela, the troubles in Northern Ireland, the death of Princess Diana, war in Iraq, the second Palestinian intifada, the war on terror, the South Asia tsunami, the Pakistan earthquake and the rise of China.
Stan has hosted major news and current affairs programs on Australian commercial and public television. He has been a political correspondent for the ABC, a Europe correspondent for the Seven Network based in London and a senior international correspondent for the international broadcaster CNN based in Hong Kong and Beijing.
Returning to Australia in 2013, Stan continued to cover international events for Sky News Australia and reignited his passion for telling the stories of his own Indigenous people. He has worked as the Indigenous editor for The Guardian Australia, managing editor for National Indigenous Television and international editor for Sky News. In 2016 Stan was appointed as special adviser to the then Prime Minister Malcolm Turnbull on Indigenous constitutional recognition.
Stan has won many major awards including an Australian TV Logie, a Columbia University Du-Pont Award (the broadcast equivalent of the Pulitzer Prize) and the prestigious United States Peabody Award. He is a four-time winner of the highly prized Asia TV Awards including reporter of the year.
Stan has written The Tears of Strangers and Talking To My Country (Harper Collins), and has published numerous articles and opinion pieces for The Sydney Morning Herald and The Australian.
Stan Grant is passionate about justice and humanity. His years of international reporting have given him a deep understanding of how the world works. He is deeply immersed in the politics and history of Asia and the Middle East. He can link the importance of leadership and the impact of history and, above all, believes in the power and resilience of people.
Stan is married to ABC Sports broadcaster, Tracey Holmes, and has four children. He lives in Sydney.
Booked through: Celebrity Speakers www.celebrityspeakers.com.au
Mark Howden
Professor Mark Howden is Director of the Institute for Climate, Energy and Disaster Solutions at The Australian National University.
He is also an Honorary Professor at Melbourne University, a Vice Chair of the Intergovernmental Panel on Climate Change (IPCC) and the Chair of the ACT Climate Change Council. He was on the US Federal Advisory Committee for the Third National Climate Assessment, was a member of the Australian National Climate Science Advisory Committee and contributes to several major national and international science and policy advisory bodies.
Mark has worked on climate variability, climate change, innovation and adoption issues for over 30 years, in partnership with many industry, community and policy groups via both research and science-policy roles. Issues he has addressed include agriculture and food security, the natural resource base, ecosystems and biodiversity, energy, water and urban systems.
Mark has over 420 publications of different types. He helped develop both the national and international greenhouse gas inventories that are a fundamental part of the Paris Agreement and has assessed sustainable ways to reduce emissions. He has been a major contributor to the IPCC since 1991, with roles in the Second, Third, Fourth, Fifth and now Sixth Assessment Reports, sharing the 2007 Nobel Peace Prize with other IPCC participants and Al Gore.
Gabrielle O'Kane
Gabrielle O’Kane is Chief Executive Officer of the National Rural Health Alliance, the peak body for rural health in Australia. She is an Adjunct Associate Professor with the University of Canberra and Charles Sturt University. Gabrielle has extensive experience in the private and public health sector, which has contributed to her deep understanding of the need for collaborative partnerships to support the rural health workforce and achieve positive health outcomes for rural communities. She promotes solutions to the Australian Government to address the needs of rural communities and health professionals, through her position on many pertinent steering groups and committees.
Roland Sapsford
The Climate and Health Alliance’s new Chief Executive Officer, Roland Sapsford, has been working to respond to the challenge of climate change and the task of reducing emissions through public policy and activism for much of his professional life.
This work has ranged from being involved in New Zealand’s first study of the impacts of carbon taxes and work on energy efficiency and home insulation policy, through to getting solar panels installed on a local community centre and campaigning against major road projects.
Roland once completed four years of a medical degree and was a senior manager in public health for five years. He has also studied economics and systems ecology to postgraduate level, and has a strong commitment to Indigenous rights.
Rabia Siddique
Rabia Siddique is a history-making humanitarian, best-selling author and multi-award-winning international keynote speaker. She is a sought after transformational coach and mentor and speaks English, French, Spanish and Arabic.
Current work
Rabia’s powerful and engaging presentations on leadership, resilience, equality and diversity draw on her personal story of strength, courage and forgiveness, in addition to her legal, military and psychology training. Surviving a hostage crisis in Iraq, Rabia garnered global attention for making the British military accountable for silencing her about her ordeal and role as a military lawyer in releasing captured Special Forces soldiers. Standing up for justice in the face of public ridicule, Rabia’s brave action in suing the British Government for sexism and racism became a catalyst for policy change to ensure a fairer workplace for women and cultural minorities in the British military.
Rabia is an expert commentator, regularly appearing in newspapers and magazines, and on television, radio and online media in Australia and around the globe, including The Guardian, 60 Minutes and ABC television.
With her best-selling memoir Equal Justice also the focus of a feature film, she is now writing her second book.
Rabia is an Ambassador for 100 Women, Angelhands, Esther Foundation, Inner Ninja (mental health support) and Ishar (multicultural health service). She is a Board Member of the International Foundation of Non-Violence, Museum of Freedom and Tolerance, Wesley College and Calan Williams Racing.
Previous experience
Law: Rabia’s extensive career as a criminal, terrorism, war crimes and human rights lawyer has taken her to Europe, the Middle East, South America, South East Asia and Australia.
Military: Her military career includes serving as a British Army officer in England, Northern Ireland and the Middle East. Rabia was one of England’s first Armed Forces Employment Law Officers – a role which took her to Royal Military Academy Sandhurst where she ran equality and diversity training. Among her charges was Prince William, the Duke of Cambridge.
Keith Suter
Dr Keith Suter is considered one of Australia’s most influential global futurists and media commentators in national and foreign affairs. He has also held many strategic leadership roles. Dr Suter is an experienced, professional and awarded presenter renowned for explaining complex global and business issues in a way his audiences can digest and understand. He is in demand as an MC and conference facilitator. Keith’s tailored keynotes, workshops and facilitated sessions are entertaining, highly compelling and always captivating.
In 2019 Keith was proudly appointed as a Member (AM) of the Order of Australia (General Division), for significant service to international relations and to the Uniting Church in Australia.
Previous experience
Academic expert: Dr Keith Suter has achieved three doctorates. The first of these was about the international law of guerrilla warfare (University of Sydney), the second about the social and economic consequences of the arms race (Deakin University) and a third doctorate on scenario planning (University of Sydney).
Leadership roles: He has been appointed to many prestigious roles throughout his career, including Chairperson of the International Commission of Jurists (NSW), Director of Studies at the International Law Association (Australian Branch) and Managing Director of the Global Directions think tank. After 25 years, Keith recently retired from the role of Chairperson of the International Humanitarian Law Committee of the Australian Red Cross (NSW).
Global recognition: He has also been a member of the prestigious Club of Rome since 1993. The Club is ‘an informal association of independent leading personalities from politics, business and science, men and women who are long-term thinkers interested in contributing in a systemic, interdisciplinary and holistic manner to a better world. The Club of Rome members share a common concern for the future of humanity and the planet.’ The club has only 100 members, with Mikhail Gorbachev among them.
Keith is a Life Member of the United Nations Association of Australia in recognition of his service. At various times from 1978 to 1999, he served as the National President of the organisation and took on the roles of WA and NSW State President.
Strategic roles: Keith was the President of the Centre for Peace and Conflict Studies (1991–98) at the University of Sydney, and was a consultant on social policy with the Wesley Mission for 17 years. In addition, he served as a consultant for a number of other organisations with a focus on local and international issues. He is also an active member of the Australian Institute of Company Directors.
Media roles: He frequently appears on radio and television discussing politics and international affairs. He has been, for many years, the foreign affairs editor on Channel 7’s Sunrise program.
Renowned author: Among Keith’s many books are All about Terrorism: Everything you were afraid to ask, as well as Global Order and Global Disorder: Globalization and the Nation-State and 50 Things You Want to Know About World Issues … But Were Too Afraid to Ask.
Susan Wearne
Susan Wearne is a general practitioner (GP) and senior adviser to the Australian Government Department of Health and Aged Care regarding rural health and health professional education. She trained at Southampton University in England and completed general practice training in Northamptonshire and back home in Cheshire. She owned a practice in York, England, and worked at the Aboriginal Medical Service in Alice Springs and for the Royal Flying Doctor Service at Ayers Rock Medical Centre. She has extra qualifications in child health, women’s health, family planning, primary health care and medical education and now works as a GP in Canberra.
Susan is a Clinical Associate Professor at Australian National University and has published over 40 peer-reviewed articles on general practice and medical education. The fourth edition of her textbook Clinical Cases for General Practice Exams was published in 2019. She held educational leadership positions in the Northern Territory before taking on national roles for the Royal Australian College of General Practitioners and General Practice Education and Training. She works in the Health Workforce Division which manages general practice training and other programs that promote Australians’ access to qualified health professionals. She was medical lead for the soon to be released Australian National Medical Workforce Strategy.
Susan’s husband, Tim Henderson, is the eye surgeon at Alice Springs Hospital. Their daughter and her family live in England and their son works in Adelaide. Between flights home to Alice, Susan swims, makes clothes and enjoys the scenery on the lake as she learns to row.
Justin Yeung
Justin is a consultant emergency physician by training. He has had a number of leadership positions in WA Health – director roles in emergency medicine (Royal Perth Hospital, Albany Health Campus and WA Country Health Service) and medical services (Great Southern region of Western Australia). He is currently Medical Director of the WA Country Health Service Command Centre, which incorporates a number of 24/7 clinical streams in acute telehealth – emergency, inpatient medicine, mental health, obstetrics and midwifery, palliative care and acute patient transfer coordination. Justin splits his time between Perth and Albany, and still maintains clinical exposure working in the Emergency Telehealth Service and locums in regional Western Australia. To add some spice to the year, Justin has started postgraduate studies in health care leadership. He’s also an oft-stung beekeeper.
From humble beginnings as a limited-hours, weekend-only, single-doctor emergency consultation service for a handful of small country hospitals in Western Australia (WA), the WA Country Health Service Command Centre is approaching a 10-year milestone of providing specialist-led clinical consultation directly to rural patients using video-enabled technology. The Emergency Telehealth Service (ETS) has grown into a 24/7 virtual emergency department, managing more than 27,000 consultations in 2021. The range of clinical services available to support our regional clinicians using telehealth has expanded to include inpatient care (2018) and mental health (2019), obstetric and midwifery, palliative care and, most recently, transfer coordination (all commenced in 2022). We will present an overview of our 10-year journey, highlight areas of innovation and success, as well as outline challenges we have and continue to face.
Plenary sessions
Opening Session:
Julieanne Gilbert MP
Assistant Minister for Health and Regional Health Infrastructure, Queensland – Welcome to Brisbane
Emma McBride MP
Federal Member for Dobell, Assistant Minister for Rural and Regional Health
Plenary Session 1:
Russell Roberts
Australian Journal of Rural Health
Editor in Chief 2017–21 – AJRH 30 Years
Jason Waterford
HESTA Australia Ltd
Plenary Session 4:
Helen Haines MP
Independent Federal Member for Indi
Closing remarks:
Stephen Gourley
Deputy Chair, National Rural Health Alliance
Concurrent AND POSTER presenters
Jessie Adams
Jessie is currently completing her PhD at Deakin University and the National Centre for Farmer Health. Her research is focused on exploring children’s exposure to occupational risk on Victorian farms by investigating their exposure to farm hazards, risk-taking behaviours, the presence or absence of safety measures and attitudes on child farm safety.
Additionally, Jessie has worked at the National Centre for Farmer Health as a research assistant for several years, working on many projects aiming to improve the health, wellbeing and safety of farmers. Prior to this, Jessie worked at Deakin University’s Institute for Physical Activity and Nutrition assisting with projects measuring children’s physical activity.
Child farm-related injury: measuring hazard exposure and farm safety attitudes
Children in outer regional, remote and very remote areas suffer injuries at a rate three times higher than their metropolitan counterparts. Particularly at risk are children on farms; between 2001 and 2019, there were 222 children under 15 years who died from farm-related injuries. Farms are unique environments as they combine a hazardous workplace with a home for many Australian families. It is well-understood children suffer farm injuries and the key agents responsible. However, research is yet to explore their exposure to farming hazards and the attitudes, behaviours and actions of children and their parents on farms.
Therefore, this study aimed to develop a greater understanding of children’s exposure to occupational risk on Victorian farms by exploring their exposure to farm hazards, risk-taking behaviours, the presence or absence of safety measures and attitudes on child farm safety.
A modified Delphi approach was undertaken as the first stage of this study. A heterogeneous group of experts (such as farm-safety specialists and researchers, child farm-injury professionals and farm-safety educators) were invited to participate in a three-round Delphi process with the aim to develop a validated survey exploring children’s exposure to farming hazards, risk-taking behaviours, attitudes towards farm safety and experience of farm injury. During the first two rounds, the expert participants were required to rate questions on whether they should be included in the final validated survey. The third round was held as an online discussion to ensure consensus was reached on all potential question items. Two surveys were developed, one targeted to children (aged five to fourteen years) and another for their parent or guardian to complete.
The Delphi procedure developed a survey that can measure behaviours and attitudes of children and their parents on farms. This tool can be used on varying cohorts, including children and parents in different geographical locations, to allow for identification of similarities and comparisons in behaviours.
Child farm-related injuries are a problem that must be addressed; children are dependent on adults to create a safe environment for them. This surveying tool will assist in addressing this issue by allowing identification and understanding of common farming exposures and behaviours of children and their parents, to assist and inform development of targeted and culturally appropriate injury prevention strategies.
RAHDaR on climate: emergency department presentations across rural south-west Victoria
The climate is changing, with more frequent and extreme heat predicted. Extreme heat kills more Australians than any other natural disaster. Current research has demonstrated increases in emergency department presentations in capital cities, but little research has examined rural and regional locations. Many factors increase the risk of heat-related illness – the work environment being a key determinant. Specifically, outdoor workers (including agricultural workers) are at high risk. This study aimed to determine if emergency department presentations across the south-west region of Victoria increased on high-heat days.
This retrospective study used the Rural Acute Hospital Data Register (RAHDaR) to explore emergency department presentations in rural south-west Victoria from 1 February 2017 to 31 January 2020 (November to March). High-heat days were defined as days with temperatures over the 95th percentile. The International Codes of Disease, 10th edition (Australian Modification), associated with heat-related illness were identified from previous research. As occupation was unknown, a protocol was developed to identify farming towns and subsequent farming populations in south-west Victoria – an area estimated to have 70% or more of the population involved in farming was identified as a farming location, presentations from those areas were classified as farming. Data analysis used SPSS and Excel.
Overall, there were 61,632 presentations of residents from the nine local government areas in south-west Victoria during the 453 study days – 3,064 (5.0%) on high-heat days and 58,568 (95.0%) on non-high-heat days. On high-heat days, 6.5% (n=199) were from farming areas and 2,865 (93.5%) from non-farming areas. Conversely, 7.4% (n=4,341) of presentations on non-high-heat days were individuals from farming areas and 54,227 (92.6%) from non- or low-farming areas. Injury was the most common reason for presentation. On high-heat days, farmer presentations were 17% less than on non-high-heat days. Non-farming area presentations also decreased, but at a much smaller rate (4.8%). On high-heat days, farmer attendance decreased by three times more than those from non-farming areas. Interestingly, admission rates per day were similar between high-heat (n=1.6) and non-high-heat days (n=1.5).
Overall, presentations on high-heat days were lower. Surprisingly, this trend was more apparent in the farming cohort. However, admission numbers per day were similar, suggesting the reduction in presentations is predominantly in less serious cases not requiring admission. Unlike previous metropolitan studies, the south-west region of Victoria does not experience increased presentations on high-heat days. The reasons for this are unclear. This presentation will highlight considerations for rural and regional health services and discuss findings.
Laura Alston
Dr Laura Alston is a National Heart Foundation Research Fellow whose research is focused on addressing rural health disparities in preventable diseases, such as cardiovascular disease. Dr Alston has been recognised by the World Heart Federation as an Emerging Leader due to her research into inequalities in cardiovascular disease in rural Australia. Dr Alston is also the Inaugural Director of Research at Colac Area Health and has established a health service research unit that now oversees more than 30 projects led by rural health service clinicians, researchers and collaborators in a medium rural township in Victoria.
Establishment of a rural health service research unit: an evolving success story
Rural health services are leadership bodies within their communities and play a key role in addressing rural health disparities through providing evidence-based prevention initiatives, community health care and clinical services. Relative to metropolitan settings, there is a paucity of rural health services research in Australia. This has been theorised to contribute to a lack of rural-specific scientific evidence, an important factor in the complex system driving health disparities in rural, regional and remote areas.
Many challenges exist for publicly funded rural health services when undertaking research, first being a lack of research funding, equipment or infrastructure, alongside workforce retention issues. A recent study by Alston et al, found that a lack of rural-specific evidence and rural health services research made it more difficult for policymakers to make evidence-informed decisions about policy that will affect the health of rural communities.
In this abstract we describe a success story of building health service research capacity and capability from [location name omitted] with the formation of the first-ever research unit to be owned by the rural health service. [Location name omitted] is defined as a ‘medium rural town’ by the Modified Monash Model. [Health service name omitted] is the largest health service in [location name omitted] and provides services across acute, aged care and community health for more than 22,000 rural Victorians. Relative to metropolitan areas, the catchment community has increased rates of obesity, cardiovascular disease, mental health conditions, as well as higher sugar-sweetened beverages consumption and sub-optimal diets, ultimately leading to increased disease burden on the health service.
Our case study shows that the initiation of an internally led project, alongside executive, the [university department name omitted] and external participation in and support from an academic health science centre, can lead to further expansion of research within rural health services. This case study also reflects Hulcombe et al’s current Australian contextual framework within the literature and we share our lessons learnt along the way.
This example has led to reflections across the health service and surrounding region around the potential of research in rural health services of all sizes. There is a strong case for large-scale research funding for rural health services, to build capacity, capability and research culture. This will play a role in addressing persistent rural health inequalities for future rural Australian generations.
Synthesising dietary intake data in rural Australian adults
Dietary risk factors, namely low intakes of fruits, vegetables and whole grains, and high intakes of sodium and saturated fat, are now the leading preventable risk factors contributing to the burden of disease in Australia. Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians.
Methods: A systematic literature review aimed to synthesise the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion.
Results: A total of 1,862 articles were screened, identifying 22 articles for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes.
Recommendations and conclusion: Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available, and a lack of consistency between dietary outcomes collected in research, to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities. Where possible, collaborations should be established with nutrition professionals with expertise in dietary assessment methodologies to ensure valid, reliable tools are selected and that the outcome data is presented clearly, interpreted in the context of relevant research, and compared with national public health recommendations.
A lack of high-quality dietary data collection and monitoring will contribute to inhibiting progress with the prevention of chronic disease in rural areas for future generations. Additionally, multidisciplinary rural health researchers should prioritise adding dietary outcomes to existing programs of health research, which could further our understanding of the environmental and/or health system factors relevant to diet-related disparities among rural populations. Future Australian research in rural communities should be conducted with representative populations; include standardised measures of rurality; use validated dietary assessment techniques; present comprehensive dietary outcome data; and clearly compare dietary intakes with relevant public health recommendations.
Mitchell Anjou
Mitchell Anjou AM is an optometrist and public health professional who works as an Academic Specialist, Associate Professor and Deputy Director of Indigenous Eye Health at The University of Melbourne. He leads advocacy and implementation initiatives to Close the Gap for Vision and eliminate avoidable vision loss and blindness for Aboriginal and Torres Strait Islander Australians. Mitchell directed public eyecare services in Victoria for over two decades at the Australian College of Optometry and currently contributes through boards and committees of the Optometry Australia, Vision 2020 Australia, Optometry Council of Australia and New Zealand, Australian College of Optometry and jurisdictional and regional eyecare groups across Australia.
Evaluating regional approaches to improving Aboriginal and Torres Strait Islander eye health
Aims: The 2012 Roadmap to Close the Gap for Vision (Roadmap) followed comprehensive consultation with service staff, eyecare practitioners, service users and communities across Australia to investigate barriers to care and develop solutions to improve Aboriginal and Torres Strait Islander eyecare. The Roadmap recommended policy and practice changes at national, jurisdictional and local levels including implementation of reform at a regional level. The regional strategy ensured flexibility and appropriateness for different needs within regions, and ownership by those living and working within the local area. Indigenous participation and leadership through Aboriginal Community Controlled Health Organisations was central to regional implementation.
Since 2013, regional approaches have been implemented across Australia, with over 60 regional groups in all states and territories. Activity is implemented differently across different regions, reflecting the diversity of communities, systems and structures, and different needs across regional, remote and urban settings – as well as stages of implementation.
This presentation will report the first comprehensive evaluation of regional implementation of the Roadmap.
Methods: A formative evaluation using a mixed-methods approach included a national survey, regional case studies, key informant interviews, administrative data and literature review. Data was captured from all jurisdictions, across regional, remote and urban settings.
The evaluation was co-designed with Indigenous and sector stakeholders. First Nations researchers were involved in the project and an Aboriginal and Torres Strait Islander reference group provided guidance and support for the project.
Results: Eight regional stakeholder group case studies, 98 national survey responses, key informant interviews, a desktop review of the literature and administrative data provided the complex data set for the evaluation.
Key findings from the evaluation include significant learnings, including barriers identified and effective solutions applied, in a regional approach to health reform and the role of intermediary organisations to support this work. Regional stakeholder groups have effectively supported more equitable eye health outcomes for Indigenous Australians and the importance of Indigenous leadership, self-determination, knowledge and capacity enhancement, and the value of collaboration are evident.
Conclusions: The aim of the Roadmap was to deliver systematic and sustainable solutions to close the gap for vision between Indigenous and non-Indigenous Australians. This evaluation explored the value of regional approaches to eye health system reform. Ongoing co-design will determine translation of the research findings and implementation in the future direction of eyecare reforms including regional collaborations, and may inform systems approaches used in the broader health sector.
Clara Jane Armstrong
No biography provided.
Start the Dream: community partnerships to build successful educational pathways
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.
Dennis Asante
Dennis is a PhD student in public health. His research interests span across environmental health, gerontology/ageing and health services in rural and underserved communities. Dennis’ PhD project focuses on co-morbidity, emotional and psychological wellbeing, and patterns of health service use among older adults in rural Australia. He has a professional teaching background, a master’s degree in public administration and a certificate in summary statistics (biostatistics) from Johns Hopkins University. He has served in various academic positions ranging from student leadership to research assistance. Dennis has 15 international, reputable peer-reviewed academic journal articles published; several others are under peer review. He has advanced skills in qualitative and quantitative analysis.
Is psychological distress associated with higher health service use among rural adults?
Background: Psychological distress refers to non-specific symptoms of stress, anxiety and depression. The impact of psychological distress can lead to poor health outcomes in chronic disease. However, there is scant evidence on psychological distress and multimorbidity in rural Australia.
Aim: Our aim was to investigate psychological distress among older adults (aged ≥60) and to evaluate the relationship between psychological distress, multimorbidity and health service utilisation in rural South Australia (SA).
Method: A retrospective cross-sectional design was adopted using data from the South Australian 2013–17 population health survey. The current study analysed a subsample of respondents age 60 years and older rural South Australians (n=6435); Modified Monash Model MM2–7. The dataset provides information on the proportions of respondents who reported physical health conditions, comorbidity, psychological distress and patterns of health service use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population. The Kessler Psychological Distress Scale (K10) is a 10-item measure designed to assess non-specific psychological distress in epidemiologic surveys. In our sample, 8% (n=515) had reported mental health conditions (anxiety, depression or other mental disorder) and were excluded from the analysis.
Results: The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress measured using Kessler’s scale was 12.5 (3.6). One-fourth (33.7%) report one chronic condition, 20.4% reported two chronic conditions and 13% had more than three chronic conditions. Presence of heart disease, diabetes, stroke, asthma, chronic bronchitis, osteoarthritis, rheumatoid arthritis, osteoporosis was associated with increased psychological distress in rural SA. Higher K10 scores were associated with increased comorbidity and service uptake. Multimorbidity was associated with increased psychological distress and higher health service utilisation. Psychological distress was independently associated with general practitioner visit (odds ratio 1.09 [95% CI 1.07-1.11], p<0.001), emergency department visit (odds ratio 1.07 [1,04-1.11], p<0.001) and hospital admission (odds ratio 1.07 [95% CI 1.04-1,1], p<0.001), after adjustment of age, gender, alcohol intake and chronic disease.
Conclusion/implication: The significant association between higher K10 scores and physical conditions suggests the presence of psychological distress. Psychological distress increases with multimorbidity and substantially influences health service use in rural Australia. Thus, rural clinicians should appropriately assess and manage psychological distress and multimorbidity.
Hannah Ascroft
Hannah is a highly regarded occupational therapist at Royal Far West, working to help preschool and school-aged children across Sydney, New South Wales and Australia. Royal Far West is a charity that has been in existence for just shy of a century and is based in Manly, Sydney. Prior to this, Hannah held the position of occupational therapist and team leader at Qualia Occupational Therapy for Children. Hannah is a Sydney University graduate, with a Bachelor of Applied Sciences in Occupational Therapy.
Currently working as a senior occupational therapist at Royal Far West, Hannah specialises in paediatric care, providing high-quality assessment and therapeutic services to country kids in regional, rural and remote Australia. These services are provided in a variety of ways, including on site at the facility in Manly, in the community on outreach visits, and into the homes and schools of the children via Telecare services.
Passionate about the use of telehealth as a modality to support student placements, Hannah also holds the role of student liaison officer and is responsible for organising the placement of students remotely and making sure these students are well-supported.
Using technology to provide virtual occupational therapy student placements during a pandemic
Aims: Student learning placements in health facilities are a core part of health-related degrees, and a requirement of clinical qualifications to ensure maintenance of high standards of clinical practice, and to create opportunity for clinical education and supervision skill development.
Despite significant strains on the system created by COVID-19, health governing bodies did not change the hours of student placements required for graduation, creating need to proceed with placements. COVID-19 substantially changed service delivery, including impacts on the ability to provide in-person service and some limits on the range of services offered. Consequentially, therapists needed to remodel and adjust, with similar adaptation required to continue providing student placements.
As an organisation that had been delivering Telecare services well before the pandemic, clinicians at [organisation name] had confidence in telehealth, which supported adaption to support virtual placements, in this case for occupational therapy (OT) students.
Method: The pilot included six OT students from two universities completing third- and fourth-year student placements. A work-from-home policy, student placement package and orientation manual were developed, and a multiple supervisor model was used. Information was collected during and at completion through use of a placement evaluation tool, anonymous student surveys and supervisor feedback to evaluate effectiveness of placement, and to gather qualitative data on overall experiences of both parties.
Relevance: Successful adaption of face-to-face student placements to provide a positive virtual learning experience has broader value and applications in the rural and remote workforce, training and education space.
Results: All virtual placements were successful. While limitations and practical implications were identified through evaluation, 100 per cent of students rated the virtual placement as ‘extremely beneficial’ in supporting professional growth and providing a worthwhile learning opportunity.
Conclusions: Virtual placements provide similar quality learning experiences for students. These findings can be used to extend the scope of student placements, by reducing geographical barriers to accessing high-quality placement experiences.
Telehealth delivery of services is a key component in reducing inequitable service access and outcomes for rural and remote communities across Australia, as well as other disadvantaged groups.
It is important to provide learning opportunities for students to develop skills in delivery of services via telehealth/virtual placements to broaden the accessibility of specialist service experience for students. From our findings this is a viable option to provide an effective student placement, as well as build clinician competence and confidence in telehealth delivery.