The Youth At Risk Research Network (YARRN) is an ARC-funded research project that is aimed at improving social, economic and health outcomes for high-risk young people in remote communities through the adaptation and implementation of a transdisciplinary research approach. Young people exposed to multiple, co-occurring risk factors experience disproportionately high rates of harm, and Indigenous adolescents are over-represented in this population. These harms persist over their lifetimes, negatively impacting on their ability to participate meaningfully in society. A high proportion of these young people are at very high risk of ending up in juvenile detention, after which their outcomes are much worse. This research project surveyed Indigenous young people participating in youth programs over a six-month period in Central Australia, Bourke, Dubbo and Lake Cargellico in regional and remote Australia to get an understanding of what works in real time. This presentation will focus on the data relating to the Central Australian region with five remote communities involved in the research project. Data analysis concluded in May 2021 and analysis is currently being completed.

The presentation will focus on how the project adapted the survey to be suited to the population including translation of the research tool into Pitjantjatjarra, audio recordings in Pitjantjatjarra, consultation, working with an Aboriginal Research Officer and creating a video in Pitjantjatjarra describing the project and informed consent. Results will also be discussed including the learnings from the research and how we intend to use that information to inform service delivery and advocacy moving forward.

Background: Stroke is a leading cause of disability and the second most common cause of death globally. In Australia, there are approximately 60,000 strokes annually, of which 12,000 people die. By 2050, there is expected to be a stroke every four minutes and 1 million Australian stroke survivors. Hospitalisation rates for stroke are greater in remote and very remote areas (where many Indigenous Australians live) than in major cities in Australia.

The treatment of acute stroke is time-critical and urgent neuroimaging is essential for treatment decisions; earlier treatment dramatically improves outcomes. The first ‘Golden Hour’ after stroke onset is the most important for stroke treatment because the brain is still salvageable within this timeframe when the correct treatment is provided. However, patients in rural and remote areas have limited access to this time-critical management, including neuroimaging, stroke specialist assessment and reperfusion therapy.

The Australian Stroke Alliance is an organisation bringing together over 30 national agencies committed to transforming pre-hospital stroke care. Our Alliance is working together to tailor approaches to meet the needs of priority populations, including remote and Indigenous Australians, in which the burden of stroke is high.

Aims: We aim to develop lightweight brain scanners, to rapidly deliver pre-hospital stroke care by air and road ambulances to all Australians, underpinned by education and a national telehealth platform. This will enable us to dramatically reduce the treatment times for stroke and improve outcomes for patients, particularly those in rural and remote Australia.

Methods: We are working to develop, test and deliver to market three world-first lightweight, portable and affordable brain scanners designed by leading scientists and engineers from South Australia, Queensland and Victoria. These brain scanners will be integrated into road and world-first air ambulances. Utilising telehealth, paramedics in remote locations will liaise directly with a network of stroke specialists who will review brain images, determine immediate patient treatment needs and triage to an appropriate stroke centre. A comprehensive education program will be developed in collaboration with stakeholders to underpin the pre-hospital application of these novel technologies.

Relevance: These new technologies will transform stroke outcomes across urban, rural and remote Australia. Benefits will include a reduction in the healthcare gap for remote and Indigenous Australians.

Results: Outcomes will include delivering: (1) brain scanners developed for the mobile setting and integrated into air and road ambulances that are tested and validated in the marketplace and clinical settings; (2) a validated model of pre-hospital stroke care to enhance capacity and capability for translational research within Australia’s health and medical research sector; and (3) commercial returns to ensure the sustainability of the Australian Stroke Alliance. This will enable reinvestment in future technologies, to be developed and built in Australia.

Conclusions: This mission will revolutionise pre-hospital stroke care, allow 5–6 times more stroke patients to be treated in the ‘Golden Hour’, and will lead to improved outcomes in an estimated 56,000 patients with stroke by 2050.

Aim: This paper describes the alignment of approaches to rural clinical training placements for medical, allied health and nursing students with the evidence for predictors of rural practice.

Method: The paper draws on a synthesis of the rural health workforce literature and a mixed-method evaluation of the Rural Health Multidisciplinary Training (RHMT) program undertaken in 2019–20.

Key findings: The evaluation identified key areas where universities can nuance current approaches to rural training to improve conversion to rural health workforce outcomes.

The evidence for rural origin for future rural work is established. However, mechanisms to identify and preference rural students and those with an interest in future rural work for rural placements are not robust and differ between universities and health courses.

For medicine, the evidence indicates that the number of undergraduate rural exposure opportunities and longer-duration rural immersions (one or more years) increases the likelihood of future rural practice. Furthermore, clinical placements combining regional hospital and rural general practice experience has the greatest impact on subsequent rural practice compared with regional hospital alone, and placements in Modified Monash (MM) 4–7 resulted in a higher likelihood of students subsequently working rurally than placements in MM 2–3. However, the evaluation found that across the RHMT program the majority of rural medical placements occur in inner regional areas (73%) and more than two-thirds of long-term medical placement weeks occur in inner regional hospitals, with less exposure to general practice and primary health care. Developing strategies to increase and support placements in smaller communities, leveraging from regional centres, aligns with the evidence.

The impact of rural placement on workforce outcomes for allied health and nursing is less clear. However, the national multidisciplinary health workforce survey (a component of the evaluation) demonstrated a significant positive impact of longer-duration rural placements (approximately 20 weeks) and positive rural training experience on future rural work. This warrants efforts by universities to review allied health and nursing curricula to enable longer rural placements in care settings reflective of rural and remote communities.

The evaluation found variation in the quality of placement in relation to student experience, wraparound support and supervision. Evaluation rubrics were developed to assess elements of placement quality and there is opportunity for these to be further developed and tested by the universities for placement planning and quality improvement purposes.

While outside the direct sphere of influence of universities, the completion of medical internship in a non-metropolitan setting is a predictor for rural practice. Similarly for allied health and nursing, first job in rural practice is the most significant predictive factor associated with longer-term rural practice. Therefore, strategies to link students who have undertaken rural clinical placements into early career positions by Regional Training Hubs and University Departments of Rural Health, in conjunction with local employers, could strengthen the rural workforce pipeline.

Conclusion: The findings have relevance for the future design and delivery of rural training models to improve conversion to rural health workforce outcomes.

Rural staff recruitment and retention is a wicked, complex problem perplexing researchers and healthcare providers alike, with training and development often described as especially influential to staff taking up rural practice. Limited access to resources, local expertise and dedicated time for learning are some of the barriers described and health services are looking for new strategies to ‘grow their own’ and upskill their staff, as well as attract others. For a comprehensive approach to rural recruitment and retention it is judicious to better understand how learning occurs and what can be implemented to sustain and foster staff learning environments in rural settings.

Aims: The aim of this poster is to describe the multidisciplinary literature on staff learning environments in healthcare settings and how these influence recruitment and retention of rural health staff. Throughout, this work will be overlayed with a lens of postmodernism to accept the inherent complexity of the health care environment.

Methods: A scoping literature review was undertaken examining what are the elements that foster and sustain a learning environment for staff in healthcare settings? Papers included health staff learning in workplace contexts and workplace cultures of learning. Databases searched included Medline, PubMed, CINAHL, ERIC, PsycINFO, Cochrane and Embase.

Relevance: The fostering and sustaining of learning environments for staff in health care is multifaceted, complex and dynamic. Because of this, no one element has been identified from the literature as more or less pivotal to how staff learn in the workplace setting and it is suggested such complexity has remained daunting for staff or the lack of literature would not indicate such a gap. This study will contribute to the body of literature by identifying ways of learning and the role of learning environments for staff of rural hospitals.

Results: The scoping literature reviewed 25 from 1673 papers and revealed staff are motivated to learn, nonetheless their own values and beliefs will guide their decision making on what and how to learn and with who (if anyone). Informal learning is important and an organisational culture that prioritised learning, collaboration and evidence-based practice. Dedicated time, heavy workloads and lack of collaboration/supportive leadership were identified as barriers. There seemed an underestimation of the impacts of physical space and resourcing on learning environments, thus space could be shown to be influential but not enough is yet understood of its impact. These elements will be considered in two further rural health services observational studies and how they influence staff learning environments.

Conclusions: The literature review has identified factors significant to staff learning while also indicating a lack of in-depth qualitative studies pertaining to rural health staff learning environments. Understanding how to create positive staff learning environments may contribute to addressing recruitment and retention issues for rural health services going forward but it is clear a flexible approach to staff learning is vital to keep staff working in rural areas. Follow-up research will involve observational studies of rural staff work-integrated-learning.

Background: Evidence is clear that when health services are not inclusive and safe, those experiencing exclusion are less likely to use them. Lack of inclusion places the health and wellbeing of some people at risk. In Australia, residents who are First Nations, immigrants, lack resources and/or have non-normative identities or understandings of health often feel unsafe, intimidated or unable to access health services. In rural communities, providing inclusive health care is particularly necessary because there are fewer services, less choice of services, fewer specialist services and greater health need. Many rural health services struggle to increase inclusion because the underlying reasons for exclusion have not been addressed.

Aim: This paper aims to present a framework that will seek to challenge exclusion in rural health services in order to prepare these services for specific inclusion frameworks.

Relevance: Inclusion is particularly important for rural health services because they are generalist services that must cater for the needs of all local residents, regardless of patients’ cultural background or identity/ies. While some health services have adopted culturally specific agendas to increase inclusion for a particular group (for example, First Nations), most rural services struggle to implement and sustain these because the reasons for exclusion have not been identified or reframed.

Methods: Authors developed this framework from action research in four rural ‘mainstream’ health services over five years. The four services were based in northern Victoria and focused on different health care models and life stage. Data comprised: (1) interviews and focus groups with staff to identify their understandings of exclusion; (2) interviews and focus groups with local residents to understand their experiences of in/exclusion; (3) evaluation of a series of change activities to reframe exclusion within these services; and (4) researcher journals and reflections that identified lessons learned from trying to deconstruct exclusion.

Results: Working in, and with, four rural health services over many years, this framework was developed from evaluation and analysis of what worked to prepare health services for inclusion. Researchers developed an interdisciplinary framework that weaves together continuous quality improvement processes with Foucauldian concepts of power and discourse to embed cultural humility and consumer voices in health care. The framework outlines: five foundational concepts (power, deconstruction, continuous quality improvement processes, cultural humility and voices of service users); followed by six principles highlighting what a rural health service can expect (a journey, expect resistance, whole-of-service approach, make visible the reasons for change, we are all cultural beings and people-centred care); and then six processes undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement).

Conclusion: Until exclusion is reframed, inclusive agendas are unlikely to be effective This framework offers a new approach to preparing rural health services for inclusion of marginalised residents as well as the opportunity for rural health services to lead new models of inclusive practice that could address persisting inequities in their communities. In a world where racial divisions are prominent, deconstructing exclusion is an important step.

Background: Apunipima Cape York Health Council, a community-controlled organisation that provides health services to remote Indigenous communities, has called for action to address food security, informed by the communities it services in Cape York, North Queensland.

Methods: Health staff and academics co-designed a research strategy to support the development of a community framework to improve food security. We outline the opportunities and challenges for co-design of a strategy to deliver benefit, through a reflective process based on The Lowitja Institute Research for Impact Tool, designed to assess research impact with Aboriginal and Torres Strait Islander peoples.

Results: In line with the tool steps, we defined end users and their evidence needs, appraised research and community-level evidence and selected the design through a process of negotiation. Staff were engaged from the outset, though community engagement was challenged by funding timelines and resources, and the notion of setting expectations that may not be met. To address this, a participatory methodology was selected which includes a strong translation focus and elements of assessing benefit. The principles of Indigenous leadership, partnership, and capacity enhancement are strengths of the strategy.

Conclusion: Partnerships between peak health organisations and academics can strengthen research to deliver community benefit. This approach, undertaken in remote Australia, has application in other contexts nationally in considering the creation of evidence that decision makers can use to inform decisions. Engaging community members in food security research will progress action towards ending hunger and achieving food security, improving nutrition, health and wellbeing and reducing intergenerational poverty amongst Aboriginal and Torres Strait Islander peoples.

A group of junior medical officers and specialists working in remote and rural settings have met every two months for two years to share their difficulties and ideas for improving training for specialists who wish to work outside the larger urban and regional hospitals. The group has included doctors working in anaesthetics, ENT and general surgery, obstetrics and gynaecology, psychiatry, emergency medicine, paediatrics and intensive care, as well as rural generalists working in a variety of settings including Papua New Guinea and Vanuatu. The group has had presentations from eight colleges and the AMA about strategies to increase remote and rural training for specialists.

This workshop will present the outcome of these discussions; a generic framework for training remote and rural specialists. There are five parts to the framework:

1. Choose rural – intake for rural.
2. Start and stay – start training remote and rural.
3. Support and succeed – access to key training.
4. GRRAD – an elite workforce of remote and rural specialists who can be deployed anywhere in the world at times of emergency.
5. Return and remain – complete training where needed.

The workshop authors will present the framework and discuss its relevance to their different specialties. The workshop will involve group work to flesh out further issues and solutions for each training stage and for different specialties. The points of failure in current training practices will be discussed and the potential solutions for colleges struggling to provide specialists to remote and rural settings.

The framework is closely aligned with the recent work from the Royal Australasian College of Surgeons (RACS) led by one author, Dr Bridget Clancy. Aspects of the RACS policy will be used to illustrate how the generic framework can be implemented.

Studies in Australia and other developed nations show that life expectancy is shortened by up to 30 per cent for clients of public mental health services compared to the general population, which equates to a life expectancy of between 50 and 59 years.

Mental health is a key priority for Australian governments. Improving the physical health of people living with mental health conditions is one of eight priority areas (Priority 5) for action agreed by all Australian governments under the Fifth National Mental Health and Suicide Prevention Plan (the Fifth Plan).

A series of maps will be presented that overlay a range of national datasets including several linked datasets to show regional variations in workforce, service delivery, health outcomes and social determinants of health.

These maps are building the evidence base to support the development of policy initiatives that are designed to close the gap in life expectancy and improve the overall wellbeing of people living with severe mental illness.

Agencies involved in the project are: Department of Health, Department of Social Services, Australian Bureau of Statistics, and Australian Institute of Health and Welfare.

Aims: To provide an overview of the RANZCP Rural Psychiatry Roadmap 2021–2031, a 10-year action plan to build the Rural Psychiatry Training Pathway to Royal Australian and New Zealand College of Psychiatrists (RANZCP) Fellowship.

Methods: The roadmap was developed through an extensive consultation process conducted by Australian Healthcare Associates on behalf of the RANZCP. This included a public consultation paper, five workshops and input from more than 200 representatives of governments, health services, medical education and workforce stakeholder groups, as well as psychiatrists and trainees with involvement, or an interest in, rural psychiatry practice.

Relevance: Rural and Indigenous communities in Australia have long suffered poorer mental health status and access to mental health services. This has created a cycle of rural disadvantage where under-investment in rural mental health and psychiatry services results in fewer work and training opportunities for psychiatrists and trainees. The medical education system is predominantly designed and delivered in metropolitan areas to meet the needs of metropolitan communities, resulting in psychiatry workforce shortages and fewer available services for people living and working in rural areas.

The RANZCP identified that greater investment in dedicated rural psychiatry training is key to redressing workforce shortages and has developed the Roadmap to support real workforce change.

Results: The RANZCP Rural Psychiatry Roadmap provides a 10-year action plan to build the Rural Psychiatry Training Pathway to RANZCP Fellowship which will enhance the quality of generalist psychiatry training and expand opportunities for trainees to achieve RANZCP Fellowship in rural locations.

The Roadmap identifies five actions and timeframes. Effective implementation of the Roadmap will require a commitment to collective action and close partnership from the RANZCP, all levels of government, public and private health services, education and regulatory bodies.

Conclusions: The RANZCP Rural Psychiatry Roadmap sets out immediate, medium- and long-term action areas to enable the delivery of the RANZCP Fellowship Program in rural locations, maximise training opportunities, and increase the availability of rural psychiatrists.

Language revitalisation programs nationally and internationally claim health and wellbeing benefits. However, this is not visible in Victorian state government policy nor is there a detailed understanding of the current status of Aboriginal languages, specifically in the south-east. The seed project sought to respond to this lack of documented understanding, by developing a health check methodology to provide evidence, sovereign Victorian-specific data to demonstrate these theories. It supported communities/VACL to articulate this significant, frequently unpaid work, and its links to improved individual/community wellbeing and beyond. It was also important to establish a ‘counter’ narrative that defines south-east languages as ‘extinct’ or ‘endangered’ instead of living and developing within communities through language reclamation activities.

The Lowitja Institute Seeding Grant enabled a small team of dedicated project staff to be employed, furthering VACL’s capacity to be engaged in research, an organisation aspiration. Our project built upon current First Nations language policies and revitalisation projects, and Aboriginal and Torres Strait Islander health measures (for example, NHMRC) to develop a community-led Victorian language health check survey. The concept was co-developed under the direction of VACL’s Advisory Working Group comprising Elders, Senior Knowledge Holders and Language Practitioners.

The project sought to be aspirational, asking questions like ‘What does success in language revitalisation look like?’, ‘How can we strive for fluent speakers?’

It was critical to gain information from all generations (children to Elders) to unpack the key issues around Victorian Aboriginal languages and language revitalisation; for example what may be preventing access and abilities to learn, and aspirations for language revival. The Victorian Aboriginal Language Health Check seed project provided important data about Victorian languages at the individual, family and community level.

The seed project aimed to provide evidentiary data and strategic directions towards further research and actions to support and grow Victorian language learning; develop sustainable language programs that build language acquisition capability towards living legacy and nurture local language ecologies that are vehicles for autonomous sovereign language stewardship into the future.

Rural and remote Australia faces many challenges with respect to healthcare delivery and rural health workforce. To counteract some of these challenges, service learning placements are an ideal mechanism to assist with addressing some of these issues, especially when done in partnership and via collaborative processes with stakeholders within the healthcare sector.

This poster presentation will focus on a collaboration and partnership between two University Departments of Rural Health and a disability support organisation in the development, mentoring and implementation of service learning models. This partnership was established with clear objectives and goals. Initially established to assist with meeting identified gaps in health service provision, the partnership enabled all stakeholders to learn with, and from, one another through the process of coordinating and conducting service learning clinical placements. What was evident through this collaboration and partnership was successful outcomes are possible for all stakeholders and service needs and gaps can be met through service learning placements facilitated through such partnerships. How the partnerships were developed and fostered will also be outlined to assist others who may be interested in starting a similar partnership. The intent of this presentation is to demonstrate what is possible with partnerships in health and the successful outcomes which can be achieved for all stakeholders through service learning placements.

Background: The 2019–20 bushfires affected tens of thousands of children and their families across rural and regional Australia. Experiencing a life-threatening natural disaster such as a bushfire can have devastating short- and long-term impacts in rural communities. Although children are often invisible during the immediate crisis response, bushfires pose significant consequences for children’s wellbeing and development. Given climate change, it is likely many more rural Australian children will be exposed to bushfires in the future. A lack of evidence-based interventions to support children affected by bushfires prompted the development and implementation of a tailored, multidisciplinary Bushfire Recovery Program by Royal Far West in 35 schools and preschools across rural NSW. The program was designed to enhance children’s resilience and wellbeing and build capacity among families and community members to support children in their bushfire recovery.

Aim: To externally evaluate the impact of the Bushfire Recovery Program on children’s resilience, wellbeing and development.

Methods: A two-phased mixed methods approach was used. Phase 1 involved analysis of pre- and post-intervention data collected using previously validated and purpose-designed instruments. Data included: descriptions of the impact of bushfires, school/preschool and community contexts, and goals for the program from school representatives (eg, principals; n=29); feedback regarding educational workshops from educators (n=67) and parents (n=9); and feedback on ‘Stormbirds’ group intervention from children (n=265), parents (n=37) and group facilitators (n=15). Quantitative data were analysed statistically, and qualitative data were analysed using content analysis. Phase 2 involved semi-structured interviews conducted online or via phone with school/preschool representatives (eg, principals, educators; n=4), parents (n=4), children (n=2) and a community leader (n=1). Interviews incorporated methods such as photovoice (photographs) and were audio recorded, transcribed, and analysed using narrative and deductive thematic analysis.

Results: Positive changes were reported in children’s behaviour (eg, increased trust and ability to talk to adults about emotions), children enjoyed the program activities, adults and children valued the opportunity to discuss shared experiences, and ongoing support needs were discussed. Participants reported learning about feelings and changes in life, and strategies for coping. Other emergent themes reflected aspects for improvement, such as increased program duration and greater parent involvement, and considerations for enhancing sustainability of the program. Children’s access to necessary allied health services through the program, which were previously unavailable in their communities or had long waiting lists, was a beneficial aspect of the program.

Conclusion: This project provided the first evaluation of a multidisciplinary intervention program designed to support children exposed to bushfires in rural and regional areas. The insights obtained from children and other stakeholders will inform policy and practice regarding bushfire recovery and trauma support in rural communities. Recommendations will be made for supporting wellbeing and resilience among children and families following natural disasters. Further investigations are underway to determine the medium- to long-term impact of the Bushfire Recovery Program, to provide insights regarding the ongoing support needs for children exposed to bushfires.

Mental health and wellbeing is an important issue in rural and remote communities. Recent data shows that, although mental health issues occur at the same rate across Australia, the rate of suicide is much higher in rural communities. In Victoria, the suicide rate in rural and remote areas is 47 per cent higher than in Melbourne. In response to tragic events in the West Wimmera Shire in late 2018, a collaborative partnership was formed, a strategy was identified, and Seasonal Conditions Funds collectively pooled, to develop, fund and implement a collective impact approach to this problem.

The Rural Outreach Program is a Victorian rural community mental health initiative. The program seeks to overcome barriers in access to services, such as mental health stigma, lengthy travel distances to supporting services, long wait times, limited service delivery hours and financial costs. The program has three local community–based Rural Outreach Workers (ROW) plus a coordinator, who have the capacity to respond to the immediate needs of people living in rural and remote communities across four Wimmera Southern Mallee shires.

The program is designed to improve the health and wellbeing of community members who are struggling to deal with tough times in their lives and support them to obtain help through service navigation and collaboration with a network of local services. Referrals to the service are made from local service providers including police, social workers, hospitals, the Royal Flying Doctor Service and bush nursing centres. Community members, including family members, friends or work colleagues, may contact the ROW team using a dedicated telephone number, a visit to the program offices, or in person when out in the community. The Rural Outreach Program provides support to community members’ wellbeing in the following areas: service navigation and collaboration, responsive and convenient times and locations, non-clinical and less threatening service delivery, mental health training and awareness raising in the community.

The Rural Outreach Program has received 500 referrals, made over 280 initial visits, and over 1,000 follow up visits. They presented at 350 health promotion events. The majority of initial visits were to community members’ homes. In some cases, the workers drove three hours to conduct initial assessments. Many community members were men, from farming backgrounds, who have been identified as particularly at risk. The workers provided support and advice around a range of issues including social isolation, anxiety and depression, grief and loss, financial hardship and family violence.

The strengths of the Rural Outreach Workers role are: rapid response times, a non- clinical informal approach and local non-stigmatising assistance for people struggling during difficult and challenging times. Community members may access the Rural Outreach Program after hours, in the privacy of their own homes, at no cost. Challenges to the service include worker fatigue, managing expectations and program sustainability. The Rural Outreach Workers are local, trusted people who are well known and embedded in the communities they service. We believe this is key to the program’s success to date.

Introduction: A strong Aboriginal and Torres Strait Islander health workforce is integral to meeting community needs, especially in regional and remote areas where two-thirds of the population lives. Previous studies examine how to increase the number of Aboriginal and Torres Strait Islander people entering the workforce, with little attention to retention and staff development. Aboriginal and Torres Strait Islander people bring unique knowledge and skills to health services that facilitate access, cultural safety and improve service provision for their communities. However, Aboriginal and Torres Strait Islander people are significantly under-represented in the health workforce and recent growth has been in low status and lower paying jobs with poor articulation to other roles and professional careers.

Objective: To identify factors that support career development of Aboriginal and Torres Strait Islander people in the health workforce and whether they may differ by location.

Methods and analysis: A cross-sectional online survey of Aboriginal and Torres Strait Islander health staff across professions, roles and jurisdictions in Australia was undertaken in 2018, promoted via email and twitter by key health professional organisations, Aboriginal and Torres Strait Islander peaks and affiliates and at national forums. Descriptive statistics were used to summarise participant responses to most questions. Satisfaction with career development was measured on a five-point scale, from very dissatisfied to very satisfied. Predictors of satisfaction with career development were examined using linear regression. Each enabler, institutional barrier and individual characteristic item was included in a simple regression to obtain the unadjusted estimate and 95 per cent CI (Model 1), and also in a model with gender, age group and type of organisation as covariates (adjusted estimate, Model 2). Regressions were run in the whole sample and by location. Assumptions of normality and homogeneity of residuals were met.

Results: There were 332 participants employed in health services with 50 per cent in regional and remote areas, with 42 per cent rating their current career development opportunities as good/very good. Among urban, regional, and remote participants all ‘enablers’, or provided career development opportunities, were associated with higher satisfaction levels among staff. In terms of ‘barriers’, limited opportunities were the main reason chosen overall and by different locations. Racism from colleagues and lack of cultural awareness were identified as predictors of lower satisfaction for those in regional and urban areas, but not for remote respondents. Aboriginal and Torres Strait Islander staff leading career development was strongly supported.

Conclusion: The study highlights the importance of providing a range of career development opportunities to Aboriginal and Torres Strait Islander staff. Barriers to career development include limited opportunities, lack of manager support, lack of mentors and inflexible human resources policies which can impact satisfaction levels. The implications for workplaces in all locations are that providing even a small number of career development opportunities, coupled with leadership by Aboriginal and Torres Strait Islander staff, can make a difference to satisfaction levels and is likely to boost retention of Aboriginal and Torres Strait Islander staff in services and build a stronger workforce to meet community needs.

There are unique challenges faced by rural and remote Aboriginal and Torres Strait Islander communities in accessing and receiving aged care services, and exercising their entitlements with the Department of Health aged care services.

This research was initiated by the Port Augusta community in understanding the gaps in Aboriginal aged care.

This research is a genuine and unique work looking at how Aboriginal peoples understood and access aged care services in rural South Australia. The research team mainly explored the access to My Aged Care portal and delivery (or not) of the Commonwealth home packages. The principal Aboriginal investigator, Kym Thomas, from Port Augusta, provided cultural support and ensured that spirit and integrity were at the forefront of all community and stakeholder community engagement and activities. Communities involved in the research included Port Augusta, Port Lincoln, Ceduna and Whyalla. Kym was supported in his work by Associate Professor Pascale Dettwiller (PL) and Emma Richards (PL). Aboriginal advisory groups were established in each town and consulted. The group consisted of Aboriginal community reps, Aboriginal workers from different organisations and non-aboriginal people representing service providers. They provided insightful and preliminary information about the lack of current culturally appropriate services and perceived barriers to service delivery of aged care. Pilot group questionnaires were trialled in two locations. A semi-structured group interview process (yarning circles) was implemented to suit participants from the four locations. All groups nominated their preferred local cultural brokers, and the principal researcher worked with them through the process, recruitment and delivery of the group interviews.

All collected data was entered into Survey Monkey®, and Microsoft Excel was used to enable quantitative analysis.

Seventy-nine per cent of participants declared that group information was the best means of receiving information about accessing aged care services and enjoyed the yarning aspect of the study approach.

Of the 50 Aboriginal participants, 68% were females and 78% were 60 years or older. Only 44% of them were currently using home aged care services (n=10 through HCP, n=1 through CHSP, n=3 through both programs, n=8 used home aged care services but not from these programs). Among those receiving these services (n=22), nine reported it was because their family were unable to provide the necessary support and seven because their health had deteriorated. The most frequent needs among all participants were help with outside chores (74%), housework (68%), transportation (58%), allied health (46%) and shopping (44%). However, only between 13% and 28% of those reporting these needs were currently receiving home aged care services for these activities. Of the 11 participants that remember how long they waited to receive either HCP or CHSP services, seven referred that they waited 12 months or more.

This community-engaged research indicates a substantial disparity between current needs and home age care services received by Aboriginal older adults in rural South Australia, as well as different barriers in accessing these services or receiving them in a timely manner.

Background: This project examines the use of eyecare services in regional and remote Australia, based on the analysis of administrative data from the National Hospital Morbidity Dataset, the National Health Workforce Dataset and the Medicare Benefits Schedule (MBS).

Methods: The age-standardised and crude rates of hospitalisations with eye-related principal diagnosis by remoteness area, full-time equivalent rate of eyecare providers by remoteness area, and use of eye-health-related telehealth items in the MBS were calculated for 2017–18 and 2018–19.

Results: Rate of hospitalisations with an eye-related principal diagnosis was higher in major cities (age-standardised rate of 1,660 hospital separations per 100,000 persons) than regional or remote areas (age-standardised rate of 1,300 hospital separations per 100,000 persons) in 2017–18.

There were almost twice as many full-time equivalent optometrists in major cities (20.7 per 100,000 persons) than in outer regional areas (11.8 per 100,000 persons), and more than three times as many full-time equivalent ophthalmologists in major cities (4.6 per 100,000 persons) than in outer regional areas (1.3 per 100,000 persons) in 2019.

In 2018–19, almost all Medicare claims for telehealth ophthalmology services in regional and remote areas facilitated by an optometrist came from Western Australia (94 services per 100,000 persons, compared to 0.3 services per 100,000 in other states and territories overall).

Conclusions: Eyecare service provision is lower in regional and remote areas when compared to major cities. Digital health initiatives such as telehealth ophthalmology may help to bridge the gap, however they are still dependent on provider enthusiasm and uptake.

Introduction: Rural allied health professionals (AHPs) provide essential and wide-ranging services to consumers. AHP recruitment and retention is challenging in rural and remote areas, with workforce challenges a key barrier to rural consumers receiving consistent, quality, timely and accessible services.

AHPs come to rural and remote areas for a variety of reasons and a range of retention strategies are used in Australia, but most leave within the first three years of practice.

The Allied Health Rural Generalist Pathway (AHRGP) is one workforce strategy that was established to support early career AHPs to develop rurally relevant specialist skills across clinical areas, support career progression, and develop relevant quality improvement and project management skills.

In 2019, South Australia introduced the AHRGP for the first time with an initial cohort of 12 early career rural AHPs across regional local health networks (LHNs). Selected AHPs were from occupational therapy, physiotherapy, podiatry and speech pathology professions. The trial incorporated a funded evaluation in partnership with Flinders University, with objectives including:

• to explore the experience of undertaking the AHRGP and the impact it has on trainees, teams, organisations and the consumers they work with
• to make recommendations for the sustainability of the pathway and to further improve workforce outcomes for rural and remote health services.

Method: A mixed methods approach was used. Fifteen AHRGP trainees and 25 of their supervisors, line managers and principal clinicians, three project leads and five consumer representatives were recruited to share their experiences and perspectives of the pathway. In-depth interviews were conducted with all participants pre- and mid-pathway, and consumer representatives participated in a focus group. Qualitative and quantitative results were analysed separately and reported together to comprehensively explore experiences and impacts.

Results: Phase one and two interim research findings include:

• the AHRGP is giving early career AHPs the opportunity for broad skill development and career progression
• perceptions of trainees’ confidence and competence improved during the pathway
• most trainees found the training to beneficial but some found aspects of the course not relevant to their caseload and learning needs
• regular, quality, accessible clinical supervision and manager support is vitally important for AHPs to feel supported to participate in the pathway
• rurally raised trainees were more likely to stay in rural areas than those raised in metropolitan areas
• workload and organisational pressures in teams may contribute to trainees leaving earlier than they had planned.

Impact/conclusion: Results and recommendations from the pre- and mid-way evaluations provided background evidence to support additional funding for a second cohort of regional LHN trainees commencing the pathway from 2021. Early evaluation outcomes and a reflection on the 2019 cohort recruitment/selection was used to adapt recruitment/selection of the 2021 cohort. Insights gained into early positive outcomes and challenges experienced by the 2019 group is also being used to improve supports for the both training cohorts. Outcomes from the 2021 cohort will be closely monitored.

Background: The 2019–20 bushfires affected tens of thousands of children and their families across rural and regional Australia. Experiencing a life-threatening natural disaster such as a bushfire can have devastating short- and long-term impacts in rural communities. Although children are often invisible during the immediate crisis response, bushfires pose significant consequences for children’s wellbeing and development. Given climate change, it is likely many more rural Australian children will be exposed to bushfires in the future. A lack of evidence-based interventions to support children affected by bushfires prompted the development and implementation of a tailored, multidisciplinary Bushfire Recovery Program by Royal Far West in 35 schools and preschools across rural NSW. The program was designed to enhance children’s resilience and wellbeing and build capacity among families and community members to support children in their bushfire recovery.

Aim: To externally evaluate the impact of the Bushfire Recovery Program on children’s resilience, wellbeing and development.

Methods: A two-phased mixed methods approach was used. Phase 1 involved analysis of pre- and post-intervention data collected using previously validated and purpose-designed instruments. Data included: descriptions of the impact of bushfires, school/preschool and community contexts, and goals for the program from school representatives (eg, principals; n=29); feedback regarding educational workshops from educators (n=67) and parents (n=9); and feedback on ‘Stormbirds’ group intervention from children (n=265), parents (n=37) and group facilitators (n=15). Quantitative data were analysed statistically, and qualitative data were analysed using content analysis. Phase 2 involved semi-structured interviews conducted online or via phone with school/preschool representatives (eg, principals, educators; n=4), parents (n=4), children (n=2) and a community leader (n=1). Interviews incorporated methods such as photovoice (photographs) and were audio recorded, transcribed, and analysed using narrative and deductive thematic analysis.

Results: Positive changes were reported in children’s behaviour (eg, increased trust and ability to talk to adults about emotions), children enjoyed the program activities, adults and children valued the opportunity to discuss shared experiences, and ongoing support needs were discussed. Participants reported learning about feelings and changes in life, and strategies for coping. Other emergent themes reflected aspects for improvement, such as increased program duration and greater parent involvement, and considerations for enhancing sustainability of the program. Children’s access to necessary allied health services through the program, which were previously unavailable in their communities or had long waiting lists, was a beneficial aspect of the program.

Conclusion: This project provided the first evaluation of a multidisciplinary intervention program designed to support children exposed to bushfires in rural and regional areas. The insights obtained from children and other stakeholders will inform policy and practice regarding bushfire recovery and trauma support in rural communities. Recommendations will be made for supporting wellbeing and resilience among children and families following natural disasters. Further investigations are underway to determine the medium- to long-term impact of the Bushfire Recovery Program, to provide insights regarding the ongoing support needs for children exposed to bushfires.

Background: A ‘situational analysis’ describes the collection and study of information to identify trends, driving forces and conditions related to the problem trying to be solved. The aims of this analysis were to deliver a useful resource for key stakeholders in the Kimberley region of Western Australia (WA) and to provide baseline data for the SToP Trial, designed to ‘See, Treat and Prevent’ skin sores and scabies in partnership with service providers in the Kimberley. Utilising a situational analysis methodology, we assessed the current ‘state of play’ of skin health in the region in 2017. We aimed to map and describe skin health services currently available in the Kimberley to manage skin infections.

Methods: A desktop review of information about skin health management and service delivery was conducted, and 42 Kimberley stakeholders interviewed to gain a deeper understanding of the broader context in which a comprehensive skin program would sit, informing most of the situational analysis. An online survey (48 questions) was completed by 87 respondents. Additional data from two focus group meetings (environmental health and health promotion) and community consultations prior to the commencement of the SToP Trial in nine remote Kimberley communities during were also included to inform results.

Results:

1. Skin infections are common in the Kimberley, however there is evident goodwill in services working together to reduce this burden.
2. The environment, including homes and resourcing within communities contributes to poor skin health. Despite this, interventions in these areas can improve skin health and overall wellbeing of individuals, families and communities.
3. Addressing the social determinants of health is critical to preventing skin infections. As their incidence is determined by a complex array of factors, a holistic approach is required to address skin infections.
4. The Kimberley has led the way in Australian environmental health by developing the Environmental Health referral form to better integrate healthcare assessment with prevention activities.
5. Achieving the Healthy Living Practices will require attention to housing maintenance systems, environmental health and health services working together.

Conclusion: The children of the Kimberley are our future. Healthy skin is one aspect of overall good health that will see them thrive and lead our communities forward. Continuing well-established health promotion programs, depending on Kimberley leadership to overcome environmental health challenges and working to eliminate the social determinants are needed to achieve healthy skin for all remote-living Aboriginal children and to achieve elimination of scabies and skin sores as public health challenges in the Kimberley and throughout Australia.

Rural maternity services in Australia have seen significant change over the last four decades. This has occurred due to several factors including economic reform, population migration, increasing litigation in the healthcare context, workforce shortages and a changing profile of childbearing women.

To date, the strategy has been to centralise maternity care but this approach has had some unintended consequences for both women and clinicians. These include degradation of skills for rural clinicians, social and economic consequences for women and families, and the introduction of new risks to the safety of the mother and baby which may outweigh any intended safety benefits.

The Rural Maternity Taskforce Report (released in 2019) in Queensland confirmed that rural women want continuity of carer within welcoming, comfortable, culturally appropriate services as close to home as possible. The chair of this taskforce also asserted that ‘Rural maternity services, including birthing, can be delivered with very good levels of safety for mother and baby, when risk identification and emergency support systems are well planned and well managed’.

Castlemaine is a small rural town in the goldfields of central Victoria and the maternity service is a Level 2 maternity service in the Victorian Capability Framework for Maternity and Newborn Services with an annual birth rate of between 40 and 60 births.

Prior to May 2020, all pregnancy and birthing care had been delivered by the GP obstetricians (GPOs) and midwives, assisted as required when women were admitted to the hospital for care. As this was a low-risk, low-volume service, midwives rarely had the opportunity to be accoucheur for a birth and were unable to participate in pregnancy care at all. This led to a significant threat to the midwifery workforce and, by extension, the service.

In May 2020, the Castlemaine maternity service was suspended to enable an evaluation of quality and safety, workforce and model of care. A transformative service redesign was required to meet the recommendations of the review team. This project was the first of its kind in Victoria and there was a shared commitment from the state government, Safer Care Victoria, the ANMF, the community and the health service to re-birth Castlemaine Health maternity service.

This work culminated in the first re-opening of a rural maternity service that had been closed in Victoria’s history. The model of care is a midwifery continuity of care model in collaboration with local GPOs that was conceived through consultation with clinicians, consumers, First Nations community members, unions, regional health services and Safer Care Victoria. In this presentation, the project consultant who led this work will walk delegates through the process of deconstructing and reconstructing a rural maternity service in a way that ensures the woman and her family are always held at the centre of the paradigm. The service re-opened in May 2021 after a staged introduction of pregnancy care and, to date, two babies have been birthed in this service – two families that would otherwise have had to travel to a regional service to receive care.

Background: Apunipima Cape York Health Council, a community-controlled organisation that provides health services to remote Indigenous communities, has called for action to address food security, informed by the communities it services in Cape York, North Queensland.

Methods: Health staff and academics co-designed a research strategy to support the development of a community framework to improve food security. We outline the opportunities and challenges for co-design of a strategy to deliver benefit, through a reflective process based on The Lowitja Institute Research for Impact Tool, designed to assess research impact with Aboriginal and Torres Strait Islander peoples.

Results: In line with the tool steps, we defined end users and their evidence needs, appraised research and community-level evidence and selected the design through a process of negotiation. Staff were engaged from the outset, though community engagement was challenged by funding timelines and resources, and the notion of setting expectations that may not be met. To address this, a participatory methodology was selected which includes a strong translation focus and elements of assessing benefit. The principles of Indigenous leadership, partnership, and capacity enhancement are strengths of the strategy.

Conclusion: Partnerships between peak health organisations and academics can strengthen research to deliver community benefit. This approach, undertaken in remote Australia, has application in other contexts nationally in considering the creation of evidence that decision makers can use to inform decisions. Engaging community members in food security research will progress action towards ending hunger and achieving food security, improving nutrition, health and wellbeing and reducing intergenerational poverty amongst Aboriginal and Torres Strait Islander peoples.

Aim: To investigate factors that impacted on access to cardiac rehabilitation (CR) and how well holistic (health and lifestyle), post-discharge needs of people with heart disease were met in rural and remote (R&R) areas of North Queensland (NQ).

Methods: Qualitative case study, through semi-structured interviews, exploring staff, potential CR participants, and community leaders understanding of CR, and health service availability in Hughenden, Cooktown, Wujal Wujal and Hope Vale.

Relevance: CR is a component of secondary prevention (SP), and recommended by the National Heart Foundation as post-hospitalisation best practice for all people with heart disease (HD), apart from those needing palliative care. Effective CR takes a holistic, multidisciplinary team approach and is known to reduce mortality, reoccurrence of HD, hospital readmissions and costs, and improve quality of life. Aboriginal and/or Torres Strait Islander people have a greater need for CR, due to higher rates of HD. Despite demonstrated benefits, CR referral rates remain low (45%), with access further compromised in R&R areas of NQ by fewer centre-based services and greater distances.

Results: There were fragmented referral pathways and case management, demonstrating a lack of a systems approach in the provision of CR. This contributed to intermittent access to CR, largely due to few centre-based CR services, low referrals, a lack knowledge or acceptance of home-based telephone support services, and poor staff/community participants understanding of holistic post-discharge care. Generally, post-hospitalisation care lacked a holistic approach, was predominantly clinical via GPs and primary health care centres (PHCC). There were few referrals to allied health professionals (AHP) for lifestyle/risk factor management, with little guidance provided by medical discharge summaries that were often delayed and rarely mentioned CR or secondary prevention.

Health care providers in the focus communities provided primary health care services predominantly led by nurses and Aboriginal and/or Torres Strait Islander Health Workers (ATSIHW). Cooktown Multipurpose Health Service (MPHS) had doctors on staff, and Hughenden MPHS had a doctor on call. Wujal Wujal and Hope Vale PHCC were supported by doctors who made daily visits, two to three days each week. All centres had intermittent visits and telehealth from medical specialists including cardiologists. In Hughenden, AHP services were provided on a visiting basis. Cooktown had resident AHP services, and also provided regular visiting services to southern Torres and Cape including Wujal Wujal and Hope Vale.

Conclusion: Is CR accessible in R&R areas? Overall, there was low access to CR/SP and health services lacked a holistic approach for people with HD. Systems changes including referrals to nurses, ATSIHW and/or AHP are required to address the shortfall. Given the general perception that CR is a high resource, facility-based program, a change of terminology to SP, supported by guidelines and in-service education, could provide a pathway to improved support for people with HD, especially in R&R areas. There is potential for provision of CR/SP through coordinated care utilising the network of available resources, consistent with the diabetes model of self-management and education.

Background: Nationally, weekend physiotherapy (WEP) services vary between hospitals. Evidence demonstrates that allied health interventions within inpatient rehabilitation settings are effective for improving quality of life and functional independence, whilst positively impacting hospital outcomes. Presently, there are limited studies within public rehabilitation units that have explored key stakeholder perspectives before and after the implementation of a WEP service. This is key for effective service implementation. This project aims to capture the ‘value add’ of the implementation of a trial, temporary WEP service, by investigating staff and patient perspectives in a rehabilitation ward in a rural public New South Wales (NSW) hospital.

Methods: Data was collected within a mixed-method evaluative approach. Qualitative data was generated through semi-structured interviews with rehabilitation staff at the conclusion of the trial period. Quantitative data was obtained through pre- and post-trial staff and patient surveys. Institutional data including patient length of stay, Functional Independent Measure (FIM) was analysed.

Results: Findings from thematic analysis of the qualitative data generated five key themes relating to positive impacts of the WEP service, including an unexpected theme of ‘Being More United as a Ward’. Quantitatively, results from a descriptive statistical analysis of the survey data indicated that, by the end of the trial period, staff perceptions of the WEP service positively changed with 100% of staff strongly agreeing that the service was a value-add to the rehabilitation ward. An analysis of patient survey data pointed to the perception by patients that the WEP service was supportive of them achieving their rehabilitation goals and outcomes more quickly. Whilst a full analysis of institutional data is still underway, preliminary results suggest that patients who received WEP had an overall FIM improvement of 21%, compared to 18% in the pre-pilot cohort.

Implications: This mixed-method evaluation demonstrated that a trial weekend physiotherapy service within a rehabilitation ward of a NSW rural hospital produced positive staff and patient perceptions of the value-add of this service. Patients believed that this service supported their rehabilitation outcomes, a perception evidenced by improvements in patient functional outcome measures. Staff feedback was unanimously supportive with indications that the WEP service not only assisted with the rehabilitation outcomes of patients, but also contributed positively to staff culture.

Despite such positive results from this and other national studies, the provision of WEP services within Australian rehabilitation facilities is not a standard practice. In order to justify and embed this service within ‘usual care’ provision in inpatient rehabilitation wards, future studies should focus on evaluating the impact of enhanced WEP provision on patient outcomes that lead to hospital cost-saving benefits including reduced length of stay and improved patient flow. Undertaking this research in rural and remote settings – where movement to and from rehabilitation settings is more problematic for patients and their families due to contextual factors – is a priority. An additional cohort study of First Nations persons and their families through the rehabilitation journey (including WEP service provision) in rural Australia is also an area that warrants focused, collaborative enquiry.

Relevance: COVID-19 has reinforced the importance of health professionals at the core of a well-functioning and robust health system. Therefore, understanding the impact of COVID-19 on remote primary health care (PHC) workforce supply can inform future remote health workforce policy and highlights the urgent need to develop strong local training pathways for health professionals.

Aim: As part of a larger project investigating PHC workforce recruitment and retention in 11 remote and rural Aboriginal Community Controlled Health Services (ACCHSs), the study aim was to explore responses of ACCHSs to COVID-19 and the workforce-related challenges in delivering health care during the pandemic in Central and Northern Australia.

Methods: Two groups of participants were recruited: (1) health service staff; and (2) clinic users. Invited health service staff included senior leaders, managers, clinical and non-clinical staff. Clinic users (aged 18+) were recruited from clinics, workplaces, public spaces and local services (ie, ranger groups, art centres). Between February 2020 and June 2021, 212 staff and 205 clinic users were interviewed or participated in small discussion groups. Staff interviews explored the impact of the pandemic on staffing, workload challenges and responses by the health service to these challenges. Clinic users discussed their use of clinical services in the context of the pandemic, what they knew about COVID-19 and what resources they had accessed. Interviews and discussion groups were audio-recorded or recorded by handwritten notes. These data were transcribed and analysed thematically.

Results: Remote and rural ACCHSs responded rapidly to the pandemic through development of COVID-19 resources in local languages and messages tailored to communities, return to country campaigns, senior leadership visits to communities and adapting health care delivery (ie, more use of telehealth). The pandemic has had profound impacts on the ACCHSs workforce. In the initial months, remote and rural ACCHSs’ ability to replenish staff was curtailed by government border restrictions, reducing their ability to recruit from Australia’s eastern seaboard and New Zealand. Remote ACCHSs had some health professionals (remote area nurses and general practitioners) remain in the communities for longer than would otherwise have been the case, motivated to maintain remote communities’ access to health care. As restrictions lifted, interstate health professionals were more easily able to work in remote locations. The pandemic has placed additional costs on ACCHSs including staff quarantine. As the pandemic has continued, and especially as vaccination rollout got underway, the impact been different for each ACCHS. Some ACCHSs have requested all new staff to work in remote clinics for longer minimum periods of time. For smaller, remote ACCHSs ongoing staff shortages have forced them to operate clinics in a reduced capacity or close for regular clinic services and operate an outreach service.

Conclusions: ACCHSs demonstrated their capacity to develop and disseminate evidence-based, culturally appropriate COVID-19 resources and responses. The pandemic has highlighted the need for local staff, permanent staff, staff from the same state/territory and longer contracts, with some success already evident. As the pandemic progresses, there is potential that the ongoing workforce shortages will present further challenges for remote ACCHSs and communities.

The National Digital Health Strategy workshop seeks to bring together thought leaders in health and social service delivery, together with technical and biomedical innovators, to define the future of health care for people living in rural and remote Australia. The workshop will also employ digital engagement methodologies that provide real-time feedback to participants on themes and initiatives being discussed, building coalitions of support around new ideas and priorities for the future.

The development of the 2022 National Digital Health Strategy (the Strategy) provides an exciting opportunity to build a vision that will achieve better health outcomes for all people living in rural and remote Australia. The Strategy will do this by engaging with stakeholders right across the country, to identify key problems and develop ideas for new innovations and the integrated use of digital health solutions that will support Australians to better manage their health challenges.

The current Strategy was approved by the former Council of Australian Governments Health Council in August 2017 and will end in 2022. Over this period, it has successfully provided a national roadmap for the implementation of a range of important national digital health services and foundational infrastructure. However, Australians living in rural and remote areas continue to have shorter lives, higher disease and injury levels, and limited access to and use of health services compared to people living in a city (Australian Institute of Health and Welfare, 2019).

The coronavirus pandemic has also accelerated the development and use of digital health solutions. Social distancing and life in lockdown have fast-tracked the use of telehealth consultation between doctors and patients. Advances in mobile health, telemedicine, telehealth, and remote patient monitoring systems have also hastened adoption of digital health and provide opportunities for further decentralisation of health care, bringing potential for greater benefits to rural and remote communities.

However, we must also ensure that the increasing use of digital health creates greater access to health care across the country, rather than exacerbate the ‘digital divide’, and encompasses the unique needs of rural and remote communities. Collaboration and community involvement are critical to defining and delivering innovative digital solutions to rural and remote communities.

Building upon the current national digital health foundations, Australia’s next Strategy will complement, enrich and deepen the strategic objectives of our stakeholders by working collaboratively to build coalitions around the best new ideas that support our national health reform priorities. In partnership with our stakeholders, the Australian Digital Health Agency will build an advanced and contemporary Strategy that continues to enable the Australian healthcare system to be the best in the world.

The Australian Digital Health Agency is responsible for developing the next National Digital Health Strategy.

Aim: To share Deakin School of Medicine’s experience with designing a Rural Training Stream (RTS) intended to improve return of graduates to our partner communities in rural Victoria. Key decisions, insights and learnings from the design process will be presented to inform others considering the strategic design of rural medical school admission and training programs with a workforce focus.

Background: In recognition of the need to return graduates to our partner rural communities, Deakin School of Medicine convened a working group in 2019 to design the RTS, aiming to maximise return of graduates to the region. Review of admissions data provided context regarding our previously unsuccessful rural applicants, many of whom met minimum admission criteria. A cross-sectional observational study of all Deakin graduates’ (2011–18) work locations in 2019 identified factors associated with rural practice being rural background, attending a regional rural clinical school (RCS) for two years or a Longitudinal Integrated Clerkship (LIC) program for one year, rurally bonded course place and international student status. Graduates who undertook the combination of Year 3 LIC and Year 4 regional RCS were seven times more likely to be working rurally, with 55 per cent of these graduates working within Deakin’s rural training region. However, the numbers following this training pathway were very small due to rural clinical school capacity limitations.

Key decisions: An intentional decision was made to prioritise graduate ‘return to region’ as the primary focus of the new RTS. A geographically precise definition of Deakin’s ‘rural training footprint’ was developed with reference to the Modified Monash Model, identifying 965 locations within the footprint. This allowed for the definition of priority tiers for applicants based on rural background location with reference to this footprint. New selection tools were designed to assess rural commitment and increase the involvement of rural communities in the selection process. The role and appropriate proportion of bonded course places within the stream was considered. Linking rural training stream students with RCS training pathways required re-design of clinical school allocation processes and increased rural training capacity. The importance of providing a second regional RCS year for Year 3 LIC students was paramount in this design. Policy, administrative and equity issues were important considerations throughout the process.

Conclusion: Deakin’s RTS design has been informed by our graduate workforce outcomes, admissions data, community stakeholder engagement and contemporary evidence. The precise definition of a rural training footprint allows for prioritisation of medical school applicants with reference to their geographical origin and connections. Commencing in 2022, 30 of 125 domestic course places will be dedicated to students from a rural background, with priority given to those from within our defined rural training footprint. RTS students will complete two years of clinical training at a RCS. Future plans involve earlier community identification of students suitable for the RTS and providing opportunities for rural undergraduate and pre-clinical training.

A report released late in 2018 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. It was found that 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 by growing rates.

The report also found that, over the next decade, there will be significant shortages of essential health services in rural and remote Australia. For example, in 2028 there is projected to 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 one-half of 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.

This presentation will further discuss the findings of these two reports, and resulting recommendations. These will be considered, in particular, alongside growing concerns about the long-term impacts from the absence of face-to-face primary and preventive health services in rural and remote areas, which is considered likely to result in many people seeking health care later or not at all, and screening activities diminishing significantly. Some research already suggests that travel and associated restrictions in rural and remote areas during the COVID-19 pandemic has led to unmanaged chronic disease, due to necessary isolating of communities and patients not being able to access ‘normal’ care pathways. This has resulted in an increase in unmanaged chronic disease, such as diabetes mellitus (DM), hypertension (HT), and chronic kidney disease (CKD), conditions that research shows are already more prevalent in rural and remote areas. It is also expected that, as regular face-to-face dental health and mental health services resume, there will be high proportions of acute presentations.

Background: Working directly with rural and remote communities, an established rural generalist and general practice training program has expanded its longstanding workforce retention and training model by directly recruiting doctors to targeted communities with high medical workforce need.

The 2018–21 pilot of the new strategy successfully secured the services of 14 doctors to 18 of Australia’s hardest to fill locations, including six remote Aboriginal Medical Services, bringing a more stable workforce and enhanced continuity of care to the communities.

Method: By collaborating with Rural Workforce Agencies, State Government Departments of Health and remote communities, locations of high medical workforce need were identified and selected based on the following criteria:

• potential for providing continuing comprehensive whole-patient medical care
• geographic remoteness
• medical workforce need
• equity in geographic distribution across Australia.

The recruitment of a doctor to a remote community was undertaken by linking candidates to locations identified as being of high workforce need. Entry to the 3–4-year rural generalist and general practice training program was guaranteed, on the attainment of minimum entry standards. In addition, from 2021, the Australian Government is providing additional salary support funding to enhance the market competitiveness and business viability of remote clinics and Health Services to attract and retain high quality rural doctors for their communities.

Results: The 2018–21 initial pilot of the program has successfully recruited 14 full-time doctors to 18 remote locations with longstanding medical workforce deficits, including Cunnamulla (Qld), Mount Isa (Qld), Cooktown (Qld), St George (Qld), Lightning Ridge (NSW), Bourke (NSW), Boggabri (NSW), Dareton & Wentworth (NSW), Mallacoota (Vic), Queenstown & Rosebery (Tas), King Island (Tas), Broome & Fitzroy Crossing (WA), Wadeye & Warruwi (NT) and Nhulunbuy (NT).

Discussion: This targeted recruitment model has brought a more stable workforce and enhanced continuity of care to the participating communities, as well as providing career progression to specialist qualifications for the recruited doctors.

Results from the initial pilot have revealed that on-ground, community-driven support and effective cross collaboration between partnering organisations delivers the best outcome for the community, the practice, and the doctor to enhance health care delivery.

Implications for practice: Initial findings suggest that the linking of high-quality vocational training to a specific location is an effective strategy to recruit and retain doctors to rural, remote, and Aboriginal and Torres Strait Islander communities with high medical workforce need.

The opportunity exists to develop new and innovative remote GP and rural generalist training posts across remote Australia to suit individual community needs and to extend this recruitment/training model to other health and medical disciplines.

General practice is well-placed to address the increasing rates of overweight and obesity in rural Australia. Multifactorial programs that address caloric intake, physical activities and support behavioural change have the greatest chance of success.

This paper reports on the results of one such program implemented in regional New South Wales, a multifaceted lifestyle and weight management program, addressing nutrition, physical activity and psychological approaches to behavioural change. De-identified data was collected of 1217 participants from sixteen participating practices. Patient weight outcome measures and functional status measures were analysed using SPSS. Mean BMI of participants was 37.4kg/m2 and 75 per cent of participants were female. Almost 40 per cent of participants who had a BMI≥40kg/m2 had been diagnosed with a mental health condition.

Upon completion of the program at six months, participants had lost an average of 3.2 kilograms. Over 31 per cent of participants had lost at least 5 per cent of their initial weight and 40 per cent had reduced their waist circumference by at least 5 centimetres. There were significant improvements in all functional status measures regardless of level of weight loss during the program indicating a positive impact on wellbeing and reinforcing the value of the program. Participant satisfaction with the program was high and benefits extended beyond individual participants; entire family units were positively impacted and had improved their lifestyle habits.

The practice staff saw the program as valuable as it was sufficiently flexible to allow it to be tailored to characteristics of individual practices, thus increasing sustainability. It also supported a broader role for general practice in health promotion activities. There was a trend towards improved recording of BMI and waist circumference over the course of the program in participating practices. Staff identified challenges such as rural workforce shortages making general practice ‘time poor’, some scepticism from individual staff about potential for success for weight loss programs and the initial workload required to develop familiarity with a new program.

Insufficient workforce, closure of lower-level hospitals and maternity centres, as well as difficulties accessing antenatal and perinatal care have been recognised as issues impacting the health outcomes of mothers and their babies in rural areas. In addition, distance and isolation add to the challenges of health services access for rural areas.

To assess the delivery of appropriate maternity care for rural women, the challenges faced by the maternity workforce need to be understood from the perspective of all stakeholders. This study aimed to gain a perspective from midwives about the benefits, challenges of, and possible solutions to, improving maternity services in one region in south-eastern New South Wales. An anonymous online survey link was emailed to all midwives working in one local health district containing demographic questions and questions about experiences. Overall, 52 out of the 150 midwives in the region responded (34.6% response rate). Respondents worked in maternity units with a level 2 to level 5 capability, representing the wide range of maternity services in the region. Almost 52% of respondents had a postgraduate diploma, 32.7% had a midwifery certificate and 15.4% had a Bachelor of Midwifery, and experience in maternity services ranged from 1 to 41 years.

The main themes that emerged regarding the benefits of providing midwifery services in the region were:

1. high level of continuity of care in rural maternity services particularly in smaller units where they are able to ‘follow our women and families through the whole journey’
2. provision of patient-centred care which enabled a ‘high level of comfort and confidence in the care provided to them’, work satisfaction
3. provision of local services enabling women to stay close to family.

Several barriers were identified as challenges facing midwives, including staff shortages of GP obstetricians and midwives, the perception of a lack of support and accessible education opportunities, as well as the lack of facilities such as access to theatre or equipment to manage women with risks. Isolation and a need for women to travel ‘long distances to access basic midwifery care’, as well as a lack of outpatient services and lack of a midwife-led model of care were also seen as issues.

One suggestion that midwives had in response to these challenges was further implementation of midwife-led models of care in the region. Such a model might provide a way to address inequity in access to maternity care in rural areas and provide a more attractive working environment for midwives, leading to improved retention and recruitment of workforce.

Rural Australians face existing social and economic disadvantage, and are particularly vulnerable to environmental health threats and social inequities. It has been argued that doctors should have a role in addressing these issues, as they have a credible voice within public discourse allowing them to influence systemic structural causes of health inequities and environmental threats. This research aimed to explore how rural doctors perceived their public role, and the potential for rural doctors to use public activity to build a healthy, just and sustainable future.

Semi-structured interviews were conducted with doctors in a rural region in NSW to examine the rural doctor’s public role. Individual action, community participation, individual political involvement and collective advocacy were the key areas of focus. Questions related to the challenges and rewards of the rural doctor’s public role, as well as recommendations on how to effectively influence public policy to safeguard healthy and thriving communities. The study used hermeneutic phenomenological methodology and data was analysed using inductive thematic analysis.

Twenty-four rural doctors with a broad range of clinical specialities, clinical experience and personal backgrounds were interviewed. All interviewees noted the importance of doctors to be actively involved in their community at some level, however, there was a spectrum of depth of involvement, issues championed and activities undertaken. Participants differed, too, on how they interpreted the concept of building a sustainable future. Some doctors understood it in terms of environmental stewardship and community building; others framed it in the context of workforce recruitment and retention, or longevity in the profession.

All doctors reflected on a strong sense of community and collegiality that they thought distinguished rural medicine from metropolitan practice. Doctors from smaller townships (population <10,000) in particular noted an inevitability of a rural doctor becoming voices and advocates for community issues due to their social proximity to their patients. Many interviewees who had successfully advocated for issues of concern, highlighted the importance of getting involved, ‘being brave’ and taking the first step to have ‘a seat at the table’. A number of doctors who were not as active in public life as they wanted to be, or felt they should be, expressed a sense of guilt, and at times were quite apologetic during the interviews. Barriers to, and challenges of, civic involvement was reflected on, as well as the rewards of contributing beyond the immediate patient encounter. Strategies and advice were also shared.

The COVID-19 pandemic has accelerated the widespread adoption of collaboration and communication software to enable medical care that follows social-distancing requirements and reduces the risk of transmission of COVID-19 between patients and healthcare providers from gathering in hospitals, offices or clinics. This has resulted in tremendous growth in telehealth services in Australia and around the world. With increased telehealth uptake in many jurisdictions during the pandemic, it was timely and important to consider what role telehealth may have post-pandemic in our rural hospital services. Telehealth has long been implemented within our rural services to overcome the tyranny of distance. However, with the pandemic restrictions to work from home due to lack of space and travel restrictions, we reflected on our traditional inpatient service to expand the chart review and include the patient. We reviewed the role of telemedicine in multidisciplinary team (MDT) meetings, which play an important role in the provision of effective and tailored patient care in remote clinical settings. The traditional workflows were mapped to assess and integrate telehealth into routine clinical workflows. We implemented a multidisciplinary virtual bedside consultation service delivered via a mobile videoconferencing system in a rural hospital. In this model, two or three healthcare workers are physically present on the ward while the pharmacist joins remotely via collaboration software from home. The redesigned model of care uses technology to leverage the multidisciplinary expertise and knowledge at the bedside. This approach creates a digital replica of traditional ward rounds. The ward round now consists of a wireless mobile videoconferencing unit using the Queensland Health Telehealth Portal being wheeled to the patient’s bedside. The multidisciplinary team – consisting of doctor, nurse, pharmacist, physiotherapist and social worker – interacts with, communicates and assesses the patient. Following the virtual ward round, a case conference is held with the multidisciplinary team via the video link. We encountered several challenges with the development of this model of care. The process involved trialling various software applications to ensure patient privacy and security were always maintained. To our knowledge, the model of service delivery described here is unique to our rural facilities. The long-term sustainability of virtual bedside ward rounds at rural hospitals relies on a solid telehealth infrastructure, developing a skilled workforce, increasing digital literacy skills and integrating telehealth into daily clinical workflows. Further investigation will study factors associated with adoption, such as acceptance from staff and patient satisfaction. The current pandemic has reminded us that innovative models of care that include digitalisation can be helpful, but organisational readiness to adopt telehealth needs attention.

A group of junior medical officers and specialists working in remote and rural settings have met every two months for two years to share their difficulties and ideas for improving training for specialists who wish to work outside the larger urban and regional hospitals. The group has included doctors working in anaesthetics, ENT and general surgery, obstetrics and gynaecology, psychiatry, emergency medicine, paediatrics and intensive care, as well as rural generalists working in a variety of settings including Papua New Guinea and Vanuatu. The group has had presentations from eight colleges and the AMA about strategies to increase remote and rural training for specialists.

This workshop will present the outcome of these discussions; a generic framework for training remote and rural specialists. There are five parts to the framework:

1. Choose rural – intake for rural.
2. Start and stay – start training remote and rural.
3. Support and succeed – access to key training.
4. GRRAD – an elite workforce of remote and rural specialists who can be deployed anywhere in the world at times of emergency.
5. Return and remain – complete training where needed.

The workshop authors will present the framework and discuss its relevance to their different specialties. The workshop will involve group work to flesh out further issues and solutions for each training stage and for different specialties. The points of failure in current training practices will be discussed and the potential solutions for colleges struggling to provide specialists to remote and rural settings.

The framework is closely aligned with the recent work from the Royal Australasian College of Surgeons (RACS) led by one author, Dr Bridget Clancy. Aspects of the RACS policy will be used to illustrate how the generic framework can be implemented.

The National Digital Health Strategy workshop seeks to bring together thought leaders in health and social service delivery, together with technical and biomedical innovators, to define the future of health care for people living in rural and remote Australia. The workshop will also employ digital engagement methodologies that provide real-time feedback to participants on themes and initiatives being discussed, building coalitions of support around new ideas and priorities for the future.

The development of the 2022 National Digital Health Strategy (the Strategy) provides an exciting opportunity to build a vision that will achieve better health outcomes for all people living in rural and remote Australia. The Strategy will do this by engaging with stakeholders right across the country, to identify key problems and develop ideas for new innovations and the integrated use of digital health solutions that will support Australians to better manage their health challenges.

The current Strategy was approved by the former Council of Australian Governments Health Council in August 2017 and will end in 2022. Over this period, it has successfully provided a national roadmap for the implementation of a range of important national digital health services and foundational infrastructure. However, Australians living in rural and remote areas continue to have shorter lives, higher disease and injury levels, and limited access to and use of health services compared to people living in a city (Australian Institute of Health and Welfare, 2019).

The coronavirus pandemic has also accelerated the development and use of digital health solutions. Social distancing and life in lockdown have fast-tracked the use of telehealth consultation between doctors and patients. Advances in mobile health, telemedicine, telehealth, and remote patient monitoring systems have also hastened adoption of digital health and provide opportunities for further decentralisation of health care, bringing potential for greater benefits to rural and remote communities.

However, we must also ensure that the increasing use of digital health creates greater access to health care across the country, rather than exacerbate the ‘digital divide’, and encompasses the unique needs of rural and remote communities. Collaboration and community involvement are critical to defining and delivering innovative digital solutions to rural and remote communities.

Building upon the current national digital health foundations, Australia’s next Strategy will complement, enrich and deepen the strategic objectives of our stakeholders by working collaboratively to build coalitions around the best new ideas that support our national health reform priorities. In partnership with our stakeholders, the Australian Digital Health Agency will build an advanced and contemporary Strategy that continues to enable the Australian healthcare system to be the best in the world.

The Australian Digital Health Agency is responsible for developing the next National Digital Health Strategy.

Background: COVID-19 is having a profound effect on daily lives of people across the world. While Australia’s proactive preventive measures and public health strategies have controlled the spread of virus, the psychological impact of COVID-19 on population may not be negated, especially for rural and remote communities.

Methods: We used data that were collected via an online COVID-19 Living Survey conducted by BehaviourWorks Australia at Monash Sustainable Development Institute between 13 and 20 May 2020. The survey aimed to collect individual experiences with COVID-19 to inform actions taken in response to the COVID-19 pandemic. The survey measured behaviour, behavioural drivers, COVID-19 attitudes and beliefs, and demographic variables and data were anonymised at the time of collection. At the time of data extraction (1 June 2020), records from 1593 adult individuals were obtained.

Results: The self-reported mean feeling of happiness and anxiousness likert scale of 0–10 (with 0 being least happy or the highest level of anxiety) was 6.5 (SD=2.4) and 3.9 (SD=2.9) respectively. Factors associated with happiness were increasing age – those aged 60 and above reported higher levels of happiness than those aged 18–29 during the COVID-19 pandemic; and having a postgraduate education compared to high school education. Consistently, feeling anxious was associated with younger age. Loneliness was an independent predicator of reduced happiness and higher anxiousness, independent of age, gender, education and geographical location. Interestingly, the effect of loneliness was greater in regional and remote regions compared to capital or major cities.

Conclusion: The negative impact of COVID-19 on rural youth and those less educated is evident, with reduced happiness and increased anxiousness. Loneliness in rural areas during the COVID-19 pandemic may adversely affect wellbeing of rural populations. Preventions and supportive programs should focus on these cohorts.

This presentation will focus on a chronic disease program (Too Deadly for Diabetes) provided in Coonamble, NSW (population 2,700), through the Aboriginal health service. Training was provided to the nurse and Aboriginal health worker, who then provided the 10-week program to the community. In eight months their patients have lost a total of 868 kilograms, with many patients achieving a reduction or removal of medications for type 2 diabetes and/or hypertension. The average reduction in HbA1c has been 1.5 per cent.

Aboriginal and Torres Strait Islander peoples are four times more likely to be diagnosed with type 2 diabetes mellitus (T2DM) than non-Indigenous Australians (AIHW, 2020). This may be secondary to storing of visceral fat around solid organs at a lower BMI (Brimblecombe et al, 2006). Recent research has indicated that it is the reduction in visceral fat around the liver and pancreas that can reverse T2DM in up to 75 per cent of patients who lose 10 kilograms or more (Lean et al, 2018). Currently in Australia, reversal of T2DM is rare with most patients progressively developing more co-morbidities over time (Swerissen et al, 2016). Within the Indigenous community, diabetes and its complications lead to significant morbidity and mortality (AIHW, 2015).

Research is now building around the reversibility of type 2 diabetes and this program has applied the latest research, and then designed to fit within the current Medicare model provided through primary care in Australia.

Language revitalisation programs nationally and internationally claim health and wellbeing benefits. However, this is not visible in Victorian state government policy nor is there a detailed understanding of the current status of Aboriginal languages, specifically in the south-east. The seed project sought to respond to this lack of documented understanding, by developing a health check methodology to provide evidence, sovereign Victorian-specific data to demonstrate these theories. It supported communities/VACL to articulate this significant, frequently unpaid work, and its links to improved individual/community wellbeing and beyond. It was also important to establish a ‘counter’ narrative that defines south-east languages as ‘extinct’ or ‘endangered’ instead of living and developing within communities through language reclamation activities.

The Lowitja Institute Seeding Grant enabled a small team of dedicated project staff to be employed, furthering VACL’s capacity to be engaged in research, an organisation aspiration. Our project built upon current First Nations language policies and revitalisation projects, and Aboriginal and Torres Strait Islander health measures (for example, NHMRC) to develop a community-led Victorian language health check survey. The concept was co-developed under the direction of VACL’s Advisory Working Group comprising Elders, Senior Knowledge Holders and Language Practitioners.

The project sought to be aspirational, asking questions like ‘What does success in language revitalisation look like?’, ‘How can we strive for fluent speakers?’

It was critical to gain information from all generations (children to Elders) to unpack the key issues around Victorian Aboriginal languages and language revitalisation; for example what may be preventing access and abilities to learn, and aspirations for language revival. The Victorian Aboriginal Language Health Check seed project provided important data about Victorian languages at the individual, family and community level.

The seed project aimed to provide evidentiary data and strategic directions towards further research and actions to support and grow Victorian language learning; develop sustainable language programs that build language acquisition capability towards living legacy and nurture local language ecologies that are vehicles for autonomous sovereign language stewardship into the future.

Background: In Australia’s Northern Territory (NT), poor intercultural communication between health providers and Aboriginal peoples is a common way patients experience racism and has resulted in death. At the NT’s Royal Darwin Hospital, more than 70 per cent of patients identify as Aboriginal, and most healthcare providers are non-Indigenous. To assist providers to deliver culturally respectful care they are offered Aboriginal cultural awareness training. Cultural awareness training is a phenomenon which is delivered despite extensive critiques globally. We evaluated feedback from more than 600 NT healthcare providers and found staff were dissatisfied with the scope of the one-day session. Staff want ongoing training focusing on communication, designed and delivered by local people, providing opportunities for self-reflection to address bias. Personal stories shared by Aboriginal educators were a highlight of the training. Also, time off clinical duties to attend training is required: only 30 per cent of staff attended.

Aim: To deliver cultural education in a flexible, concentrated format which promotes critical self-reflection. The program includes podcasts and facilitated discussions. Podcasts are useful in medical education, delivering high yield information in a short time and ideal for sharing personal stories which counter racist narratives.

Method: This participatory action research project is a collaboration between doctors from diverse backgrounds, a group of ‘Specialists’: a Larrakia and Tiwi Elder, a Yolngu public health professional, a Burarra and Kriol language interpreter, an Aboriginal Health Practitioner and a White researcher. Doctors were observed interacting with hospitalised patients and semi-structured interviews revealed the intercultural issues hospital-based health providers struggle with. Analysis identified common questions requiring attention from the Specialists, a carefully chosen label to invert the usual medical hierarchy power dynamic.

Results: Doctors ask questions spanning practical issues: ‘When should I get an interpreter?’ to issues at the heart of cultural safety: ‘Hospitals aren’t a place that people really want to be, but is it that unpleasant for people that it’s a horrible racist place?’ To address questions we created Ask the Specialist, a cultural education package which consists of seven 20-minute podcasts and one-hour facilitated discussions with the Specialists, which are delivered over eight weeks (includes an introductory session to cultural safety). The Specialists answer doctors’ questions thereby revealing the reality of the hospital experience for Aboriginal patients. The subsequent group discussions, conducted during protected clinical training time, create an opportunity for providers to reflect and develop strategies to deliver culturally competent care. The wisdom shared by the Specialists reveals universal truths applicable beyond the NT and outside of the health domain.

Conclusion: One doctor described Ask the Specialist as: ‘Clinical care gold. This project will change the healthcare professional–patient communication landscape.’

Participating doctors reported: spending more time with their Aboriginal patients to ensure informed consent; an increase in the use of Aboriginal interpreters; and plans to employ more Aboriginal health professionals at the hospital. The podcast has been incorporated into NT Health workplace training. Ask the Specialist: Larrakia, Tiwi and Yolngu stories to inspire better healthcare, a multi-award winning podcast, has also been endorsed by medical colleges, ACCHOs and more.

Health organisation-led research produces more relevant and readily translatable research findings to address real-world health practice and policy issues. The importance of responding to local health issues is even greater in regional, rural and remote (RRR) settings, as people living in these settings experience worse health outcomes than those in metropolitan areas. Not only do health needs and health care delivery differ in RRR communities, health services’ and health professionals’ capacity to undertake research and translate into practice is affected by geographical location.

Western Alliance Academic Health Science Centre (Western Alliance) has partnered with 10 health organisations across the Barwon South West and Grampians regions of Victoria to improve the health of these rural and regional communities. Western Alliance actively supports health organisation-led research across the region and has commissioned a scoping exercise undertaken via interviews with key stakeholders and a scoping review, to understand the research training needs of rural and regional health practitioners and identify evidence-based approaches to research capability building in these communities. This scoping exercise informed development of the Supporting Translation of Research in Rural and Regional Settings (STaRR) program.

The STaRR program is a novel, multifaceted, region-wide research capability-building program that aims to promote health organisation-led, translation-focused research. It combines research translation training for mentors, health organisation managers/leaders and emerging researchers with other initiatives including embedded research translation coordinators, organisation research strategy development and creation of an online research translation resource repository.

To further inform development of the STaRR program, and measure its outcomes and impacts, a mixed methods approach comprising pre- and post-training surveys, stakeholder focus groups, individual interviews and 12-month outcomes surveys, is in place. To date, 27 mentors and 32 managers/leaders have attended STaRR training, and 54 have expressed interest in the upcoming emerging researcher training program.

Surveys to measure understanding and performance of research translation were completed by mentors (six pre- and four post-training), and by managers (18 pre- and 13 post-training). Three focus groups with 19 participants, including emerging practitioner-researchers, mentors, and managers, have been conducted. The focus groups explored understandings and conceptualisations of research translation, emerging researcher training needs, and perceived markers of success for the STaRR program.

Preliminary thematic analysis of the focus group data highlights multiple conceptualisations of research translation, common aspirations for the STaRR program, specific education and training needs for emerging researchers, as well as regional-system-level developments. These include the need for strengthened and strategic collaborations across the region, identification of regional research priorities, and learning from other health organisations who have successfully translated research in their settings. The survey data collected to date indicates STaRR training participants have experienced improvements in their understanding and performance of research translation.

To our knowledge, the STaRR program represents the only co-developed, multifaceted research capacity building program, actively involving health organisation managers and leaders, to be implemented in a Victorian rural and regional setting. The development and implementation of the STaRR program, and our learnings from the evaluation, will inform future research capacity building in RRR areas.

The Leveraging Effective Ambulatory Practice (LEAP) Project is a research partnership between quality improvement networks and eight Aboriginal and Torres Strait Islander Primary Health Care (PHC) services in regional and remote Australia. This project provides a strengths-based approach to explore the ways factors interact and impact on continuous quality improvement (CQI) implementation in the Aboriginal and Torres Strait Islander PHC setting.

Central to this work is the importance of building relationships and sharing knowledge two-ways, to utilise the age-old practice of ‘yarning’ and the genuine relationships formed through that culturally safe space. Driven by physical remoteness, and more recently widespread travel restrictions due to the COVID-19 global pandemic, this project is working to build togetherness from a distance by creating new Gayi Wajarr (Gumbaynggirr for ‘talking grounds’) using unique communication and engagement approaches.

Previous studies have highlighted the critical role that centralising respect of Aboriginal and Torres Strait Islander culture has in creating positive change in PHC services. This project is working to put these findings into practice. Supported by the ‘LEAP Learning Community’ (made up of participating PHC workforce, peak bodies and Primary Health Networks), focus is placed on creating respectful relationships, building trust and encouraging connections. These relationships then facilitate change or generate ideas to strengthen the processes that enable improvement.

The LEAP Project is also exploring new ‘ways of doing’ through communication and knowledge translation that honors how First Nations peoples have in the past and continue to connect and engage. Communication outputs incorporate cultural symbolism, Aboriginal language and slang, and ideas of collectivism into digital data dissemination. Culturally appropriate research output materials are created to share new knowledge with PHC workforce and communities, and there are plans for using online media for making project feedback and reporting more engaging and accessible.

Using mixed methods, an evaluation of these communication and engagement strategies will measure the uptake of project communications, levels of partners engagement, the range of knowledge sharing, and the experiences of the project’s Learning Community members.

With findings from this evaluation, we aim to showcase Gayi Wajarr and share our learnings of how we might more effectively and appropriately engage and communicate with Aboriginal and Torres Strait Islander primary health care partners, bringing together research, practice and communities in new and meaningful ways.

Background: In Australia’s Northern Territory (NT), poor intercultural communication between health providers and Aboriginal peoples is a common way patients experience racism and has resulted in death. At the NT’s Royal Darwin Hospital, more than 70 per cent of patients identify as Aboriginal, and most healthcare providers are non-Indigenous. To assist providers to deliver culturally respectful care they are offered Aboriginal cultural awareness training. Cultural awareness training is a phenomenon which is delivered despite extensive critiques globally. We evaluated feedback from more than 600 NT healthcare providers and found staff were dissatisfied with the scope of the one-day session. Staff want ongoing training focusing on communication, designed and delivered by local people, providing opportunities for self-reflection to address bias. Personal stories shared by Aboriginal educators were a highlight of the training. Also, time off clinical duties to attend training is required: only 30 per cent of staff attended.

Aim: To deliver cultural education in a flexible, concentrated format which promotes critical self-reflection. The program includes podcasts and facilitated discussions. Podcasts are useful in medical education, delivering high yield information in a short time and ideal for sharing personal stories which counter racist narratives.

Method: This participatory action research project is a collaboration between doctors from diverse backgrounds, a group of ‘Specialists’: a Larrakia and Tiwi Elder, a Yolngu public health professional, a Burarra and Kriol language interpreter, an Aboriginal Health Practitioner and a White researcher. Doctors were observed interacting with hospitalised patients and semi-structured interviews revealed the intercultural issues hospital-based health providers struggle with. Analysis identified common questions requiring attention from the Specialists, a carefully chosen label to invert the usual medical hierarchy power dynamic.

Results: Doctors ask questions spanning practical issues: ‘When should I get an interpreter?’ to issues at the heart of cultural safety: ‘Hospitals aren’t a place that people really want to be, but is it that unpleasant for people that it’s a horrible racist place?’ To address questions we created Ask the Specialist, a cultural education package which consists of seven 20-minute podcasts and one-hour facilitated discussions with the Specialists, which are delivered over eight weeks (includes an introductory session to cultural safety). The Specialists answer doctors’ questions thereby revealing the reality of the hospital experience for Aboriginal patients. The subsequent group discussions, conducted during protected clinical training time, create an opportunity for providers to reflect and develop strategies to deliver culturally competent care. The wisdom shared by the Specialists reveals universal truths applicable beyond the NT and outside of the health domain.

Conclusion: One doctor described Ask the Specialist as: ‘Clinical care gold. This project will change the healthcare professional–patient communication landscape.’

Participating doctors reported: spending more time with their Aboriginal patients to ensure informed consent; an increase in the use of Aboriginal interpreters; and plans to employ more Aboriginal health professionals at the hospital. The podcast has been incorporated into NT Health workplace training. Ask the Specialist: Larrakia, Tiwi and Yolngu stories to inspire better healthcare, a multi-award winning podcast, has also been endorsed by medical colleges, ACCHOs and more.

Relevance: The Aboriginal community-controlled health service (ACCHS) sector is central towards the efforts to close the health gap between Aboriginal and Torres Strait Islander peoples and other Australians. Historically, remote primary health care (PHC) services have been reliant on short-term health professionals to deliver health care. This study identifies staffing priorities for remote and rural health clinic users in their access to and use of PHC.

Aims: With 11 remote and rural ACCHSs in the Northern Territory and Western Australia, this study aims to understand the impact of short-term staffing from a clinic user perspective and identify areas for improvement.

Methods: Participants were community members (aged 18+) who use clinic services delivered by one or more of the partnering ACCHSs. Between February 2020 and June 2021, 205 clinic users completed an individual interview or participated in a discussion group. Recruitment of clinic users occurred at clinics, workplaces, public spaces and local services (including ranger groups, men’s and women’s groups, art centres and employment services). The interview schedule contained questions about clinic services used, impact of short-term or rotating staff on the services received and governance and management of the health service. Interviews and discussion groups were either audio-recorded or handwritten notes were completed. Thematic analysis of the data was conducted.

Results: Five key findings related to staffing were identified. First, clinic users appreciated access to a quality health service to address their health needs. Examples included access to a comprehensive range of health professionals (including specialists and allied health services) as well as outreach to homelands. In a small number of communities, healthcare access was diminished by clinical staff shortages. Second, clinic users preferred clinical staff to be permanent or long-term for continuity of care and to develop strong clinical relationships with their health professionals. Short-term clinical staff lacked knowledge of clinic users and their medical histories. This resulted in longer consult times for clinic users. In some examples, clinic users avoided using the clinic when staff were unfamiliar to them. Third, clinic users valued holistic health care, including access to traditional bush medicine, facilities to cook and family health programs. Fourth, clinic teams were predominantly women, with some male clinic users waiting until a male health professional was working at the clinic to address their health needs. Fifth, clinic users of all ACCHSs reminisced about the ‘old days’ when Aboriginal Health Workers worked in remote clinics. To strengthen communication, cultural safety and staff safety, clinic users suggested efforts to increase local employment in clinics were needed, including Aboriginal Health Practitioners and trained interpreters.

Conclusions: It is vital that remote and rural PHC services minimise staff turnover and retain the wealth of experienced health professionals to maintain quality patient health care. The importance of culturally (including gender) appropriate PHC and local employment were stressed as key to effective service delivery in these ACCHSs. Strategies to gain these outcomes can be priorities in ACCHSs across the Northern Territory and Western Australia.

Responding to the needs expressed by Aboriginal patients in clinical settings is an essential mechanism for improving wellbeing. No survey, process, or system exists that routinely responds to cultural wellbeing needs of rural and remote Aboriginal people. An Aboriginal patient-reported outcome measure (APROM) will lead to improved cultural wellbeing because patients receive the care that matters to them when clinicians respond to a culturally validated survey of patient outcomes. This significant translational action research project joins up hundreds of diverse stakeholders through a culturally safe, culturally rigorous, and co-designed philosophy.

The NSW Agency for Clinical Innovation started the project in 2019 with impacts from COVID causing collaboration through online tools, which provided unique online data collection. In parallel, the NHMRC-funded What Matters Wellbeing study developed a tool to measure wellbeing for Aboriginal and Torres Strait Islander people. Our collaboration has learned much about joining research, policy, and practice to provide relevant outcomes for all stakeholders. A key lesson is showing what cultural rigour looks like through governance processes. We use an Australian research critical appraisal tool to analyse multiple streams of data from three current APROM survey pilot sites, from online workshop tools, from the What Matters Wellbeing survey, and from the APROM program logic model.

Our analysis reveals – expectedly – complexities with survey development and testing considering culturally diverse Aboriginal nations, different patient demographics and needs, and various clinical practitioners’ needs for measuring and monitoring patient responses to different health issues. In particular, rural and remote Aboriginal communities are structurally disadvantaged to receive benefits from APROMs because of the lack of culturally safe services and clinicians. However – unexpectedly – are the strength of assertions to design survey systems to consider data sovereignty, for data to be of immediate relevance to the patient in the clinic, and for data governance to be culturally safe. These are keystone issues affecting the potential implementation utility of APROM. Arising from the current data and stakeholder processes, the next phase of the project – in progress – builds on the philosophy of cultural rigour as a process response to these issues.

This presentation will provide an analysis of multiple types of information informing the ongoing collaboration to develop, implement, and evaluate an Aboriginal patient-reported outcome survey for the NSW health system. We present data from three pilot sites in rural and remote communities. From these data streams, all stakeholders can learn from our experience of adopting cultural rigour in responding to developing culturally safe patient surveys.

Background: Paediatric feeding challenges are common, affecting up to half of typically developing children and 90% of children with a disability or developmental delay. In contrast, specialist clinicians and interdisciplinary paediatric feeding clinics are scarce, particularly in rural settings. In response to service and workforce gaps, an existing rural interdisciplinary feeding clinic was expanded into a virtual outreach service. The Virtual Paediatric Feeding Clinic (VPFC) used a joint model of care to link an existing clinic (the ‘hub site’) with allied health and child/family health clinicians from the client’s local community health service (‘spoke sites’). While there is growing evidence supporting the interdisciplinary treatment of feeding disorders, there is little regarding use of telehealth in a rural context to connect communities with specialist paediatric services.

Aims: To evaluate the accessibility, effectiveness and acceptability of the VPFC in rural NSW; and to explore family and ‘spoke site’ clinicians’ experiences with the VPFC.

Methods: Mixed-methods study. Clinical audit was used to determine service access (client numbers, occasions of service and saved client travel); and effectiveness (VPFC client feeding outcomes compared with the existing in-person clinic). Questionnaires administered at commencement and at the end of the pilot service measured clinician-perceived competence and confidence regarding assessment and treatment of complex feeding challenges. End-of-trial surveys assessed VPFC acceptability (both clients and clinicians). A strengths-based appreciative enquiry approach was used in semi-structured interviews with clinicians to explore further their experiences with the VPFC.

Results: The feeding clinic ‘hub’ service was accessed by 31 clients during the study; 14 via the VPFC, with a median of 4 (IQR 2) occasions of service. VPFC clients lived a median 123 kilometres from the hub, compared with 8 kilometres for those attending in-person. Feeding outcomes were similar between clinic modalities (in-person vs VPFC). While weight ‘z scores’ improved over time for both modalities (paired analysis, p=.001), there was no significant interaction by clinic. A similar pattern was observed for intake of an increased food range. There were significant decreases in the number and frequency of feeding problems, and an increase in parent mealtime confidence for both modalities. Both families and ‘spoke site’ clinicians reported high satisfaction with the VPFC service. Analysis of the clinician interviews revealed four key themes: impact of the VPFC on ‘spoke site’ clinicians; benefits for clients and families; perceptions of the virtual model of care; and VPFC service challenges. Clinicians reported improvements in their knowledge and confidence in provision of care, as well as reduced professional isolation through connection with discipline-specific colleagues.

Conclusions: The virtual service model resulted in improved equity of access for children with feeding difficulties in a rural NSW Local Health District. This study adds to the scarce evidence regarding use of telehealth in a rural context to improve paediatric service access. The expansion of the existing interdisciplinary feeding clinic into a virtual service demonstrated the effective and acceptable use of technology to bridge a gap in health care to connect rural families and local clinicians with specialist services.

Insulin is an important medication for many diabetics. There are two generations in current use: the daily dose and the weekly dose. The daily dose medication is presented in either a 3ml pen (vial) with 100 units per ml OR a 1.5ml pen with with 300 units per ml. The standard prescription quantity is 25 pens. The weekly dose medication standard prescription is for 4 pens.

The research outlined in this poster is mainly focused on the daily dose insulin.

The key points are:

1. Insulin has a variable shelf life dependent on storage conditions.
2. The cold chain distribution, from manufacturer to wholesaler to the pharmacy, is controlled and monitored.
3. Once dispensed, for various reasons, this controlled environment is not maintained and not monitored.
4. When stored outside these conditions, the potency decreases, to varying degrees.

1. Many diabetics in rural communities encounter the following issues:

1. • they live a significant distance from the pharmacy
   • environmental conditions when summer temperatures are well above 35 degrees
   • transportation between pharmacy and home is lengthy and may not include adequate cold storage
   • home refrigeration standards as provided by NSW authorities confirm that a standard fridge will vary within the cabinet from 3 degrees to above 15 degrees
   • the potential for power outages and, even with good techniques and no opening of the cabinet, temperatures will exceed 8 degrees.

5. Clients who monitor their BSL regularly will adjust their Insulin dose to compensate for higher than normal BSL, unaware that potentially these could be caused by the degeneration of their stored insulin.
6. Review of more than 500 insulin users at our pharmacies identified that the majority (55%) of diabetics required less than 50 units of insulin per day. The average was 35 units. This means that a prescription of 25 pens, each of 300 units, is potentially more than seven months’ supply.
7. When a new supply of insulin was dispensed and the first new pen used, there were increases in the number and severity of nocturnal hypos. Many required emergency hospitalisation.
8. The guidelines do not address these issues.
9. The PBS quantities are not practical for most clients and the option for ‘staged supply’ as is provided with dose administration aids is not available.

Introduction: Rural allied health professionals (AHPs) provide essential and wide-ranging services to consumers. AHP recruitment and retention is challenging in rural and remote areas, with workforce challenges a key barrier to rural consumers receiving consistent, quality, timely and accessible services.

AHPs come to rural and remote areas for a variety of reasons and a range of retention strategies are used in Australia, but most leave within the first three years of practice.

The Allied Health Rural Generalist Pathway (AHRGP) is one workforce strategy that was established to support early career AHPs to develop rurally relevant specialist skills across clinical areas, support career progression, and develop relevant quality improvement and project management skills.

In 2019, South Australia introduced the AHRGP for the first time with an initial cohort of 12 early career rural AHPs across regional local health networks (LHNs). Selected AHPs were from occupational therapy, physiotherapy, podiatry and speech pathology professions. The trial incorporated a funded evaluation in partnership with Flinders University, with objectives including:

• to explore the experience of undertaking the AHRGP and the impact it has on trainees, teams, organisations and the consumers they work with
• to make recommendations for the sustainability of the pathway and to further improve workforce outcomes for rural and remote health services.

Method: A mixed methods approach was used. Fifteen AHRGP trainees and 25 of their supervisors, line managers and principal clinicians, three project leads and five consumer representatives were recruited to share their experiences and perspectives of the pathway. In-depth interviews were conducted with all participants pre- and mid-pathway, and consumer representatives participated in a focus group. Qualitative and quantitative results were analysed separately and reported together to comprehensively explore experiences and impacts.

Results: Phase one and two interim research findings include:

• the AHRGP is giving early career AHPs the opportunity for broad skill development and career progression
• perceptions of trainees’ confidence and competence improved during the pathway
• most trainees found the training to beneficial but some found aspects of the course not relevant to their caseload and learning needs
• regular, quality, accessible clinical supervision and manager support is vitally important for AHPs to feel supported to participate in the pathway
• rurally raised trainees were more likely to stay in rural areas than those raised in metropolitan areas
• workload and organisational pressures in teams may contribute to trainees leaving earlier than they had planned.

Impact/conclusion: Results and recommendations from the pre- and mid-way evaluations provided background evidence to support additional funding for a second cohort of regional LHN trainees commencing the pathway from 2021. Early evaluation outcomes and a reflection on the 2019 cohort recruitment/selection was used to adapt recruitment/selection of the 2021 cohort. Insights gained into early positive outcomes and challenges experienced by the 2019 group is also being used to improve supports for the both training cohorts. Outcomes from the 2021 cohort will be closely monitored.

Background: In April 2020, the NSW Ministry of Health determined that final-year medical students may be employed as Assistants in Medicine (AiM) as part of the COVID-19 surge workforce strategy. In an environment where clinical placements were in jeopardy, the program ensured continuity of clinical training, supporting medical students to complete their studies. The AiM positions were to provide medical care and support, as part of a multidisciplinary team, under the supervision of senior doctors. In 2020, 16 Bathurst Rural Clinical School students stayed on at the Bathurst Hospital as AiMs for a 16-week term, placed across various wards/departments.

Aim: To determine the value of the AiM term to the Bathurst Health Service from the perspective of all hospital employees (approximately 600), with a focus on exploring perceptions on preparedness for internship, perceived skills and competencies, integration within the team, and education/training provided.

Methods: Ethics approval was granted by GWHREC and WSUHREC. An online survey for all staff was distributed halfway through the term (n=66) and once the AiMs had finished (n=48). Focus groups/interviews were completed with clinical supervisors (n=10) and hospital staff (n=7). Quantitative data underwent descriptive analysis and qualitative data was thematically analysed by two researchers.

Results: Overall, survey participants agreed AiMs were an integral part of their team and were effective communicators. Approximately two-thirds of survey respondents agreed that AiMs were useful on the wards, and over half thought they improved the efficiency of the clinical team. This was supported by the qualitative data, with participants reporting that AiMs were of value to their team: ‘They have been a great addition to (our) team … always been willing to assist when asked, and have provided a positive influence on the team’. Hospital staff also observed significant improvement over time, in both their confidence and skills: ‘They were more like student doctors to start with, but the growth over the time was incredible. Their confidence soared, they were practising doctors, and they were collaborative’. The AiMs were viewed to be stepping up and taking on more responsibility compared to their student role; this enhanced their learning experience and the development of their clinical and professional competencies (‘They were learning to do the job, supported to do the job, and then doing the job of a JMO [Junior Medical Officer]’), and thereby preparedness for internship (‘Towards the end I found their competency approaching that of an intern’). Hospital staff orientation to the AiMs and their scope of practice was one area identified for improvement.

Conclusion: The AiM program was perceived by most staff as an exceptional education opportunity for students that also added clinical value to the regional hospital. Although it was initiated as a surge workforce strategy during the height of the pandemic, the AiM program has opened up an opportunity to revisit the value that a final-year medical student can bring to a regional hospital and to the multidisciplinary clinical team.

Background: Producing enough doctors working in rural areas and primary care roles remains a key global policy focus. Many of the potential influences or determinants of practice location and specialty are well researched. However, evidence is less clear of the timing of these decisions, particularly how decision certainty progresses over time from being an intent or preference (but without certainty), to a finalised (with certainty) decision. The aim of this study is to explore with early career doctors based in a specialty and location, how the certainty of practising in a preferred specialty field and a preferred location progressed over time.

Methods: A cross-sectional cohort study, conducted in 2019, of medical graduates of The University of Queensland 2002–2018. Participants were asked to reflect on five career stages (start of medical school, end of medical school, after internship, start of registrar training, end of registrar training) and for each stage answer: How certain were you about which field of medicine (specialty) you wanted to practice medicine?; and How certain were you about where you wanted to practice medicine (geographic location)? These were explored against their observed location (rural, metropolitan) and specialty (general practice, other specialist).

Results: There were 775 eligible participants at PGY 1–18 who reflected back on their certainty of these distribution decisions. At the end of medical school, certainty levels were similar between GPs and specialists, with 30–31% having strong certainty of the specialty field. By the start of their registrar training, more notable differences emerged between GPs and other specialists, with around 35% of GPs compared with 17% of other specialists not having strong certainty of their specialty field. One exception was those completing rural undergraduate training (>=1 year), with an equivalent proportion certain of a GP decision as those choosing other specialties.

Consistently (and significantly) less of those working rurally had strong certainty of the location where they wanted to practice medicine at each career time point. Only 26% of those currently working rurally had strong certainty of this decision at the end of medical school training, compared with 51% of the group working in metropolitan areas. At the start of registrar training, a similar gap remained (strong certainty: 51% rural versus 70% metropolitan). Rural origin and rural undergraduate training (>=1 year) were mostly not associated with certainty progression.

Conclusions: This study provides new evidence that career intent decisions at the end of medical school are not fixed outcomes, but are finalised late in their training for most junior doctors. The high level of uncertainty highlights the importance of regular positive experiences throughout their training that help to reinforce decisions towards key distribution concerns of sufficient numbers choosing both general practice and rural practice. Notably, rural practice decisions only reach strong certainty late in their training pathway for most doctors, further emphasising that such decisions relate to much more than just having either a rural background, previous rural training experiences, or both.

Background: Key to addressing workforce shortages in rural health is improving access to pre-professional courses for students living in rural areas. A strong indication for rural practice is a student rural upbringing. The cost of relocating to metropolitan centres to attend university is a barrier for students wanting to become health professionals. This barrier is particularly significant for mature-aged students with other commitments including rural employment or children/family. Costs of providing university courses on regional campuses is higher than metropolitan campuses due to economies of scale.

Aim: To map the offerings of allied health, nursing, dental and medical university courses in rural, regional and remote locations (Modified Monash Model 2, 3, 4, 5, 6 and online) to determine availability for rural students.

Methods: This quantitative study involved searching relevant websites to identify rural/regional courses for allied health (occupational therapy, physiotherapy, podiatry, pharmacy, optometry, social work, speech pathology, dietetics and psychology), dental (dentistry and oral health), medicine, nursing and midwifery. The Australian Health Practitioner Regulation Agency (AHPRA) website list of accredited courses for AHPRA-registered professions was searched and the professional associations websites of non-AHPRA registered professions were searched. Courses identified were then cross-checked by searching university websites to ensure courses were currently being offered. Rurality of course locations were checked using the Monash Modified Model (MMM) website. Data was tabulated and descriptive statistics were used for data analysis.

Results: Two medicine courses were available in MMM2 locations and three in MMM3 locations. Three dentistry courses were in MMM2 locations and one in MMM3, while oral health had two courses in MMM2 locations. For nursing, 20 Bachelor degrees of nursing (including nursing studies or Bachelor of science and honours) were offered in MMM2 locations, 17 in MMM3, five in MMM4, three in MMM5, one in MMM6 and nine online offerings. Only one midwifery degree was in a MMM2 location and two were online. One double degree (nursing and midwifery) course offered in a MMM2 location and two online double degree courses were offered. Another double degree (nursing and paramedicine) course was in a MMM2 location. One graduate entry nursing degree was offered in a MMM2 location and one in a MMM5 location, with two online courses. For enrolled nurses articulating to Bachelor degrees, one course was in a MMM2 location, two in a MMM3 location and one in a MMM5 location. Five diploma of nursing courses were in MMM2 locations.

Most allied health (physiotherapy, occupational therapy, speech pathology, pharmacy) had some courses in MMM2 and MMM3 locations but none online. Podiatry had only two courses in MMM2 locations. Optometry and dietetics had no courses outside of MMM1 locations. Social work had courses in MMM2 and MMM3 locations and online. Psychology had numerous Bachelor degrees offered online and in MMM2 and MMM3 locations.

Significance: The location of pre-professional health courses is still predominantly in large metropolitan centres. Provision of end-to-end courses in regional and rural areas or online, or flexible course delivery, is needed to reduce access barriers for rural mature-aged students.

The prevalence of people experiencing a mental disorder across Australia may appear similar (one in five). Sadly, the rates of self-harm and suicide increase with remoteness. People living in rural and remote areas face unique challenges and often have poorer health outcomes than people living in urban areas.

In Australia, geographical classification systems are often applied to guide ‘who gets what where’ in relation to health care funding and services. To differentiate regions solely on geographical criteria, rather than ‘fit-for-purpose’ criteria relevant to specific issues, results in significant inconsistencies and inequities between rural and remote communities.

There are common early warning signs for the mental disorders. Most people can learn to recognise early warning signs, provide peer support, and communicate their knowledge. Rural and Remote Mental Health (RRMH) deliver co-designed early intervention and prevention-based mental health activities for remote organisations and their FIFO workforce, rural communities, and Aboriginal and Torres Strait Islander people. RRMH tailor workplace and community-led programs using co-design principles that have been shown to improve mental health literacy and help-seeking behaviours, and decrease stigma in over 500 locations.

RRMH programs have two components: (1) Train the Presenter; and (2) Community Workshops. Program coordinators connect with local people with lived experience and professional expertise to tailor solutions that address the communities’ needs and measure effectiveness. The Train the Presenter model builds the capacity of workplaces and communities, their confidence and sense of ownership, and supports leaders who embed the skills and knowledge and become a local source of information.

The panel will explore the personal, social and cultural barriers that RRMH have addressed and case studies that showcase the tailored solutions using co-design principles.

Background: Despite government implementation of initiatives and frameworks to improve cultural inclusion over the past decade, the health and wellbeing of Aboriginal and Torres Strait Islander Victorians has not significantly improved. In light of this, there has been increasing pressure on the Victorian mainstream rural health sector to prioritise improvement of cultural inclusion for Aboriginal and Torres Strait Islander peoples. Currently, there exists little guidance about how to achieve cultural inclusion at a health service level. Health services often undertake specific actions and projects relating to cultural inclusion, such as displaying Aboriginal and Torres Strait Islander flags and artwork and/or employing Aboriginal Liaison Officers. While important, such changes are early movements and constitute only part of a much longer and complex process of change required to improve cultural inclusion.

Aim: This case study provides a detailed analysis of a process towards developing culturally inclusive health care in a small rural Victorian health service and identifies the challenges encountered throughout this process.

Methods: The study draws upon qualitative research methods and analysis, and the implementation of continuous quality improvement processes to document and facilitate change processes. Data was generated from focus groups, document reviews, discussion groups, researcher journals, meeting minutes and individual interviews with both health service staff and Aboriginal and Torres Strait Islander community members over a four-year period.

Findings: The development and delivery of culturally inclusive health care within rural mainstream Victorian healthcare settings is a long-term process requiring the following key elements: (1) ongoing commitment of health service leadership (Board of Directors and Management); (2) a whole-of-organisation approach to, and implementation of, inclusive policies, procedures and practices; (3) understanding that resistance to change will be encountered; and (4) developing engagement opportunities and working relationships with the Aboriginal community. Barriers encountered during this process were resistance to change; a lack of knowledge and understanding of Aboriginal and Torres Strait Islander health, wellbeing and access to health care; leadership and/or staff turnover within the organisation; and the persistence of systemic and institutional racism within the Victorian healthcare system. Enablers of change included changes in government legislation and policy; ongoing education and training in Aboriginal culture, health, wellbeing and identification; engagement with, and feedback from, the local Aboriginal community; employment of an Aboriginal Health Liaison Officer; and the accountability of health services to demonstrate change.

Outcomes: The health service has observed a steady and sustained increase in people identifying as Aboriginal and/or Torres Strait Islander accessing the health service since the study began in 2016.

Conclusions: Improving cultural inclusion requires a long-term commitment to change. To be effective, this approach and commitment must involve staff across all clinical and non-clinical areas. Effective communication between health service leadership and staff is critical to develop a shared understanding of the need for change, ongoing learning and the effective implementation of inclusive policies, processes and practices.

Background/aim: Spasticity is involuntary muscle overactivity, commonly following damage to the central nervous system. Management is challenging due to diversity of patient presentation and treatment aims, typically requiring a combination of individualised physical and pharmacological management. Botulinum toxin is a pharmacological agent forming part of a coordinated multidisciplinary approach to improve upper and lower limb function.

In Orange NSW, the Spasticity Clinic (OSC) is run by a multidisciplinary team (MDT) consisting of rehabilitation physicians, physiotherapists and occupational therapists. Clear treatment goals are established in consultation with patients and they are followed up post-injection. This Spasticity Clinic is the only MDT clinic in the district and therefore it covers a large area of 250,000 square kilometres. The remote location of patients and reduced allied health staff has its own challenges.

This study reviews OSC patient outcomes from calendar year 2019 to 2020 inclusive, with a particular focus on the impact of COVID-19.

Method: This is a retrospective case review of clinic notes, where established patient goals and treatment outcomes were reviewed. Goals were categorised as patient-specific active and passive in upper and lower limbs. Goal outcomes for each category were reviewed four weeks post-intramuscular botulinum toxin injection.

Results: Fifty-six injection episodes between 33 patients occurred in 2019–20. The patient group had an average age of 46.5, with 18 male and 15 female. Three were excluded as one deceased and two became unwell. Patients who received botulinum toxin injection achieved 81.73% of their set out goals. In 2019, 31 injection episodes occurred, with a reduction in injections to 25 in 2020. When comparing the average number of goals achieved, no decline was observed in 2020, with an average of 90.62% of patient goals achieved compared to an average of 68.1% goals achieved in 2019.

Conclusions: Patients who received botulinum toxin injections at the OSC experienced high levels of success in meeting their treatment goals. Despite reduced activity, the outcomes of these injections were not negatively impacted by COVID-19 during 2020. Goal attainment scale could be incorporated into the future clinics.

Introduction: People living with chronic conditions utilise services from different health professionals working in different locations. A fragmented health system characterised by shortage of health workforce, lack of coordination and communication between the different parts of the health system, are some of the challenges people living with chronic conditions face in their access to services. This can be frustrating for these people, their carers and families. It can also put their safety at risk, therefore increasing their rates of hospital readmission, which in the long term may cost the health system more.

Aim: Increase care coordination for patients with chronic conditions on presentation at Royal Flying Doctor Service (RFDS) Tasmania Primary Health Care to enable better service provision for chronic disease management in rural and remote areas.

Relevance: Improved outcomes for chronic conditions are influenced by how patient care is coordinated among service providers and what strategies patients use to self-manage their chronic conditions. Studies have shown that physical activity provides health benefits in the management of chronic conditions. A number of areas of deficiency into active participation in the RFDS physical health program in Scottsdale, Tasmania were identified, including participants presenting with high or unstable blood pressure readings, non-adherence to prescribed medication and long wait times to get medical clearance from general practitioners or specialists.

Methods: The referral pathway was reviewed to improve shared decision making between RFDS physical health workers and general practitioners in order to avoid the risk of a hypertensive event.

A person-centred plan was developed utilising the pharmacy as a local-based health solution to support patients in the self-management of blood pressure and adherence to prescribed medication.

A long-term strategy was initiated to enable better coordinated and more flexible care for participants presenting with obesity and mental health conditions.

Results: There has been improved communication linkages with the general practitioners in Scottsdale through implementation of follow-up phones calls for chronic care patients.

There has been an improved uptake of locally available services which has empowered chronic care patients to take control of their health.

The coordination of care within RFDS Tasmania’s programs indicates patients with chronic conditions can benefit from a care team that communicates and shares care information adequately, and one that understands and utilises accessible referral pathways.

Conclusions: The coordination of care for patients with chronic conditions in rural and remote communities is different to what happens in cities. Poor transfers of care across health and community providers due to inadequate communication, information sharing and coordination of care, coupled with lack of easily understood and accessible referral pathways across settings and providers are some of the challenges to improving the quality of care for patients with chronic conditions in rural and remote areas. The delivery of person-centred care and patient self-management strategies with a focus on strong local provider networks is ideal for improving the coordination of care for people in rural and remote areas for patients with complex chronic care needs.

Introduction: A strong Aboriginal and Torres Strait Islander health workforce is integral to meeting community needs, especially in regional and remote areas where two-thirds of the population lives. Previous studies examine how to increase the number of Aboriginal and Torres Strait Islander people entering the workforce, with little attention to retention and staff development. Aboriginal and Torres Strait Islander people bring unique knowledge and skills to health services that facilitate access, cultural safety and improve service provision for their communities. However, Aboriginal and Torres Strait Islander people are significantly under-represented in the health workforce and recent growth has been in low status and lower paying jobs with poor articulation to other roles and professional careers.

Objective: To identify factors that support career development of Aboriginal and Torres Strait Islander people in the health workforce and whether they may differ by location.

Methods and analysis: A cross-sectional online survey of Aboriginal and Torres Strait Islander health staff across professions, roles and jurisdictions in Australia was undertaken in 2018, promoted via email and twitter by key health professional organisations, Aboriginal and Torres Strait Islander peaks and affiliates and at national forums. Descriptive statistics were used to summarise participant responses to most questions. Satisfaction with career development was measured on a five-point scale, from very dissatisfied to very satisfied. Predictors of satisfaction with career development were examined using linear regression. Each enabler, institutional barrier and individual characteristic item was included in a simple regression to obtain the unadjusted estimate and 95 per cent CI (Model 1), and also in a model with gender, age group and type of organisation as covariates (adjusted estimate, Model 2). Regressions were run in the whole sample and by location. Assumptions of normality and homogeneity of residuals were met.

Results: There were 332 participants employed in health services with 50 per cent in regional and remote areas, with 42 per cent rating their current career development opportunities as good/very good. Among urban, regional, and remote participants all ‘enablers’, or provided career development opportunities, were associated with higher satisfaction levels among staff. In terms of ‘barriers’, limited opportunities were the main reason chosen overall and by different locations. Racism from colleagues and lack of cultural awareness were identified as predictors of lower satisfaction for those in regional and urban areas, but not for remote respondents. Aboriginal and Torres Strait Islander staff leading career development was strongly supported.

Conclusion: The study highlights the importance of providing a range of career development opportunities to Aboriginal and Torres Strait Islander staff. Barriers to career development include limited opportunities, lack of manager support, lack of mentors and inflexible human resources policies which can impact satisfaction levels. The implications for workplaces in all locations are that providing even a small number of career development opportunities, coupled with leadership by Aboriginal and Torres Strait Islander staff, can make a difference to satisfaction levels and is likely to boost retention of Aboriginal and Torres Strait Islander staff in services and build a stronger workforce to meet community needs.

Introduction: A strong Aboriginal and Torres Strait Islander health workforce is integral to meeting community needs, especially in regional and remote areas where two-thirds of the population lives. Previous studies examine how to increase the number of Aboriginal and Torres Strait Islander people entering the workforce, with little attention to retention and staff development. Aboriginal and Torres Strait Islander people bring unique knowledge and skills to health services that facilitate access, cultural safety and improve service provision for their communities. However, Aboriginal and Torres Strait Islander people are significantly under-represented in the health workforce and recent growth has been in low status and lower paying jobs with poor articulation to other roles and professional careers.

Objective: To identify factors that support career development of Aboriginal and Torres Strait Islander people in the health workforce and whether they may differ by location.

Methods and analysis: A cross-sectional online survey of Aboriginal and Torres Strait Islander health staff across professions, roles and jurisdictions in Australia was undertaken in 2018, promoted via email and twitter by key health professional organisations, Aboriginal and Torres Strait Islander peaks and affiliates and at national forums. Descriptive statistics were used to summarise participant responses to most questions. Satisfaction with career development was measured on a five-point scale, from very dissatisfied to very satisfied. Predictors of satisfaction with career development were examined using linear regression. Each enabler, institutional barrier and individual characteristic item was included in a simple regression to obtain the unadjusted estimate and 95 per cent CI (Model 1), and also in a model with gender, age group and type of organisation as covariates (adjusted estimate, Model 2). Regressions were run in the whole sample and by location. Assumptions of normality and homogeneity of residuals were met.

Results: There were 332 participants employed in health services with 50 per cent in regional and remote areas, with 42 per cent rating their current career development opportunities as good/very good. Among urban, regional, and remote participants all ‘enablers’, or provided career development opportunities, were associated with higher satisfaction levels among staff. In terms of ‘barriers’, limited opportunities were the main reason chosen overall and by different locations. Racism from colleagues and lack of cultural awareness were identified as predictors of lower satisfaction for those in regional and urban areas, but not for remote respondents. Aboriginal and Torres Strait Islander staff leading career development was strongly supported.

Conclusion: The study highlights the importance of providing a range of career development opportunities to Aboriginal and Torres Strait Islander staff. Barriers to career development include limited opportunities, lack of manager support, lack of mentors and inflexible human resources policies which can impact satisfaction levels. The implications for workplaces in all locations are that providing even a small number of career development opportunities, coupled with leadership by Aboriginal and Torres Strait Islander staff, can make a difference to satisfaction levels and is likely to boost retention of Aboriginal and Torres Strait Islander staff in services and build a stronger workforce to meet community needs.

Rural and remote Australia faces many challenges with respect to healthcare delivery and rural health workforce. To counteract some of these challenges, service learning placements are an ideal mechanism to assist with addressing some of these issues, especially when done in partnership and via collaborative processes with stakeholders within the healthcare sector.

This poster presentation will focus on a collaboration and partnership between two University Departments of Rural Health and a disability support organisation in the development, mentoring and implementation of service learning models. This partnership was established with clear objectives and goals. Initially established to assist with meeting identified gaps in health service provision, the partnership enabled all stakeholders to learn with, and from, one another through the process of coordinating and conducting service learning clinical placements. What was evident through this collaboration and partnership was successful outcomes are possible for all stakeholders and service needs and gaps can be met through service learning placements facilitated through such partnerships. How the partnerships were developed and fostered will also be outlined to assist others who may be interested in starting a similar partnership. The intent of this presentation is to demonstrate what is possible with partnerships in health and the successful outcomes which can be achieved for all stakeholders through service learning placements.

Incorporating clinical pharmacy services into the provision of health care has long been considered best practice. Historically, rural and remote health services have not had access to the skills and knowledge of a clinical pharmacist. This is largely due to difficulty integrating clinical pharmacy into small hospitals with dispersed geography and low patient numbers.

Aim: To evaluate virtual clinical pharmacy support to inpatient care in facilities where there is no access to onsite clinical pharmacy services.

Method: The virtual pharmacy intervention was delivered using a stepped wedge randomised controlled trial design. The intervention was sequentially implemented in eight facilities across two local health districts. The ‘steps’ are the order in which each site cross-over from the control condition to intervention.

Virtual clinical pharmacist activities were provided using the electronic medication record (eMR), electronic medication management (eMeds) and a wireless teleconferencing cart with two-way audio and visual capacity. Activities were consistent with face-to-face hospital pharmacy services and included:

• medication reconciliation, particularly during transitions of care
• medication review
• patient education
• staff education
• antimicrobial stewardship.

Medication supply continued through existing processes and was not evaluated in this project.

Routinely collected health data was evaluated pre- and post-implementation of the service. This included, but was not limited to:

• number of medication reconciliations completed
• number of medication histories completed
• medication-related issues identified.

A qualitative analysis was performed using staff focus groups (n=60) and patient-reported experience measures survey (PREMs) (N=249) to explore the issues, benefits, barriers and overall acceptability of the service.

Relevance: Translating best-practice standards for delivering clinical pharmacy services from face-to-face services to telehealth has not been well documented, particularly in rural and remote Australia. Furthermore, this service evaluates the scalability of service delivery across local health district boundaries.

Results: Over a nine-month period, 660 patients were reviewed by pharmacists with a total of 3716 episodes of care. There were 1691 medication issues or recommendations identified by the pharmacist, with an average of 3.4 issues or recommendations made per patient.

Patient feedback via PREMS was overwhelmingly positive. Ninety-four per cent of patients rated their experience of care as good or very good. Ninety per cent of patients felt more confident managing their medications after interacting with a clinical pharmacist. Clinicians were able to clearly describe the benefits of virtual pharmacy including improved medication knowledge, safety, and confidence in prescribing and administering medications.

The results demonstrate improvement in medication reconciliation and detection of medication-related issues. Patients now have access to clinical pharmacy services, high satisfaction with care provision, and more confidence with medication management.

Conclusions: The evaluation of virtual pharmacy services demonstrates pharmacy can be effectively delivered using digital health and technology and is acceptable to patients and other clinicians.

Due to the high acceptability and supporting research data, the health district is working on the expansion of the service to other facilities. This is an example where research outcomes have been directly translated into practice to support patients in rural and remote healthcare facilities.

Resilience can be defined as one’s ability to successfully adapt to stressful life events. COVID-19 has undeniably affected reality as we know it, more so for healthcare workers being on the frontline during this pandemic. Due to the pandemic, healthcare workers have experienced psychological distress, therefore putting their mental health at risk. As resilience has strong implications for psychological consequences, factors affecting resilience should be considered. Since mental health benefits of healthy sleep behaviours have been established in the existing literature, it is suggested that the quality of sleep will be associated with highly resilient healthcare workers. The aim of the current study is to cross-sectionally examine the association between self-reported quality of sleep measured by the Pittsburgh Sleep Quality Index and resilience measured by the Brief Resilience Scale, within a sample of healthcare workers (N=1300) in the Loddon Mallee region of rural and regional Victoria, Australia. It is hypothesised that higher quality of sleep will be associated with higher reported resilience. Multiple linear regression will be used to examine the association of total sleep quality score with total resilience score while controlling for confounding variables. Potential confounding variables will be selected a priori using Directed Acyclic Graphs. Unadjusted and adjusted effect estimates will be presented.

Background and aim: There are significant challenges associated with health service provision to rural and remote populations, who face inequities in accessing healthcare resulting in poorer health-related outcomes compared to their urban counterparts. Telehealth provides an innovative solution to mitigate the healthcare access challenges arising from healthcare workforce shortages, geographic isolation and socioeconomic disadvantage for rural-dwelling people, and more recently has assisted in continuing to provide care during the COVID-19 pandemic restrictions. That telehealth is beneficial is of little doubt, however addressing barriers related to funding, internet connectivity, technology capabilities and staff/healthcare practitioner ability to facilitate wider diffusion appear to be in a state of inertia. Aiming to address some of these barriers, the Flying Doctor Telehealth Specialist Service (FDT-SS) was implemented in 2017/18 and scaled up to mitigate specialist access challenges in rural and remote areas of Victoria. The aim of this research was to evaluate the geographic reach of FDT-SS and its effect on health service utilisation and costs.

Methods: Service activity minimum data was obtained from RFDS Victoria and used to map service reach and scale. Linkage datasets (01/07/2016 to 30/06/2019) for Medicare, Victorian Admitted Episode Dataset (VAED), Victorian Emergency Minimum Dataset (VEMD), and Victorian Patient Transport Assistant Scheme (VPTAS) were obtained for FDT-SS clients. Variables for health service utilisation (‘before-commencement’ and ‘after-commencement’, taken as the 16 months either side of the March 2018 FTD-SS commencement date) were created by identifying Medicare item numbers and International Classification of Disease (ICD-10) codes relevant to the main FDT-SS specialties (Endocrinology, Cardiology, Psychiatry and Respiratory). Data were analysed in SPSS using negative binomial regression. Utilisation costs comparison and econometric analysis were performed.

Results: The FDT-SS covered 52 remote sites; 73% in postcodes classed as outer regional or remote i.e. areas of “significantly restricted accessibility of goods, services and opportunities for social interaction”. The incident rate for Medicare item claims (any claims including those relevant to FDT-SS specialties) was 30-50% higher after FTD-SS commencement, and telehealth specific claims were three times higher. There were no significant changes in hospital admissions or emergency department presentations between before- and after- FTDSS commencement. Interestingly, the rate of VPTAS claims were twice as high ‘after-commencement’ for any usage reason but was unchanged for reasons associated with the medical condition for accessing FDT-SS. There was an actual vs. predicted inflation adjusted hospitalisation cost saving of 1,000 over 4000 patient months of FDT-SS. The main drivers for primary care utilisation costs were females gender, geographic remoteness, socio-economic disadvantage, FDT-SS access.

Conclusion: Our findings suggest that the FDT-SS improves access to specialists for people in regional locations which have significantly restricted physical accessibility to such services. Other specialties currently not serviced through the FDT-SS may still require extended travel, therefore FDT-SS may consider expanding the breadth of specialties. Hospitalisation trends are consistent with telehealth increasing access to health services for the remote and regional group of participants in the study, while perhaps reducing the need for expensive acute intervention.

Illicit drug use during pregnancy has been shown to result in serious medical implications for the newborn infant both in the neonatal period and with regard to long-term neurodevelopmental outcomes. There is a paucity of literature available regarding the specific effects of maternal illicit drug use during pregnancy, especially in rural centres. The aims of this study were to determine neonatal outcomes and maternal characteristics associated with illicit drug use during pregnancy in a regional setting. A retrospective cohort study was conducted to determine neonatal outcomes. Neonates born from 2014 to 2019 at Wagga Wagga Base Hospital were included in the study. The sample population consisted of 186 neonates known to be exposed to illicit drugs. Outcomes were compared to a control group consisting of 186 randomly selected neonates known to not have been exposed to illicit drugs. Results indicated that neonates exposed to illicit drugs in utero were more likely to be premature, have lower birth weight, have higher rates of admissions to the special care nursery and have higher rates of neonatal abstinence syndrome. These results were all statistically significant (p<0.001). Maternal characteristics that were associated (p<0.001) with illicit drug use during pregnancy included younger women, higher gravida and parity, less antenatal visits, increased likelihood to smoke tobacco during pregnancy, higher rates of hepatitis C infection, reduced likelihood to be married and less likely to have private health insurance. Illicit drug use in pregnancy is associated with poorer health outcomes for newborn infants either because of in utero drug exposure or as a consequence of maternal characteristics shown to be associated with taking illicit drugs. To improve outcomes for these infants, clinical services should provide an optimal environment for antenatal care including programs for cessation and minimisation of illicit drug usage and a supportive environment for mothers to attend regular antenatal appointments in order to minimise any additional risks associated with illicit drug use. Babies born to mothers taking illicit drugs should be managed with an evidenced-based, multidisciplinary approach to optimise their medical and neurodevelopmental outcomes.

Relevance: Access to timely and effective emergency and primary care is critically important for optimising health outcomes of rural and remote populations yet little is known about what systems changes could improve outcomes. In 2018, in Central Australia, the system by which remote clinicians accessed medical support changed: instead of telephoning RMPs (GPs experienced in remote practice) for both emergencies and usual primary care (PC) problems, the emergency and primary care consultation functions were separated and doctors with critical care skills were called for emergencies, while RMPs were called for primary care problems.

Aims: To evaluate the timeliness, efficiency, cost-effectiveness and impact of the new model for providing emergency and primary care medical advice to remote clinicians.

Methods: Pre- and post-implementation design. Mixed methods: scoping review of remote retrieval systems literature; cost-effectiveness analyses using NT Department of Health, Royal Flying Doctor Service and St John Ambulance Australia’s retrieval, emergency department, hospitalisation, primary care and financial data (2015–20); thematic analysis of qualitative interview data with 36 Central Australian health professionals; and pre- and post-surveys of Central Australian health professionals. Quantitative analyses used descriptive and inferential statistics. A main outcome was the incremental cost-effectiveness ratio.

Results: Under the new system there were fewer retrievals and a lower likelihood of dying (Hazard Ratio 0.45, 95%CI 0.35–0.57). ICU hours and length of hospital stay (per admitted patient) were unchanged. It cost an extra $377 (95%CI 9, $496,) per year of life saved, which is highly cost-effective at current Australian willingness-to-pay thresholds ($202,942).

Interview participants attributed earlier identification of appropriate retrievals and improved consultation quality to the specialised training and experience of staff.

Referral processes enabled more timely provision of advice and support for both PC problems and emergencies.

Survey respondents mostly agreed that obtaining critical care advice was quicker (23/31, 74%) and clinical assessment was of higher quality (27/34, 79%). It was also more likely that response times were acceptable (OR 3.5); clear, relevant information about patients was received (OR 5.9); policy and procedures for evacuation were clear (OR 2.6) and effective (OR 5.0).

Conclusions: Remote retrieval systems literature is scant, lacking the cost-effectiveness analyses so critical for informing policy development. This research provides important new evidence to inform policymakers when allocating scarce public dollars to improve health outcomes and health equity, especially for populations living in remote communities. GPs who have extended skills in critical care or in remote health have a central role in the new and improved system introduced in Central Australia. Our research demonstrated that the new model is highly cost-effective and is associated with more timely emergency and PC than the preceding system and saves lives.

Other remote regions in Australia and internationally that have GP-led retrieval services should strongly consider the costs and benefits of transitioning to a system which separates emergency and primary care referrals with each type of referral being directed to the health professional with the most appropriate skills for managing the presenting problem: connecting the right health professionals at the right time.

Strongyloides stercoralis are parasitic roundworms that cause a persistent infection. They multiply out of control on immunosuppression, causing a potentially fatal hyperinfection. In Australia, Strongyloides infections are either locally acquired, affecting mostly Aboriginal and Torres Strait Islander peoples, or overseas acquired, affecting immigrants and returned travellers.

Major diagnostic pathology laboratories that carried out serological tests for Strongyloides (one declined) contributed deidentified results of Strongyloides serology tests from 2012 to 2016 inclusive. The tests used an ELISA assay for Strongyloides-specific IgG antibodies. One laboratory provided positive results only. We calculated the number of people positive at least once and the number who never had a positive result.

The number of people positive/100,000 of population was outstandingly highest in the Northern Territory (489/100,000), followed by South Australia (34/100,000).

We mapped the number of people positive per 100,000 of population, the percentage positive of those tested (omitting the results from the laboratory that provided positive results only), and the number tested/100,000 for each region as well as the number positive in each suburb of residence. 
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The highest seropositivity (260–996/100,000 of population) was in regions across northern Australia, north-west South Australia and north-east New South Wales where many Aboriginal and Torres Strait Islander people live in remote communities. There were also some regions in greater capital cities with a high seropositivity (112–188/100,000), likely reflecting higher numbers of immigrants and returned travellers who were infected outside Australia.

Centres with residents who tested positive were scattered throughout Australia. The centres with the highest number of people who tested positive (50–257) were in the Kimberley, Northern Territory, north Queensland and northern New South Wales, all centres with significant Aboriginal populations. Greater capital cities were omitted.

Frequency diagrams showing number tested and the number positive per 100,000 of population and the percentage positive by year, age and sex were also prepared. The number tested/100,000 in the Northern Territory decreased sharply over the five-year period, likely due to a shift in test requests to the laboratory that declined to provide results.

Consequently, the number positive/100,000 also decreased. The frequency diagram of the percentage of people positive of those tested by age showed that the percentage positive increased with age from a relatively low percentage in 0–5-year-olds. The frequency diagram of the number tested/100,000 showed that children were under-represented in the data except in Tasmania.

These data strongly suggest that Aboriginal and Torres Strait Islander peoples bear the major burden of Strongyloidiasis. Although this study represents a significant step forward in our understanding of the geographical distribution of Strongyloides in Australia, it underestimates the number of people who were infected because of the missing data and it does not distinguish between the at-risk groups. We could make only rough generalisations based on known distributions. Already the data are five years out of date. Strongyloidiasis meets the criteria for a notifiable disease. If it were notifiable nationally, we would have more comprehensive up-to-date data on which to base control strategies.

Rural and remote Australia faces many challenges with respect to healthcare delivery and rural health workforce. To counteract some of these challenges, service learning placements are an ideal mechanism to assist with addressing some of these issues, especially when done in partnership and via collaborative processes with stakeholders within the healthcare sector.

This poster presentation will focus on a collaboration and partnership between two University Departments of Rural Health and a disability support organisation in the development, mentoring and implementation of service learning models. This partnership was established with clear objectives and goals. Initially established to assist with meeting identified gaps in health service provision, the partnership enabled all stakeholders to learn with, and from, one another through the process of coordinating and conducting service learning clinical placements. What was evident through this collaboration and partnership was successful outcomes are possible for all stakeholders and service needs and gaps can be met through service learning placements facilitated through such partnerships. How the partnerships were developed and fostered will also be outlined to assist others who may be interested in starting a similar partnership. The intent of this presentation is to demonstrate what is possible with partnerships in health and the successful outcomes which can be achieved for all stakeholders through service learning placements.

Background: Community-based palliative and end-of-life care (PEOL) services provide support to patients who want to die at home, and to their caregivers. Research shows that most people want to die at home. In rural areas, PEOL services are often provided on a trial basis, and limited or insecure human and financial capital threaten their continuity. With an ageing population and a rise in the prevalence of chronic conditions, there is increased demand for PEOL services. This makes it pertinent to address their long-term sustainability. Sustainability has three key attributes: acceptability, affordability and adaptability. Having already established the acceptability and affordability of community-based PEOL services in an earlier study, this study focused on adaptability as a crucial element affecting long-term sustainability.

Aim: The aim of this study was to identify components of the PEOL service which require adaptability to ensure long-term sustainability for the service.

Methods: A mixed methods approach was used for this study. Semi-structured interviews were conducted with family members. Semi-structured focus groups and interviews were held with health professionals. Patient data were included to describe frequency and nature of contacts. The setting was a rural town in Victoria, Australia.

Results: Nine family members were interviewed and 16 health professionals were interviewed or took part in a focus group. Patient data included 121 participants.
Two major components were identified that require adaptability: workforce issues and pain management. When not addressed effectively, both issues could result in unnecessary hospitalisation and an unwanted death in hospital.

Relevance: Medical workforce shortages are a prominent issue in rural and remote areas. Rather than focus on shortage of GPs, we need to look at available health care worker capacity in the community. Community paramedicine is an emerging model of health care where paramedics apply their training and skills in community-based environments. Community paramedics have been known to provide PEOL care in residential aged care facilities or in-home care situations, thus preventing unnecessary hospitalisation.

Adequate pain management is a crucial component of PEOL care. In our study, issues with pain management were often a result of the inability to acquire sign-off on medication due to lack of GP availability.

There is a need to investigate different ways around this issue, taking the Australian legal context into consideration. One way to address this discrepancy could be by providing a medication kit aimed at symptom control, which has been proven to be effective in Canada. With specialist knowledge available in metropolitan hospitals, another way to increase adaptability would be to explore ways to improve access to specialist medical palliative care support, through stronger partnerships and 24/7 availability.

Conclusion: With sufficient attention paid to the adaptability of the service, community palliative and end-of-life care service can become more sustainable, thus offering choice and dignity for people approaching the end of life.

Aims: Exploring perspectives of rural patients and general practitioners (GPs) regarding the implementation of telehealth services in rural and remote areas of Australia.

Methods: A qualitative study was conducted in three local health districts (LHDs) of rural New South Wales (NSW): Hunter New England, Southern NSW and Western NSW. These LHDs were selected to represent different contexts and accessibility levels to referral hospitals. Research participants were rural GPs with a visiting medical officer (VMO) arrangement with a local hospital and rural patients. Data were collected through in-depth interviews. A total of 13 participants were interviewed. Data were analysed using thematic analysis.

Relevance: Telehealth was introduced to rural and remote communities in various forms to address accessibility of health services in rural and remote areas. Accelerated by the COVID-19 pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed, people-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied.

Results: Telehealth services can address the issue of distance and reduce travel time to specialist consults from remote locations where a clinician is not available to provide clinical care. Our study indicates a number of risks associated with implementing telehealth services to rural and remote communities, which included reduced trust in rural health systems, loss of in-person care, disruptions of continuity of care and equity ramifications. Telehealth might impede the quality of care provided to rural patients because it is fragmented and is unable to establish in-depth caring relationships. Implementation of telehealth increases the risk of losing sight of social circumstances, health risk, and environmental factors related to patients’ health, which are crucial in promoting patient-centred care for rural and remote communities.

Conclusions: Assuming telehealth provides all dimensions of care in the absence of a clinician on the ground is a significant and potentially dangerous fallacy, which may result in lower quality of care, a lack of continuity and reduced trust. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within the integrated service delivery model of rural health system and across diverse rural contexts in Australia.

There are unique challenges faced by rural and remote Aboriginal and Torres Strait Islander communities in accessing and receiving aged care services, and exercising their entitlements with the Department of Health aged care services.

This research was initiated by the Port Augusta community in understanding the gaps in Aboriginal aged care.

This research is a genuine and unique work looking at how Aboriginal peoples understood and access aged care services in rural South Australia. The research team mainly explored the access to My Aged Care portal and delivery (or not) of the Commonwealth home packages. The principal Aboriginal investigator, Kym Thomas, from Port Augusta, provided cultural support and ensured that spirit and integrity were at the forefront of all community and stakeholder community engagement and activities. Communities involved in the research included Port Augusta, Port Lincoln, Ceduna and Whyalla. Kym was supported in his work by Associate Professor Pascale Dettwiller (PL) and Emma Richards (PL). Aboriginal advisory groups were established in each town and consulted. The group consisted of Aboriginal community reps, Aboriginal workers from different organisations and non-aboriginal people representing service providers. They provided insightful and preliminary information about the lack of current culturally appropriate services and perceived barriers to service delivery of aged care. Pilot group questionnaires were trialled in two locations. A semi-structured group interview process (yarning circles) was implemented to suit participants from the four locations. All groups nominated their preferred local cultural brokers, and the principal researcher worked with them through the process, recruitment and delivery of the group interviews.

All collected data was entered into Survey Monkey®, and Microsoft Excel was used to enable quantitative analysis.

Seventy-nine per cent of participants declared that group information was the best means of receiving information about accessing aged care services and enjoyed the yarning aspect of the study approach.

Of the 50 Aboriginal participants, 68% were females and 78% were 60 years or older. Only 44% of them were currently using home aged care services (n=10 through HCP, n=1 through CHSP, n=3 through both programs, n=8 used home aged care services but not from these programs). Among those receiving these services (n=22), nine reported it was because their family were unable to provide the necessary support and seven because their health had deteriorated. The most frequent needs among all participants were help with outside chores (74%), housework (68%), transportation (58%), allied health (46%) and shopping (44%). However, only between 13% and 28% of those reporting these needs were currently receiving home aged care services for these activities. Of the 11 participants that remember how long they waited to receive either HCP or CHSP services, seven referred that they waited 12 months or more.

This community-engaged research indicates a substantial disparity between current needs and home age care services received by Aboriginal older adults in rural South Australia, as well as different barriers in accessing these services or receiving them in a timely manner.

Introduction: Trust is a critical component of effective health system function. In Australia, a colonial legacy of targeted and structural violence makes the question of how to promote Indigenous people’s access to, and trust in, government health services a critical one. We explored the potential of, and threats to, Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) carrying out such transformative trust-building work.

Methods: We conducted interviews with 51 government-employed A&TSIHW, 19 non-Indigenous health providers and eight community members. Analysis was guided by Kroeger’s theory of ‘facework’, which suggests certain types of behaviour from a (health) system ‘representative’ can translate interpersonal (person-to-person) trust, into trust in an organisation (eg clinic/hospital) or broader (health) system.

Results: Facilitated by cultural, linguistic, and familial relations, A&TSIHWs devoted significant energy to maintaining and strengthening interpersonal trust-relationships with Indigenous clients. These trust-relationships enabled A&TSIHWs to explain and negotiate service-access with many who would otherwise be unwilling to seek care and aligned with their mandate to promote cultural safety. Non-Indigenous health workers acknowledged that A&TSIHWs ‘accompaniment’, and ‘interpretation’ were essential for carrying out their own (clinical) duties effectively. Despite this, we found comparatively little effort by A&TSIHWs to translate Indigenous clients’ interpersonal trust into broader organisational trust, with multiple contributing factors. For example, although cultural brokerage is mentioned in role descriptions and training courses, performance metrics do not reference these intangible aspects of A&TSIHW work. Rather, performance indicators are typically linked to ‘documented instances of care’ resulting in operational and managerial constraints on the time and space made available to A&TSIHWs to engage in out-of-clinic trust-building activities. Investing in organisational trust building is thus not only perceived to be difficult and largely unrewarded, but actually unattractive, due to the risk of A&TSIHWs being viewed as unaccountable by colleagues or managers with consequential punitive action.

Conclusion: Notwithstanding the critical potential of A&TSIHWs to translate interpersonal- into organisational- or systems-trust, embedded structural barriers and organisational devaluing of such efforts currently influence them to choose not to invest in such work.

WA Country Health Service (WACHS) Wheatbelt Population Health Unit (WPHU) is leading the way to promote health and wellbeing in the region by addressing risk and protective factors for chronic diseases via the Healthy Eating Activity and Lifestyle (HEAL™) program.

With high rates of obesity and chronic disease compared to the state, and in line with the Government of Western Australia’s ‘Sustainable Health Review’, the WPHU reoriented services towards prevention, person-centred care and self-management. Consultation with Primary Health teams identified long waitlists with low priority weight-management clients, restricting clients’ access to a timely service for weight management, healthy lifestyle advice and support. HEAL™ provides timely intervention in a group setting, educating clients on healthy eating and forming healthy exercise habits that help prevent chronic disease.

Implemented by a multidisciplinary team of health promotion officers, allied health assistants, dietitians, physiotherapists, nurses and Aboriginal health professionals, the eight-week program is open to those who are at risk of chronic illness. Trained HEAL™ facilitators conduct an hour of group education and an hour of tailored exercise weekly. Follow-ups were held at five and 12 months. Reorienting multidisciplinary teams at the district level to implement the program has been a major change management success.

HEAL™ provides holistic, client-centred care, empowering clients to make lifestyle changes to improve their health with the support of healthcare professionals. Participants are regaining control of their health and have increased knowledge, skills and confidence in healthier lifestyle habits and improvements in health outcomes.

Between 1 July 2018 and 31 December 2019, WPHU delivered HEAL™ to 190 participants in 20 programs run across the vast regional area. At eight weeks, statistically significant (p<0.05) improvements on all 16 behavioural and physical variables were measured. Notably, the majority of measures (11 of 16) were significantly improved at five months compared to baseline, while half of the measures (8 of 16) significantly improved at 12 months.

On average:

• clients lost 1kg of body mass
• reduced waist circumference by 1cm
• increased physical activity by 160 minutes per week
• increased serves of fruits and vegetables by 0.7 and 0.4 serves, respectively
• walked an extra 27m in their six-minute walk test.

Implementation of the HEAL™ program from 2017 to 2021 incorporated a needs assessment, identification of best practice programs, developing referral pathways and a model of care, building multidisciplinary teams, evaluating activity and outcomes, and pursuing a sustainable delivery model.

HEAL™ benefits the community by providing a program that supports long-term healthier lifestyle choices. Facilitators create a safe and supportive environment free of shame, bias and stigma as emphasised in the WA Healthy Weight Action Plan 2019–2024. Post-program satisfaction surveys show participants value the supportive group environment, quality of the HEAL™ resources and the skills of their facilitators with 96 per cent of participants confident that they would be able to maintain positive behaviour changes learned during the program in the long term.

(2020 data is currently being evaluated, but was impacted with HEAL™ facilitators being absorbed into supporting COVID-19 communications; and COVID-19 restrictions limiting service delivery.)

Aims: To assess adherence to endorsed guidelines and appropriateness of antimicrobial prescribing in Central Australia.

Methods: A retrospective study assessing antimicrobial prescriptions in 10 Aboriginal clinics (three in remote communities and seven in regional centres) using a validated evaluation tool. One hundred and eighty antimicrobial prescriptions written between 1 January and 31 December 2018 were randomly selected for inclusion in the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing.

Relevance: Australians living in remote and very remote areas have poorer health outcomes, greater burden of disease and higher incidence of infection. Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Aboriginal) make up a significant portion of the remote populations of Australia; approximately three per cent of the 25.3 million Australian population are Aboriginal, but they make up 46 per cent of the population in very remote and 16 per cent in remote regions.

Aboriginal Australians have a higher incidence of sepsis and infection-associated mortality compared with non-Aboriginal Australians, compounded by higher rates of antimicrobial resistance (AMR). The increasing rates of AMR may be contributed to by inappropriate antimicrobial use; however, there has been limited investigation of antimicrobial use and AMR in remote primary healthcare settings.

Results: A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Thirteen (7.2%) prescriptions were not assessable for appropriateness and 11 (6.1%) were not assessable for guideline adherence, due to incomplete documentation. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines.

Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively.

Conclusions: A quarter of antimicrobial prescriptions written in select remote Central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.

Aims: To assess adherence to endorsed guidelines and appropriateness of antimicrobial prescribing in Central Australia.

Methods: A retrospective study assessing antimicrobial prescriptions in 10 Aboriginal clinics (three in remote communities and seven in regional centres) using a validated evaluation tool. One hundred and eighty antimicrobial prescriptions written between 1 January and 31 December 2018 were randomly selected for inclusion in the study. The main outcome measures were the rates of guideline adherence and inappropriate prescribing.

Relevance: Australians living in remote and very remote areas have poorer health outcomes, greater burden of disease and higher incidence of infection. Aboriginal and Torres Strait Islander people (hereafter respectfully referred to as Aboriginal) make up a significant portion of the remote populations of Australia; approximately three per cent of the 25.3 million Australian population are Aboriginal, but they make up 46 per cent of the population in very remote and 16 per cent in remote regions.

Aboriginal Australians have a higher incidence of sepsis and infection-associated mortality compared with non-Aboriginal Australians, compounded by higher rates of antimicrobial resistance (AMR). The increasing rates of AMR may be contributed to by inappropriate antimicrobial use; however, there has been limited investigation of antimicrobial use and AMR in remote primary healthcare settings.

Results: A total of 180 prescriptions were included (96.1% Aboriginal, 32.2% male). Ninety-nine (55.0%) prescriptions were written by general practitioners (GPs), 57 (31.7%) by nurses and 24 (13.3%) by others. Thirteen (7.2%) prescriptions were not assessable for appropriateness and 11 (6.1%) were not assessable for guideline adherence, due to incomplete documentation. Forty-three (25.7%) assessable prescriptions were deemed inappropriate and 75 (44.4%) did not adhere to guidelines.

Prescriptions written by GPs were less likely to adhere to guidelines, particularly GPs located in remote communities. The most common reasons for inappropriate prescribing were incorrect dosage/frequency and antimicrobial not indicated. Skin and soft-tissue infection was the commonest indication, with 29 of 41 (70.7%) prescriptions deemed appropriate. Prescriptions for lower respiratory tract infection had the lowest rate of appropriateness, with one of seven prescriptions deemed appropriate (14.3%). Antimicrobials with the lowest rate of appropriateness were ciprofloxacin, amoxicillin-clavulanate and cefalexin, at 50%, 56%, and 62%, respectively.

Conclusions: A quarter of antimicrobial prescriptions written in select remote Central Australian Aboriginal primary healthcare clinics were deemed inappropriate. The implementation of a comprehensive antimicrobial stewardship program is recommended.

Background: A key reform in the 2015 Western Australia (WA) Health Director-General in supporting statewide stroke reform was the establishment of the WA Acute TeleStroke Service (‘TeleStroke Service’) aimed at improving access for people in regional WA to specialist stroke advice and time-critical treatment. The proof of concept has been led by the WA Department of Health Stroke Services Project (WASSP) team in collaboration with metropolitan tertiary hospital neurology/stroke specialist providers. The WACHS TeleStroke Program provided funding to support the regional implementation of the TeleStroke Service, which occurred incrementally across regional WA during 2016–17. A geographically dispersed population within the largest country health service in Australia presented unique challenges to the TeleStroke Service.

Method: This research examined the impact of consultations with a stroke specialist via telehealth on the care of stroke patients presenting to regional WA emergency departments (EDs). A mixed-methods approach was employed to systematically analyse the routine administrative and stroke audit datasets interpreted together with the experience of WACHS clinicians.

Findings: Marked increase in stroke admissions to WACHS hospitals from EDs between 2016/17 and 2017/18. The number of ischaemic stroke and TIA patients doubled in this one year of implementation of TeleStroke Service. This is partially explained by a relative increase in an ‘ischaemic stroke’ diagnosis in place of ‘stroke unspecified’. WACHS ED clinicians have also reported improved stroke diagnosis and self-sufficiency in managing stroke patients locally since the commencement of the TeleStroke Service.

A little less than a quarter of stroke and TIA patients presented to regional EDs in WA were transferred to another hospital and the proportion transferred to tertiary centres demonstrated an upward trend for patients presenting with haemorrhagic stroke. For patients admitted to a WACHS hospital with ischaemic stroke and TIAs, the rate of transfer to a tertiary centre showed declining trends since 2016/17. Transfer for specialist examination increased from 0% in 2016/17 to 32% in 2019/20, and transfer due to need for endovascular therapy from 2% in 2016/17 to 18% in 2018/19. An overall increase in the rate of thrombolysis was noted at 4.4% over 24 months between January 2018 and December 2019 including the drip-and-ship method where WA regional patients received thrombolysis before transfer to tertiary centres, most likely for thrombectomy. These trends are in alignment with clinicians’ reports of increased access of regional WA patients to the expertise and resources available in tertiary centres.

While complete attribution of these observations has been challenging due to the likely impact of concurrent developments in stroke management within WA Health (for example, expanded eligibility for endovascular therapy), frontline WACHS clinician’s experience confirms the impact of TeleStroke on these trends.

Conclusion: The descriptive analysis in this research provides evidence for the impact of improved access equity to stroke specialists on improving regional hospital capacity in acute stroke management and enabling the transfer of suitable stroke and TIA patients for further specialist assessments and endovascular interventions. This is partially attributed to the availability of TeleStroke Service for stroke patients presenting to WACHS hospitals.

Background: Working directly with rural and remote communities, an established rural generalist and general practice training program has expanded its longstanding workforce retention and training model by directly recruiting doctors to targeted communities with high medical workforce need.

The 2018–21 pilot of the new strategy successfully secured the services of 14 doctors to 18 of Australia’s hardest to fill locations, including six remote Aboriginal Medical Services, bringing a more stable workforce and enhanced continuity of care to the communities.

Method: By collaborating with Rural Workforce Agencies, State Government Departments of Health and remote communities, locations of high medical workforce need were identified and selected based on the following criteria:

• potential for providing continuing comprehensive whole-patient medical care
• geographic remoteness
• medical workforce need
• equity in geographic distribution across Australia.

The recruitment of a doctor to a remote community was undertaken by linking candidates to locations identified as being of high workforce need. Entry to the 3–4-year rural generalist and general practice training program was guaranteed, on the attainment of minimum entry standards. In addition, from 2021, the Australian Government is providing additional salary support funding to enhance the market competitiveness and business viability of remote clinics and Health Services to attract and retain high quality rural doctors for their communities.

Results: The 2018–21 initial pilot of the program has successfully recruited 14 full-time doctors to 18 remote locations with longstanding medical workforce deficits, including Cunnamulla (Qld), Mount Isa (Qld), Cooktown (Qld), St George (Qld), Lightning Ridge (NSW), Bourke (NSW), Boggabri (NSW), Dareton & Wentworth (NSW), Mallacoota (Vic), Queenstown & Rosebery (Tas), King Island (Tas), Broome & Fitzroy Crossing (WA), Wadeye & Warruwi (NT) and Nhulunbuy (NT).

Discussion: This targeted recruitment model has brought a more stable workforce and enhanced continuity of care to the participating communities, as well as providing career progression to specialist qualifications for the recruited doctors.

Results from the initial pilot have revealed that on-ground, community-driven support and effective cross collaboration between partnering organisations delivers the best outcome for the community, the practice, and the doctor to enhance health care delivery.

Implications for practice: Initial findings suggest that the linking of high-quality vocational training to a specific location is an effective strategy to recruit and retain doctors to rural, remote, and Aboriginal and Torres Strait Islander communities with high medical workforce need.

The opportunity exists to develop new and innovative remote GP and rural generalist training posts across remote Australia to suit individual community needs and to extend this recruitment/training model to other health and medical disciplines.

Established in 2015, the National Best Practice Unit Tacking Indigenous Smoking (NBPU TIS ) is an Aboriginal-led consortium comprised of Ninti One, University of Canberra and the Australian Indigenous HealthInfoNet. With a key focus on translating research into practice, the NBPU TIS provides evidence-based Tobacco Control and monitoring and evaluation advice to 41 community-based teams across Australia. The majority of these teams (36) work in regional or remote settings; all are based in organisations which have received a Regional Tobacco Control Grant (RTCG) under the Tackling Indigenous Smoking (TIS) Program. This program takes a population health promotion approach to addressing the health inequities driven by tobacco use.

Funded by the Australian Government Department of Health, the TIS program has proven to be one of the most effective packages provided under the Closing the Gap strategy. The program has been funded by the Department in various guises since 2010, however the biggest drop in smoking rates has been since the program was revised in 2015 following an independent review, and the introduction of new elements to the program including the NBPU TIS: for example, the proportion of Aboriginal and Torres Strait Islanders aged 15 years or over who smoked daily was 41.4 per cent in 2014–15, reducing to 37.4 per cent in 2018–19.

The NBPU TIS continues to play an important role in this success story from the tailored support and advice delivered to TIS teams on the ground through to the evidence base provided via the TIS website, which is hosted by the Australian Indigenous HealthInfoNet. Funding the NBPU was a novel step for the federal government in many ways, but one that has proven to be very successful. This relates, in part, to the Unit’s distinctive positioning, Aboriginal leadership, and ability to adapt and evolve within a strong continuous quality improvement framework. In this presentation, we reflect on the challenges and opportunities which this unique service design has provided and share the insights offered by six years of internal monitoring and evaluation data into how and why this model of support for improving health equity for Aboriginal people and Torres Strait Islanders has been so successful.

In conclusion we offer some suggestions for future model development (both in our sector and elsewhere) and our hard-earned advice for connecting research, practice and communities.

Established in 2015, the National Best Practice Unit Tacking Indigenous Smoking (NBPU TIS ) is an Aboriginal-led consortium comprised of Ninti One, University of Canberra and the Australian Indigenous HealthInfoNet. With a key focus on translating research into practice, the NBPU TIS provides evidence-based Tobacco Control and monitoring and evaluation advice to 41 community-based teams across Australia. The majority of these teams (36) work in regional or remote settings; all are based in organisations which have received a Regional Tobacco Control Grant (RTCG) under the Tackling Indigenous Smoking (TIS) Program. This program takes a population health promotion approach to addressing the health inequities driven by tobacco use.

Funded by the Australian Government Department of Health, the TIS program has proven to be one of the most effective packages provided under the Closing the Gap strategy. The program has been funded by the Department in various guises since 2010, however the biggest drop in smoking rates has been since the program was revised in 2015 following an independent review, and the introduction of new elements to the program including the NBPU TIS: for example, the proportion of Aboriginal and Torres Strait Islanders aged 15 years or over who smoked daily was 41.4 per cent in 2014–15, reducing to 37.4 per cent in 2018–19.

The NBPU TIS continues to play an important role in this success story from the tailored support and advice delivered to TIS teams on the ground through to the evidence base provided via the TIS website, which is hosted by the Australian Indigenous HealthInfoNet. Funding the NBPU was a novel step for the federal government in many ways, but one that has proven to be very successful. This relates, in part, to the Unit’s distinctive positioning, Aboriginal leadership, and ability to adapt and evolve within a strong continuous quality improvement framework. In this presentation, we reflect on the challenges and opportunities which this unique service design has provided and share the insights offered by six years of internal monitoring and evaluation data into how and why this model of support for improving health equity for Aboriginal people and Torres Strait Islanders has been so successful.

In conclusion we offer some suggestions for future model development (both in our sector and elsewhere) and our hard-earned advice for connecting research, practice and communities.

A group of junior medical officers and specialists working in remote and rural settings have met every two months for two years to share their difficulties and ideas for improving training for specialists who wish to work outside the larger urban and regional hospitals. The group has included doctors working in anaesthetics, ENT and general surgery, obstetrics and gynaecology, psychiatry, emergency medicine, paediatrics and intensive care, as well as rural generalists working in a variety of settings including Papua New Guinea and Vanuatu. The group has had presentations from eight colleges and the AMA about strategies to increase remote and rural training for specialists.

This workshop will present the outcome of these discussions; a generic framework for training remote and rural specialists. There are five parts to the framework:

1. Choose rural – intake for rural.
2. Start and stay – start training remote and rural.
3. Support and succeed – access to key training.
4. GRRAD – an elite workforce of remote and rural specialists who can be deployed anywhere in the world at times of emergency.
5. Return and remain – complete training where needed.

The workshop authors will present the framework and discuss its relevance to their different specialties. The workshop will involve group work to flesh out further issues and solutions for each training stage and for different specialties. The points of failure in current training practices will be discussed and the potential solutions for colleges struggling to provide specialists to remote and rural settings.

The framework is closely aligned with the recent work from the Royal Australasian College of Surgeons (RACS) led by one author, Dr Bridget Clancy. Aspects of the RACS policy will be used to illustrate how the generic framework can be implemented.

The Leveraging Effective Ambulatory Practice (LEAP) Project is a research partnership between quality improvement networks and eight Aboriginal and Torres Strait Islander Primary Health Care (PHC) services in regional and remote Australia. This project provides a strengths-based approach to explore the ways factors interact and impact on continuous quality improvement (CQI) implementation in the Aboriginal and Torres Strait Islander PHC setting.

Central to this work is the importance of building relationships and sharing knowledge two-ways, to utilise the age-old practice of ‘yarning’ and the genuine relationships formed through that culturally safe space. Driven by physical remoteness, and more recently widespread travel restrictions due to the COVID-19 global pandemic, this project is working to build togetherness from a distance by creating new Gayi Wajarr (Gumbaynggirr for ‘talking grounds’) using unique communication and engagement approaches.

Previous studies have highlighted the critical role that centralising respect of Aboriginal and Torres Strait Islander culture has in creating positive change in PHC services. This project is working to put these findings into practice. Supported by the ‘LEAP Learning Community’ (made up of participating PHC workforce, peak bodies and Primary Health Networks), focus is placed on creating respectful relationships, building trust and encouraging connections. These relationships then facilitate change or generate ideas to strengthen the processes that enable improvement.

The LEAP Project is also exploring new ‘ways of doing’ through communication and knowledge translation that honors how First Nations peoples have in the past and continue to connect and engage. Communication outputs incorporate cultural symbolism, Aboriginal language and slang, and ideas of collectivism into digital data dissemination. Culturally appropriate research output materials are created to share new knowledge with PHC workforce and communities, and there are plans for using online media for making project feedback and reporting more engaging and accessible.

Using mixed methods, an evaluation of these communication and engagement strategies will measure the uptake of project communications, levels of partners engagement, the range of knowledge sharing, and the experiences of the project’s Learning Community members.

With findings from this evaluation, we aim to showcase Gayi Wajarr and share our learnings of how we might more effectively and appropriately engage and communicate with Aboriginal and Torres Strait Islander primary health care partners, bringing together research, practice and communities in new and meaningful ways.

Background: Aboriginal and Torres Strait Islander people living in remote communities experience an inequitably high burden of rheumatic heart disease (RHD); driven by bacterial Strep A infections which precipitate acute rheumatic fever and lead to RHD. The END RHD Communities program aims to explore the acceptability of an outreach, community-based, program for reducing Strep A infections in three remote Northern Territory communities. The program focuses on household approaches to environmental health and primary care through education and employment of Aboriginal Community Workers (ACWs).

Results: In the first year of the program 27 primary participants consented to participate. Five Aboriginal Community Workers (ACWs) were trained and employed, delivering a range of supports to households affected by acute rheumatic fever. ACWs also collected data, approximately fortnightly, on household Strep A infections, household occupancy and household maintenance issues. A total of over 534 household surveys were completed (a median of 21 surveys per household), revealing median household occupancy of 5 people (range 2–16). Access to clinical records was provided by health services in participating communities. In total, there were 32.8 years of retrospective baseline data from clinical records of the primary participants and 18.5 years of prospective data clinic record data during the first year of the activity period. This prospective clinic record data was matched with household self-reported data. Overall, relatively few Strep A infections were reported and there was no association between clinic-reported and self-reported infections. This may indicate under-reporting or under-recognition of Strep A infections by participants and/or health care staff. Qualitative analysis has been used to contextualise these results, including two group yarning sessions and 13 semi-structured interviews involving 14 people (program participants and ACWs). Three health professionals were also interviewed from relevant clinics. Collectively, thematic analysis of qualitative findings suggest that knowledge about Strep A, acute rheumatic fever and RHD is generally low and that intensive input is required to address knowledge gaps for ACWs and participants. However, trusting relationships between ACWs and participants meant that the program was broadly acceptable and practical assistance to report household maintenance issues was particularly valued by participants. Opportunities to strengthen the role of ACWs, improve coordination with health services and education providers, and build community capacity were highlighted in qualitative data. Participant and staff feedback was used to iterate the approach but could be further strengthened to include feedback and data sovereignty input from the wider community.

Conclusion: This outreach-based prevention program offers a new approach to addressing primordial and primary prevention of acute rheumatic fever. The iterated END RHD model appears acceptable in participating communities and associated with improved reporting of household maintenance issues and awareness of prevention opportunities for Strep A infections. Data analysis is ongoing beyond the first year of the program and expanding to include household members of primary participants. The END RHD Communities approach is being refined to increase support for ACWs, utilise their strengths and centre operational leadership of the program within local health services.

Background: Positive rural clinical placement experiences strongly correlate with rural career intention. There is a growing body of literature on the factors which contribute to positive rural placement experiences for health students. However, less is known about the impact of rural health student placements on the rural health services where students are placed. In particular, there is a lack of literature on the impact of health students on the workload and productivity of rural health services.

Aim: The aim of this study was to understand the impact of nursing and midwifery student placements on rural and remote health services, from the perspectives of health service staff.

Method: Thirty-six nursing and midwifery staff working in clinical and management roles in ten rural and remote south Queensland health facilities participated in a semi-structured interview. Staff either acted as direct clinical supervisors of students, or were in leadership positions with responsibility for overseeing and supporting placements.

Results: Staff perceived that student placements impacted on their health service in a number of ways. Staff saw that students brought new ideas and knowledge to their rural health services and found that, in the process of educating students, staff reflected on their own practices. Staff had mixed perceptions on the influence of supervising students on their workload and productivity and, as such, this impact was unable to be quantified. Some staff believed that students could be a valuable ‘extra pair of hands’ while others found that supervising students slowed them down and could be fatiguing. However, staff saw the importance of educating students to support the future rural workforce. Staff commented that the workload associated with supervising students could vary depending on the student, and often decreased over the placement duration. Staff identified a range of strategies to reduce workload associated with supervising students and increase their contribution to rural care.

Implications/conclusions: The findings indicate that there are opportunities to further support rural health services to optimise the positive impacts of student placements and mitigate challenges. To do so requires collaboration between health services and education providers to allocate students appropriately to health services and support health service staff. This study also highlighted the challenges associated with quantifying the objective impact of nursing and midwifery placements on rural health services.

Background: This project examines the use of eyecare services in regional and remote Australia, based on the analysis of administrative data from the National Hospital Morbidity Dataset, the National Health Workforce Dataset and the Medicare Benefits Schedule (MBS).

Methods: The age-standardised and crude rates of hospitalisations with eye-related principal diagnosis by remoteness area, full-time equivalent rate of eyecare providers by remoteness area, and use of eye-health-related telehealth items in the MBS were calculated for 2017–18 and 2018–19.

Results: Rate of hospitalisations with an eye-related principal diagnosis was higher in major cities (age-standardised rate of 1,660 hospital separations per 100,000 persons) than regional or remote areas (age-standardised rate of 1,300 hospital separations per 100,000 persons) in 2017–18.

There were almost twice as many full-time equivalent optometrists in major cities (20.7 per 100,000 persons) than in outer regional areas (11.8 per 100,000 persons), and more than three times as many full-time equivalent ophthalmologists in major cities (4.6 per 100,000 persons) than in outer regional areas (1.3 per 100,000 persons) in 2019.

In 2018–19, almost all Medicare claims for telehealth ophthalmology services in regional and remote areas facilitated by an optometrist came from Western Australia (94 services per 100,000 persons, compared to 0.3 services per 100,000 in other states and territories overall).

Conclusions: Eyecare service provision is lower in regional and remote areas when compared to major cities. Digital health initiatives such as telehealth ophthalmology may help to bridge the gap, however they are still dependent on provider enthusiasm and uptake.

Background: In Australia there is a large disparity in distribution of health services in metropolitan and rural areas, therefore it is commonplace to transfer patients to metropolitan areas. This is especially true for surgical patients who may need subspecialised services. This includes those with choledocholithiasis requiring endoscopic retrograde cholangio pancreatography (ERCP) by a hepatobiliary service or the trauma patient with neurovascular compromise of a limb requiring transfer to a vascular unit. Rural hospitals have budgets allocated to transfer patients in emergent or semi-elective settings.

Aims: The main objective of this study is to analyse the cost burden associated with transfer of surgical patients to metropolitan hospitals and assess whether the funds can instead be allocated to providing the same service in our hospital.

Methods: This is a retrospective cohort study from a 12-month period between June 2020 and May 2021. All patients admitted under the care of a general surgeon who required escalation of care to another surgical service during the index admission were included. This also included patients who were directly transferred from the emergency department after review by the resident surgical team. Demographic information such as age, gender, ethnicity; patient information such as pre-existing comorbidities, public/private account status, location and mode of transfer (eg ambulance, fixed wing aircraft, helicopter); and transfer costs associated were analysed.

Relevance: Availability of certain services in a rural healthcare setting reflects on the health equity of that population, which is one of the social determinants of health as defined by WHO. Timely access to health care within the same geographical location therefore is a basic human right and patients should not need to travel distances to access much needed care.

Results: There was a total of 140 (n=140) patients who were transferred to metropolitan services within a 12-month period, with an equal distribution of male and female patients (M=49%, F=51%); 77.8% (n=109) were older than 50 years of age; 21% (n=30) of patients required transfer due to femoral fractures, 15% (n=21) for biliary tract procedures and 9% (n=12) due to ureteric calculi; 94% (n=131) of patients were public therefore transfer costs were born by Medicare, whereas 3% had private health care. The remainder was funded by DVA and TAC. The total cost of transfer within this period was AUD 0,800.

Conclusion: The preliminary analysis suggests that the majority of patients requiring transfer or escalation of care are older than 50 years of age, are comorbid with more than one condition, and were transferred in a planned semi-urgent fashion. The most commonly required services were ERCP and orthopaedics. The hospital has a monthly ERCP list by a visiting surgeon, however they would benefit from a more regular planned elective ERCP list. The author will perform a comprehensive analysis of costs, nature of transfer (whether planned transfer when bed available at receiving service, or emergent transfer when patient deteriorated) to ascertain whether the transfer was essential and balance against the allocated budget. Key recommendations will be made based on these observations.

Introduction: Stroke is a sudden, life-changing event. The New South Wales Stroke Foundation suggests that there is one stroke every nine minutes in Australia. Aboriginal and Torres Strait Islander people are over-represented and are twice as likely to be hospitalised and 1.4 times as likely to die of stroke.

In rural Australia, the outcome of Indigenous stroke survivors’ recovery is often less favourable due to limited resources, and geographical and cultural challenges. Stroke survivors grieve for the life and identity they’ve lost so suddenly. They often feel intensely frustrated, angry and later depressed and loose will to survive.

Study design: Case report.

Objective: We report a case of a 28-year-old, socially disadvantaged Aboriginal woman’s journey from being bedridden in the Intensive Care Unit (ICU) to independently living and caring for her family with a tracheostomy tube.

Setting: Orange Health Service and into her own community.

Method: A 28-year-old Aboriginal mother of a 10-year-old boy was admitted with right-middle cerebral artery embolic stroke due to infective endocarditis on the background of heroin use. Her other comorbidities include obesity, diabetes mellites, hepatitis C and severe periodontal disease which contributed to posterior glottis stenosis and fixation of vocal cords compromising her airway and requiring permanent tracheostomy. She simultaneously developed blood clots and intracerebral bleed. Given the multiple complications and treatment challenges, palliative options were discussed on two occasions. After 42 days in ICU, she was deemed appropriate to have trial of neurological rehabilitation.

When she arrived in the rehabilitation unit, she was completely dependent and had a tracheostomy tube for breathing and nasogastric tube for feeding. She required full nursing care from tracheostomy care, oral care to bed mobility, transfers, showering and toileting. She cried all day and expressed suicidal thoughts on two occasions. She wouldn’t engage with the Aboriginal Health Workers (AHA), the Social Worker (SW) and even her own family. After two weeks, she was struggling to make any functional gains. Therefore, a family conference was recommended with the view to high level placement. During the multidisciplinary family conference, clear and simple explanations were given to her that if she didn’t participate in therapy, she would be discharged to a nursing home. Patient and family were in distress, SW and AHA reassured her. She finally spoke up and said she would never go to a nursing home as her mother had died in one.

Following the family conference, the patient worked hard in intensive neuro-rehabilitation therapy and, after 183 days, she walked out of hospital independently.

She bravely told her story to the public on NAIDOC (National Aboriginal Islander Day of Celebration).

Despite her tracheostomy tube, she currently participates twice weekly in ‘Aunty Judy Healthy Lifestyle’ program, and is an advocate for other Aboriginal stroke survivors.

Conclusion: This case study highlights the true spirit of Aboriginal heritage. Her spirit is so sincere and pure that every person who comes across her can feel her dedication and commitment towards life.

Objective: Our aim was to systematically review qualitative evidence regarding the experiences and perceptions of general practitioners and the factors influencing retention in remote areas of Canada and Australia. The objectives were to identify gaps and inform policy to improve retention of remote doctors, which should in turn reduce health inequalities for remote communities.

Design: Meta-aggregation of qualitative studies of general practitioners and general practice registrars who had worked in a remote area of Australia or Canada for a minimum of one year and/or were intending to stay remote long term in their current placement.

Results: Twenty-four studies were included in the final analysis. A total of 811 participants made up the sample with a length of retention ranging from two to 40 years. Six synthesised findings were identified from a total of 401 findings. These were: peer and professional support; organisational support; uniqueness of remote lifestyle and work; burnout and time off; personal family issues; and cultural and gender issues.

Conclusions: Long-term retention of doctors in remote areas of Australia and Canada is influenced by a range of negative and positive perceptions and experiences, with key factors being professional, organisational, and personal. All six synthesised findings span a spectrum of policy domains and service responsibilities and therefore a central coordinating body could be well placed to implement a multifactorial retention strategy.

Mental health and wellbeing is an important issue in rural and remote communities. Recent data shows that, although mental health issues occur at the same rate across Australia, the rate of suicide is much higher in rural communities. In Victoria, the suicide rate in rural and remote areas is 47 per cent higher than in Melbourne. In response to tragic events in the West Wimmera Shire in late 2018, a collaborative partnership was formed, a strategy was identified, and Seasonal Conditions Funds collectively pooled, to develop, fund and implement a collective impact approach to this problem.

The Rural Outreach Program is a Victorian rural community mental health initiative. The program seeks to overcome barriers in access to services, such as mental health stigma, lengthy travel distances to supporting services, long wait times, limited service delivery hours and financial costs. The program has three local community–based Rural Outreach Workers (ROW) plus a coordinator, who have the capacity to respond to the immediate needs of people living in rural and remote communities across four Wimmera Southern Mallee shires.

The program is designed to improve the health and wellbeing of community members who are struggling to deal with tough times in their lives and support them to obtain help through service navigation and collaboration with a network of local services. Referrals to the service are made from local service providers including police, social workers, hospitals, the Royal Flying Doctor Service and bush nursing centres. Community members, including family members, friends or work colleagues, may contact the ROW team using a dedicated telephone number, a visit to the program offices, or in person when out in the community. The Rural Outreach Program provides support to community members’ wellbeing in the following areas: service navigation and collaboration, responsive and convenient times and locations, non-clinical and less threatening service delivery, mental health training and awareness raising in the community.

The Rural Outreach Program has received 500 referrals, made over 280 initial visits, and over 1,000 follow up visits. They presented at 350 health promotion events. The majority of initial visits were to community members’ homes. In some cases, the workers drove three hours to conduct initial assessments. Many community members were men, from farming backgrounds, who have been identified as particularly at risk. The workers provided support and advice around a range of issues including social isolation, anxiety and depression, grief and loss, financial hardship and family violence.

The strengths of the Rural Outreach Workers role are: rapid response times, a non- clinical informal approach and local non-stigmatising assistance for people struggling during difficult and challenging times. Community members may access the Rural Outreach Program after hours, in the privacy of their own homes, at no cost. Challenges to the service include worker fatigue, managing expectations and program sustainability. The Rural Outreach Workers are local, trusted people who are well known and embedded in the communities they service. We believe this is key to the program’s success to date.

Background: There is a gap between health research and rural health practice – with a mismatch between academic research and the needs and priorities of consumers and health professionals. To bridge this gap, it is vital that the issues researched are important to those who use and benefit from the research findings. To date, there has been limited public or consumer involvement in health research decision-making, particularly in rural and regional communities. There is a need for a systematic and transparent approach to setting health care research priorities that is evidence-based and incorporates the perspectives of stakeholders. This study brings together consumers, who can identify and prioritise areas for improvement based on their lived experiences; health professionals, who understand the local public health system; and academics, with research expertise and an understanding of the scientific evidence, to identify and prioritise health issues for a regional research agenda.

Aim: To identify actionable health research priorities relevant to stakeholders in the Grampians region, Victoria.

Methods: This study was conducted in five rural and regional communities in the Grampians region of Victoria. There were three phases: (1) surveys and community forums to identify consumers’ and allied health professionals’ perceptions of health care service gaps and local health issues; (2) Focus groups with allied health professionals and community members to explore the values considered important in determining health care priorities; and (3) a modified Delphi where participants (consumers, allied health professionals, and researchers) rated the health issue statements using the priority-setting criteria (identified in Phase 2) and grouped similar issues. Hierarchical cluster analysis was used to group conceptually similar issues (‘cluster maps’). The priority-setting criteria rating descriptive statistics were calculated and used to generate three four-quadrant ‘go-zone’ graphs. The upper right quadrant, labelled the ‘go zone,’ shows the issues that were rated above average by participants on the priority setting criteria.

Results: 187 survey respondents (70 health professionals, 117 community members) and three community forums provided over 400 health issue statements that the research team synthesised into 72 unique statements. Six focus groups (n=30) identified three key values to guide priority-setting: health burden (number of people affected); health equity (equal access for equal need); and feasibility (capacity to implement effective interventions). A nine-cluster map included: transport and technology challenges; social determinants of health; social issues; cancer and respiratory health; health behaviours and environmental determinants; cost of health care; availability of essential health services; quality and capacity of health services; and mental health and disability funding and service delivery. Issues, such as addressing anxiety and mental health issues in young people and lack of access to technology-based interventions due to poor internet coverage, were in the go zone, that is above average on all of the priority setting criteria.

Significance: This study used a structured approach to consult consumers, clinicians and researchers to identify and prioritise health issues. Results of this study provide important information about the prioritized health needs of the community that should be used to inform the health research agenda.

Existing issue: The important role of the early childhood education and care (ECEC) sector in our rural communities has been highlighted throughout the Black Summer bushfires and COVID-19. As key settings for community connection and recovery, ECEC services strengthen the network of support around children as they grow and develop through their early years and into school.

Planning and implementation: Since 2008, we have worked with local ECEC services to implement NSW Health’s Munch & Move^® program. When bushfires devastated our region, followed closely by the COVID-19 pandemic, we undertook a needs assessment to understand how we could best support the sector. The analysis revealed a core need for educators to connect with other educators, leading to the creation of a place-based Munch & Move Early Education Network.

Professional learning networks (PLNs) are groups that engage in collaborative learning with others outside of their everyday community of practice, with the ultimate aim of improving outcomes for children. Research suggests PLNs are suitable for isolated practitioners, because of their capacity to respond to educators’ diverse interests and needs, decreasing isolation and promoting independence.

When face-to-face support to services was put on hold in March 2020, we sought to provide this support online instead. Supported by specialist mental health clinicians, we delivered a tailored series of webinars, addressing a key challenge – how educators could best support children and families, when feeling overwhelmed themselves.

Outcomes, sustainability in embedding change and transferability: Online delivery allowed us to reach a wider audience, including educators from other fire-affected communities in NSW and in Indonesia, where wildfires have been a common occurrence over recent years. Seventy-one educators participated in the webinar series.

Evaluation revealed that educators were able to identify and implement practical strategies that they could use to support both themselves and children. The Munch & Move Early Education Network plans to continue meeting regularly, adapting our practice as needed. The project increased our capability of using tools to support remote delivery of other programs.

Key take home message: Children depend on early childhood teachers and educators who are not only skilled, but have their wellbeing and needs supported too. Supporting educators to care for themselves; to be present in their teaching; to be available in their interactions/relationships with young children has a positive flow-through to children, their families and our communities.

Introduction: Workplace health and safety in very remote primary health clinics across Australia is a longstanding issue. Research assessing workplace violence towards Remote Area Nurses (RANs) showed a significant increase between 1995 and 2008, with 28.6% of participating RANs personally experiencing physical violence in the previous 12 months, and 79.5% experiencing verbal aggression. In a 2017 survey, 25% of participating RANs did not have safe clinics or safe accommodation, and only 55% had ‘never alone’ guidelines at their workplace.

In 2016, the murder of RAN Gayle Woodford in South Australia sparked calls for safer working conditions for RANs, particularly around call-out safety. This call for change drove reviews of existing safety policy frameworks and led to new safety legislation in South Australia.

This study aims to measure how well existing safety recommendations have been met, and assess the impact of workplace safety on RAN wellbeing.

Method: Using a combination of validated tools and remote-specific safety recommendations, a national online cross-sectional survey of RANs was conducted in December 2020 and January 2021. The main outcome was a workplace safety score that quantified how well the safety recommendations had been met. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and ‘never alone’ policy were broken down into specific safety criteria to generate the score. Data on incidents, stress, and job satisfaction were gathered to assess the impact of workplace safety on staff wellbeing.

Data were analysed using SPSS Version 25, to compare safety scores between different states/territories and other workplace characteristics. The impact of workplace safety scores on stress, job satisfaction, and the occurrence of workplace violence and other incidents was also assessed.

Results: 170 participants completed the survey. Overall, the average national workplace safety score was 53.1% of recommendations met (SD=19.8%), with median 38.5% (IQR=15.4%–61.5%) of staff preparation recommendations, median 59.4% (IQR=43.8%–78.1%) of safe work environment recommendations, and median 50.0% (IQR=30.0%–66.7%) of safe work practice recommendations met.

Significant variation in safety scores was found between NT (mean=57.5%, SD=18.7%) and Qld (mean=41.7%, SD=16.7%) (p<0.01), and between SA (median=74.5%, IQR=43.6%–79.5%) and Qld (p<0.05).

Safety scores had a strong negative correlation with RAN stress levels (r=-0.624, n=162, p<0.01). Safety scores were also significantly lower among RANs who had experienced physical violence (mean=48.7%, SD=20.1%) than those who had not (mean=57.6%, SD=18.7%), (t=3.0, p<0.01).

Conclusion: This study found that significant gaps remain in the remote health sector’s approach to staff safety, especially outside of South Australia. Workplace safety was shown to have a significant impact on staff wellbeing, highlighting the urgent need for further improvements. The insights provided by this study strengthen the evidence base which remote health professionals and their representatives can draw on to advocate for change. They may also assist policymakers and health services to identify focus areas for further improvements.

Background: Aboriginal and Torres Strait Islander people living in remote communities experience an inequitably high burden of rheumatic heart disease (RHD); driven by bacterial Strep A infections which precipitate acute rheumatic fever and lead to RHD. The END RHD Communities program aims to explore the acceptability of an outreach, community-based, program for reducing Strep A infections in three remote Northern Territory communities. The program focuses on household approaches to environmental health and primary care through education and employment of Aboriginal Community Workers (ACWs).

Results: In the first year of the program 27 primary participants consented to participate. Five Aboriginal Community Workers (ACWs) were trained and employed, delivering a range of supports to households affected by acute rheumatic fever. ACWs also collected data, approximately fortnightly, on household Strep A infections, household occupancy and household maintenance issues. A total of over 534 household surveys were completed (a median of 21 surveys per household), revealing median household occupancy of 5 people (range 2–16). Access to clinical records was provided by health services in participating communities. In total, there were 32.8 years of retrospective baseline data from clinical records of the primary participants and 18.5 years of prospective data clinic record data during the first year of the activity period. This prospective clinic record data was matched with household self-reported data. Overall, relatively few Strep A infections were reported and there was no association between clinic-reported and self-reported infections. This may indicate under-reporting or under-recognition of Strep A infections by participants and/or health care staff. Qualitative analysis has been used to contextualise these results, including two group yarning sessions and 13 semi-structured interviews involving 14 people (program participants and ACWs). Three health professionals were also interviewed from relevant clinics. Collectively, thematic analysis of qualitative findings suggest that knowledge about Strep A, acute rheumatic fever and RHD is generally low and that intensive input is required to address knowledge gaps for ACWs and participants. However, trusting relationships between ACWs and participants meant that the program was broadly acceptable and practical assistance to report household maintenance issues was particularly valued by participants. Opportunities to strengthen the role of ACWs, improve coordination with health services and education providers, and build community capacity were highlighted in qualitative data. Participant and staff feedback was used to iterate the approach but could be further strengthened to include feedback and data sovereignty input from the wider community.

Conclusion: This outreach-based prevention program offers a new approach to addressing primordial and primary prevention of acute rheumatic fever. The iterated END RHD model appears acceptable in participating communities and associated with improved reporting of household maintenance issues and awareness of prevention opportunities for Strep A infections. Data analysis is ongoing beyond the first year of the program and expanding to include household members of primary participants. The END RHD Communities approach is being refined to increase support for ACWs, utilise their strengths and centre operational leadership of the program within local health services.

Objectives: Fewer than 50 per cent of postnatally depressed women seek help. Untreated postnatal depression (PND) has significant deleterious effects. In particular, women living in outer regional, remote or very remote areas may have difficulties accessing appropriate antenatal health care due to distance and limited availability of services. They often lack practical and emotional support, are isolated and are required to give birth away from their communities. Few well-validated, specialised perinatal mental health treatment programs have been successfully implemented in real-world practice. We at PIRI have developed, and evaluated in RCTs, a six-session cognitive behavioural therapy (CBT) internet intervention for PND and antenatal depression, now available free to all Australian women through the MumSpace PDeC initiative.

Methods: Since 2017, the internet CBT program (MumMoodBooster) has been supported by the Department of Health and available nationally on the MumSpace website in Australia to all perinatal women, at no cost to individual users. The intervention was developed and evaluated over six years of consumer-driven research using focus groups and systematic usability testing. We completed a feasibility study, a two-group randomised controlled trial, and have just finalised a NHMRC-funded three-arm study comparing the online treatment to face-to-face therapy and treatment as usual. Telephone-coached and SMS-supported versions are available for both pregnant and postnatal women.

Our recent translational study in rural NSW evaluated the implementation of the MumMoodBooster program to support isolated and hard-to-reach new mothers, identifying the key facilitators and barriers impacting optimal uptake. Results provide useful information for adjusting the successful MumMoodBooster program for implementation across other rural, remote and isolated areas.

In addition to MumMoodBooster, the MumSpace website offers a stepped-care approach for perinatal women with access to a range of universal and preventive programs.

Results: In our research trials we focused on women with diagnosed depressive disorders and 80 per cent of those who received the internet CBT treatment achieved clinical remission (a four-fold superiority over treatment as usual, and better than face-to-face). Treatment adherence was excellent. Translation into the real world setting, including in rural communities, has shown the clinical gains in reducing depression symptoms are similar across an eight-week period (approximate halving of PHQ-9 depression scores) despite better adherence to the coached version compared to SMS-supported version.

Conclusions: Results suggest that MumMoodBooster is an effective treatment option for women clinically diagnosed with perinatal depression. It is accessible to rural women, can be integrated into clinicians’ practice, and remains effective when translated into real-world use – connecting research, practice and communities in action.