Background: The Roadmap to Close the Gap for Vision (Roadmap) was published in 2012 following comprehensive consultations with service staff, specialist eye health personnel, service users and communities across Australia to investigate barriers to care and develop solutions to improve Aboriginal and Torres Strait Islander eye care. The Roadmap made a series of recommendations for policy and practice changes at national, jurisdictional and local levels; considered remote, rural and urban geographies; and included implementation of reform at a regional level to improve eye care for Indigenous Australians. The regional implementation strategy was to ensure flexibility and appropriateness for different needs within regions, and ownership by those living and working within the local area. Indigenous participation and leadership through Aboriginal Community Controlled Health Organisations (ACCHOs) was central to regional implementation.

Since 2013, regional approaches have been implemented across Australia, with over 60 regional groups in all states and territories. Activity is implemented differently across different regions, reflecting the diversity of communities, systems and structures, and different needs across remote, regional and urban settings – as well as stages of implementation. Aboriginal and Torres Strait Islander leadership has emerged as the critical determinant to eliminate avoidable vision loss and blindness and sustain good eye health and vision care for Aboriginal and Torres Strait Islander Australians.

Methods: A formative evaluation using a mixed-methods approach included a national survey, regional case studies, key informant interviews, administrative data and a literature review. Data was captured from all jurisdictions, across remote, regional and urban settings, after multisite ethics approvals and with some elements conducted by contracted external consultants.

The evaluation was co-designed with Indigenous and sector stakeholders to ensure community benefit, priorities and aspirations were addressed and Indigenous leadership supported. First Nations researchers were involved in the project, from co-design through to data collection and analysis. An Aboriginal and Torres Strait Islander Reference Group provided guidance and support for the project.

Results: Eight regional stakeholder group case studies, 98 national survey responses, key informant interviews, a desktop review of the literature and administrative data provided the complex data set for the evaluation. The findings identify the effectiveness of regional stakeholder groups and how they can better support equitable eye health outcomes for Indigenous Australians.

The co-design evaluation process and outcomes include a priority of Indigenous leadership, self determination, knowledge and capacity enhancement, and these enablers have been increasingly advanced in subsequent work.

This presentation will present key findings from the evaluation including significant learnings about regional approaches to health reform, the fundamental importance of Indigenous leadership, the value of collaboration and lessons for health system improvement beyond eye health. The emergence and development of Aboriginal and Torres Strait Islander eye health groups to lead Aboriginal and Torres Strait Islander eye health is an exciting outcome to be shared.

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better understanding of healthcare access and their specific unmet needs. This qualitative study sought the views of both rural-centric older people and healthcare professionals to understand health needs, barriers and enablers of accessing health services, with a focus on chronic health condition(s).

Methods: Between April and July 2022, separate in-depth interviews were conducted with 20 older people (≥60 years) in a rural South Australian community. Additionally, focus group interviews were conducted with 15 healthcare professionals involved in providing health services to older adults. Transcripts were coded using the NVivo software and data were thematically analysed.

Results: Participants described a range of unmet care needs including chronic disease management, specialist care, psychological distress, and the need for formal care services. Four barriers to meeting care needs were identified: workforce shortages; a lack of continuity of care; self-transportation; and long waiting times for appointments. Self-efficacy, social support and positive provider attitudes emerged as crucial enabling factors of service use among  rural ageing populations.

Discussion: Older adults confront four broad ranges of unmet needs: chronic disease management care; specialist care; psychological care; and formal care. There are potential facilitators, such as  self-efficacy, provider positive attitudes and social support, that could be leveraged to improve healthcare services access for older adults.

Objective: To assist teams providing education to doctors and nurses managing rural emergency facilities, we examined the type of emergency presentations to Australian emergency departments (EDs) of all sizes and remoteness classifications. We did this because some researchers have argued that rural emergency facilities see mainly minor illnesses and injuries. Knowing the type of patients encountered is a small but essential step in curriculum development.

Methods: We conducted a secondary analysis of a dataset containing 88% of Australian ED presentations for one year. EDs were classified by their location using the Modified Monash Model (MMM).

Results: One hundred and ninety rural EDs managed 2,447,254 patients. As the MMM classification increased from 1 to 7, the EDs generally became smaller (median yearly presentations MM1 48,354 to MM7 2,294). Planned and prearranged attendances were more common in smaller and remote facilities. All Australian EDs saw triage category 1 and 2 patients (triage 1 proportion ranging from 0.7% in MM1 urban to 0.3% in MM7 remote). Within each MMM remoteness area, individual EDs had a wide range of results for triage categories, arrival by ambulance and admission rate, with most MMM groups overlapping. EDs in all areas saw a similar spectrum of common diagnoses. EDs in small rural towns (MM4-5) saw the highest percentage of patients over 65 years old. Remote and very remote EDs (MM6-7) saw the highest proportion of Indigenous patients.

Conclusion: All classes of rural and remote emergency facilities see a wide variety of patients, including critically ill patients. There was a general progression to less acute presentations as the MMM class became more remote. Still, there was great variability in presentations to individual EDs within each MMM class.

Health promotion is increasingly being recognised as an integral skill for many health professions as resource constraints push care out of the acute sector and into the community. Health professions such as paramedicine are reflective of this change, as their occupational role and scope of practice are progressively moving into the community setting. This is particularly relevant for rural Australia where paramedics are beginning to have a significant role in the community in health education and promotion, in addition to providing emergency response care. Consequently, tertiary education institutions need to provide paramedic students with the opportunity to learn about health promotion as a professional role in their future practice.

This research explored the learning afforded to undergraduate paramedicine students through participation in a short-term health promotion activity. The health promotion activity was conducted in 2022 over three days at a large agricultural event located in southern New South Wales. It occurred as a partnership between a University Department of Rural Health and the Australian Men’s Shed Association in delivery of the ‘Spanner in the Works?’ health screening and health promotion initiative primarily targeting rural men. First-year paramedicine students from a regional university participated in the health promotion activity under the supervision of registered health professionals from nursing and allied health backgrounds. To ascertain the learnings afforded to the students and the attributes and practices that facilitated their learning, the undergraduate paramedicine students were invited to participate in case study research based on the ECOUTER mind-mapping method.

Thirteen of the 14 paramedicine students who participated in the activity consented to participate in the research. Three key themes were identified as the attributes and practices that facilitated their learning, including the high-dose narrow scope nature of the activity, creation of a space for reciprocal connection between students and the community participants, and an unanticipated change in perception for the students who participated in the activity. Short-term health promotion activities such as this have the potential to provide students with an invaluable learning experience to prepare them for future professional practice.

Aim: This paper outlines strategies to increase dental and oral health training in rural and remote areas to enhance access to dental and oral health care and develop rural workforce.

Method: A synthesis of the rural health workforce literature, analysis of university dental and oral health placement data and consultations undertaken with university, public and private sector stakeholders and students engaged in dental and oral training was undertaken to identify and assess the feasibility of strategies to increase training in rural, remote and regional areas through the Rural Health Multidisciplinary Training (RHMT) program.

Key findings: The elements of quality of rural placements for positive rural training immersions to promote future rural workforce outcomes are known. However, current approaches by the 12 Australian universities delivering dental and/or oral health courses is highly variable in the extent to which rural training and placements are likely to promote rural workforce outcomes. Improvements include increasing placement length; curricula modifications to better prepare students for rural placements; increased linkages with University Departments of Rural Health (UDRHs) and Rural Clinical Schools for interprofessional learning, cultural training, pastoral and professional support.

Access to supervision challenges dental and oral health training in rural areas exacerbated by variable and limited attention to working with Local Health Networks to develop supervision capability and capacity.

Structural issues including disconnect of oral health from primary care and training system, diminishing dental and oral health academic capacity, dental and oral health siloing, and absence of a national focus hinders dental and oral health workforce development and distribution.

A set of guiding principles underpinned development of layered strategies to progress an evidence-based and multidisciplinary training and workforce development pathway. Strategies include:

• National summit to develop a rural and remote dental and oral health training and workforce plan.
• Universities’ student selection and approaches to rural training and placements are evidence based.
• Develop a rural graduate and career program supporting transition to rural work with structured clinical and professional development and mentoring concomitant with supervision capacity development and academic capacity building.
• Embed oral health in UDRHs, developing placements in alternate service settings, facilitating dental and oral health networks and providing orientation and structured student support on placement.
• Develop rural dental and oral health clinical and teaching hubs to build clinical, teaching, supervision and research capacity and capability to support placements and service delivery to smaller ‘spoke’ communities.
• Invest in the Indigenous dental and oral health peak body to provide leadership to grow the Aboriginal and Torres Strait Islander oral health workforce.

Conclusions: The dental and oral health workforce development and training pathway draws on findings from the feasibility study and learnings from the RHMT evaluation to develop a pathway that spans pre-university to early career consolidation. The pathway optimises current Commonwealth and state investment in capital and human infrastructure in rural training and service investment, identifies where additional investment is needed, and promotes a national policy approach for dental and oral health workforce development and distribution.

Background: Cardiovascular disease (CVD) has the highest disease-associated expenditure in Australia, costing $5 billion annually to provide healthcare services for hospitalised patients. Re-hospitalisation due to poor medication management presents as a significant issue for the cardiology patient, which has been found to increase the likelihood of hospital readmission in the following month by 28%. Each year, roughly 250,000 Australians are hospitalised and a subsequent 400,000 present to emergency departments of hospitals due to medication-related events; 50% of which are considered preventable. Such events include the inappropriate use of medicines, medication misadventure or medication errors. Availability of pharmacist-led medication reconciliation programs at hospital transitions has been established as a means for improving post-hospital healthcare utilisation.

Aims: To explore patient perceptions surrounding their experience with medication reviews and pharmacist-led medication services. Results have potential to highlight existing unmet needs and will help inform coordinated health care incorporating medicines reviews.

Design: An interpretative qualitative study involving 13 semi-structured interviews with patients discharged from John Hunter Hospital (JHH) cardiology unit. The JHH is one of the primary facilities providing care for regional, rural and remote patients (ARIA codes 1 to 5) across the Hunter New England Local Health District. These patients therefore provided a broad spectrum of localities and offered unique perspectives on pharmacist-led medication reviews.

Method: Potential participants eligible for inclusion were those over the age of 18 years and being discharged to a community setting. Patients were identified by a cardiology unit nurse or pharmacist according to their admission diagnosis, or CVD risk factors as determined by the CVDCheck assessment tool. Consented patients (8 male, 5 female, aged between 36 and 75 years) participated in a single 30-minute interview to discuss their perceptions of medication review services and current medication management practices. Interviews were audio-recorded (with participants’ permission) and transcribed verbatim. Data collection and analysis was concurrent. Data was analysed using an inductive thematic approach with a process of constant comparison.

Results: Our data suggest that patient knowledge of medication regimes is challenging in a hospital environment while simultaneously adjusting to a critical medical event. All participants acknowledge the benefit of having a medication review to ensure the safe and effective use of medications. Pharmacists were considered a readily available resource for medication-related information and education, fulfilling a critical role within a patient’s healthcare team. Benefits of medication review included reassurance surrounding medication-associated uncertainty or anxiety, provision of personalised care, and the ability to engage in medication-related conversation within the comfort of their homes. Barriers to medication compliance include understanding side effects, relationship with community pharmacist, establishing a routine, financial concerns and feelings of stigma. An in-depth data analysis will be presented.

Discussion: To our knowledge, this study is the first to explore perspectives of CVD patients following the updated Australian medication review program guidelines. The acceptability and potential benefit of pharmacist-led medication reviews is apparent. Greater implementation of such services will be an important mechanism to reduce medication-related misuse and subsequent hospitalisations throughout regional, rural and remote communities.

Background: Many rural organisations have very limited resources yet a huge imperative to invest in areas that will most help the community. To help inform planning as to how to invest in areas of the most value for the money and resources available, in 2022–23 this organisation undertook to develop a value-for-investment framework.

Objective: This case study is about the development of a value-for-investment framework to help a rural organisation to plan and review how well we are investing in strengthening the rural primary care system.

Methods: A specialist evaluation and evidence team was recruited in a Strategy and Performance Unit in 2022. They commenced the development work by having regular meetings, reviewing existing organisational strategy, understanding the complex adaptive system context and the planning and evaluation landscape of the organisation, exploring the wider evaluative and systems literature, and drafting the framework. The framework underwent further consultation and engagement to ensure it was relevant to the requirements.

Results: The value-for-investment framework consists of six dimensions of value which align with the most important elements for strengthening the rural health system. These are feasibility and relevance, appropriateness, equity, implementation quality, efficiency and effectiveness.

Conclusion: The framework and its dimensions and high-level performance criteria were defined and refined across the project timeline, and the consultation process identified that the framework is clarifying and feasible to implement (in stages) for small- to medium-sized primary care organisations. This work has the potential to improve systematised planning for primary care system improvement.

Objective: To compare regional and metropolitan prescribing rates of key medications in the treatment of ischaemic heart disease, based on patients’ residence and treatment location, in patients who have coronary artery disease (CAD) and have undergone percutaneous coronary intervention (PCI).

Design: Multicentre, prospective, observation cohort study. Data was taken from the Victorian Cardiac Outcomes Registry (VCOR) and was used to identify and include any patient who was over the age of 18 and who had received or was intended to receive PCI from 1 January 2014 until 31 December 2020.

Setting: Thirty-three Victorian hospitals with a cardiac catheterisation laboratory where PCI is performed.

Participants: This cohort study included 80,635 patients who received PCI for stable or unstable CAD in Victoria. This data was further divided into where the patient resided (regional or metropolitan Victoria) and where they received their PCI (regional or metropolitan Victoria) resulting in three groups (metropolitan patients treated in metropolitan centres, regional patients treated in metropolitan centres and regional patients treated in regional centres).

Main outcome and measures: Of the three groups, patients who were treated regionally had higher rates of aspirin, betablockers, statins and oral anticoagulants prescription compared to regional patients who were treated in metropolitan centres and metropolitan patients.  Similar rates of ticagrelor were prescribed in metropolitan-treated patients and regionally treated patients. Of the three groups, regional patients treated in metropolitan setting had higher rates of thienopyridines (clopidogrel and prasugrel) being prescribed compared to the other two groups.

Conclusion and relevance: Patients who were treated regionally had higher rates of prescription of key medications used to treat ischaemic heart disease when compared to patients treated in metropolitan centres, highlighting the quality of regional cardiac care in Victoria.

Rural generalist training has been emerging in Australia since the 90s and was recently expanded through state-funded programs that support doctors’ educational transitions across the prevocational and vocational years. Australia now has a National Rural Generalist Pathway and, in each state and territory, rural generalists are being trained as a selective cohort in the regions where we want to practice. However, a key question remains as to how to promote stable employment for graduates emerging from rural generalist training in locations where rural generalists are needed. This includes considering where rural generalists are most likely to be viable and sustainable so that there is an end point to training that results in supported high-quality professional practice and services for the community.

The Victorian rural generalist program has done some work to explore this question in the context of Victoria. This presentation explores interviews with 36 stakeholders who were program staff, policy decision makers, executives and active rural generalists. The findings were that the decision about where rural generalist models are viable in Victoria is informed by a context of specialist professional competition and changing health service executive and executive values over rural generalist models, introducing a level of person and place dependency to decision making. Further, the Victorian context or planning is devolved where individual doctors are negotiating individual models with individual health services.

There is no clear accreditation framework and, while this persists, rural generalist scope of practice is at risk. With this context in mind, rural generalist models are likely to require a statewide clear accreditation framework informed by the profession and regional-level planning (use of emerging Health Service Partnerships and training networks) to set out services, at the scope and distribution, which will best serve people in the regions, rather than individual services. Also needed is a clear payment structure relative to the skill and scope of work areas which covers both state and privately funded services (and which is as integrated as possible for the employee salary and benefits).

By addressing employment models, there is the potential for rural generalist training investments to achieve good uptake and retention of workforce in a way that matches community need.

It is estimated a third of Australians live in regional, rural and remote communities, and patients in these communities have poorer cancer outcomes. One of the key priorities embedded within the research portfolio of the Australia New Zealand Gynaecological Oncology Group (ANZGOG) is patient equity in access to clinical trials. To support this, ANZGOG is developing a Patient Referral Network project that will map patient referral pathways for treatment of gynaecological cancer across Australia and New Zealand. It is expected that this project will integrate with and utilise the opportunities presented by teletrials, enabling patients with gynaecological cancers access to treatment offered through ANZGOG’s clinical research program closer to home.

The Patient Referral Network project has distributed surveys to ANZGOG’s 65 affiliated clinical trial sites, to identify the standard arrangements for patient treatment referral. Once collated, this information will help in developing a ‘map’ that ANZGOG’s research unit can utilise when looking at health network optimisation for clinical trial site selection, and will help inform the development of hub and spoke opportunities for teletrials. An added benefit of this project and its approach is the ability for gynaecological cancer patients to be treated closer to home, which has shown increased patient satisfaction and greater adherence to treatment schedules, thereby improving treatment efficacy and health outcomes. This project will serve to address the needs of Indigenous Australian and culturally and linguistically diverse (CALD) patient populations by optimising the treatment of patients within, or near to, their communities.

ANZGOG has used an early version of this ‘map’ to enable its first teletrial cluster in Queensland for one of its newest studies in recurrent cervical cancer. The breadth of patient reach that this cluster enables is over 3,000 kilometres, as patients from Townsville and Mackay will be able to participate in this research under the oversight of study personnel in Brisbane. For most patients, traveling that considerable distance wouldn’t be feasible for clinical trial participation, owing to the schedule of assessments and required safety oversight in Phase 2 clinical trial research. This cluster model will be reviewed as a proof of principle for suitability across ANZGOG’s research portfolio, which will enable patients from regional, rural and remote locations to participate in world-leading clinical trials.

We know clinical trials offer patients new treatment opportunities that may improve outcomes, have fewer toxicities and improve quality of life. Research evidence indicates patients taking part in clinical trials do better than other patients with the same disease or condition, and that being part of a clinical trial helps the patient play an active role in their health care and learn more about treating and managing their condition. As such, equitable access to clinical trials is paramount and a patient’s geographic location shouldn’t preclude them from participating. To learn where regional, rural and remote patients are located, and using this information to map the easiest and least burdensome journey for their clinical trial participation is vital.

Background: Many rural organisations have very limited resources yet a huge imperative to invest in areas that will most help the community. To help inform planning as to how to invest in areas of the most value for the money and resources available, in 2022–23 this organisation undertook to develop a value-for-investment framework.

Objective: This case study is about the development of a value-for-investment framework to help a rural organisation to plan and review how well we are investing in strengthening the rural primary care system.

Methods: A specialist evaluation and evidence team was recruited in a Strategy and Performance Unit in 2022. They commenced the development work by having regular meetings, reviewing existing organisational strategy, understanding the complex adaptive system context and the planning and evaluation landscape of the organisation, exploring the wider evaluative and systems literature, and drafting the framework. The framework underwent further consultation and engagement to ensure it was relevant to the requirements.

Results: The value-for-investment framework consists of six dimensions of value which align with the most important elements for strengthening the rural health system. These are feasibility and relevance, appropriateness, equity, implementation quality, efficiency and effectiveness.

Conclusion: The framework and its dimensions and high-level performance criteria were defined and refined across the project timeline, and the consultation process identified that the framework is clarifying and feasible to implement (in stages) for small- to medium-sized primary care organisations. This work has the potential to improve systematised planning for primary care system improvement.

Introduction: Access to high-quality, cost-effective, professional education is an essential workforce retention strategy. However, staff in rural and remote areas face many barriers in accessing such education. When local education resources are scarce, a focus on mandatory training takes precedence. The Rural and Remote Education Support Program (RRESP) commenced in 2017, in four rural or remote Hospital and Health Services in Queensland, to support novice rural and remote nurses to transition to practice and develop essential skills and knowledge.

Aim: To evaluate the education support program (RRESP) for clinical staff in rural and remote Queensland.

Methods: A three-phase mixed methods evaluation was conducted. Phase 1 focused on historical feedback received from clinicians who participated in the education sessions. Phase 2 included the development of an online survey to assess user satisfaction, accessibility and feasibility of the education program, including educational approaches utilised throughout different rural and remote clinical contexts. Phase 3 used data from individual semi-structured interviews conducted with 13 participants – seven clinicians and six organisational stakeholders.

Results: Phase 1 elicited 594 feedback responses, mostly positive, particularly for topics that addressed serious but infrequent presentations. Areas for improvement included technology issues, recording more sessions and increased use of case-application approach. Phase 2 had 41 responses with representation from all health disciplines and levels, and across all care contexts. RRESP met the needs of 85% of participants. The importance of RRESP educators having rural or remote work experience, and the presentation of evidence and guidelines for practice was identified. Application of education was impacted by the relevance of content, local practice policy, staff turnover and levels of management support. It was felt by 48% of participants that access to RRESP positively impacted recruitment and retention of rural and remote staff. Interview data from Phase 3 confirmed that the model was acceptable, feasible and effective in providing best-practice approaches to rural and remote clinical care, education and professional communication. The principles that were used to underpin teaching approaches were confirmed as positive and credible. Data analysis uncovered dominant themes including ‘Credible, appropriate educators know the context’, ‘Accessible, relevant education’, ‘Safety net’ and ‘Resourcing issues block education access’. Additionally, secondary data outlines specific challenges faced when working in rural and remote settings, including ‘Less layers, less support, more complex’, ‘Different knowledge/skills needed’, ‘Knowledge of context impacts confidence’, ‘Treating the community you know’ and ‘Rural generalist – every kind of presentation at any time’. Alongside challenges, positives of working in rural and remote were also outlined including ‘Part of the community’, ‘Easy to have a positive impact’ and ‘Something different’.

Conclusion: The RRESP is a model that can be translated into any rural or remote setting. Education programs and approaches need to be context specific, collaborative, accessible and focused on improving clinician confidence to practice. Linking evidence-based guidelines to practice tips and how to manage presentations in low-resourced environments were key factors to successful education. Participants and stakeholders who also helped co-develop the program and model felt the program provides a safety net and bigger picture connection, creating a symbiosis between clinical support and education.

Demand for general practitioners (GPs) is forecast to widen (shortfall expected to reach 11,392 GPs FTE). For rural generalist trainees, training in public secondary care services administered by local health districts (LHDs) are a core element of fellowship. As such, rural generalist trainees represent a significant workforce contingent in hospitals and clinics servicing rural and remote communities. However, rural generalist trainees in secondary care facilitates face barriers including professional and personal isolation, under-representation and intercraft conflict between specialties, which may contribute to professional and personal burnout and attrition from rural practice.

Research focus: Our research sought to provide ground-level data on factors contributing to retention and quality of registrars working in areas of high workforce need. The policy window for action for staff wellbeing is heralded by three factors: the transition to college-led training; the rural communities calling for assistance to fill workforce shortages; and the International Labour Organization/World Health Organization joint publication advocating strengthened protection of workforce.

Methodology: This work consists of 18 months of in-depth ethnographic fieldwork including participant observation semi-structured interviews with rurally based registrars and direct observation of workplace, health and social spaces. It draws on the experience of multiple rural generalist registrars working across multiple states.

Key findings: Key findings of our research include the importance of secular, dedicated pastoral care as a critical resource of staff wellbeing beyond the current model of employee assistance programs and the centrality of empathetic managerial leadership for staff retention.

Implications: We argue for provision of dedicated onsite staff wellbeing and support offices under the oversight of a LHD-appointed Chief Wellbeing Officer. This proposal is underpinned by the ethos of empathic leadership, principals of sound labour economics and the need to address root causes of general practice trainee attrition.

Aims: This project aims to increase the capacity of the rural nursing workforce in the Murrumbidgee region of New South Wales through the redevelopment and implementation of a microbiology workshop. The project focuses on the evaluation of the workshop and the perceived effectiveness of interdisciplinary education. Reflecting on the results of the first iteration in 2020, changes have been made to target specialised infection prevention nurses, bring academia to an industry location, and draw upon interdisciplinary and allied health experts to develop content and facilitate.

Methods: This project incorporates a program evaluation design to measure the outcomes of the microbiology workshop. The content of the workshop is designed by an interdisciplinary team of medical, nursing and allied health professionals from a tertiary institution and local health district. Pre- and post-surveys are used with the option for participants to opt out and still attend the workshop. The primary analytical test is likely to be a paired t-test, dependent on the received data characteristics. This method evaluates if and how well the workshop has achieved its aims by analysing the average within-person change in responses to items asked pre- and post-workshop. Open-ended survey responses are used to provide descriptive information about the workshop.

Relevance: Providing access to postgraduate microbiology education is a service that would not normally be accessible to nurses, especially those working in rural areas. Knowledge related to microbiology and antibiotic resistance is imperative for infection prevention nurses as they are the frontline staff responsible for infection control, specimen collection and delivery of treatment. The recent pandemic exhibits a pressing imperative to ensure nurses have access to the knowledge they need to maintain infection control standards. It reinforces the need to deliver and evaluate microbiology education. This workshop connects rural nurses from satellite sites, provides necessary education taught by industry experts and is replicable.

Results: We will provide the analysed data from the first iteration of this education session, which was run in 2020. The second iteration is currently undergoing data collection. Indirect outcomes of this project include stronger internal and external university connections between schools and with industry partners. Information generated from this project is used to inform future workshops and ultimately ensure yearly replication for the infection prevention nurses. This maintains their knowledge and the sharing of it among their peers within the scope of their leadership role.

Conclusion: Healthcare-associated infections are the most common preventable complication of healthcare delivery for hospital patients in Australia, making it essential that nurses who are responsible for the prevention and treatment of these infections have a sound understanding of microbiology. We are not retrofitting a metropolitan education opportunity to rural stakeholders; rather it’s rurally designed, delivered and evaluated.

Introduction: No longer can aged care providers maintain the status quo. Facing significant aged care reforms, increasing community expectations and ongoing workforce challenges, rural aged care services need to use collaborative and innovative partnerships to meet the increasingly complex needs of older people in rural and remote communities, including Aboriginal and Torres Strait Islander elders.  Collaboration across the healthcare ecosystem that includes technology and product providers and researchers can facilitate new and better ways of working. However, an understanding of how this applies in rural and remote aged care settings is needed to develop appropriate strategies to create opportunities for innovation. This workshop aims to broaden research knowledge to understand the range of factors that might enable greater collaboration and innovation into rural and remote aged care services. By sharing practical experience and providing the opportunity to reflect, we will draw together insights on what is needed to drive innovation in rural aged care and how best to support that.

Methods: After a short presentation and examples of collaborative approaches to innovation that have driven improvements within caring environments, a World Café approach to yarning will be used to:

• Hear the voices of key people and sectors needed for innovation in rural aged care services.
• Share ways to overcome challenges and make the most of enablers for implementing innovative approaches.
• Consider key drivers of innovation to suit rural and remote communities.

This approach will be used to ensure all participants have a chance to contribute to the discussion and build upon and elaborate ideas to create opportunities for innovation. Ethics approval will be sought to collect unidentified contributions. A summary of the discussion and key strategies will be shared with participants after the symposium workshop. This process of shared discussion and feedback is designed to build partnerships and capacity in innovation.

Results: Participants will gain a deeper understanding of:

1. How collaborative innovation can support rural aged care providers to confront the sector’s critical challenges.
2. The role of researchers in building partnerships in rural aged care.
3. How industry partners can support innovation within aged care in rural and remote areas.

Outcomes from this workshop will inform programs to drive partnerships in cross-sector collaboration and innovation in rural aged care.

Objectives: To quantify the efficiency of current chronic conditions care for Northern Territory (NT) Aboriginal peoples, through a patient-centred measure of activation.

Design: Retrospective cohort study of Primary Care Information System from 2 April 2020 to 1 April 2022 and a comparative costing analysis of primary, acute and ‘whole-of-system’ healthcare costs.

Setting, participants: All Aboriginal peoples enrolled at NT Government health services who have ≥ one preventable chronic condition and are prescribed ≥ one oral chronic condition medication. An activated patient has the belief, knowledge, skills and behaviours to manage their chronic conditions. Patient activation was defined as 90-day medicine possession ratio ≥80%.

Main outcome measures: Associations between activation and chronic conditions secondary prevention treatment targets and use of health care. Annual actual cost of primary health care (PHC) for chronic conditions in remote settings.

Results: 5356 patients met the inclusion criteria; 9% of these patients were activated. Patient activation is associated with achieving treatment targets for glycosylated haemoglobin, blood pressure and total and low-density lipoprotein cholesterol. Under the current system of remote PHC, cost and subsequent annual inefficiency (patients remaining unactivated) is estimated to be $20.38 million ($4194.53 per patient) in PHC.

Conclusions: The current PHC system is providing low-value health care for patients and funders. Marginal investment in Aboriginal-led self-management support could deliver efficiency gains and improved care value for Aboriginal peoples.

Background: In 2002, Monash University School of Rural Health – Bairnsdale (SRH-B) was established under the Australian Government’s Rural Clinical School (RCS) program to address rural medical workforce shortages. Reciprocal relationships have been developed between the SRH-B, students, staff, health professionals and the community. Furthermore, the SRH-B and its stakeholders contribute to spending in the region. To date, there has been no comprehensive research study addressing what are the social and economic impacts (positive or negative) a medical school has on a rural community in Australia, in which it resides.

Aim: This research aimed to explore the social and economic impacts a small rural medical school has on its community. A key aspect of the study is to better understand the community expectations and perception, and how relationships are developed and continued. Furthermore, to understand and analyse the economic contribution through direct expenditure arising from the establishment of the SRH-B and its stakeholders. Understanding the social and economic impacts will support strategic direction for education, community engagement, workforce planning and evidence to funding holders of the importance to support small medical schools.

Methods: This study used a mixed-methods case study approach using qualitative and quantitative data from the interviews and questionnaire. The interviews explored the community’s perception and expectations of the RCS, and the questionnaire explored the participants’ expenditure in the region. A mathematical approach using an input-output table analysed the participants’ expenditure and its impact on the local economy in the East Gippsland region.

Results: A total of 56 online questionnaires were completed and 63 participants agreed to be interviewed across the four participant groups Three main themes (with further sub-themes) were identified from the qualitative data analysis: (1) ‘a vision for the future’; (2) ‘an evolving community’; and (3) ‘growing a rural workforce’. The effect from the SRH-B and its stakeholders’ direct expenditure resulted in an increase in industry sales, employment and contributed to the region’s gross regional product.

Conclusion: The study has demonstrated that the SRH-B and its stakeholders together have a positive social and economic impact on the community in which the SRH-B resides. Moreover, provides a way forward in terms of sustainability and direction of a RCS residing in a rural community.

Details of topic: The unacceptable disparity in health outcomes and access to health services between rural and urban Australians is a complex issue that is getting worse. We need a new, innovative way to research and address this disparity and for solutions to be embedded in the experiences of rural people. The XXXX located in XXXX, launched Australia’s first Rural Health Consumer Panel (RHCP) in May 2022. A key objective of the panel is to engage rural health consumers systematically and sustainably in identifying research priorities and approaches beneficial to the health of rural Australians. The panel facilitates a meaningful, practical and relevant collaboration between consumers, rural health services, academic institutions and industry partners.

The RHCP puts real-time lived experience and wisdom of service users in the driver’s seat, guiding where and how our research can make a difference. The panel was developed in close collaboration with Nivel Health Care Research in the Netherlands who have a strong consumer panel that has been going for over 30 years, with around 12,000 members. We aim to have 1,500 rural consumers on our panel within five years.

The aims of this workshop are to introduce participants to the RHCP and engage participants in the interpretation of results, co-design recommendations for the use of panel data and future development of the panel.

Process: Using the well-established World Café method, workshop participants will be presented with a summary of the panel’s membership, activities and preliminary survey results and participate in small group discussions to answer four important questions:

1. Who are rural health consumers and how do we recruit and retain them?
2. What do the results tell us and what can we learn from rural health consumers?
3. How do we translate findings for consumers, researchers, health and community services and policymakers?
4. How do we ensure sustainability of the panel?

The workshop will be rounded off with a large group process that clarifies and prioritises recommendations, including if and how participants would like to engage with RHCP.

Outcomes:

1. Workshop participants will have an enhanced understanding of the role and impact of a consumer panel in prioritising, designing and translating rural health research.
2. Workshop presenters will benefit from engaging with a diverse range of participants in contributing to the impact and sustainability of the RHCP.

This is the topic for a PhD research thesis. Data collection hasn’t commenced. This poster is an opportunity for discussion to adjust the research to appropriately inform policy and support doctors to provide health care in rural communities.

Background: Sustainability of general practice is of concern to general practitioners (GPs). Elements contributing to this concern include GP workforce shortage and the Medicare rebate being insufficient to cover the cost of care.

A factor in the national GP workforce shortage is declining numbers entering general practice.

The number of medical students considering general practice as a career path has declined from 16.5% in 2017 to 13.8% in 2021. Similarly, there has been a declining number of doctors entering the Australian General Practice Training (AGPT) program since 2017. Of note, the increased entrants in 2021 and 2022 will increase the number of GPs entering the profession as they achieve Fellowship.

The GP workforce shortage also has an impact on rural communities. People living in rural and remote areas have reduced access to primary healthcare service compared to those in major cities. When care is required, 28.7% of residents living in outer regional, rural and remote locations report waiting longer than they felt acceptable to get an appointment with a GP. This compares to 21.6% of residents in major cities.

Viability and sustainability of the traditional model of general practice influences the capability of the GP in rural general practice. While a range of potential incentives to attract doctors to rural practice have been identified, there has not been research into the work engagement models and how they influence doctors’ choice of practice location.

Aims: The aim of this research is to explore the elements of the work engagement models available for doctors in rural general practice and evaluate how the elements and models influence doctors’ decisions to work in rural general practice.

The gaps in the research are: (1) what are the finance and work engagement related elements important to doctors?; and (2) how does work engagement influence doctors in their decision about where to practice?

Methods: Data collection will be mixed methods. The quantitative data collection will focus on historical and current workforce elements. The qualitative data collection will be through interviews, surveys and focus groups.

Participants in the qualitative data collection will be doctors currently working in rural general practice, doctors considering rural practice and existing rural practice managers.

Relevance: This research will provide information for rural GP workforce planning and support provision of health care to rural communities by informing:

• development of viable and attractive GP engagement packages by practices/business entity
• practices’ strategic plans for sustainable business models
• workforce planning by governments and rural workforce agencies
• rural healthcare workforce policies.

Results and conclusions: Data collection has not yet commenced for this research. Results and conclusions will be published as part of the thesis.

Background: Research education and training opportunities are known to attract and retain healthcare staff and build crucial skills in the workforce to generate and implement evidence to improve the safety, quality and effectiveness of care delivered. Research education and training also represents a key opportunity for health organisations to position themselves as a place to live and work as a healthcare professional.

Aim and vision: The Rural Research Collaborative Learning Network (RR-CLaN) is a rural-led initiative that aims to provide high-quality research education and training to healthcare staff working in rural, regional and remote (R3) areas. The first goal of the RR-CLaN was to develop and deliver a research education and training calendar that can be accessed by R3 health services and partner organisations. The vision for the education and training calendar is to provide learning opportunities across the spectrum of research engagement (research user, research engaged and research leader) but has an initial focus on research capacity building.

Method: Through a collaborative and consultative approach, research offices and research staff across a variety of health services and organisations in New South Wales (NSW) and Queensland have come together to develop a research education and training calendar that leverages from existing content within respective organisations. The main concept of the calendar is to broaden the reach of existing content by leveraging from information technology that is widely accessible across multiple organisations and jurisdictions (such as Microsoft Teams, YouTube). To date, the partnership comprises 10 R3 NSW Local Health Districts (Central Coast, Far West, Hunter New England, Illawarra Shoalhaven, Mid North Coast, Murrumbidgee, Nepean Blue Mountains, Northern NSW, Southern NSW, Western NSW), the Tropical Australian Academic Health Centre (TAAHC) in Queensland and the NSW Health Education and Training Institute (HETI).

Results: An early insight into the scope, experience and impact of the research education and training calendar, based on the assessment of the inaugural seminar, shows that the concept has broad reach, with over 400 staff from more than 17 organisations in NSW and Queensland attending the live session, and over 150 views registered on the YouTube channel hosting the recorded session, within two weeks of its publishing. Key findings from a 12-question evaluation survey (N=176) showed the seminar was well received with the majority of respondents finding the seminar accessible, the presenter knowledgeable and engaging, the content informative and the duration just right. Over 80% of respondents noted the seminar increased their knowledge of the topic and over 85% of respondents indicated they probably or definitely will use what they learned in their work.

Discussion: Collaboration among research offices and key research staff, across multiple organisations and jurisdictions, demonstrates the potential to broaden the reach of existing research education and training content, providing crucial learning opportunities across many organisations. While some facilitation and governance are required to establish robust processes, the RR-CLaN represents a resource-efficient initiative to provide meaningful research education and training opportunities to a broad audience of learners in R3 areas.

The Department of Health and Aged Care poster will showcase the Government’s Innovative Models of Care (IMOC) Program. In the October 2022 Budget, the Government provided $24.7 million over four years to trial additional innovative models of primary care in rural and remote communities alongside six existing trials of innovative models of care.

IMOC already supports organisations to trial innovative multidisciplinary models of primary care in rural and remote communities – Modified Monash (MM) 3–7 – and to evaluate whether they improve rural practice and lead to better health outcomes.

IMOC funds costs of governance, community engagement and program management activities needed to support innovative ways of delivering health services to rural and remote communities.

Further information on the program, is available on the department’s website at: www.health.gov.au/our-work/imoc-program

Introduction/background: Exercise and nutrition support services in oncology care are ad hoc, despite national calls for widespread implementation. While evidence confirms many health benefits and the need for these co-therapies during treatment, referrals are not routinely provided in practice. This is a particular issue for people living in the South West region of Western Australia (WA), where factors such as longer travel times, accessibility and appropriateness of existing services impact the level of care received. This has led to a gap between current service delivery and evidence-informed care. We propose that co-designing and implementing a standardised exercise and nutrition referral protocol will connect regional cancer patients to these co-therapies, improving the quality of care and health outcomes for WA regional patients.

Aims: Our study has three aims:

1. To conduct a needs assessment exploring current oncology referral pathways and services, and the experiences of patients receiving cancer care in regional WA.
2. To co-design a new exercise and nutrition referral protocol and strategies that facilitate the integration of these services into standard oncology care.
3. To test the effectiveness of the integrated exercise and nutrition referral protocol and evaluate the success of our partnerships.

We hypothesise that applying the principles of implementation science (IS) will facilitate the co-design and implementation of a new exercise and nutrition referral system into standard oncology care, which will be accepted by health service providers and improve health outcomes for patients receiving cancer care. Overarchingly, our project aims to optimise the delivery of evidence-based health care to people living with cancer to enhance the health and wellbeing of our WA regional communities.

Methods/design: This study is a hybrid effectiveness-implementation project based on co-designing and implementing an exercise and nutrition referral protocol into regional oncology services in WA. Our approach draws on mixed-methods research and IS, both in the theories and frameworks used to guide the research process.

• Exploration: We will use information collected from population-level data, patient surveys, interviews and focus groups to identify existing service gaps and elicit patients’ experiences of care.
• Preparation: An implementation plan will be developed with context-specific implementation strategies, and a new exercise and nutrition referral protocol will be co-designed with our stakeholders to increase acceptability by health service providers and accessibility for regional patients.
• Implementation: We will trial the new referral protocol in three regional oncology services, monitoring, adapting and evaluating our implementation strategies to ensure a best-fit solution is achieved.
• Sustainment: We will target our outcomes to be maintained over time by measuring the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of our implementation efforts.

Discussion: This project will report on the implementation process and the effectiveness of a new referral system in regional oncology care, aligning national recommendations with current practice to ensure all healthcare professionals involved in the care of people with cancer refer patients to a health professional who specialises in both exercise and nutrition.

Funding for this project has been provided by the WA Department of Health Future Health Research and Innovation Office.

Research reports that one in five women will experience perinatal anxiety and/or depression. These challenges are often exacerbated in rural and remote communities where access to perinatal mental health care is limited. A desktop review initiated by midwives in a rural South Australian health service identified a high proportion of women presenting with risk of perinatal mental health challenges. In response to this, funding was obtained to implement an online perinatal mental health education program.

Aim: The aim of this study was to evaluate the effectiveness of a facilitated online perinatal mental health education program (e-PMHEP) in developing perinatal mental health knowledge, skills and confidence in rural midwives and practitioners.

Method: Evaluation of the e-PMHEP incorporated a validated pre/post survey design to assess self-reported knowledge, skill and confidence regarding perinatal mental health care before and after the program. An additional anonymous questionnaire sought feedback on satisfaction and feasibility.

Findings: Twelve participants completed the pre/post survey and questionnaire. The overall pre/post knowledge scores were statistically significant (t=2.73, 8df, p=0.025) with improvement from the pre-testing mean score of 41.55, std 12.34, to the post-testing score of 60.33, std 12.76. Pre and post data also suggests a measurable increase in confidence and skills. All respondents agreed that the content specifically addressed their learning needs, 75% indicated it was very beneficial (highest choice), 75% rated it as excellent and all participants indicated they would recommend this program to other practitioners.

Discussion: The findings suggest that the e-PMHEP was beneficial in developing perinatal mental health knowledge, skills and confidence in midwives and practitioners providing perinatal care to women in a rural local health network. Notably, a third of participants had not undertaken previous training and only a third routinely developed a care plan with women who had a pre-existing mental health diagnosis. Key strengths of the program included the accessible content, and the combination of both an experienced clinician and facilitator with lived experience.

Conclusion: There is a need for perinatal mental health education for midwives and practitioners working in rural Australia. The results of the pilot e-PMHEP suggest that providing an online, facilitated education program could be beneficial for rural midwives and health practitioners working in the perinatal mental health space.

Aims: The study examines survival outcomes of New South Wales (NSW) cancer registrants diagnosed with primary lung cancer from 2012 to 2018, focusing on residents of the New England North West and selected rural regions. Factors related to surgical treatment, survival and adjusted risk of death were examined by a range of co-variants including age, stage at diagnosis, rurality, socioeconomic disadvantage, health insurance status, health sector, time to treatment and regional jurisdiction.

Relevance: Surgical resection is a priority treatment for early and regional stage lung cancer. Specialist surgical services for lung cancer are unavailable in some rural regions, requiring patients to travel excessive distances to metropolitan areas for treatment. Non-surgical services for lung cancer have been increasingly available in regional cancer centres. Survival outcomes reported only at local health district level may lose sight of regional differences in patient characteristics and available services.

Methods: De-identified records from the NSW Cancer Registry (2012–18) were linked with records from the NSW Register of Births, Deaths and Marriages (Deaths Register) and NSW Admitted Patients Data Collection (2012–20). Data access was facilitated through the Centre for Health Record Electronic Linkage (CHeREL), with linkage enabled using the Master Linkage Key (MLK).

Results: Stage at diagnosis indicators for the New England North West were similar to other regions and NSW, suggesting the region had comparable diagnostic treatment pathways for lung cancer patients, despite regional patient disadvantage. However, the region had significantly lower surgical resection rates, likely related to unavailability of regionally based thoracic surgeons and the need to travel outside the region for specialist surgical care. For those who had surgery, time to treatment was comparable with other regions.

Overall survival outcomes were associated with age and stage at diagnosis, socioeconomic disadvantage, health insurance status and surgical treatment, although the latter may have included concurrent non-surgical therapies. Despite having greater regional patient disadvantage and lower rates of surgical resection, the New England North West region had comparable survival outcomes to other rural regions and Newcastle and Lake Macquarie. Comparative risk of death remained lower within metropolitan Sydney–Inner West as a region, but was not clearly defined by remoteness category, particularly after adjusting for patient disadvantage.

Conclusions: Understanding and accounting for regional variation will lead to improved cancer services and outcomes for people living with cancer in rural areas. Greater access to non-surgical treatment at regional cancer centres in recent years has likely improved rural lung cancer survival outcomes. Improved access to and/or provision of specialist respiratory surgical services in regional areas needs to be considered too in regions with low rates of lung cancer surgical resection. Further financial support for transport and accommodation for rural patients needing to travel for care, and improved clinician understanding and communication at clinician–patient level, is required to enable optimal treatment decision making and further improve lung cancer survival outcomes beyond metropolitan Sydney.

Closing the gap on Indigenous mortality rates and life expectancy has been described as ‘not on track’ by the federal government for many years now. Chronic diseases account for 80% of the 12-year mortality gap for Aboriginal Australians, with remote communities experiencing the worst outcomes. North-east Arnhem Land communities have the highest rate of avoidable deaths in Australia. We considered an holistic approach to chronic disease prevention and early intervention in one of these communities. The program combines traditional Yolngu knowledge with modern approaches to teaching and supporting Aboriginal people in nutrition and lifestyle change. The acceptability and effectiveness of the program was recently evaluated, identifying a number of key successful elements of the approach. Despite challenges in participation in the full program, significant health improvements were demonstrable even though the majority of participants received only basic ‘health coaching’. This consisted of individualised consultations explaining carefully their individual baseline measurements and blood test results using culturally effective methods, followed by educational videos, in local language, exploring the casual relationships between food and biology. The critical importance of early diagnosis and medical management is not to be understated, but this program added an additional layer of information and engagement with clients, as well as optional face-to-face support and group learning, for people at risk of chronic disease (based on weight and waist measurement). We consider how these, and other, elements of the program may have supported the results through community context and motivational influences.

Working with this early analysis, the local Aboriginal leaders and staff involved in developing the program (over the past eight years), emphasise the importance of giving remote Aboriginal people an effective and accurate understanding of the ‘inside’ story, including inner workings of nutrition and the body, and individual health results. Exploring personal health status, health goals and measuring progress through culturally effective ‘coaching’ they believe can inspire informed action. Such a service can be aligned with screening and clinical objectives.

Capacity and resources towards prevention and early intervention in remote Aboriginal communities currently focus on clinical KPIs and risk management essentials. However, Aboriginal leaders and program founders recognise the need for community services to support individuals and families in self-determined health improvement. Providing better access to relevant information, face-to-face individualised support and deep learning may enable Aboriginal people to make their own interventions. This is not surprising in that such services are available to mainstream urban communities. However, in rural and remote Aboriginal communities, cultural and language barriers call for specialised skills at the regional level, as well as holistic slower-paced engagement in the client’s space. This data raises the possibility that a small number of additional engagements by adequately trained staff could make a significant preventive impact.

While early in analysis, outcomes provide a positive pointer towards ways we can improve prevention outcomes, through integrating existing disease monitoring guidelines with services designed for supporting individual understanding, behaviour change and self-management.

Background: Burden of disease analysis is a way of estimating the amount of healthy life lost in a population due to ill health and premature death. For a specific year, the number of future years lost due to deaths before the expected lifespan of 86 years at birth (fatal burden), plus the number of years spent in less than full health (non-fatal burden), are combined into a summary measure called the disability-adjusted life year or DALY.

Aim: To explore geographic variation in the burden of disease among Aboriginal and Torres Strait Islander people.

Methods: DALY were estimated for more than 200 individual diseases and injuries in the Aboriginal and Torres Strait Islander population, and proportionally allocated across the five remoteness areas at the disease group level based on evidence from national administrative or survey data sources.

Results: In 2018, the main disease groups contributing to the burden in Aboriginal and Torres Strait Islander people were mental health and substance use disorders (23% of total DALY), injuries (12%), cardiovascular diseases (10%), cancers (10%) and musculoskeletal disorders (8%). The majority of the burden (53%) was due to living with ill health.

Aboriginal and Torres Strait Islander people living in Outer Regional, Remote and Very Remote areas experienced a greater proportion of the total burden than would be expected based on population distribution, with these areas together accounting for 38% of the Indigenous population but 44% of the burden.

Rates of burden generally increased with remoteness, with a similar pattern in males and females, but this varied by disease group. Aboriginal and Torres Strait Islander people living in Very Remote areas experienced around twice the rate of burden due to cardiovascular diseases, three times the burden due to endocrine diseases and five times the burden due to kidney diseases, compared with those living in Major Cities.

Rates of burden increased with age in all remoteness areas and were fairly similar across remoteness for age groups 5–64. In very young children and from age 65, however, the age-specific rates of burden in Outer Regional, Remote and Very Remote areas were generally higher than in Inner Regional areas and Major Cities.

The gap in burden between Indigenous and non-Indigenous Australians was also greater in Outer Regional, Remote and Very Remote areas than in Inner Regional areas and Major Cities.

Conclusions: The burden of disease is not evenly spread across remoteness areas, with Aboriginal and Torres Strait Islander people living in more remote locations experiencing a considerably greater burden than those living in urban areas.

Background: Access to clinical trials by rural, regional and remote (RRR) Australians is limited, adding to the current health inequity between RRR and metropolitan populations. The hub-and-spoke Australasian Teletrial Model (ATM) was developed to bring clinical trials ‘closer to home’. In 2020, the Australian Teletrial Program (ATP) was funded to expand and support the uptake of the ATM across six Australian states and territories, through jurisdictional regional clinical trial coordinating centres (RCCCs) and supporting pillars. The ATP is being independently evaluated by our team.

Aim: To describe the clinical trial landscape and teletrial readiness in RRR Australia prior to ATP implementation.

Method: Context mapping used a mixed-methods approach involving an environmental scan (desktop review of grey literature about clinical trial activity by jurisdiction and analysis of ANZCTR data of trials registered in 2021 by rurality) and interviews with clinical trial stakeholders (HREC approval HREC/2022/QTHS/85173). Stakeholders (clinician researchers, academics, industry representatives, trial staff) from RRR and metropolitan areas of the six jurisdictions participated in semi-structured interviews to elicit their view about clinical trial education and training, workforce, site and participant recruitment, equipment and services, and policy and processes. Interviews were recorded, transcribed and analysed initially with deductive clustering by question followed by inductive analysis to identify themes and concepts.

Results: One thousand and twenty HREC approved clinical trials were registered in 2021 involving 2065 clinical trial sites, of which 88% were in metropolitan (MMM1) areas. A wide range of clinical trial capability and capacity (maturity) exists in each state/territory as determined by level of research activity, executive strategy and resources. Health services in capital cities were considered most mature across all states/territories. Thirty-four clinical trial informants (12 male, 17 MMM1; 16 MMM2; 1 MMM3–7, mean experience 13.4 years) were interviewed between August 2022 and February 2023. The main barriers reported to conducting clinical trials in RRR areas were lack of investment and engagement by health service executives, workforce limitations, physical infrastructure and competing clinical priorities. Despite these challenges, stakeholders reported an appetite to conduct clinical trials and opportunities for health services to partner with larger metropolitan/regional hospitals (for example, using ATM or TrialHub), regional universities, general practice and community to support growth of clinical trial capability and capacity.

Conclusion: While clinical trial activity in Australia is currently predominantly metropolitan, there is an appetite for clinical trials to be conducted in RRR areas, thus the ATP is timely.

Relevance: Clinical trials are an essential part of healthcare innovation, advancement and translation where the trial benefits can extend beyond the objectives to improve patient care, upskill the workforce and optimise health service delivery. Australians living in RRR areas have limited access to clinical trials and their benefits. The ATP has an opportunity to improve access by providing a support framework to build clinical trial capacity in RRR Australia.

Objectives: To explore systems and management processes required to develop and implement Chronic disease: Road to health, to improve access and provision of secondary prevention in rural and remote areas of Australia.

Methods: Mixed method, predominantly qualitative case study series was used to explore access to cardiac rehabilitation/secondary prevention in rural and remote areas of north Queensland. Data collection was via semi-structured interviews, plus an audit of medical records and community-based healthcare services, and included a focus on the special needs of Aboriginal and Torres Strait Islander people. Thematic data analysis, followed by an iterative process that included information sharing and discussions with health staff and community members, plus conference presentations and discussions, resulted in the development of a model for secondary prevention of heart disease or a Heart: Road to Health. The findings were widely canvassed with government and non-government organisations, including Aboriginal Community Controlled Health Services.

Results: This research resulted in the Heart: Road to Health which subsequently evolved to a model of Chronic disease: Road to health that is potentially applicable for all people in rural and remote areas throughout Australia.

The Chronic disease: Road to health was designed to improve access to secondary prevention for people with heart or other chronic diseases such as diabetes, renal disease and stroke, through holistic, multidisciplinary healthcare provision and a holistic, culturally responsive, flexible, client-centred approach. The research demonstrated that resources were available in rural and remote areas, but systems such as post-discharge planning, referrals to local nurses and/or Aboriginal and Torres Strait Islander Health Workers, in-service education that includes secondary prevention, routine communication, coordination and collaboration, were weak and ineffectual. To address these issues, effective management processes, policies, pathways and guidelines utilising continuous quality improvement to develop and implement a pilot program are required. A framework and pathways for the model have been developed, combined with consideration of health systems and management processes necessary for effective implementation and improved client health outcomes. Well implemented, these factors have the potential to lead to improved healthcare systems that, in turn, provide improved access to holistic, culturally responsive health care.

Conclusion: The Chronic disease: Road to health developed through this research is in line with the recommendations of the Medicare reform taskforce, which found that a review of the current systems is necessary before future funding options are considered. Likewise, it is proposed that through revised healthcare systems and improved service communication, coordination and collaboration, a Chronic disease: Road to health has the potential to provide effective and efficient secondary prevention for chronic diseases in rural and remote areas of Australia. Further research is required to pilot this innovative model of healthcare delivery.

Background: The Roadmap to Close the Gap for Vision (Roadmap) was published in 2012 following comprehensive consultations with service staff, specialist eye health personnel, service users and communities across Australia to investigate barriers to care and develop solutions to improve Aboriginal and Torres Strait Islander eye care. The Roadmap made a series of recommendations for policy and practice changes at national, jurisdictional and local levels; considered remote, rural and urban geographies; and included implementation of reform at a regional level to improve eye care for Indigenous Australians. The regional implementation strategy was to ensure flexibility and appropriateness for different needs within regions, and ownership by those living and working within the local area. Indigenous participation and leadership through Aboriginal Community Controlled Health Organisations (ACCHOs) was central to regional implementation.

Since 2013, regional approaches have been implemented across Australia, with over 60 regional groups in all states and territories. Activity is implemented differently across different regions, reflecting the diversity of communities, systems and structures, and different needs across remote, regional and urban settings – as well as stages of implementation. Aboriginal and Torres Strait Islander leadership has emerged as the critical determinant to eliminate avoidable vision loss and blindness and sustain good eye health and vision care for Aboriginal and Torres Strait Islander Australians.

Methods: A formative evaluation using a mixed-methods approach included a national survey, regional case studies, key informant interviews, administrative data and a literature review. Data was captured from all jurisdictions, across remote, regional and urban settings, after multisite ethics approvals and with some elements conducted by contracted external consultants.

The evaluation was co-designed with Indigenous and sector stakeholders to ensure community benefit, priorities and aspirations were addressed and Indigenous leadership supported. First Nations researchers were involved in the project, from co-design through to data collection and analysis. An Aboriginal and Torres Strait Islander Reference Group provided guidance and support for the project.

Results: Eight regional stakeholder group case studies, 98 national survey responses, key informant interviews, a desktop review of the literature and administrative data provided the complex data set for the evaluation. The findings identify the effectiveness of regional stakeholder groups and how they can better support equitable eye health outcomes for Indigenous Australians.

The co-design evaluation process and outcomes include a priority of Indigenous leadership, self determination, knowledge and capacity enhancement, and these enablers have been increasingly advanced in subsequent work.

This presentation will present key findings from the evaluation including significant learnings about regional approaches to health reform, the fundamental importance of Indigenous leadership, the value of collaboration and lessons for health system improvement beyond eye health. The emergence and development of Aboriginal and Torres Strait Islander eye health groups to lead Aboriginal and Torres Strait Islander eye health is an exciting outcome to be shared.

Aims: The project aimed to co-design a patient-centred service delivery model that would enable Gippsland residents to access innovative multidisciplinary team-based primary health care that met local community need.

Methods: The project was phased across four components: Analysis, Discovery, Design and Commissioning.

The first phase involved an analysis of the region’s Health Needs Assessment, Health Priorities and relevant literature including Australia’s Primary Health Care 10 Year Plan 2022–2032.

The Discovery stage engaged rural community, service providers and sector professionals to participate in workshops, interviews and surveys.

The Design stage involved working with rural community and healthcare professionals to design care models and draft the tender specifications.

The final Commissioning stage carried out a procurement, culminating in contracted services.

Relevance: The Community-Led Integrated Health Care (CLIHC) model design project addressed the quadruple aim for improved health care. This work occurred before health equity was added to the quadruple aim. Health equity is an underpinning aim of the national Primary Health Network program.

Results: The Analysis phase identified key principles to guide the project.

• Innovation in primary care service delivery needs to occur alongside innovations in technology.
• Improving access to services in Gippsland requires local system design and innovation.
• There needs to be increased access to multidisciplinary care, harnessing the full skills of nurses, pharmacists and allied health professionals.
• Models of care need to build in flexibility and avoid ‘one-size-fits-all’ rural health ‘solutions’.

During the Discovery phase, there were:

• Seven interviews with representatives from allied health units in rural organisations.
• Two online workshops with 10 community members.
• Six online workshops with 42 health and other professionals.
• One qualitative survey for community with 27 responses.
• One qualitative survey for health professionals with 16 responses.
• 28 insights and 32 key priorities offered from engagement activities.

Design

• Four models of care designed; one model chosen to proceed with.
• Design of tender approach documents.
• Inclusion of ‘I’ statements as service model outcomes, such as ‘I want access to services in one place as it is very difficult to face access issues when you are feeling unwell or damaged, especially when you are older’.

Commissioning

• Pre-procurement workshops encouraged partnership models = 44 health professionals.
• Health organisation participation booklet designed to enable collaboration discussions and joint tender submissions.
• In procurement briefing held and attended by 20 potential tenderers.

Conclusions: The CLIHC model builds on local community strengths.

• Local care provided in hubs by a shared and appropriately remunerated integrated workforce, working to the full scope of their practice and facilitated by service provider partnerships.
• Care coordination at the centre of care.
• Incorporation of prevention and health education.
• Affordable, quality person-centred care.
• Can be accessed face to face and via supported telehealth technology.

Comprehensive market-sounding activities ensured that communities were empowered to design tailored solutions that reflected the reality of local strengths, challenges and needs.

The project highlights the value of embedding community leadership and collaboration into all aspects of commissioning models of health care.

Introduction: For medical students, having research skills is related to improved academic performance, propensity for evidence-based practice, and preparedness for compulsory research activity once they reach specialty training. Despite the established benefits of medical students being trained in research, the volume and type of research activity embedded within the curriculum varies considerably across medical schools. In medical schools where research is sparsely embedded into the core curriculum, it is often supplemented with opportunities for extracurricular research activity for interested students.

At present, there is a lack of available evidence relating to involvement in extracurricular research of medical students training in regional and rural areas and a lack of benchmarking of outcomes relative to metropolitan-trained students. Therefore, the aim of this study was to explore baseline research skills and interests when medical students commence at one Rural Clinical School (RCS), identify the proportion of students who engage with a project, and the resulting publication rates.

Methods and results: Data from the past six years were collated, including student research expression of interest survey data and administrative data of RCS student research participation and outputs. Around 40% of the cohort expressed an interest in research and, of those, 39% engaged with a project while at the RCS. Most projects were literature reviews (47%) or audits (29%) and almost all (83%) were extracurricular (unpaid and completed outside of any structured research programs). Only 19% of research-interested students engaged with a project in their most preferred clinical area and 53% in one of their top three preferred clinical areas. At RCS commencement, over half (55%) the students had basic research skills, with few (5%) at the advanced level. Of all projects in the past six years, 36% were still in progress at the time of data analysis, 25% had insufficient information to determine project status and 20% led to an identified output. Of only completed projects (excluding those in progress or with insufficient information), 51% led to a publication, presentation or conference poster, and 33% led to a published manuscript.

Discussion and conclusions: While a large proportion of students expressed an interest in research when they came to the RCS, less than half went on to engage with a project. This may be related to the small proportion who secure a project in their preferred clinical area. These data suggest that more should be done to educate students on the transferability of research skills and knowledge irrespective of the research topic/area.

Given that most students have limited baseline research skills at RCS commencement, students engaging in extracurricular research need to be actively supported and closely supervised by RCS staff and project supervisors to ensure favourable outcomes. It is also important that, from the outset, potential supervisors understand the baseline skills of students and the mentoring and support required to successfully supervise medical student projects. While suggestions for improvement can be identified, data show that despite being in a regional/rural context, publication rates of RCS student projects are comparable to those reported in metropolitan areas.

Dementia is an umbrella term for a group of conditions that cause progressive and irreversible impairment to brain function, primarily in older people. Dementia is a leading cause of death and burden of disease in Australia, and people living in regional and remote areas face particular challenges in accessing services for dementia diagnosis, support and care. There is a need for better evidence to inform policy and service responses to support people living with dementia in regional and remote Australia.

It is estimated that 126,000 Australians in regional and remote areas were living with dementia in 2021 and, with Australia’s ageing population, this number is expected to increase. Dementia prevalence estimates are usually provided at the national and state/territory level, but estimates for smaller geographies are important to support service planning at the local level. Due to the lack of data on the variability of dementia prevalence by geographic area, new prevalence estimates for 2021 were calculated for Primary Health Networks and Statistical Area Level 2 (SA2, representing suburbs and rural cities, towns or regions) by applying national age- and sex-specific dementia prevalence rates to the population of each geographic area. This presentation will present the data for regional and remote areas of Australia.

Recent evidence from the Royal Commission into Aged Care Quality and Safety points to the high variability of accessible and appropriate dementia care across Australia. This presentation will also describe the method for new research that uses a multi-source enduring linked data set to explore geographical variation in the use of health and aged care services by people with dementia. People with a dementia record were assigned to a study group based on their place of residence in 2018–19: permanent residential aged care or the community. Analysis variables include general practitioner and specialist attendances, medicines dispensed, emergency department visits and hospital stays, and respite residential aged care use in 2018–19 and mortality outcomes in 2019–20. In the final publication, results will be reported by state/territory, remoteness and socioeconomic area and at Statistical Area Level 4 (SA4, representing larger regional areas).

These insights can be used to better plan and deliver services to improve outcomes for regional and remote Australians living with dementia, their families and carers.

Details of topic: The unacceptable disparity in health outcomes and access to health services between rural and urban Australians is a complex issue that is getting worse. We need a new, innovative way to research and address this disparity and for solutions to be embedded in the experiences of rural people. The XXXX located in XXXX, launched Australia’s first Rural Health Consumer Panel (RHCP) in May 2022. A key objective of the panel is to engage rural health consumers systematically and sustainably in identifying research priorities and approaches beneficial to the health of rural Australians. The panel facilitates a meaningful, practical and relevant collaboration between consumers, rural health services, academic institutions and industry partners.

The RHCP puts real-time lived experience and wisdom of service users in the driver’s seat, guiding where and how our research can make a difference. The panel was developed in close collaboration with Nivel Health Care Research in the Netherlands who have a strong consumer panel that has been going for over 30 years, with around 12,000 members. We aim to have 1,500 rural consumers on our panel within five years.

The aims of this workshop are to introduce participants to the RHCP and engage participants in the interpretation of results, co-design recommendations for the use of panel data and future development of the panel.

Process: Using the well-established World Café method, workshop participants will be presented with a summary of the panel’s membership, activities and preliminary survey results and participate in small group discussions to answer four important questions:

1. Who are rural health consumers and how do we recruit and retain them?
2. What do the results tell us and what can we learn from rural health consumers?
3. How do we translate findings for consumers, researchers, health and community services and policymakers?
4. How do we ensure sustainability of the panel?

The workshop will be rounded off with a large group process that clarifies and prioritises recommendations, including if and how participants would like to engage with RHCP.

Outcomes:

1. Workshop participants will have an enhanced understanding of the role and impact of a consumer panel in prioritising, designing and translating rural health research.
2. Workshop presenters will benefit from engaging with a diverse range of participants in contributing to the impact and sustainability of the RHCP.

Aims and relevance: Compared with common cancers, patients diagnosed with rare cancers (RCs) have poorer outcomes due to increased diagnostic complexity, limited evidence base to guide management and less access to funded treatments and clinical trials. Ensuring optimal health care for regional, rural and remote patients with RC is especially challenging, as expertise is often concentrated in metropolitan centres, requiring travel with associated financial and time toxicity. To improve equitable access, we developed and implemented a nationally accessible online platform for coordinating RC expertise and research.

Methods: The Australian Rare Cancer (ARC) Portal was established in 2019 to assist cancer specialists caring for patients with RCs (incidence <6/100,000 population per annum). Referring clinicians receive a report tailored to their patient’s diagnosis and situation, prepared by research fellows and reviewed by principal investigators. Care is streamlined by providing a singular access point to available clinical guidelines, molecular test advice, and national and international RC expertise. Collaboration with Australasian expert tumour groups and consumer groups, including Rare Cancers Australia, helps promote national awareness, patient support services and clinical trials.

ARC Portal patients contribute their clinical data and (optional) biospecimens towards research via the Walter and Eliza Hall Institute Stafford Fox Rare Cancer Program (MH HREC 2015.300). National electronic consent was implemented in early 2021 to overcome geographic and COVID19-related access barriers, improving the viability of rare disease research by simplifying and accelerating participant accrual and linkage of Australian patients with relevant researchers.

Results: As of 31 December 2022, 1313 patients with RCs were referred and consented to the ARC Portal. Two hundred and forty-nine referrers (including medical oncologists, radiation oncologists, surgeons and other healthcare professionals) have registered for ARC Portal accounts, from every Australian state and territory (VIC n=92, NSW n=75, QLD n=35, TAS n=14, WA n=13, SA n=9, ACT n=5, NT n=5).

An analysis of patient referrals demonstrated that 45% of ARC Portal participants resided outside major cities (inner regional 34%, outer regional 8%, remote or very remote 3%). This higher uptake compared with the proportion of population living in regional or remote areas (29%) helps to demonstrate the unmet need the ARC Portal addresses, in providing Australians access to the same rare cancer expertise, molecular testing, trials and other research opportunities, often available only to patients treated at tertiary or specialist cancer centres.

In 180 recent referrals, guidelines were requested in 50%, molecular test advice in 50% and expert opinion in 60% (combinations included). Guidelines <5 years old were only available in 64% of cases. Management recommendations in 132 cases included review of diagnosis (n=13), molecular sequencing (n=43), clinical trial (n=51) and therapeutic access pathway (n=23).

Conclusion: Designed to streamline rare cancer care, the ARC Portal model helps to support local clinicians in the management of their RC patients as close to home as possible. Our approach aligns with the expectation of equity of access to care for all Australians diagnosed with a rare cancer, including those living in regional and remote areas.

It is estimated that one-fifth of people in Australia live with chronic pain. Optimal management of chronic pain involves multidisciplinary team care, individualised treatment plans and consideration of co-morbid mental ill health and disability. Rural patients with chronic pain are likely to experience barriers to accessing care and obtaining optional management, contributing to the risk of poorer outcomes and issues of inequity. The aim of this paper is to describe service use by residents in four rural towns who live with chronic pain and their reported barriers to utilising services to manage their pain.

A mixed-methods, cross-sectional survey (2016–18) was completed by adults from randomly selected households in the Goulburn Valley, Victoria. Trained research assistants attended households in person and recorded participant responses to survey questions face to face, using an electronic data capture tool (RedCap) and tablet technology. Respondents who indicated that they lived with chronic pain were asked an additional chronic pain sub-questionnaire about use of services, barriers to accessing services, and barriers to optimal management of chronic pain. Quantitative data were analysed using descriptive statistics or between group comparisons (t-tests and chi-square tests). Qualitative data underwent inductive content analysis.

The household response rate was 60.9%. Among the 2680 respondents (57.6% female, mean age 53.7 years ± 19.2 [standard deviation]), 594 (22.2%) reported chronic pain (60.4% female, mean age 59.7 years ± 16.3 [standard deviation]). Few respondents with chronic pain (6.1%) were accessing specialist pain clinics. Respondents with chronic pain were significantly more likely to use a range of health services than respondents without chronic pain: general practice (97.8% vs 91.7%, p<0.001), psychiatry (5.9% vs 2.3%, p<0.001), psychology (10.8% vs 5.6%, p<0.001), physiotherapy (30.5% vs 14.2%, p<0.001), exercise physiology (5.1% vs 2.2%, p<0.001), acupuncture (8.6% vs 4.0%, p<0.001) and pharmacy for advice (43.8% vs 29.6%, p<0.001). Most respondents were using medications (57.1% used prescribed medications, 55.1% used over-the-counter medications) and multiple therapies (70.6%) to manage their pain. Respondents reported that extended waiting times and prohibitive costs were barriers associated with accessing specialists, specialist pain clinics and allied health services. They also identified a lack of awareness and education about treatment options. Reported barriers to optimal care included prohibitive cost, barriers to accessing general practitioners (cost, continuity, appointment availability, waiting times) and specialists, lack of knowledge about treatment options, comorbid disability or chronic illness, distance and work/study commitments.

Results confirm the significant need for accessible and affordable chronic pain services in rural areas, particularly specialist services, as well as the need for promotion of available services and accessible education around chronic pain. The study also suggests that rural models of chronic pain management need to consider access to multidisciplinary chronic pain teams, address issues of travel distance, have minimal out-of-pocket costs and be adequately resourced to meet demand and reduce waiting times. Incorporating these elements and potentially telehealth options to specialist care, in a primary care model, requires further consideration and research.

Background: Aboriginal and Torres Strait Islander children are at a significantly higher risk of developmental challenges resulting in educational and health disadvantage. The Be Well Learn Well (BWLW) program is a Queensland Department of Education program. CheckUP Australia has worked in partnership with Gidgee Healing and the Apunipima Cape York Health Council, both Aboriginal Community Controlled Health Services (ACCHS) in Far North and North West Queensland, to deliver culturally appropriate allied health services for eight remote schools since 2017. Through BWLW, a multidisciplinary team of allied health professionals delivers culturally safe assessment and therapy services in both classroom and community settings. The program aims to address developmental delays and disabilities that could lead to poor health and learning outcomes. BWLW’s objectives are to:

• Deliver psychology, clinical psychology, occupational therapy, speech therapy services and needs assessments to students in the school, home and community environment.
• Strengthen and build knowledge and capacity of school staff (including teachers, support staff) to identify and address learning and development difficulties.

Aim: To externally evaluate the implementation and early outcomes of BWLW on children’s wellbeing and development, as well as changes in the capacity of school staff to better support these children.

Methods: A mixed-methods approach was used utilising a realist evaluation framework, supported by case studies. Phase 1 involved analysis of program throughput data, as well as surveys conducted over the period of program delivery prior to the evaluation (2017–21). Quantitative data were analysed to produce descriptive statistics and identify trends, qualitative data were analysed using content analysis by three researchers to ensure data triangulation. Phase 2 involved semi-structured interviews conducted online or via phone with school representatives (principals, heads of special education; n=7), ACCHS representatives (team leaders, senior staff; n=3). Interviews were conducted via Zoom, transcribed and analysed using narrative thematic analysis. Case study site visits were organised for two schools (Aurukun State School and Kowanyama State School), where an experienced evaluator-educator conducted semi-structured interviews and engaged in yarning circles with teaching staff, community liaison officers and ACCHS clinical and non-clinical staff). Qualitative data were analysed and case studies developed.

Results: The evaluation found that the classroom screening provided by allied health teams substantially improved the identification of students at risk of developmental delays and communication difficulties. This improved identification resulted in verified diagnoses for students due to the program which allowed them to access therapy and medication not just from the allied health teams but from local health providers as well. The case study site visits revealed increased confidence and capabilities among teaching and non-teaching school staff to better identify children in need of support or referral/assessment, as well as an improved understanding of specific children’s behaviours in class and approaches to better support them.

Conclusion: This project provided the first evaluation of a multidisciplinary outreach program designed to provide better access to allied health support to children in remote Aboriginal communities. The insights obtained from key stakeholders will inform policy and practice to better support children’s developmental and health needs in remote communities.

Significant investments are being made into evidence-based home visiting programs to improve maternal wellbeing, parenting and child outcomes. These programs have been implemented for First Nations families in remote communities in the Northern Territory (NT). Models developed in mainstream Australian or international contexts require contextualisation and adaptation to meet the diverse needs, cultures and preferences for engagement of families in remote communities. There is recognition that, for nurse home visiting programs to be successful, the practitioner and client need to establish a positive and trusting relationship, ideally based on continuity over years. This has been said to require skills and capabilities not normally associated with standard health care. Our aim was to understand how practitioners successfully initiate those relationships, what aspects are valued by women, and what organisational strategies best support this work in the NT context.

As part of the formative evaluation of Maternal and Early Childhood Sustained Home-visiting (MECSH) in the NT, we explored the experiences of MECSH practitioners in engaging and building relationships, and what aspects and qualities of the relationship were valued by their clients retained in the program. In 2022, we interviewed 21 providers and 46 female clients who had been enrolled or otherwise involved in MECSH in eight remote NT communities. With participants’ consent, interviews were audio recorded and transcribed verbatim. The data was coded inductively using NVivo (version 12). Thematic analysis was conducted on codes relating to relationships, trust and perceptions of the interaction between providers and clients during home visits. Provider and client data were analysed separately and later compared for divergence and commonalities.

Both clients and practitioners described the significant amount of time it took to develop a trusting relationship, which was facilitated by the nurse being helpful and providing practical support, not only to the clients but also their children, partners and extended families. Clients described high levels of trust in their MECSH provider because she was a ‘good person’, had their back, was knowledgeable and could keep their stories confidential. The practitioners described challenges they faced when there was no organisational support for relationship building with families and with the community more broadly. Success in relationship building was facilitated by individual factors such as previous remote NT nursing experience and by organisational system elements such as support by First Nations community mentors and cultural advisers, explicit handover processes when staff changed, with clear program integration into the primary healthcare service.

The time and commitment required to build relationships based on trust, flexibility and adaptation to the needs of clients and their families tends to be underestimated in program design. Relationship building should be incorporated into the structure of home visiting programs and better supported by organisational systems. To reap the rewards of sustained engagement and retention, funders and program designers will need to explicitly build relationship-based practice into the delivery of programs.

Anorexia nervosa is a serious psychiatric illness with potentially life-threatening consequences. Fortunately, family-based treatment (FBT) has demonstrated efficacy as a first-line intervention for the illness and is being progressively disseminated from research settings into real-world health services. However, access to FBT is notoriously challenging for young people and families living in rural and regional areas, and telehealth has been proposed as a potential solution to this access gap. A study is currently underway (due to complete June 2023) exploring the effectiveness, acceptability and feasibility of using telehealth to deliver FBT directly into the home.

This presentation discusses the results of a recently conducted qualitative study that explored the impact of translational research processes on implementing FBT via telehealth into the complex rural health system. The study explores the perspectives of several stakeholders and their perspectives regarding the barriers and facilitators to implementing this potential digital solution into health services.

Importantly, translational research afforded rural health services access to clinical expertise, improved access to evidence-based care and assisted with meeting government directives. However, translational research also introduced challenges with embedding research and telehealth into rural clinical pathways, creating additional ethical dilemmas, with stakeholders holding multiple roles. This presentation will discuss some of the benefits and challenges that arose when integrating research into non-academic health services. This presentation reinforces the imperative to continue real-world implementation of research-delivered care, in an effort to continue moving evidence-based treatments from bench to bedside.

Background: Rural communities need accessible primary care for optimal health outcomes. However, delivering services in rural communities is increasingly challenging due to workforce shortages and metro-centric healthcare and funding models that are not sustainable in rural contexts. Rural communities have strong potential to inform what will work in their context due to their in-depth understandings of local priorities, strengths and opportunities.

Objective: To involve rural communities in the co-design of place-based and evidence-informed models for building sustainable rural health systems, and to identify learnings and develop tools for knowledge translation.

Methods: In rural Victoria, a community-based participatory action research method to co-design, with a health service executive steering committee, relevant local primary care models. Perspectives from healthcare professionals (n=42), consumers and carers (n=21) were gathered through qualitative interviews. Qualitative content analysis was used to identify priorities and develop descriptive themes. Rigour was enhanced through a process of member checking and the research procedures were approved by a university human research ethics committee.

Results: Health priorities, system strengths and challenges, and sustainability barriers, enablers and resources were identified. Three models were proposed for building health system sustainability, forming a multilevel systems strategy. These are: (1) a strengths-based regional workforce strengthening plan; (2) models of integrated primary care; and (3) innovative rural generalist employment models and models of care.

Conclusion: The executive-level regional co-planning and design process can be trialled in other rural regions. Trial sites are recommended to be of a similar population size and rurality, and where existing partnerships can be leveraged. Place- and strengths-based co-design was effective for locating finite resources for developing models that were locally supported, aligned to community healthcare access priorities and barriers, and responsive to existing workforce capacity.

Background: The benefits of telehealth in the form of improved access to health care, reduced travel and wait times, improved patient experience and positive health outcomes are well documented. The uptake of telehealth grew rapidly as a result of the COVID-19 pandemic, with speech pathology services being well-positioned as an early adopter of this mode of service delivery. As the service emerged from restrictions and looked to cement telehealth usage into future service planning, the need to understand who was and wasn’t taking up this mode of care, as well as to identify potential barriers to equitable access, became apparent.

Study aim: To investigate the utilisation of telehealth as a mode of service delivery in speech pathology services across a regional-rural district of New South Wales.

Methodology: All speech pathology occasions of service (in person, telephone and videoconference) between 2018 and 2021 were extracted based on Australian Tier 2 Non-Admitted Services Classification. Australian Bureau of Statistics data including area level remoteness and socioeconomic disadvantage (Index of Relative Social Advantage and Disadvantage) were linked to the occasion of service data at the level of Statistical Area 2 (SA2). Exploratory mapping of service delivery was initially conducted at the level of SA2 geographic unit of analysis using GIS software (ESRI ArcGIS Desktop 10.8)

Results: The rapid uptake of telehealth saw an overall 8% growth in speech pathology services provided during the pandemic. This growth was particularly reflected in services delivered to children (0–14 years, +39.9%) and to Indigenous (+22.6%) consumers. Proportionally, less uptake of telehealth was found for older patients. Approximately 36% of speech pathology services were provided to those in the most disadvantaged areas, where only 24% of the population reside; however, proportionally less uptake of telehealth was found in these areas, despite being high service users. Spatial mapping demonstrated geographical changes in service utilisation across this period.

Conclusions: Telehealth is a convenient, effective and acceptable mode of service delivery for many speech pathology consumers, and providing a range of service delivery modes to meet the healthcare needs of the local population is critical especially in a district where significant distances may need to be travelled to access care. Disparity in uptake based on age, geographical and economic factors suggest there are still barriers that hinder equitable access to telehealth. Factors contributing to the lack of telehealth uptake may include comfort with and preference for adopting videoconference technology, especially amongst older consumers. Furthermore, limited access to internet speeds or devices sufficient for videoconference appointments may also exist, particularly in inner regional areas. This paper will also explore the environmental impact of telehealth and discuss opportunities for clinical practice change, including strategies for reducing the barriers that hinder equitable access.

Background: Disparities in poor health outcomes are well documented for people living in remote and regional areas in comparison to their metropolitan counterparts and contribute to a higher rate of chronic diseases and preventable cancers.

Inequalities in social and cultural determinants, and geographical disparities, make influencing behavioural change challenging. Education regarding the importance of making healthy lifestyle choices is only effective when people are concurrently provided with the resources to engage in these behaviours. The Moriarty Foundation, a holistic Aboriginal-led initiative, aims to address the intergenerational disadvantage experienced by Aboriginal and Torres Strait Islander peoples by building capacity and empowering communities to engage in healthy lifestyles.

Method: The Minderoo Foundation is partnering with the Moriarty Foundation to support the delivery of two of its Indigenous-founded, Aboriginal community-led programs, which focus on 13 of the 17 Closing the Gap targets.

The two interrelated programs reach 2000+ Indigenous children in 19 remote and regional communities in the Northern Territory (NT), Queensland and New South Wales. The Indi Kindi program focuses on the early years (children under five) in remote NT Aboriginal communities.

The John Moriarty Football program is Australia’s longest running and most successful Indigenous football program for 2–18 year olds, harnessing football for positive change. Both programs also provide nutrition for the children who access their services.

Results: The Indi Kindi program is delivering an early years solution for children under five in multiple remote Aboriginal communities, integrating health, wellbeing, education and development to give children the best start in life. The John Moriarty Football program is successfully improving school attendance and resilience in 19 remote and regional communities across three states. This presentation will share outcomes, challenges, and opportunities in delivery of the nutritional component of these two key initiatives as they aim to improve outcomes for Aboriginal communities.

Conclusion: Through further collaboration to ensure nutrition is affordable, utilising a model of culturally embedded learning on Country, we can address multigenerational disadvantage and improve outcomes for Indigenous children and families in rural and remote settings.

Background: Rural communities need accessible primary care for optimal health outcomes. However, delivering services in rural communities is increasingly challenging due to workforce shortages and metro-centric healthcare and funding models that are not sustainable in rural contexts. Rural communities have strong potential to inform what will work in their context due to their in-depth understandings of local priorities, strengths and opportunities.

Objective: To involve rural communities in the co-design of place-based and evidence-informed models for building sustainable rural health systems, and to identify learnings and develop tools for knowledge translation.

Methods: In rural Victoria, a community-based participatory action research method to co-design, with a health service executive steering committee, relevant local primary care models. Perspectives from healthcare professionals (n=42), consumers and carers (n=21) were gathered through qualitative interviews. Qualitative content analysis was used to identify priorities and develop descriptive themes. Rigour was enhanced through a process of member checking and the research procedures were approved by a university human research ethics committee.

Results: Health priorities, system strengths and challenges, and sustainability barriers, enablers and resources were identified. Three models were proposed for building health system sustainability, forming a multilevel systems strategy. These are: (1) a strengths-based regional workforce strengthening plan; (2) models of integrated primary care; and (3) innovative rural generalist employment models and models of care.

Conclusion: The executive-level regional co-planning and design process can be trialled in other rural regions. Trial sites are recommended to be of a similar population size and rurality, and where existing partnerships can be leveraged. Place- and strengths-based co-design was effective for locating finite resources for developing models that were locally supported, aligned to community healthcare access priorities and barriers, and responsive to existing workforce capacity.

Background: Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better understanding of healthcare access and their specific unmet needs. This qualitative study sought the views of both rural-centric older people and healthcare professionals to understand health needs, barriers and enablers of accessing health services, with a focus on chronic health condition(s).

Methods: Between April and July 2022, separate in-depth interviews were conducted with 20 older people (≥60 years) in a rural South Australian community. Additionally, focus group interviews were conducted with 15 healthcare professionals involved in providing health services to older adults. Transcripts were coded using the NVivo software and data were thematically analysed.

Results: Participants described a range of unmet care needs including chronic disease management, specialist care, psychological distress, and the need for formal care services. Four barriers to meeting care needs were identified: workforce shortages; a lack of continuity of care; self-transportation; and long waiting times for appointments. Self-efficacy, social support and positive provider attitudes emerged as crucial enabling factors of service use among  rural ageing populations.

Discussion: Older adults confront four broad ranges of unmet needs: chronic disease management care; specialist care; psychological care; and formal care. There are potential facilitators, such as  self-efficacy, provider positive attitudes and social support, that could be leveraged to improve healthcare services access for older adults.

The northern Queensland region consists of diverse communities with a mixture of farming, mining and Aboriginal and Torres Strait Islander communities in the more rural and remote areas, and places of higher density and urban living in major regional townships on the east coast. There are many similarities in health challenges and service delivery across the region, with small, dispersed populations in challenging geographies. However, unique and context-specific factors that undoubtedly characterise individual communities tend to be lost in regional and state-level planning for health.

Place-based planning focuses on demographic, socioeconomic, environmental and cultural factors of the local community, and uses local data and perspectives on health to inform planning. Place-based planning processes prioritise collaboration with local and regional stakeholders including local government, service providers, community groups and general community members to implement solutions to identified issues affecting health and health service delivery.

The Integrating Health Care Planning for Health and Prosperity in North Queensland (IHCP-NQ) project aims to improve the responsiveness of health services to the health needs of communities in the northern Queensland region. The three-year project, being conducted together with the communities of Clermont, Hughenden and Kowanyama, uses a place-based approach to planning with participatory, co-design methods.

In Phase 1, the Northern Queensland Health Atlas was developed to inform planning in the region. The online, freely available, interactive tool contains publicly available data (with data dictionary) about demographics, health services and health workforce that can be overlayed to facilitate comparisons and understandings of place. It presents data, that are otherwise difficult to find across a multitude of platforms, in a single, highly accessible place for use by community members and other stakeholders. The process of developing the tool highlighted a lack of reliable, publicly available data for local (community-level) planning particularly for health status, health workforce and service availability.

In Phase 2 of the project, co-design methods were used to identify and prioritise areas for action to improve health and health services.  Co-design methods are becoming more common in health services planning. Our co-design process involved four steps, carried out via workshops, and small group and individual meetings. The co-design process worked through: (1) identification of key health priorities; (2) possible solutions to identified issues that affect health and health services; (3) factors affecting implementation of agreed on solutions; (4) confirming implementation; and (5) evaluation methods.

This presentation will describe the IHCP-NQ project within the context of place-based health planning for rural and remote communities in northern Queensland. A case example of the co-design process and early outcomes based on one of the project communities will be described. Learnings from implementation of the co-design process will be discussed in light of what is already known about factors for successful co-design with rural, remote and First Nations communities.

Within the Three Rivers Department of Rural Health (TRDRH) footprint, access to community-based rural mental health placements is limited and typically offered as traditional clinical placements situated in higher-acuity settings.

This creates limited exposure and reduces the types of interprofessional learning experiences that students have available to them within mental health and wellness. Within the TRDRH footprint, we are seeing higher reported levels of psychological distress and reduced access to mental health services and general poorer health outcomes.

In partnership with an established regional primary mental health service, a student placement model has been designed to provide undergraduate paramedicine, nursing and social work students with an ongoing service-learning placement. A key component of the placement is the delivery of a student-led program whereby consumers are provided with an opportunity to strengthen their digital health literacy skills. Students also take part in essential components of the service activity supported by a dedicated student educator. This pilot placement model aims to deliver a high-quality experience that provides students with essential mental health practice skills that are necessary upon graduation.

The project has taken a participatory evaluation approach to measure the impact of the student placement model on community and the host organisation. This paper will reveal the essential components for success, lessons learnt that are driving ongoing development of this project and outline the transferability to a wide range of practice settings.

Details of topic: The unacceptable disparity in health outcomes and access to health services between rural and urban Australians is a complex issue that is getting worse. We need a new, innovative way to research and address this disparity and for solutions to be embedded in the experiences of rural people. The XXXX located in XXXX, launched Australia’s first Rural Health Consumer Panel (RHCP) in May 2022. A key objective of the panel is to engage rural health consumers systematically and sustainably in identifying research priorities and approaches beneficial to the health of rural Australians. The panel facilitates a meaningful, practical and relevant collaboration between consumers, rural health services, academic institutions and industry partners.

The RHCP puts real-time lived experience and wisdom of service users in the driver’s seat, guiding where and how our research can make a difference. The panel was developed in close collaboration with Nivel Health Care Research in the Netherlands who have a strong consumer panel that has been going for over 30 years, with around 12,000 members. We aim to have 1,500 rural consumers on our panel within five years.

The aims of this workshop are to introduce participants to the RHCP and engage participants in the interpretation of results, co-design recommendations for the use of panel data and future development of the panel.

Process: Using the well-established World Café method, workshop participants will be presented with a summary of the panel’s membership, activities and preliminary survey results and participate in small group discussions to answer four important questions:

1. Who are rural health consumers and how do we recruit and retain them?
2. What do the results tell us and what can we learn from rural health consumers?
3. How do we translate findings for consumers, researchers, health and community services and policymakers?
4. How do we ensure sustainability of the panel?

The workshop will be rounded off with a large group process that clarifies and prioritises recommendations, including if and how participants would like to engage with RHCP.

Outcomes:

1. Workshop participants will have an enhanced understanding of the role and impact of a consumer panel in prioritising, designing and translating rural health research.
2. Workshop presenters will benefit from engaging with a diverse range of participants in contributing to the impact and sustainability of the RHCP.

Background: Nutrition and hydration are important, highly topical elements of quality residential aged care. Following the Royal Commission into Aged Care Quality and Safety, the federal government provided an increase to the basic daily fee for residential aged care providers, specifically for nutrition-focused expenses. In the Hunter New England Local Health District (HNELHD) in New South Wales, a portion of this funding provided new dietetics services within residential aged care at multipurpose services (MPS). MPS in the project area received between one and two days of new, aged-care-focused dietetics services per month, predominantly provided to small rural towns as a visiting outreach service from larger regional towns and centres.

Aims: The purpose of this abstract is to provide an overview of project activities, including collaboration between HNELHD dietitians and the University of Newcastle Department of Rural Health.

Processes and findings: A project team, consisting of seven HNELHD dietitians, worked collaboratively across 10 MPS to develop and deliver the new dietetics services. Project activities included a comprehensive nutrition assessment and the development of a nutrition care plan for each resident; however, were otherwise individualised to the unique context at each MPS. Across all sites, over 160 residents have received an assessment and nutrition interventions, where required. Identified rates of malnutrition, and risk of malnutrition, have not differed largely from other Australian data.

Within the Peel Cluster, a collaboration was established with the University of Newcastle Department of Rural Health. This involved final-year nutrition and dietetics student placements, focused on data collection, evaluation and increased understanding of food services within the MPS. Across the first year of the project, four student food service placements were hosted, with a fifth currently underway. These projects assessed resident satisfaction, food-related quality of life, overall dietary intake of residents and the mealtime environment. Residents were generally satisfied with the food and fluids offered, and very complimentary of food service staff. However, opportunities for quality improvement were identified across the areas of mid-meal variety, systems for ordering nutrition support and increasing the homeliness of mealtime environments. Importantly, collaboration between the health service and student dietitians significantly increased the project capacity and allowed for increased understanding of the food services that would not have been possible for the dietitians to obtain on their own.

Conclusions: Enhancing services to provide nourishing, enjoyable food and fluids has the potential to significantly improve the health, wellbeing and quality of life for people living in residential aged care facilities. In resource-constrained settings, implementing collaborative approaches with local partners can enhance project capacity and allow for improved outcomes.

Introduction: Depression is a prevalent mental health condition that can be reliably diagnosed and treated in the Australian primary healthcare system. This study was conducted to estimate the prevalence and factors associated with depression among Indigenous people attending primary healthcare services in the Darling Downs and West Moreton Primary Health Network (DDWMPHN) region and how these patients are treated and managed in primary healthcare practices.

Methods and analysis: We used a data set of Aboriginal and Torres Strait Islander patients who had at least one general practitioner visit in the past two years with one of the 149 general practices (GP) in the DDWMPHN  region. We used logistic regression modelling to estimate the aged-sex standardised prevalence of diagnosed depression and its association with comorbidities and covariates available in the PHN-GP database.

Results: As of January 2022, nearly 28,401 Indigenous people had at least one visit to a GP in the past two years. Almost half (42.9%) of the people live in rural and remote communities in the region. The estimated prevalence of depression diagnosis was 14.9% (15.7% in women and 10.3% in men).

The diagnosis of depression was significantly associated with being overweight (OR 1.50, 95% CI 1.32-1.70), obese (OR 1.67, 95% CI 1.50-1.86), current smoker (OR 2.41, 95% CI 1.54-1.92) and alcohol drinker (OR 1.23, 95% CI 1.14-1.34). Women smokers or past smokers have slightly higher rates of depression, while men with a higher body mass index have higher depression rates. Compared with First Nations people who did not have a depression diagnosis, those with depression were more likely to have one or more comorbidities (one chronic condition – OR 1.17, 95% CI 1.05-1.31; two chronic conditions – OR 1.24, 95% CI 1.07-1.44; three or more chronic conditions – OR 1.35, 95% CI 1.06-1.71). In addition, nearly two-thirds (60.4%) of patients with depression were taking one or two antidepressant medications, while 29.8% did not receive a prescription.

Conclusion: The prevalence of depression among Indigenous people accessing primary healthcare services in the PHN region is slightly higher than the national Indigenous community estimates. Additionally, the findings from the study further highlight the ongoing need for primary care service providers to understand the importance of the relationships between protective and risk factors of depression among Indigenous people in developing prevention programs and management of depression.

In the rural, regional and remote (R3) setting, populations have poorer health outcomes and shorter life expectancies when compared to metropolitan communities. Further exacerbating health inequities is the lack of access to clinical trials in these communities, and hence to many novel and specialist therapies. Barriers to conducting research in the R3 setting – including geographic isolation, lack of an experienced workforce, infrastructure and capacity – often make running clinical trials challenging and unattractive to sponsors.

The NSW Health and ACT Health Rural, Regional and Remote Clinical Trial Enabling Program (R3-CTEP) aims to deliver a sustainable clinical trial ecosystem with increased and more equitable access to clinical trials for patients in R3 NSW and the ACT.

The R3-CTEP will be delivered through five interconnected key activity programs that will:

• Deliver clinical trials directly to R3 communities, through the development of virtual clinical trials capacity and capability. It will support individuals who may want to take part in clinical trials but are limited by barriers such as distance, geographical isolation and availability.
• Build awareness and engagement and improve recruitment and retention in clinical trials through empowering local communities with knowledge about clinical trials, and how clinical research can directly benefit the needs of R3 patients. Ensuring health consumers and community, including Aboriginal and Torres Strait Islander and culturally and linguistically diverse populations, have a voice in local health research priorities will also be central to ensure the needs of R3 communities are met.
• Professionalise clinical trial services through developing, building and nurturing a local clinical trial workforce and supporting research infrastructure (including research equipment, systems and services) ensuring quality conduct of clinical trials that align to international best-practice standards. Building an R3 community of practice will create local networks to share learnings and help embed clinical research as a career path for those in health services.
• Support and develop the local workforce and infrastructure by establishing a network of R3 clinical trial support units to facilitate clinical trial delivery, providing high-quality research support services. These units will address the challenges associated with trial conduct in the R3 setting and champion the unique identity of regional research and research centres.
• Develop the systems to underpin sustainability by fostering ongoing partnerships and collaborations across regions and with government, industry, academic, consumer and community organisations to help deliver significant economic, medical and scientific benefits to R3 NSW and the ACT.

The R3-CTEP will deliver innovative solutions to help address health inequities and make R3 NSW and the ACT a vibrant, attractive and valuable location for clinical and health research. The program is supported until 2027 by $30.6 million funding from the Australian Government Medical Research Futures Fund.

Background: The benefits of telehealth in the form of improved access to health care, reduced travel and wait times, improved patient experience and positive health outcomes are well documented. The uptake of telehealth grew rapidly as a result of the COVID-19 pandemic, with speech pathology services being well-positioned as an early adopter of this mode of service delivery. As the service emerged from restrictions and looked to cement telehealth usage into future service planning, the need to understand who was and wasn’t taking up this mode of care, as well as to identify potential barriers to equitable access, became apparent.

Study aim: To investigate the utilisation of telehealth as a mode of service delivery in speech pathology services across a regional-rural district of New South Wales.

Methodology: All speech pathology occasions of service (in person, telephone and videoconference) between 2018 and 2021 were extracted based on Australian Tier 2 Non-Admitted Services Classification. Australian Bureau of Statistics data including area level remoteness and socioeconomic disadvantage (Index of Relative Social Advantage and Disadvantage) were linked to the occasion of service data at the level of Statistical Area 2 (SA2). Exploratory mapping of service delivery was initially conducted at the level of SA2 geographic unit of analysis using GIS software (ESRI ArcGIS Desktop 10.8)

Results: The rapid uptake of telehealth saw an overall 8% growth in speech pathology services provided during the pandemic. This growth was particularly reflected in services delivered to children (0–14 years, +39.9%) and to Indigenous (+22.6%) consumers. Proportionally, less uptake of telehealth was found for older patients. Approximately 36% of speech pathology services were provided to those in the most disadvantaged areas, where only 24% of the population reside; however, proportionally less uptake of telehealth was found in these areas, despite being high service users. Spatial mapping demonstrated geographical changes in service utilisation across this period.

Conclusions: Telehealth is a convenient, effective and acceptable mode of service delivery for many speech pathology consumers, and providing a range of service delivery modes to meet the healthcare needs of the local population is critical especially in a district where significant distances may need to be travelled to access care. Disparity in uptake based on age, geographical and economic factors suggest there are still barriers that hinder equitable access to telehealth. Factors contributing to the lack of telehealth uptake may include comfort with and preference for adopting videoconference technology, especially amongst older consumers. Furthermore, limited access to internet speeds or devices sufficient for videoconference appointments may also exist, particularly in inner regional areas. This paper will also explore the environmental impact of telehealth and discuss opportunities for clinical practice change, including strategies for reducing the barriers that hinder equitable access.

Rural communities face significant challenges in seeking to provide people access to the right level of mental health services, when and where they need them. There are increasing players in the mental health system who have a role in supporting access to high-quality community-based services, particularly in Victoria with the state government introducing regional mental health and wellbeing boards. However, service integration and accessibility at the community level remains a challenge. This presentation will discuss a review of mental health services conducted by a Primary Health Network to inform how to position its service commissioning to ensure client access across the spectrum of stepped care. The relevant region comprises almost 100,000 square kilometres of rural Victoria. The presentation will provide an overview of the review and the set of principles that emerged from it. These are being used to guide future investment into the mental health system by the Primary Health Network. The review methods included appraising data, policy, research, guidelines and exploring evidence from stakeholder interviews.

Key contextual variables that informed this work were the Victorian State Mental Health reform agenda (investing $5.1 billion over the 2022 and 2023 financial years as part of a 10-year plan) as part of implementing the Royal Commission into Victoria’s Mental Health System report (handed down in 2021). This followed the Australian Government Productivity Commission report into Mental Health in 2020. The extensive changes accompanying these recent policy developments contribute to a state of flux for rural mental health workforce and service provision. Additional context impacting planning also includes the major reforms affecting rural general practice capacity.

The principles outlined in this presentation will include consideration of how socioeconomic efficiencies can be realised through integrating approaches to system design. Collaboration of funders through the sharing and alignment of data, technology systems, models and planning could reduce duplication and wastage of public money. Secondly, improved quality and accessibility of appropriate care (enabling adjustment of care with changing patient need) can be achieved through investment in the delivery of holistic and coordinated care using a multidisciplinary workforce and connected agencies including alcohol and other drug services, Aboriginal Community Controlled Health Organisations, and other primary and tertiary services. Finally, equity of access to services can be progressed by investment in a stable and sustainable rural mental health workforce and sharing, rather than competing over, workforce within the system. These principles are now being applied by the Primary Health Network to purposefully plan investment in relevant, efficient and equitable services in rural Victoria.

Background: An ST-Elevation Myocardial Infarction (STEMI) is a serious form of heart attack involving the obstruction of coronary artery supply. STEMIs are time-critical emergencies that require urgent restoration of blood flow, known as revascularisation, to preserve heart tissue. There are two main types of revascularisation: administration of thrombolytic or fibrinolytic medications (clot dissolving drugs) or a non-surgical procedure called percutaneous coronary intervention (PCI) where a stent is used to open blood vessels. Guidelines recommend that following thrombolysis all patients should be immediately transferred to a hospital capable of performing PCI. This facilitates timely access to emergency PCI for patients who do not reperfuse with thrombolysis.

The lack of PCI-capable hospitals in regional and rural areas, and frequency of inter-hospital transfers to reach PCI-capable hospitals, means that rural patients with a STEMI often experience delayed access to evidence-based definitive care. This results in inferior outcomes, such as increased mortality and lower rates of definitive revascularisation, in rural populations. Currently in Western New South Wales (NSW) the Orange Health Service (OHS) is the only PCI-capable hospital.

Aim: This study examined whether implementation of a centralised management system (CMS) with routine immediate transfer to a PCI centre improved the timeliness of treatment for rural patients in Western NSW with STEMI.

Methods: The study used a quasi-experimental design, including STEMI patients treated in Western NSW Local Health District between January 2014 to December 2015 (prior to implementation of the CMS) and May 2019 to April 2021 (during implementation of the CMS). Existing pre-hospital and in-hospital thrombolysis programs were combined with a centralised ‘hot transfer’ strategy for patients experiencing STEMI 90 minutes or further away from the PCI centre in ‘medium’ and ‘long’ distance ambulance transfer regions. ‘Medium’ patient transfer regions were defined as 90 to under 120 minutes from the PCI hospital, and ‘long’ as further than 120 minutes. Protocols for those patients within 90 minutes, or the ‘shorter’ transfer region remained unchanged.

Results: Data on outcomes were available for 274 patients who presented with STEMI before, and 348 after, CMS implementation, with approximately half from the medium and long transfer regions (17% and 31% respectively). There were significant reductions in transfer time to the PCI centre at the OHS for those in the medium (288 to 243 minutes, P<0.05) and long (344 to 296 minutes, P<0.01) transfer regions and, as anticipated, no change for those in the ‘shorter’ transfer region. Time to administration of thrombolysis improved significantly in the long transfer region (from a median 108 minutes pre-implementation to 97 minutes during; P<0.05). The proportion of patients who received angiography within 24 hours improved in the medium (77% to 91%, P<0.05) and long transfer regions (58% to 77%, P<0.01).

Conclusion: A CMS with immediate transfer enabled delivery of STEMI patients across a vast geographical area directly to a rural PCI centre. Those patients furthest away from the PCI-capable hospital experienced the greatest benefit. The further development of 24/7 PCI services in existing rural cardiac hubs has the potential to reduce disparities in rural Australian STEMI outcomes.

Rural and remote communities continue to experience a higher prevalence of chronic and other disease, potentially preventable hospitalisations, and associated workforce and service shortages. The maldistribution of allied health professionals (AHPs) (and associated workforce shortages) in rural and remote Australia are about twice as severe as for medical practitioners, with numbers dropping sharply on a per head of population basis with increasing rurality or remoteness.

The response to address workforce shortages needs to be multifaceted – and one approach to be considered is scholarships. The Nursing and Allied Health Scholarship and Support Scheme ran from 2011 to 2017. During that time, 4617 scholarships were awarded to allied health professionals and students, representing 23 different allied health professions.

The data collected throughout the scheme, and an independent evaluation conducted in 2021, provide a significant insight into the effectiveness of scholarships for positively impacting on the rural and remote allied health workforce.

This poster gives snapshot data that tell an interesting story – and one we believe is worth revisiting. We encourage you to engage with the insights generated by the data and consider the effectiveness of the scheme, the evidence of its impact, and the missed opportunity for rural and remote health by no longer having this scheme in place.

Given the chronic lack of access to allied health workforce and services in rural and remote Australia, can we afford to ignore distribution programs that work?

Introduction: No longer can aged care providers maintain the status quo. Facing significant aged care reforms, increasing community expectations and ongoing workforce challenges, rural aged care services need to use collaborative and innovative partnerships to meet the increasingly complex needs of older people in rural and remote communities, including Aboriginal and Torres Strait Islander elders.  Collaboration across the healthcare ecosystem that includes technology and product providers and researchers can facilitate new and better ways of working. However, an understanding of how this applies in rural and remote aged care settings is needed to develop appropriate strategies to create opportunities for innovation. This workshop aims to broaden research knowledge to understand the range of factors that might enable greater collaboration and innovation into rural and remote aged care services. By sharing practical experience and providing the opportunity to reflect, we will draw together insights on what is needed to drive innovation in rural aged care and how best to support that.

Methods: After a short presentation and examples of collaborative approaches to innovation that have driven improvements within caring environments, a World Café approach to yarning will be used to:

• Hear the voices of key people and sectors needed for innovation in rural aged care services.
• Share ways to overcome challenges and make the most of enablers for implementing innovative approaches.
• Consider key drivers of innovation to suit rural and remote communities.

This approach will be used to ensure all participants have a chance to contribute to the discussion and build upon and elaborate ideas to create opportunities for innovation. Ethics approval will be sought to collect unidentified contributions. A summary of the discussion and key strategies will be shared with participants after the symposium workshop. This process of shared discussion and feedback is designed to build partnerships and capacity in innovation.

Results: Participants will gain a deeper understanding of:

1. How collaborative innovation can support rural aged care providers to confront the sector’s critical challenges.
2. The role of researchers in building partnerships in rural aged care.
3. How industry partners can support innovation within aged care in rural and remote areas.

Outcomes from this workshop will inform programs to drive partnerships in cross-sector collaboration and innovation in rural aged care.

Research reports that one in five women will experience perinatal anxiety and/or depression. These challenges are often exacerbated in rural and remote communities where access to perinatal mental health care is limited. A desktop review initiated by midwives in a rural South Australian health service identified a high proportion of women presenting with risk of perinatal mental health challenges. In response to this, funding was obtained to implement an online perinatal mental health education program.

Aim: The aim of this study was to evaluate the effectiveness of a facilitated online perinatal mental health education program (e-PMHEP) in developing perinatal mental health knowledge, skills and confidence in rural midwives and practitioners.

Method: Evaluation of the e-PMHEP incorporated a validated pre/post survey design to assess self-reported knowledge, skill and confidence regarding perinatal mental health care before and after the program. An additional anonymous questionnaire sought feedback on satisfaction and feasibility.

Findings: Twelve participants completed the pre/post survey and questionnaire. The overall pre/post knowledge scores were statistically significant (t=2.73, 8df, p=0.025) with improvement from the pre-testing mean score of 41.55, std 12.34, to the post-testing score of 60.33, std 12.76. Pre and post data also suggests a measurable increase in confidence and skills. All respondents agreed that the content specifically addressed their learning needs, 75% indicated it was very beneficial (highest choice), 75% rated it as excellent and all participants indicated they would recommend this program to other practitioners.

Discussion: The findings suggest that the e-PMHEP was beneficial in developing perinatal mental health knowledge, skills and confidence in midwives and practitioners providing perinatal care to women in a rural local health network. Notably, a third of participants had not undertaken previous training and only a third routinely developed a care plan with women who had a pre-existing mental health diagnosis. Key strengths of the program included the accessible content, and the combination of both an experienced clinician and facilitator with lived experience.

Conclusion: There is a need for perinatal mental health education for midwives and practitioners working in rural Australia. The results of the pilot e-PMHEP suggest that providing an online, facilitated education program could be beneficial for rural midwives and health practitioners working in the perinatal mental health space.

Background and aims: Approximately one-third of Australians live outside of metropolitan areas, but these proportions are rarely presented in clinical or randomised trials. This is not unexpected, given reduced population density dictates a change in context and approach. Ensuring rural residents are equally represented is increasingly a priority as the generalisability of metropolitan evidence to rural contexts is now disputed. The recruitment invitation source may impact on the initial engagement of potential participants. The aim is to discuss the relative successes and failures of two recruitment methods trialled by rural researchers to engage rural people in four research studies.

Methods: Four rurally based and anchored studies were commenced in a catchment inclusive of towns meeting the Modified Monash classification 3–6. Two key recruitment methods were trialled: two studies used a face-to-face (FTF) methodology and two studies used a letter from a trusted local intermediary (TLI). The FTF method involved rural researchers using a stall at a local rural event to promote the research study to attendees. The TLI method involved a letter of invitation to participate in research being provided by a person’s general practitioner, either by post or following a consultation. All studies highlighted the rural location of the research team to create rural credibility with potential participants.

Relevance: Recruiting in rural areas requires a tailored approach and an understanding that extended time and multilevel engagement with local input is required.

Results: The primary benefit of the FTF method was the opportunity to promote credibility and authenticity personally. The TLI benefits included the leveraging of the existing trusted relationship by using another’s credibility. Both methods met with significant challenges. Positive FTF engagements were gained when potential participants learned that the researcher lived and worked in the same communities, and potential participants could capitalise on opportunistic health-related activities. The TLI method had higher consent returns when the trusted local had a strong relationship with the potential participant.

In terms of failures, all four studies either did not meet the recruiting target, required longer recruitment periods or more resources. The TLI method increased burden on primary care employees, that may have already been under time pressures, despite enthusiasm for the trial and possible benefits for patient groups. Participant follow-up was challenging after a FTF engagement, despite consent being provided willingly at the time.

The risk profile of recruited participants was challenging, which had higher health literacy and self-care tendencies, and often motivated by altruism, similar to metropolitan study volunteers. Recruiting higher-risk participants with limited or no exposure to research remains difficult, with many not routinely accessing healthcare services.

Conclusions: Recruitment of rural residents requires a nuanced understanding of community and relationships. Leveraging the rural locality of research staff and those with community knowledge is imperative to success. Completion times will take longer, and engaging higher-risk residents for health studies is likely to be challenging. Success is a must to ensure evidence-based strategies exist to improve health care and delivery to all Australians, regardless of postcode.

Introduction: Insufficient medical graduates are choosing a rural career. Medical careers and specialty training pathways in Australia commence after at least one mandatory internship year of clinical (prevocational) service. Medical school graduate tracking evidence of who works rurally has broadly demonstrated the importance of selecting those of rural background/rural interest and supporting extended placements in rural communities as part of their training. In contrast, evidence of the additional contribution of preferencing and take-up of rural internships is less clear. This study aims to evaluate the importance of rural medical internship location to observed future work location.

Methods: This study utilised administrative data from three sources. Firstly, Queensland Health provided internship preferences and acceptances of all graduates of The University of Queensland who were interns in 2014–2021. Secondly, these were then matched to university data of key factors including childhood origin, rural clinical school participation, being rural bonded, gender and age. Thirdly, graduates were matched to their AHPRA current practice location in 2022. Statistical associations were measured between internship location, current location and other key pathway and demographic characteristics. Outcomes were observed up to nine years post-graduation, although data from the second post-graduation year were excluded due to its immediate proximity to their intern year. There were 1930 observations after excluding international students. Rural internship was modelled as both a dependent variable (stage 1) and an independent variable in a multivariable model of current work location (stage 2).

Results: Accepting rural internship (stage 1) was most strongly associated with having completed two clinical training years rurally (OR 5.8, 95% CI 4.4 to 7.7), but was also significantly associated with one rural training year (OR 2.8) and being rural origin (OR 1.5). Factors not significant with accepting a rural internship were being rural bonded, gender and age at graduation. Stage 2 modelling revealed the dominant importance of rural internship on current work location being rural (OR 4.6, 95% CI 3.5 to 5.9), while two-years’ rural training (OR 1.7), one-year rural training (OR 1.4) and rural origin (OR 1.6) remained significant and being rural bonded, gender and age remained non-significant. This pattern was consistent when models were stratified by years since graduation. Those accepting a rural internship where it was preferenced outside of their top five were much less likely to stay rural (OR 0.2) compared with first-preference acceptances.

Conclusion: This study provides new evidence of the importance of medical internship location on subsequent rural practice, after accounting for key factors across the training pathway. This evidence supports the need for strengthened and expanded rural training pathways after medical school, given its strong association with longer-term decisions to work rurally. The availability of rural pathways should be aligned with supporting sufficient rural careers, with evidence encouraging stakeholders involved in post-graduation training to be more cognisant of the impact of training location(s) on workforce distribution outcomes.

Demand for general practitioners (GPs) is forecast to widen (shortfall expected to reach 11,392 GPs FTE). For rural generalist trainees, training in public secondary care services administered by local health districts (LHDs) are a core element of fellowship. As such, rural generalist trainees represent a significant workforce contingent in hospitals and clinics servicing rural and remote communities. However, rural generalist trainees in secondary care facilitates face barriers including professional and personal isolation, under-representation and intercraft conflict between specialties, which may contribute to professional and personal burnout and attrition from rural practice.

Research focus: Our research sought to provide ground-level data on factors contributing to retention and quality of registrars working in areas of high workforce need. The policy window for action for staff wellbeing is heralded by three factors: the transition to college-led training; the rural communities calling for assistance to fill workforce shortages; and the International Labour Organization/World Health Organization joint publication advocating strengthened protection of workforce.

Methodology: This work consists of 18 months of in-depth ethnographic fieldwork including participant observation semi-structured interviews with rurally based registrars and direct observation of workplace, health and social spaces. It draws on the experience of multiple rural generalist registrars working across multiple states.

Key findings: Key findings of our research include the importance of secular, dedicated pastoral care as a critical resource of staff wellbeing beyond the current model of employee assistance programs and the centrality of empathetic managerial leadership for staff retention.

Implications: We argue for provision of dedicated onsite staff wellbeing and support offices under the oversight of a LHD-appointed Chief Wellbeing Officer. This proposal is underpinned by the ethos of empathic leadership, principals of sound labour economics and the need to address root causes of general practice trainee attrition.

Background: Each year, over 700,000 people die by suicide worldwide, with many more attempting suicide. In the past two decades, global age-standardised suicide rates declined by 36%, also observed in Australia which experienced a considerably smaller decline of 2.4%. However, in Australia, while such deaths mostly decreased among males (a decline of 7%, from 20.0 to 18.6 per 100,000 population comparing 2000 with 2021), an opposite trend was observed in females with suicide deaths increasing by 11.5% (5.2 to 5.8 per 100,000 population). Differences in Australian self-harm hospital admissions over time are also observed by residential areas with hospitalisations decreasing in major cities (111 to 107 per 100,000, in 2012–13 and 2020–21, respectively) but increasing in outer regional (136 to 149 per 100,000) and rural remote locations (146 to 171 per 100,000).

Aims: This population-based retrospective study, which linked hospital data with Ambulance Victoria data, aimed to describe self-harm hospital admissions over time in Greater Bendigo in regional Victoria during 2010–20 and to investigate methods used and risk factors for dying during admission.

Statistical methods: Trends in self-harm admissions over time were tested by sex using Dickey-Fuller and MacKinnon tests. Paramedic pre-hospital management was described during the 30 days prior to hospital admission. Risk-adjusted odds ratios of in-hospital mortality were estimated using a logistic regression that accounted for age, sex, socioeconomic disadvantage, complexity level, admission via the emergency department, self-harm intent, self-harm method and paramedic management during 30 days prior to the hospital admission.

Results: During the study period, 2000 individuals (59% female) (mean age 36.5 [SD 18.6] years) were admitted for self-harm. Increased trends in self-harm admissions over time were observed in both sexes. Poisoning was more commonly used by females whereas males used more methods that involved blunt and sharp objects, smoke and fire and firearms. Factors significantly associated with increased risk of dying in the hospital were older age, male sex, low socioeconomic status, DRG classified major complexity, critical care admission, and self-harm method of suffocation. Patients who had been attended by paramedics during the 30-day period prior to admission were 36% less likely to die than those who had not been attended by paramedics (adjusted-OR 0.64, 95% confidence interval (CI) 0.42-0.97). Patients coming from regional locations were 41% more likely to die compared to those coming from rural or metropolitan regions (adjusted-OR 1.41, 95% CI 1.03-1.96).

Conclusion: The increased trends in self-harm detected in our study warrant population-wide suicide literacy campaigns tailored to high-risk groups living in regional communities. Our findings show that individuals should seek treatment for such injuries as they are less likely to die from them when being attended by paramedics. However, past literature indicates that paramedics feel ill-equipped to deal with mental health and suicide calls. Further focused training/education to enhance paramedics’ confidence during mental health related responses may further improve patients’ outcomes.

Background and aim: Frequent potentially avoidable presentations to the emergency department (ED) are a ‘wicked’ system-level problem globally. They have a substantial impact on health resources, resulting in decreased quality and timely access to health care. This problem is compounded in rural and regional areas due to increased reliance on EDs, in part because of health workforce shortages and limited primary care availability. Frequent presenters to the ED (typically defined as patients who present to the ED ≥five times within a 12-month period) contribute disproportionately to the overall rate of avoidable presentations and have unique needs. Traditional approaches to addressing their needs are typically linear, and there is a need to view such complex ‘problems’ as part of a wider, dynamic system.

Knowledge into the system-level dynamics of avoidable presentations in rural areas is limited. The aim of this study was to understand drivers of frequent presentations in a large regional health service, and to identify opportunities for intervention within the system.

Population/setting: Representatives from key health service stakeholder groups (such as allied health, paramedics, community health services, consumers) who operate within regional Victorian health services, servicing both regional and rural populations.

Methods: Perspectives of stakeholders that use, or operate within, the health system were incorporated using Group Model Building (GMB), a systems thinking process that seeks to guide decision making for complex problems. Three three-hour online GMB workshops were held with key stakeholders. They were guided through a series of participatory tasks to examine participants’ mental models of the causes and effects of frequent presentations, and to identify priority action areas to reduce such presentations.

Relevance: This research sought to address the lack of knowledge on the drivers of frequent presentations in a regional/rural context, as well as the absence of a system-wide understanding of the problem. Using a systems thinking approach, diverse perspectives were captured, creating an unprecedented understanding of the local context and drivers of frequent presentations.

Results: A causal loop diagram identifying the interrelated factors driving frequent presentations in a rural/regional setting was developed through the GMB process. Factors influencing the management of people at risk of frequent presentations were categorised into four themes: (1) access to services; (2) patient and service coordination; (3) patient needs; and (4) knowledge and skills. Nine action areas were also identified, focusing on improving service and care coordination within a rural/regional population. Actions centred around creating system-level processes for improved delivery of care, ensuring comprehensive support to patients at risk of future ED admissions. Information sharing between services was identified as a key barrier to implementation and highlighted as a priority.

Conclusion: This research provided an in-depth understanding of influencing factors and potential solutions for avoidable ED presentations across a regional health system. It provided a foundation for the formation of working groups to implement action priorities. GMB has previously been used across a range of contexts including health systems and community settings, however this was the first time systems thinking has been used to address frequent presentations within a regional context.

Natural disasters are frequent events and global warming will lead to more frequent bushfire disasters and flooding in rural Australia. Without timely and effective interventions, the effects of community-wide natural disasters on children and young people’s development and wellbeing may be long lasting and serious. Children’s life opportunities could be significantly compromised. Consequently, this may cause detrimental mental health and chronic disease costs in the health sector and wider society. Play therapists have skills and knowledge that can benefit children and families post natural disaster, particularly in rural settings.

This scoping review was designed to map the existing literature and the role of the play therapist in supporting children and families following natural disasters, and to formulate a model to guide play therapists in the future. The model identifies rural disadvantages that can be overcome by play therapists’ application of unique skills and knowledge to support children and young people at each stage of disaster planning and response.

Play therapy is a developmentally sensitive mental health intervention which respects the child and young person’s voice and promotes resilience. Play therapy is an emerging profession in Australia and has the potential to support the mental health and wellbeing of children following natural disaster. Play is the language of children to make sense of their experiences. A play therapist has the skills to view the child’s inner world through play and encourage mastery and healing. Children’s psychosocial difficulties experienced in trauma can be resolved to achieve optimal growth and development.

The outcome of the systematic search of the literature emphasised that play therapists are well suited to support children after natural disaster. Yet, play therapists should be mindful of the different phases of natural disaster response and how their role may vary across these phases. More traditional play therapy interventions may be better suited to the latter stages of disaster response. It was also identified that there is a need for research into the impact of natural disasters on children and families and interventions that aid mental health and wellbeing, especially for children who may be more vulnerable and potentially overlooked in the wake of such disasters. Further research is also needed into the effectiveness of play therapy as a post-disaster intervention for children.

This scoping review indicates that play therapists could provide a key role in disaster response to facilitate psychosocial recovery and wellbeing. Due to an increasing number of natural disasters in rural settings, play therapists need to expand their role to communities that need healing for children and young people devastated by these tragic events. This emerging profession in Australia has the potential to facilitate new hope and renewed purpose in children and young people in rural and remote communities post natural disaster.

Rural generalist training has been emerging in Australia since the 90s and was recently expanded through state-funded programs that support doctors’ educational transitions across the prevocational and vocational years. Australia now has a National Rural Generalist Pathway and, in each state and territory, rural generalists are being trained as a selective cohort in the regions where we want to practice. However, a key question remains as to how to promote stable employment for graduates emerging from rural generalist training in locations where rural generalists are needed. This includes considering where rural generalists are most likely to be viable and sustainable so that there is an end point to training that results in supported high-quality professional practice and services for the community.

The Victorian rural generalist program has done some work to explore this question in the context of Victoria. This presentation explores interviews with 36 stakeholders who were program staff, policy decision makers, executives and active rural generalists. The findings were that the decision about where rural generalist models are viable in Victoria is informed by a context of specialist professional competition and changing health service executive and executive values over rural generalist models, introducing a level of person and place dependency to decision making. Further, the Victorian context or planning is devolved where individual doctors are negotiating individual models with individual health services.

There is no clear accreditation framework and, while this persists, rural generalist scope of practice is at risk. With this context in mind, rural generalist models are likely to require a statewide clear accreditation framework informed by the profession and regional-level planning (use of emerging Health Service Partnerships and training networks) to set out services, at the scope and distribution, which will best serve people in the regions, rather than individual services. Also needed is a clear payment structure relative to the skill and scope of work areas which covers both state and privately funded services (and which is as integrated as possible for the employee salary and benefits).

By addressing employment models, there is the potential for rural generalist training investments to achieve good uptake and retention of workforce in a way that matches community need.

Introduction: While research has reported many benefits of telehealth for rural communities, there is little known about the unintended consequences of telehealth on healthcare delivery in rural Australia. There is a lack of empirical research that considers the unique social and health circumstances of these communities and the complex nature of introducing a technical intervention such as telehealth to the healthcare system. By taking a systems-thinking approach and involving diverse stakeholder groups, this qualitative study aims to close this gap by assessing its unintended consequences in rural Australia.

Methods: This is a qualitative study using semi-structured interviews to collect the perspectives of various stakeholders involved directly or indirectly with telehealth in rural Australia. Participants included consumers, health providers, state government representatives and primary health network (PHN) representatives. There were 17 participants interviewed, with an average interview time of 32 minutes. Interviews were conducted using Microsoft Teams and, where that was not possible, telephone was used. Interviews were recorded either with the built-in feature in Teams or using an audio recorder for the telephone interviews. Interviews were transcribed verbatim. Transcripts were analysed inductively and deductively to identify themes using systems archetypes as a framework.

Results: The emerging themes of telehealth unintended consequences in rural Australia fall into two categories: reported unintended consequences and concerns, or potential unintended consequences as voiced by some stakeholder groups. Some of the reported positive unintended consequences of telehealth are its support for person-centred care by: (1) providing care in a familiar environment; (2) empowering patients by making them feel in control during consultations; (3) offering flexibility and saving unnecessary costs of travel and accommodation; and (4) giving them choice on where to seek care. Also, telehealth was seen as a driver of health equity. Some of its negative unintended consequences are: prone to financial exploitation by doctors, tendency of some doctors to overprescribe antibiotics over telehealth, change of clinical workflows, overriding or bypassing the decision making of local general practitioners, lack of metropolitan telehealth services of the local context leads to inefficiency, no added value and extra cost for patients, concerns about whether telehealth encourages ‘lazy medicine’ by care providers, the funding policies of telehealth could inadvertently redirect resources from rural areas to metropolitan areas, and whether telehealth is increasing the digital divide between rural and metropolitan areas.

Conclusion: Drawing on systems thinking and complexity science, this study contributes to our understanding of what unintended consequences telehealth has on the delivery of health care in rural Australia. The study has invaluable implications for telehealth evaluation programs and health policymaking to optimise telehealth utilisation and mitigate its negative impact on rural communities in Australia.

Introduction: The rural medical workforce is known for its high turnover rate, influenced by personal and workplace factors such as retirement and inadequate remuneration. Government initiatives such as allocation of Distribution Priority Areas (DPAs) for general practitioners (GPs) have assisted medical workforce recruitment in rural areas, allowing access to international medical graduates on a moratorium. Recent Australian Government policy changes in July 2022 have resulted in all areas outside of metro regions being declared DPAs for GPs. One possible way to investigate the impact of this change would be to examine practitioner movements in rural Queensland in 2022 compared to previous years.

Method: Each year on 30 November, Health Workforce Queensland (HWQ) undertakes a quality assurance project, the Minimum Data Set (MDS), to record employment details of medical practitioners working in a primary care context (such as general practice, Aboriginal Community Controlled Health Organisations, the Royal Flying Doctor Service and small hospitals) in Modified Monash (MM) 2–7 Queensland. The MDS is a reporting requirement to the Department of Health and Aged Care. Practitioner employment data was obtained through practice calls and annual surveys to practitioners/practice managers. Practitioner migration was based on the number of practitioners who remained through each 12-month period (2020–22). Net Change (NC) of MM was calculated by subtracting the MM value of the previous year from the MM value of the current year. Positive values indicate a movement to a more rural location and negative values represent less rural.

Results: The total number of medical practitioners increased from 2,609 in 2020 to 2,727 in 2022. A little over 50% were employed in MM2 locations. Between 2020 and 2022, 92–95% of practitioners remained in their MM location each year. The number of medical practitioners who migrated between MM2–7 locations was 167 in 2020, 110 in 2021 and 120 in 2022. The number of MM2 practitioners who migrated to a more rural MM decreased from 59 in 2020 to 17 in 2022. In contrast, the migration from MM3–7 to MM2 increased from 34 to 64 in 2022. For 2020, the NC of MM was +46, indicating movements to more rural locations. In 2022, the result turned negative (NC = -117), suggesting more movements into less rural locations. In 2022, 85.8% of migrations were departures from MM3–7, a considerable increase from 2020 and 2021 (approximately 65%).

Discussion: With yearly increases in the number of medical practitioners in rural Queensland and the majority working in MM2, there is comparatively little migration between MM locations. However, the increase in the number of practitioners migrating to MM2 and the reduction in those leaving MM2 for more rural locations was more pronounced in 2022. This could point to the impacts of the DPA policy change implemented during 2022. It remains to be verified whether these trends sustain into the future. Personal and workplace factors that motivate practitioners to migrate between MM locations have been prevalent for many years, however it appears that this initiative provided a new option to work less rurally. Emphasis should be placed on underlying factors and how they influence workforce departures to inform policy and programs that aim to address practitioner recruitment and retention in rural areas.

Students enrolled in Flinders University’s longstanding Doctor of Medicine Rural Stream (MDRS) program undertake a longitudinal integrated clerkship (LIC) in year three of their studies, with placements distributed across multiple sites in South Australia. In the MDRS students live and learn in their host communities, splitting their hands-on clinical time between general practice and local hospital settings. Parallel to their LIC, all students enrolled in the medical degree are required to undertake research training, choosing either a research project or coursework project pathway.

In the rural context, the LIC is underpinned by a person-centred, community-based ethos; we can conceive this as a ‘principle of community’ that animates the distinctiveness of the LIC as a form of clinical learning. By extension, the same ‘principle of community’ can be reasonably seen to also apply to the research learning context. Indeed, it makes sense that MDRS students undertaking research projects do so in their local communities. We can presuppose that conducting action-focused research in, with and for their host communities stands to benefit the community as well as the student and the university.

As such, the MDRS Advanced Studies program is taking the initiative to support students to conceive and conduct their project within their local community context.

This ‘principled’ program also directly addresses program improvements identified in the 2021 MDRS evaluation Maximising the MDRS Learning Experience, in particular the sub-principles: (1) Serve the community through civic engagement, enabling opportunities for new healthcare partnerships within community, and extending the settings and contexts for healthcare learning; and (2) Foreground the patient experience, fostering different ways of engaging with the human experience, taking a person-centred approach, and introducing curricular opportunities to focus on wellness and preventive care.

This presentation will outline the notion of a ‘principle of community’ and touch on its implications for practical implementation, including: the policy context for researching in community; the role of context in research; possible settings for community-based research; supervisory matters; the role of community in the project; the intended learning outcomes and some additional possible other outcomes taken from the literature; appropriate methodologies and supporting students’ methodological expertise; required sensitivities of the researcher; and potential outcomes and benefits to the community, and to the medical student in terms of their career.

Attention to these wide-ranging considerations provides a theoretical and philosophical beginning point for thinking about how the ‘principle of community’ might be practically expressed in program form, what quality might look like, and how the initiative might be supported and evaluated. What is most essential, though, is that the ‘principle of community’ is embedded from the outset – in other words, that the communities themselves are involved in the development and offerings of the program, in partnership with the university.

Background: Rural and remote Australians face pervasive health inequalities that are, in part, perpetuated by chronic workforce shortages. Current efforts to address this issue include ensuring health students can undertake quality rural placements that foster future rural practice; students who do so are more likely to consider practicing rurally. While there is no universal definition of quality in rural health placements, student placement satisfaction and support from key stakeholders have been identified as fundamental factors. Unfortunately, the start of the COVID-19 pandemic in 2020 brought many changes and uncertainties, including disruptions to health student placements. During this time, students with scheduled placements voiced concerns about safety, clinical learning, supervision, graduation, future employment and financial strain, and might have been at risk of mental health concerns, stress and wellbeing decline. This national study aimed to explore self-reported mental health, stress and wellbeing concerns among nursing, allied health and medical students who undertook a rural placement during the early stages of the pandemic. It also aimed to examine how indicators of quality placements (specifically perceived support and placement satisfaction) are related to these concerns.

Methodology: As part of a larger mixed-method project involving all 16 University Departments of Rural Health (UDRHs) across Australia, students with a UDRH-facilitated placement scheduled between February and October 2020 were invited to complete an online survey post-placement. The survey, distributed through an email link from UDRHs, included questions about mental health, stress, wellbeing concerns, perceived support from the university, UDRH and placement, and perceived placement satisfaction. Descriptive statistics and inferential tests were used to analyse the data.

Results: A total of 1315 responses with sufficiently complete data were received, with 81.1% of students able to undertake a rural placement. Of the students who undertook a rural placement, 42.9% reported mental health concerns, 63.8% reported feeling stressed and 41.1% reported a wellbeing decline. Most felt supported by their university (60.6%), the UDRH (50.5%) and their supervisor or other clinicians (86.6%). Overall, 82.6% were satisfied with their placement experience. Students who felt supported by their university, the relevant UDRH and/or their placement site were less likely to report mental health concerns, stress or wellbeing decline. Three multiple logistic regression models including all support and satisfaction variables found perceived support from universities to be the only significant predictor of mental health concerns (p=.00, OR=.58), stress (p=.00, OR=.64) and wellbeing decline (p=.00, OR=.53), with students who felt supported by their university less likely to report these issues.

Conclusion: The pandemic brought many challenges in 2020, particularly for students undertaking health placements in this turbulent time. Many students reported mental health, stress and wellbeing concerns, but this was less likely if students perceived university support. This underscores the importance of universities providing targeted supports for students undertaking rural placements during unforeseen events. UDRHs can provide universities with context around rural placements and advocate for student support at the university level, in addition to providing support directly to students.

Background: The research capacity and capability of rural health professionals influences quality of care, evidence-based practice and leads to localised solutions to rural health inequities. Evidence-based care is more likely to be delivered to people in rural communities when health professionals in those communities are engaged with research and current literature. While research education and training is the cornerstone of rural health professional research capacity and capability, research education and training opportunities vary across Australian jurisdictions. Little is known about the characteristics of research training for rural health professionals in Victoria, Australia. A better understanding of these characteristics is required to inform government policy on health professional research capacity and capability.

Aim: To inform a future model for rural health professional research capacity and capability building by identifying characteristics of the design and implementation of current research training for rural health professionals in Victoria, Australia.

Methods: This study adopted a qualitative descriptive design. Participants (n=20) including regional health service managers, rural health academics and university managers, from Modified Monash Model categories 2–5 communities, with extensive knowledge of research education and training in rural Victorian health services, were recruited via snowballing methods. Semi-structured telephone interviews were conducted with participants. Interview audio recordings were transcribed verbatim. Transcripts were analysed inductively using thematic analysis techniques. Codes and data associated with research training were mapped to the Consolidated Framework for Implementation Research (CFIR).

Results: Rural health professional research training design and implementation characteristics related to 15 constructs within the five CFIR domains. Within domain (1) intervention characteristics, key barriers to implementation included the ad hoc nature of training, training costs and poor tailoring to the rural context, although experiential learning opportunities enhanced training uptake and engagement. In domain (2) outer setting, the policies, structures and processes surrounding health services either stifled or enabled implementation opportunities, with government structures hampering training coordination and cross-region rural health service networks aiding training development capacity. In domains (3) and (4) inner setting and characteristics of individuals, the beliefs and knowledge of health professionals and tension between clinical practice and research participation and other research-related activities shaped the delivery of training programs. In domain (5) process, participants acknowledged that evaluation of rural health research training was limited to initial training perceptions and could benefit from processes that embed skilled researchers within health services and further development of rural health research networks co-driven by health professionals.

Conclusions: This study identifies a host of research training design and implementation characteristics that suggest future rural research training and education needs to reflect the innate ways of rural practice; rurally designed with content that is experiential and flexible in delivery, place based and relevant in the local context, targeted to rural health services and multidisciplinary in nature. The design and implementation characteristics and principles identified in this study offer timely ideas for implementing and resourcing coordinated rural research training opportunities to the Victorian Government, as it develops a government-led, statewide strategic health research plan.

Background: Of those living in permanent residential aged care, more than 50% of residents die within eight weeks of admission. As these two months are associated with rapidly deteriorating health, it is a critical time for the general practitioners (GPs), residential aged care facility (RACF) staff, residents and their families/caregivers, as it represents a time of significant change.

SA Health uses a unique hybrid model of co-located acute and aged care beds to assist in pooling resources. For the aged care beds, SA Health contracts local GPs and pharmacists to deliver care in collaboration with salaried nursing time.

In 2021, SA Health funded the Regional Hospice in Residential Aged Care Facility (RHRACF) project. This project supports 15 of the 48 publicly funded facilities with aged care beds, including onsite education and mentoring by a qualified palliative care nurse educator.

This report aims to list and analyse the results from the pre-project ELDAC After Death Audits to influence how the project team shapes their activities for the project.

Methods: Before the project commenced, two palliative care nurses from the RHRACF project conducted site visits at each pilot site. Many sites had already completed ELDAC After Death Audits. Fourteen of the 15 sites were happy to share this data, ensuring we had a record of documented outcomes before the project commenced at their sites.

Results: One hundred ELDAC After Death Audits were collected from 14 of the 15 project sites.

The audit identified that 15 (15%) deaths involved transfer to the co-located acute service in the last week of life. Importantly, these transfers resulted in 30 hospital bed days for the 100 residents audited. Interestingly, the GP was the most likely to request a transfer to the hospital. While the transfer to the acute service may be warranted, it would also reflect the GP’s knowledge and understanding of end-of-life care issues.

Additionally, the audit identified staff across 14 aged care services consistently failing to identify families at risk of complex bereavement. Furthermore, the audit identified no family referrals to bereavement or other services after the resident’s death. The evidence shows that poor bereavement care results in increased anxiety and depression for families and caregivers, compounded by financial stressors and lack of social support.

Conclusion: This report outlines and reviews results from 100 ELDAC After Death Audits before the RHRACF project commenced. Critical reflection and analysis emphasised the need to focus on multidisciplinary end-of-life care education, especially for GPs. In addition, there is a crucial need for bereavement resources and education of RACF staff in supporting families and caregivers throughout the dying process.

Significant investments are being made into evidence-based home visiting programs to improve maternal wellbeing, parenting and child outcomes. These programs have been implemented for First Nations families in remote communities in the Northern Territory (NT). Models developed in mainstream Australian or international contexts require contextualisation and adaptation to meet the diverse needs, cultures and preferences for engagement of families in remote communities. There is recognition that, for nurse home visiting programs to be successful, the practitioner and client need to establish a positive and trusting relationship, ideally based on continuity over years. This has been said to require skills and capabilities not normally associated with standard health care. Our aim was to understand how practitioners successfully initiate those relationships, what aspects are valued by women, and what organisational strategies best support this work in the NT context.

As part of the formative evaluation of Maternal and Early Childhood Sustained Home-visiting (MECSH) in the NT, we explored the experiences of MECSH practitioners in engaging and building relationships, and what aspects and qualities of the relationship were valued by their clients retained in the program. In 2022, we interviewed 21 providers and 46 female clients who had been enrolled or otherwise involved in MECSH in eight remote NT communities. With participants’ consent, interviews were audio recorded and transcribed verbatim. The data was coded inductively using NVivo (version 12). Thematic analysis was conducted on codes relating to relationships, trust and perceptions of the interaction between providers and clients during home visits. Provider and client data were analysed separately and later compared for divergence and commonalities.

Both clients and practitioners described the significant amount of time it took to develop a trusting relationship, which was facilitated by the nurse being helpful and providing practical support, not only to the clients but also their children, partners and extended families. Clients described high levels of trust in their MECSH provider because she was a ‘good person’, had their back, was knowledgeable and could keep their stories confidential. The practitioners described challenges they faced when there was no organisational support for relationship building with families and with the community more broadly. Success in relationship building was facilitated by individual factors such as previous remote NT nursing experience and by organisational system elements such as support by First Nations community mentors and cultural advisers, explicit handover processes when staff changed, with clear program integration into the primary healthcare service.

The time and commitment required to build relationships based on trust, flexibility and adaptation to the needs of clients and their families tends to be underestimated in program design. Relationship building should be incorporated into the structure of home visiting programs and better supported by organisational systems. To reap the rewards of sustained engagement and retention, funders and program designers will need to explicitly build relationship-based practice into the delivery of programs.

The health systems in remote Australia are broken. For many years they have been characterised by long-term and persistent workforce shortages, non-viable services and fragmentation of care. Since the COVID-19 pandemic began, the struggles of remote health services to keep clinics open have greatly increased, with many clinics forced to close or offer reduced services. Nowhere, and at no time, is the need for access to an effective, comprehensive primary healthcare system more urgent than in remote Australia right now. Residents of remote areas of Australia, characterised by the poorest health status and greatest health needs, many with multiple complex chronic diseases, are bearing the brunt of the current primary healthcare system crisis and marked decline in access to primary health care. Healthcare providers and authorities are struggling with excessive levels of staff burnout and turnover, inequitable funding and escalating service costs, and structural barriers resulting from a fragmented healthcare system.

The new CRE for Strengthening Health Systems in Remote Australia (CRESTRA) seeks to lead research addressing the current crisis through leveraging strong partnerships, built over many years, between Menzies School of Health Research, Aboriginal Community Controlled Health Services, Aboriginal Medical Services Alliance Northern Territory, NT Health, Rural and Remote Medical Services and NT Primary Health Network/NT Rural Workforce Agency.

Importantly, the program of work is driven by the expressed needs and priorities of partnering remote Aboriginal Community Controlled Health Services, which are to tackle four fundamental issues:

1. improve workforce retention through multiple evidence-based strategies
2. address the current inequitable funding of remote health services
3. improve service integration and coordination to provide an efficient, seamless pathway to care for remote residents
4. build remote area research capacity.

Through its sustained research effort and whole-of-system approach to service provision, CRESTRA will strengthen the current evidence base about what bundles of retention supports are most effective in different circumstances, and how they work for different groups of remote health professionals.

CRESTRA will also build on our previous work to determine the quantum of equitable funding required by remote health services and efficient mechanisms to allocate these funds. This is not just a matter of more funding overall but, importantly, how it is allocated.

Thirdly, an implementation science approach will be taken to develop primary health care and consumer-led, co-designed, sustainable, integrated and better coordinated models of care for patients with cardiometabolic conditions (including diabetes, obesity, chronic kidney disease and cardiovascular disease). Further, CRESTRA will describe and define barriers and enablers to uptake of community-based dialysis, so that patients with severe kidney failure can better maintain connections with family, community and country.

Using a multifaceted approach to capacity building, CRESTRA will strengthen both the research cohort living in central and northern Australia, and the capability of remote services to engage in and conduct research that meets their own priorities.

CRESTRA’s translation of newly generated evidence will strengthen remote primary healthcare services by enabling them to better retain their workforce, improve access to appropriate funding, and ensure better integration and sustainability, thereby improving health outcomes in remote Australia.

SA Pharmacy provides services to onsite public hospital pharmacy departments and outreach sites across South Australia. In Riverland Mallee Coorong Local Health Network, the onsite pharmacy team at Berri provides clinical and inventory management for the surrounding 10 public hospitals that do not have a pharmacy department. The outreach site visits range from twice a week to once a month and require significant travel between sites, making it an unsustainable and inequitable service model. A telepharmacy model was proposed to improve the service, offering a sustainable and adaptive approach to clinical pharmacy service delivery and providing timely access for patients in regional areas. A pilot was undertaken at two outreach sites – Waikerie and Loxton Hospitals – in 2020. The pilot resulted in an increased number of high-risk patients reviewed by a pharmacist and patient feedback was positive.

A new service implementation like telepharmacy can increase nursing staff work demands and introduce new or altered workflows, especially in small rural settings. Only a few studies have represented the perspectives of the staff who support the implementation of a telepharmacy service. Therefore, this study aimed to explore perspectives of nursing staff on the barriers and enablers to embedding a telepharmacy service model across regional South Australia.

A descriptive qualitative study was employed to gain insights into nursing staff perspectives. Purposeful sampling was done to include key staff involved in the pilot. Two focus groups were conducted with 10 nursing staff at Waikerie and Loxton Hospitals combined. The interviews were recorded and transcribed, and then thematically analysed using an inductive approach.

Three main themes emerged from the analysis:

1. Utility and scope of telepharmacy service. Staff identified that telepharmacy has the potential to effectively provide patient and nurse education, medication history, clinical review and development of medicines plans. It was noted that a telepharmacy service provides a virtual presence that can be called upon as and when needed.
2. Improvements in feasibility and design. Staff noted important areas for improvement in the service: increased accessibility enabling it to be used on an as-needed basis, user-friendly and portable interface, and streamlining the referral process.
3. Addressing nursing staff capacity to facilitate uptake. Nursing staff time constraints was identified as a barrier and the need to provide adequate and regular nursing staff training on the use of the telepharmacy services was identified.

This study provides valuable insights into the perspectives of nursing staff on implementing a telepharmacy service in regional South Australia. The findings highlight the potential benefits of telepharmacy in improving medication management and patient outcomes while addressing the scope of improvement in its feasibility and design. This study also suggests that supporting nursing staff with efficient referral pathways and training are critical to successful implementation. Findings from this study provide important learning to support integration of a flexible and sustainable model of a telepharmacy service across rural South Australia.

Introduction: In March 2020, the Australian Government expanded the availability of telehealth services in response to the COVID-19 pandemic. This study sought to evaluate the implementation and utilisation of telehealth services in rural Victoria, Australia, before and during the pandemic.

Methods: To evaluate the implementation of telehealth, we conducted semi-structured interviews with practice managers working in general practices across rural Victoria. Interview data was coded to the Consolidated Framework for Implementation Research and emerging themes were synthesised. To evaluate the utilisation of telehealth, we examined longitudinal Medicare claims data from July 2019 to June 2021 from approximately 140 general practices in rural Victoria. The patterns of monthly proportion of general practitioner and nurse consultations, overall and by type of consultation (videoconference vs telephone), were analysed descriptively. Further, the pattern of consultations stratified by consumer characteristics and length of consultation was estimated using generalised linear mixed models.

Results: Preliminary analysis of interview data suggests that the implementation of telehealth was challenging due to: (1) multiple rapid changes in rulings for telehealth use; (2) staff difficulty in adapting to sudden workflow changes; and (3) a lack of support from the government. Infrastructure and clinician motivation determined the availability of video services within the general practice. In terms of utilisation, telehealth represented one in four general practice consultations over the two-year period (July 2019 until June 2021). The introduction of the telehealth expansion policy in March 2020 led to an unprecedented and rapid uptake in telehealth services. This was followed by a steady decline until January 2021 and by June 2021 telehealth utilisation had stabilised. Telephone services and shorter consultations were the most dominant form. The proportion of video consultations was higher during periods with government-imposed lockdown, and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas.

Conclusions: Our findings support the continuation of telehealth use in rural and regional Australia post-pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of shorter telephone consultations. Governments must ensure sufficient financial and infrastructure support to improve efficiency of telehealth implementation and use in rural areas of Australia.

Introduction: The Rural Research Capacity Building Program (RRCBP) has been conducted in New South Wales, Australia, since 2006. Aimed at novice researchers, the program aims to build research capacity in rural health workers by providing a mix of workshop and remotely-delivered research education, grant funding and support to undertake a workplace-based research project.

One of the features of the program since its inception is the structure of the program, where candidates are recruited as a cohort. On average, 17 candidates are accepted into the two-year program each intake and continue to work together during the program. Graduates of the program are actively linked to new candidates to provide peer support. Candidates are also linked to experienced researchers for mentoring. These support strategies are crucial as candidates are distributed throughout the state and often work in isolation from program peers. This peer support continues as the research projects progress to completion.

While candidate reports indicate the value of shared experience and peer support, this aspect of rural research capacity building has not been previously examined. The aim of this presentation is to explore the way rural research capacity-building programs can build community through shared learning experiences.

Methods: Drawn from a larger critical realist study exploring long-term outcomes of the RRCBP, this presentation uses data from focus groups and interviews with 22 graduates from the 2006 to 2015 cohorts of the program. Thematic analysis of outcomes at the individual level are highlighted.

Results: The program successfully developed research-capable individuals who felt like they belonged in ‘the world of research’. This sense of community was a result of a transformation in personal and professional capability. This transformation was accompanied by new embedded knowledge, skills, authority and confidence, and created capability for ongoing research activity.

Discussion: Rural research capacity-building programs have potential to help novice researchers build relationships through building community. These connections with fellow learners can be enhanced by careful program design and supporting novice researchers to build networks within and across organisations. This support and sense of belonging creates both research capacity and a sense of community.

Linking graduates to new candidates adds to program continuity and sustainability, in essence becoming both a peer-support network and future mentors.

Those interested in rural research capacity building should consider the value of relationship building, peer support and the ability to create research community while developing rural researchers.

Background: Aboriginal and Torres Strait Islander children are at a significantly higher risk of developmental challenges resulting in educational and health disadvantage. The Be Well Learn Well (BWLW) program is a Queensland Department of Education program. CheckUP Australia has worked in partnership with Gidgee Healing and the Apunipima Cape York Health Council, both Aboriginal Community Controlled Health Services (ACCHS) in Far North and North West Queensland, to deliver culturally appropriate allied health services for eight remote schools since 2017. Through BWLW, a multidisciplinary team of allied health professionals delivers culturally safe assessment and therapy services in both classroom and community settings. The program aims to address developmental delays and disabilities that could lead to poor health and learning outcomes. BWLW’s objectives are to:

• Deliver psychology, clinical psychology, occupational therapy, speech therapy services and needs assessments to students in the school, home and community environment.
• Strengthen and build knowledge and capacity of school staff (including teachers, support staff) to identify and address learning and development difficulties.

Aim: To externally evaluate the implementation and early outcomes of BWLW on children’s wellbeing and development, as well as changes in the capacity of school staff to better support these children.

Methods: A mixed-methods approach was used utilising a realist evaluation framework, supported by case studies. Phase 1 involved analysis of program throughput data, as well as surveys conducted over the period of program delivery prior to the evaluation (2017–21). Quantitative data were analysed to produce descriptive statistics and identify trends, qualitative data were analysed using content analysis by three researchers to ensure data triangulation. Phase 2 involved semi-structured interviews conducted online or via phone with school representatives (principals, heads of special education; n=7), ACCHS representatives (team leaders, senior staff; n=3). Interviews were conducted via Zoom, transcribed and analysed using narrative thematic analysis. Case study site visits were organised for two schools (Aurukun State School and Kowanyama State School), where an experienced evaluator-educator conducted semi-structured interviews and engaged in yarning circles with teaching staff, community liaison officers and ACCHS clinical and non-clinical staff). Qualitative data were analysed and case studies developed.

Results: The evaluation found that the classroom screening provided by allied health teams substantially improved the identification of students at risk of developmental delays and communication difficulties. This improved identification resulted in verified diagnoses for students due to the program which allowed them to access therapy and medication not just from the allied health teams but from local health providers as well. The case study site visits revealed increased confidence and capabilities among teaching and non-teaching school staff to better identify children in need of support or referral/assessment, as well as an improved understanding of specific children’s behaviours in class and approaches to better support them.

Conclusion: This project provided the first evaluation of a multidisciplinary outreach program designed to provide better access to allied health support to children in remote Aboriginal communities. The insights obtained from key stakeholders will inform policy and practice to better support children’s developmental and health needs in remote communities.

Background: Disparities in poor health outcomes are well documented for people living in remote and regional areas in comparison to their metropolitan counterparts and contribute to a higher rate of chronic diseases and preventable cancers.

Inequalities in social and cultural determinants, and geographical disparities, make influencing behavioural change challenging. Education regarding the importance of making healthy lifestyle choices is only effective when people are concurrently provided with the resources to engage in these behaviours. The Moriarty Foundation, a holistic Aboriginal-led initiative, aims to address the intergenerational disadvantage experienced by Aboriginal and Torres Strait Islander peoples by building capacity and empowering communities to engage in healthy lifestyles.

Method: The Minderoo Foundation is partnering with the Moriarty Foundation to support the delivery of two of its Indigenous-founded, Aboriginal community-led programs, which focus on 13 of the 17 Closing the Gap targets.

The two interrelated programs reach 2000+ Indigenous children in 19 remote and regional communities in the Northern Territory (NT), Queensland and New South Wales. The Indi Kindi program focuses on the early years (children under five) in remote NT Aboriginal communities.

The John Moriarty Football program is Australia’s longest running and most successful Indigenous football program for 2–18 year olds, harnessing football for positive change. Both programs also provide nutrition for the children who access their services.

Results: The Indi Kindi program is delivering an early years solution for children under five in multiple remote Aboriginal communities, integrating health, wellbeing, education and development to give children the best start in life. The John Moriarty Football program is successfully improving school attendance and resilience in 19 remote and regional communities across three states. This presentation will share outcomes, challenges, and opportunities in delivery of the nutritional component of these two key initiatives as they aim to improve outcomes for Aboriginal communities.

Conclusion: Through further collaboration to ensure nutrition is affordable, utilising a model of culturally embedded learning on Country, we can address multigenerational disadvantage and improve outcomes for Indigenous children and families in rural and remote settings.

Health promotion is increasingly being recognised as an integral skill for many health professions as resource constraints push care out of the acute sector and into the community. Health professions such as paramedicine are reflective of this change, as their occupational role and scope of practice are progressively moving into the community setting. This is particularly relevant for rural Australia where paramedics are beginning to have a significant role in the community in health education and promotion, in addition to providing emergency response care. Consequently, tertiary education institutions need to provide paramedic students with the opportunity to learn about health promotion as a professional role in their future practice.

This research explored the learning afforded to undergraduate paramedicine students through participation in a short-term health promotion activity. The health promotion activity was conducted in 2022 over three days at a large agricultural event located in southern New South Wales. It occurred as a partnership between a University Department of Rural Health and the Australian Men’s Shed Association in delivery of the ‘Spanner in the Works?’ health screening and health promotion initiative primarily targeting rural men. First-year paramedicine students from a regional university participated in the health promotion activity under the supervision of registered health professionals from nursing and allied health backgrounds. To ascertain the learnings afforded to the students and the attributes and practices that facilitated their learning, the undergraduate paramedicine students were invited to participate in case study research based on the ECOUTER mind-mapping method.

Thirteen of the 14 paramedicine students who participated in the activity consented to participate in the research. Three key themes were identified as the attributes and practices that facilitated their learning, including the high-dose narrow scope nature of the activity, creation of a space for reciprocal connection between students and the community participants, and an unanticipated change in perception for the students who participated in the activity. Short-term health promotion activities such as this have the potential to provide students with an invaluable learning experience to prepare them for future professional practice.

Accurate assessment of pain experienced by aged care residents is important for their comfort and clinical management. Pain assessment is more challenging when the resident has cognitive impairment. Data on the pain experience for Aboriginal and Torres Strait Islander peoples is scarce.

This study aimed to assess the observed pain behaviours of Aboriginal residents (n=87) with cognitive impairment in aged care facilities across the Northern Territory of Australia using PainChek® Adult and compare these results with a matched national sample of non-Indigenous residents (n=420). Pain scores are derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff.

The median total pain score for the Aboriginal residents was 2 (IQR 1–4) and for the matched external residents was 3 (IQR 2–5). In a multi-variable negative binomial regression model, this difference in total pain score was statistically significant (p<0.001).

The pain score derived from the automated facial recognition and analysis component of the PainChek® Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97–1.16, p=0.169).

This indicates under-reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary, and a continuing shift in clinical practice to using technology and point-of-care assessment.

Details of topic: The unacceptable disparity in health outcomes and access to health services between rural and urban Australians is a complex issue that is getting worse. We need a new, innovative way to research and address this disparity and for solutions to be embedded in the experiences of rural people. The XXXX located in XXXX, launched Australia’s first Rural Health Consumer Panel (RHCP) in May 2022. A key objective of the panel is to engage rural health consumers systematically and sustainably in identifying research priorities and approaches beneficial to the health of rural Australians. The panel facilitates a meaningful, practical and relevant collaboration between consumers, rural health services, academic institutions and industry partners.

The RHCP puts real-time lived experience and wisdom of service users in the driver’s seat, guiding where and how our research can make a difference. The panel was developed in close collaboration with Nivel Health Care Research in the Netherlands who have a strong consumer panel that has been going for over 30 years, with around 12,000 members. We aim to have 1,500 rural consumers on our panel within five years.

The aims of this workshop are to introduce participants to the RHCP and engage participants in the interpretation of results, co-design recommendations for the use of panel data and future development of the panel.

Process: Using the well-established World Café method, workshop participants will be presented with a summary of the panel’s membership, activities and preliminary survey results and participate in small group discussions to answer four important questions:

1. Who are rural health consumers and how do we recruit and retain them?
2. What do the results tell us and what can we learn from rural health consumers?
3. How do we translate findings for consumers, researchers, health and community services and policymakers?
4. How do we ensure sustainability of the panel?

The workshop will be rounded off with a large group process that clarifies and prioritises recommendations, including if and how participants would like to engage with RHCP.

Outcomes:

1. Workshop participants will have an enhanced understanding of the role and impact of a consumer panel in prioritising, designing and translating rural health research.
2. Workshop presenters will benefit from engaging with a diverse range of participants in contributing to the impact and sustainability of the RHCP.

Introduction: One in five cancer diagnoses involve a rare cancer. The average five-year survival rates are 20% lower than common cancers. Patients with a rare cancer have a more difficult, often lonely, illness trajectory and worse medical and psychosocial outcomes, and they have substantial unmet needs. Importantly, about 25% of people diagnosed with a rare cancer live outside major cities. Evidence shows that the further from a metropolitan centre a cancer patient lives, the more likely they are to die within five years of diagnosis. Rurality likely aggravates the more difficult trajectory for patients with a rare cancer. Rural patients have difficulty in accessing medical (specialised) services and supportive care. People with rare cancer living in rural areas also experience physical and psychosocial isolation, and have reported feelings of insecurity, loneliness and limited access to peer support. To better support people with rare cancer living in rural areas, we need to develop interventions that address their unmet needs. Peer-support programs have positive impacts on quality of life, self-efficacy and psychological outcomes in people with cancer. Currently, there is no evidence-based, supportive care intervention tailored for rural patients with a rare cancer. This project aims to develop and pilot a supportive care intervention for people with rare cancer living in rural and remote communities.

Methods: A supportive care intervention for people with rare cancer living in rural communities will be co-developed and tested, in three stages: (1) Co-design of the intervention – focus groups with rare cancer patients, review of the literature on peer-support services,  interviews with clinicians about their experiences; (2) Intervention development and testing – development of the intervention, which will have an online component because of the spread-out group of rural rare cancer patients; and (3) Intervention pilot – testing the intervention with approximately 30 patients on feasibility, acceptability and effectiveness.

Results and translation: We will present the results of the co-design stage at the conference. The peer-support intervention will aid patients in improving their psychosocial wellbeing and quality of life, and it can help them in navigating their complex illness trajectory. The development of an online peer-support (ideally peer-led) intervention for rural people with a rare cancer will provide a gateway to access peer support, designed to decrease feelings of isolation and decrease unmet information needs. For clinicians, the intervention means they can introduce rural patients to this support network. The network will be hosted through the platform of Rare Cancers Australia (RCA). Current intervention programs (such as breast or prostate cancer supportive care initiatives) are often location based, in person and centring around one type of diagnosis, which severely limits the availability of rural supportive cancer care. The rural context of this project, with smaller number of patients with a rare cancer and a geographic spread, will result in an intervention that is location independent and not dependent on larger numbers of patients with a similar diagnosis.

Background: Research education and training opportunities are known to attract and retain healthcare staff and build crucial skills in the workforce to generate and implement evidence to improve the safety, quality and effectiveness of care delivered. Research education and training also represents a key opportunity for health organisations to position themselves as a place to live and work as a healthcare professional.

Aim and vision: The Rural Research Collaborative Learning Network (RR-CLaN) is a rural-led initiative that aims to provide high-quality research education and training to healthcare staff working in rural, regional and remote (R3) areas. The first goal of the RR-CLaN was to develop and deliver a research education and training calendar that can be accessed by R3 health services and partner organisations. The vision for the education and training calendar is to provide learning opportunities across the spectrum of research engagement (research user, research engaged and research leader) but has an initial focus on research capacity building.

Method: Through a collaborative and consultative approach, research offices and research staff across a variety of health services and organisations in New South Wales (NSW) and Queensland have come together to develop a research education and training calendar that leverages from existing content within respective organisations. The main concept of the calendar is to broaden the reach of existing content by leveraging from information technology that is widely accessible across multiple organisations and jurisdictions (such as Microsoft Teams, YouTube). To date, the partnership comprises 10 R3 NSW Local Health Districts (Central Coast, Far West, Hunter New England, Illawarra Shoalhaven, Mid North Coast, Murrumbidgee, Nepean Blue Mountains, Northern NSW, Southern NSW, Western NSW), the Tropical Australian Academic Health Centre (TAAHC) in Queensland and the NSW Health Education and Training Institute (HETI).

Results: An early insight into the scope, experience and impact of the research education and training calendar, based on the assessment of the inaugural seminar, shows that the concept has broad reach, with over 400 staff from more than 17 organisations in NSW and Queensland attending the live session, and over 150 views registered on the YouTube channel hosting the recorded session, within two weeks of its publishing. Key findings from a 12-question evaluation survey (N=176) showed the seminar was well received with the majority of respondents finding the seminar accessible, the presenter knowledgeable and engaging, the content informative and the duration just right. Over 80% of respondents noted the seminar increased their knowledge of the topic and over 85% of respondents indicated they probably or definitely will use what they learned in their work.

Discussion: Collaboration among research offices and key research staff, across multiple organisations and jurisdictions, demonstrates the potential to broaden the reach of existing research education and training content, providing crucial learning opportunities across many organisations. While some facilitation and governance are required to establish robust processes, the RR-CLaN represents a resource-efficient initiative to provide meaningful research education and training opportunities to a broad audience of learners in R3 areas.

Clinical courage in rural generalists has the following features: standing up to serve anybody and everybody in the community; accepting uncertainty and persistently seeking to prepare; deliberately understanding and marshalling resources in the context; humbly seeking to know one’s own limits; clearing the cognitive hurdle when something needs to be done for your patient; and collegial support to stand up again.

Further work has illustrated that, as a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors’ way of working.

More recent research has begun to consider clinical courage in rural paramedics, nurses and other professions. This interactive workshop will present a short summary of clinical courage and provide opportunities for participants to discuss:

• How relevant is clinical courage to your rural practice?
• How can this exploratory research be translated into educational practice to develop the next generation of multidisciplinary rural generalists?
• What next for clinical courage?

This forum will appeal to rural generalist doctors, nurses, allied health professionals and Aboriginal health practitioners interested in developing a language to describe their clinical practice. Others who may find this presentation interesting include practice managers, students and university staff involved in health professional student training.

Introduction: In regional South Australia, patients can now attend 15 regional sites for oncological treatments, with six having a co-located clinic. Furthermore, oncology activity has significantly increased and continues to do so across all 15 sites. Rising patient numbers have resulted in increased resourcing and more focus on safety and quality systems to ensure regional patients get access to good-quality care closer to home. Indeed, with patient numbers rising, quality initiatives must factor in strategies for responding to patient issues that develop after hours.

Rural general practitioners (GPs) have access to a 24-hour on-call telephone number to seek an oncologist’s advice about issues arising for oncology patients receiving care across these 15 units. However, just as taking a call and responding to the immediate clinical need is critical, oncologists need a standard approach to documenting their response. In addition, recording the clinician’s perspective in writing is essential as other clinicians can interpret conversations and their outcomes differently. Therefore, the regional cancer services developed an online form using Microsoft 365 for oncologists to log any calls. Significantly this form is automated to send the information to the specific unit where the patient receives therapy for filing in the clinical record.

This presentation outlines an audit to identify the challenges to transferring information gathered from the on-call enquiry to the patient’s clinical record.

Methods: The Regional Cancer Service team developed an audit tool to capture patient details, date and time of call and evidence of the on-call record filed in the patient’s clinical history. The cancer services team liaised with the staff at the local sites to gather information against the audit tool for 10 randomly selected on-call records.

Results: The audit found evidence that staff at the local sites transferred 70% of the on-call records into the patient’s clinical record. Interestingly, there was a different approach by the sites without an onsite clinic, with no on-call records making their way to the patient’s medical record.

In conducting this audit, an incidental finding was on the level of patient details provided by the medical oncologists. For instance, the median number of patient identifiers was one. Indeed, while medical oncologists routinely documented the patient’s name, they recorded other patient identifiers less often. As a result, the staff at the regional cancer unit could find it challenging to confirm the file within to place the information. Interestingly, the recording of three patient identifiers was not associated with an increased likelihood of the data being filed.

Conclusion: While the innovative use of the Microsoft 365 suite provides a practical avenue for medical oncologists to record their version of the on-call conversation, more work is needed to ensure that local site staff file on-call records in the appropriate patient record. In addition, further work is required to ensure that all after-hours calls are documented using three patient identifiers and thus abide by quality standards.

Accurate assessment of pain experienced by aged care residents is important for their comfort and clinical management. Pain assessment is more challenging when the resident has cognitive impairment. Data on the pain experience for Aboriginal and Torres Strait Islander peoples is scarce.

This study aimed to assess the observed pain behaviours of Aboriginal residents (n=87) with cognitive impairment in aged care facilities across the Northern Territory of Australia using PainChek® Adult and compare these results with a matched national sample of non-Indigenous residents (n=420). Pain scores are derived from inbuilt automated facial recognition and analysis software plus a series of digital checklists requiring manual input by care staff.

The median total pain score for the Aboriginal residents was 2 (IQR 1–4) and for the matched external residents was 3 (IQR 2–5). In a multi-variable negative binomial regression model, this difference in total pain score was statistically significant (p<0.001).

The pain score derived from the automated facial recognition and analysis component of the PainChek® Adult app was not statistically different between the two groups when adjusted for multiple observations and context of observation (odds ratio = 1.06, 95% confidence interval 0.97–1.16, p=0.169).

This indicates under-reporting of observed pain signs and behaviours for Aboriginal aged care residents by assessors. Further training in the assessment of pain in Aboriginal and Torres Strait Islander aged care residents may be necessary, and a continuing shift in clinical practice to using technology and point-of-care assessment.

Background: The Australian College of Rural and Remote Medicine (ACRRM) provides Fellowship training that leads to qualification as a specialist general practitioner but trains doctors to be proficient in the rural generalist model of care. The rural generalist scope of practice involves special capacity to work effectively in rural and remote clinical settings providing services across primary, emergency and hospital care.

The selection process was developed following literature review and consultation with assessment experts.

The process is unique in Australia and internationally, and cited in the National Medical Workforce Strategy as a model for broader adoption. The College is now able to draw upon eight years of cumulative workforce data to assess its outcomes and impacts.

Intervention: Between 2017 and 2022, candidates undertook a two-stage entry assessment process.

Firstly, a Suitability Assessment; a written application marked using a rubric to assess the following domains:

• intention to have a career working in rural or remote Australia
• capacity and motivation to acquire knowledge and skills in the ACRRM curriculum
• connection with rural communities
• commitment to meeting the needs of rural and remote communities through an extended scope of practice
• personal characteristics including persistence, adaptability, recognition of limitations, comfort with uncertainty and teamwork.

These domains were expected to correlate with future practice outcomes.

Secondly, a Selection Assessment; candidates deemed to meet the minimum suitability standard undertook an eight (later changed to six) station multiple mini interview (MMI), marked using behaviourally anchored rating scales (BARS). These BARS assessed the same domains as above.

Evaluation: Over 800 selection records from October 2017 to December 2022 are incorporated into the review with scores assessed for correlations with success in Fellowship assessments, attrition and rural location of practice (MMM3–7).

Conclusions: The scores are reviewed for their predictive validity comparable to the medical assessment literature, particularly with regard to rural health workforce outcomes.

The review builds on previous analysis of 2017 to 2020 outcomes, which found a significant positive association between Suitability and Selection Assessment scores and attrition (p<0.001). It also found that applicants who score higher in MMI are associated with a higher likelihood of being trained at practices in rural regions.

Given that approximately 28% of the Australian population lives outside of a metropolitan area, the known decline in access to health services with increasing remoteness affects a substantially sized community and is particularly concerning. In response to this inequity, the Australian Government has made a substantial investment in education and training programs designed to improve the rural health workforce by increasing the number of students who receive rurally based medical education. However, despite these efforts, maldistribution of the health workforce in rural and remote areas of Australia remains a significant issue.

The Murray–Darling Medical Schools Network (MDMSN) is a recent Australian Government initiative to establish a network of rurally based medical programs in the Murray–Darling Region. The MDMSN is part of the Stronger Rural Health Strategy and builds on the Government’s existing Rural Health Multidisciplinary Training (RHMT) Program to allow students to study medicine wholly within a rural area.

A multi-university research community – the MDMSN research collaboration – is a proactive partnership between the member universities of the MDMSN, which was established to explore the effect of rurally based medical school programs in the Murray–Darling region. A longitudinal, multi-university program of work, the MDMSN research collaboration answers calls for multi-institution and longitudinal studies. The collaboration was initiated in 2021 by the University of Sydney (Dubbo), who invited partner Universities – UNSW Sydney (Wagga Wagga campus), Charles Sturt University (Orange) in partnership with Western Sydney University, Monash University (Gippsland, Bendigo, Mildura) and the University of Melbourne (Shepparton) in partnership with La Trobe University. This presentation will describe the formation and progress of the MDMSN research collaboration.

To date, the group has developed an ‘entry survey’ to collect student demographic information as well as information regarding rural background, students’ journey to medicine, preferences and future practice intention. Survey questions have been aligned with and adapted from the Medical Schools Outcomes Database (MSOD) survey, the Australian Bureau of Statistics (ABS) and from the literature. This information will be combined with administrative student data, university-level tracking data and registration data from the Australian Health Practitioners Regulatory Agency (Ahpra). Future work will focus on the establishment of a centralised repository of de-identified aggregate data from which to build an evidence base to inform and influence policy and practice, to grow the rural medical workforce.

The MDMSN collaboration forms the first longitudinal, multi-university program of work investigating the impact of complete rural immersion during medical school on successive cohorts of medical students and graduates.

Background: The Australian College of Rural and Remote Medicine (ACRRM) provides Fellowship training that leads to qualification as a specialist general practitioner but trains doctors to be proficient in the rural generalist model of care. The rural generalist scope of practice involves special capacity to work effectively in rural and remote clinical settings providing services across primary, emergency and hospital care.

The selection process was developed following literature review and consultation with assessment experts.

The process is unique in Australia and internationally, and cited in the National Medical Workforce Strategy as a model for broader adoption. The College is now able to draw upon eight years of cumulative workforce data to assess its outcomes and impacts.

Intervention: Between 2017 and 2022, candidates undertook a two-stage entry assessment process.

Firstly, a Suitability Assessment; a written application marked using a rubric to assess the following domains:

• intention to have a career working in rural or remote Australia
• capacity and motivation to acquire knowledge and skills in the ACRRM curriculum
• connection with rural communities
• commitment to meeting the needs of rural and remote communities through an extended scope of practice
• personal characteristics including persistence, adaptability, recognition of limitations, comfort with uncertainty and teamwork.

These domains were expected to correlate with future practice outcomes.

Secondly, a Selection Assessment; candidates deemed to meet the minimum suitability standard undertook an eight (later changed to six) station multiple mini interview (MMI), marked using behaviourally anchored rating scales (BARS). These BARS assessed the same domains as above.

Evaluation: Over 800 selection records from October 2017 to December 2022 are incorporated into the review with scores assessed for correlations with success in Fellowship assessments, attrition and rural location of practice (MMM3–7).

Conclusions: The scores are reviewed for their predictive validity comparable to the medical assessment literature, particularly with regard to rural health workforce outcomes.

The review builds on previous analysis of 2017 to 2020 outcomes, which found a significant positive association between Suitability and Selection Assessment scores and attrition (p<0.001). It also found that applicants who score higher in MMI are associated with a higher likelihood of being trained at practices in rural regions.

Clinical courage in rural generalists has the following features: standing up to serve anybody and everybody in the community; accepting uncertainty and persistently seeking to prepare; deliberately understanding and marshalling resources in the context; humbly seeking to know one’s own limits; clearing the cognitive hurdle when something needs to be done for your patient; and collegial support to stand up again.

Further work has illustrated that, as a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors’ way of working.

More recent research has begun to consider clinical courage in rural paramedics, nurses and other professions. This interactive workshop will present a short summary of clinical courage and provide opportunities for participants to discuss:

• How relevant is clinical courage to your rural practice?
• How can this exploratory research be translated into educational practice to develop the next generation of multidisciplinary rural generalists?
• What next for clinical courage?

This forum will appeal to rural generalist doctors, nurses, allied health professionals and Aboriginal health practitioners interested in developing a language to describe their clinical practice. Others who may find this presentation interesting include practice managers, students and university staff involved in health professional student training.

Obstetrics and gynaecology (O&G) workforce data demonstrated that over 80% of the specialist O&G workforce are based in MMM1 and only around 8% are based in MMM 3–7. This highlights a significant maldistribution of the workforce that requires attention. The data also identified a lack of upskilling and training opportunities provided in rural, regional and remote areas. Consequently, this has contributed to significant gaps in access to maternity services in rural, regional and remote Australia. O&G care in Australia is delivered by a range of professionals including O&G specialists, GP obstetricians, midwives, nurses and allied health workforce. Particularly in rural and remote areas, maternity care requires a multidisciplinary approach across a range of disciplines.

Given the well-documented challenges in accessing upskilling and training on a consistent basis, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) identified an opportunity to develop a program that enables health professionals involved in the provision of maternity care to learn and develop together as a team, using case-based learning, workshops and lectures, and ongoing discussions and engagement. With funding support from the Australian Government Department of Health and Aged Care, RANZCOG has developed the Obstetrics and Gynaecology Education and Training (OGET) Program to cater to this need.

Based on similar successful models, the OGET program delivers upskilling and education for a range of medical professionals who play a role in the provision of maternity or maternity-related services. The primary outcomes of the program are:

• To improve quality and access to localised maternity care received by women in regional, rural and remote areas through targeted training and education of medical professionals. This will remove barriers to quality care such as travel, relocation and the associated financial and opportunity costs.
• To create a more sustainable model for maternity care in regional, rural and remote areas through capacity building and upskilling within local hospitals and enabling strategic succession planning. This will ensure that maternity services are consistently available within the local communities, reducing the need for patient transfers and locums.

The program is delivered using a hub and spoke model, with hubs located in Warrnambool, Sunshine Coast, Darwin and Orange. Between them, the hubs service 15 peripheral sites, providing opportunities for 250+ health professionals to participate in workshops and case-based learning in a multidisciplinary setting. RANZCOG has worked closely with the hubs to contextualise the education on offer to local settings and challenges.

We believe the topic aligns strongly with several conference themes, particularly around innovation, teaching and training, health service access and equity, and workforce. We would like to present on the progress and outcomes from this project, drawing from specific examples of program delivery. The presentation will also serve as a catalyst for further discussions and sharing of ideas for future iterations of this program.

Introduction: The rural medical workforce is known for its high turnover rate, influenced by personal and workplace factors such as retirement and inadequate remuneration. Government initiatives such as allocation of Distribution Priority Areas (DPAs) for general practitioners (GPs) have assisted medical workforce recruitment in rural areas, allowing access to international medical graduates on a moratorium. Recent Australian Government policy changes in July 2022 have resulted in all areas outside of metro regions being declared DPAs for GPs. One possible way to investigate the impact of this change would be to examine practitioner movements in rural Queensland in 2022 compared to previous years.

Method: Each year on 30 November, Health Workforce Queensland (HWQ) undertakes a quality assurance project, the Minimum Data Set (MDS), to record employment details of medical practitioners working in a primary care context (such as general practice, Aboriginal Community Controlled Health Organisations, the Royal Flying Doctor Service and small hospitals) in Modified Monash (MM) 2–7 Queensland. The MDS is a reporting requirement to the Department of Health and Aged Care. Practitioner employment data was obtained through practice calls and annual surveys to practitioners/practice managers. Practitioner migration was based on the number of practitioners who remained through each 12-month period (2020–22). Net Change (NC) of MM was calculated by subtracting the MM value of the previous year from the MM value of the current year. Positive values indicate a movement to a more rural location and negative values represent less rural.

Results: The total number of medical practitioners increased from 2,609 in 2020 to 2,727 in 2022. A little over 50% were employed in MM2 locations. Between 2020 and 2022, 92–95% of practitioners remained in their MM location each year. The number of medical practitioners who migrated between MM2–7 locations was 167 in 2020, 110 in 2021 and 120 in 2022. The number of MM2 practitioners who migrated to a more rural MM decreased from 59 in 2020 to 17 in 2022. In contrast, the migration from MM3–7 to MM2 increased from 34 to 64 in 2022. For 2020, the NC of MM was +46, indicating movements to more rural locations. In 2022, the result turned negative (NC = -117), suggesting more movements into less rural locations. In 2022, 85.8% of migrations were departures from MM3–7, a considerable increase from 2020 and 2021 (approximately 65%).

Discussion: With yearly increases in the number of medical practitioners in rural Queensland and the majority working in MM2, there is comparatively little migration between MM locations. However, the increase in the number of practitioners migrating to MM2 and the reduction in those leaving MM2 for more rural locations was more pronounced in 2022. This could point to the impacts of the DPA policy change implemented during 2022. It remains to be verified whether these trends sustain into the future. Personal and workplace factors that motivate practitioners to migrate between MM locations have been prevalent for many years, however it appears that this initiative provided a new option to work less rurally. Emphasis should be placed on underlying factors and how they influence workforce departures to inform policy and programs that aim to address practitioner recruitment and retention in rural areas.

Introduction: Remote and rural primary healthcare professionals tend to have a higher turnover than their metropolitan colleagues and the rate of turnover generally increases with remoteness. Various contributors to this turnover have been proposed, including issues such as heavy workload, personal and professional isolation, and family reasons such as partner opportunities and children’s schooling. While the reasons for primary care staff departures have been supported by evidence, usually from self-reports by departing staff, there has been little evidence from existing practitioners and service managers that captures their perceptions of the relative importance of multiple reasons for staff departures that enable stratification and comparison between remoteness areas.

Method: This project was part of a larger quality assurance study conducted to fulfil reporting requirements to the Australian Government Department of Health and Aged Care. An annual online survey to inform the Health Workforce Needs Assessment for remote and rural Queensland targets primary care health practitioners and service managers in Modified Monash (MM) categories 2–7. The survey was available to participants from September 2022 until February 2023 and included items to measure the importance of various factors that could have impacted staff departures in the previous 12 months. There were 19 individual factors, such as retirement and work–life balance, and 19 organisation-based factors, such as workplace culture and workplace flexibility. Each factor could be rated along a 101-point scale, from ‘0 = Not at all important’, to ‘100 = Extremely important’. Participants had the opportunity to detail the main reasons for staff departures in the previous 12 months.

Results: Responses were received from 736 participants. These were from medical practitioners (50%), allied health practitioners (28%), practice managers (11%) and nurses and midwives (10%). Thirteen of the 19 individual and organisational factors for staff departures had means of 60 or higher. The highest individual factors were heavy workload/burnout (M=79.54), work–life balance (M=74.28), career progression (M=72.42) and mental health/wellbeing (M=72.10). The highest-rated organisational factors were workforce shortages (M=76.27), financial incentives/rewards (M=72.05), workplace culture (M=70.00) and workplace flexibility (M=67.97). Differences between participants’ MM location were noted. For example, schooling for children was the highest-rated individual factor in MM7 and accommodation was rated the second-highest organisational factor by MM4 participants. Qualitative responses provided deeper understanding of some of highest-rated factors.

Discussion: Primary care staff departures are difficult and expensive to deal with in remote and rural locations but can be expected to occur regularly. Sometimes departures are linked to personal considerations and offer little opportunity to intervene. However, this study has provided information about the factors that practitioners and managers believe are the most important drivers, some of which can be used by service managers and staff to address factors such as heavy workloads and issues around culture and flexibility in the workplace. Further, having a clearer understanding of the differences between geographic locations in how practitioners rate important factors impacting staff departures may assist with location-specific strategies.

The northern Queensland region consists of diverse communities with a mixture of farming, mining and Aboriginal and Torres Strait Islander communities in the more rural and remote areas, and places of higher density and urban living in major regional townships on the east coast. There are many similarities in health challenges and service delivery across the region, with small, dispersed populations in challenging geographies. However, unique and context-specific factors that undoubtedly characterise individual communities tend to be lost in regional and state-level planning for health.

Place-based planning focuses on demographic, socioeconomic, environmental and cultural factors of the local community, and uses local data and perspectives on health to inform planning. Place-based planning processes prioritise collaboration with local and regional stakeholders including local government, service providers, community groups and general community members to implement solutions to identified issues affecting health and health service delivery.

The Integrating Health Care Planning for Health and Prosperity in North Queensland (IHCP-NQ) project aims to improve the responsiveness of health services to the health needs of communities in the northern Queensland region. The three-year project, being conducted together with the communities of Clermont, Hughenden and Kowanyama, uses a place-based approach to planning with participatory, co-design methods.

In Phase 1, the Northern Queensland Health Atlas was developed to inform planning in the region. The online, freely available, interactive tool contains publicly available data (with data dictionary) about demographics, health services and health workforce that can be overlayed to facilitate comparisons and understandings of place. It presents data, that are otherwise difficult to find across a multitude of platforms, in a single, highly accessible place for use by community members and other stakeholders. The process of developing the tool highlighted a lack of reliable, publicly available data for local (community-level) planning particularly for health status, health workforce and service availability.

In Phase 2 of the project, co-design methods were used to identify and prioritise areas for action to improve health and health services.  Co-design methods are becoming more common in health services planning. Our co-design process involved four steps, carried out via workshops, and small group and individual meetings. The co-design process worked through: (1) identification of key health priorities; (2) possible solutions to identified issues that affect health and health services; (3) factors affecting implementation of agreed on solutions; (4) confirming implementation; and (5) evaluation methods.

This presentation will describe the IHCP-NQ project within the context of place-based health planning for rural and remote communities in northern Queensland. A case example of the co-design process and early outcomes based on one of the project communities will be described. Learnings from implementation of the co-design process will be discussed in light of what is already known about factors for successful co-design with rural, remote and First Nations communities.

Aims: To examine the impact of the Adelaide Rural Clinical School (ARCS) longitudinal integrated clerkship on the rural medical workforce and how ARCS training experiences influence rural practice location.

Methods: A retrospective cohort study of University of Adelaide medical school alumni graduating between 2004 and 2019 (ARCS alumni who completed a full year of rural training [n=423], metropolitan-trained peers [n=1,655]). Practice location data were sourced from the Australian Health Practitioner Regulation Agency (Ahpra, January 2021) and matched using university records. The main outcome measure was the proportion of graduates working in a rural location (Modified Monash Model [MMM] 3–7). Logistic regression was used to examine the association between ARCS training and working rurally, and the influence of rural background and sociodemographic factors. Details of ARCS students’ experiences and preferences were extracted from the Federation of Rural Australian Medical Educators (FRAME, 2013–18) survey and linked to these graduates’ recorded practice location (n=234). Logistic regression was used to examine associations between ARCS experiences and rural practice location.

Relevance: Our findings reinforce evidence from previous studies suggesting Rural Clinical School (RCS) training encourages future practice in rural locations. Furthermore, the study identifies student characteristics that are associated with rural career choices.

Results: Working in a rural location (MMM3–7) was almost three times more frequent among ARCS alumni than their metropolitan-trained peers (14.7% vs 5.3%). In adjusted analysis, working rurally was associated with having a rural or remote residence on enrolment (OR 8.29, 95% CI 4.22–16.26) and was 3.1 times more likely for ARCS alumni (OR 3.06, 95% CI 2.06–4.53) than their peers. The magnitude of the effects of ARCS training on working rurally was similar among those with metropolitan or rural background.

A total of 241 ARCS students (60.1% females; mean age 23.2±1.8 years) completed the FRAME survey between 2013 and 2018 (response rate 93.2%). Practice locations were identified for 234 alumni, and 11.5% of these were working rurally in 2020. In adjusted analysis, the odds of working rurally were 4–12 times more likely among those preferring a rural practice location and increased with the student’s rural practice self-efficacy score (p-value <0.05 in all cases). Neither the perceived RCS support nor having a rural-based mentor were associated with rural practice location.

Conclusions: Extended rural placements through the ARCS increased the rural medical workforce, particularly in South Australia, with a similar impact among those with a rural or metropolitan background.

Among ARCS alumni, a reported preference for a rural career and student rural practice self-efficacy score were significant predictors of subsequent rural medical practice. Other RCS could use these variables as indirect indicators of the impact of RCS training on the rural health workforce.

Clinical courage in rural generalists has the following features: standing up to serve anybody and everybody in the community; accepting uncertainty and persistently seeking to prepare; deliberately understanding and marshalling resources in the context; humbly seeking to know one’s own limits; clearing the cognitive hurdle when something needs to be done for your patient; and collegial support to stand up again.

Further work has illustrated that, as a collective, rural doctors can learn, use and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion rural doctors’ way of working.

More recent research has begun to consider clinical courage in rural paramedics, nurses and other professions. This interactive workshop will present a short summary of clinical courage and provide opportunities for participants to discuss:

• How relevant is clinical courage to your rural practice?
• How can this exploratory research be translated into educational practice to develop the next generation of multidisciplinary rural generalists?
• What next for clinical courage?

This forum will appeal to rural generalist doctors, nurses, allied health professionals and Aboriginal health practitioners interested in developing a language to describe their clinical practice. Others who may find this presentation interesting include practice managers, students and university staff involved in health professional student training.

Aims: Cancer and heart disease are the two most common health conditions in the world and are associated with high morbidity and mortality. In regional areas adverse outcome disparity continues. Cardiovascular disease is the leading cause of death in cancer survivors. We aimed to evaluate the cardiovascular outcomes of patients receiving chemotherapy in a regional hospital.

Methods: This was an observational retrospective cohort design in a single rural hospital over a 10-year period. All patients who received chemotherapy during this period were compared to patients who were admitted to the hospital without a cancer diagnosis.

Results: A total of 268 patients received chemotherapy during the study period. High rates of cardiovascular risk factors, hypertension (52.2%), smoking history (54.9%) and dyslipidaemia (38.4%), were observed in the chemotherapy group. Patients who had chemotherapy were more likely to be readmitted with ACS (5.9% vs 2.8%, p=0.005) and AF (8.2% vs 4.5%, p=0.006) when compared to the general admission cohort. There was a statistically significant difference observed for all cause cardiac readmission, with a higher rate observed in the chemotherapy group (17.1% vs 13.2%, p=0.042). Patients undergoing chemotherapy had a higher rate of mortality (49.5% vs 10.2%, p=<0.001) and shorter time (days) from first admission to death (401.06 vs 994.91, p=<0.001) when compared to the general admission cohort.

Conclusion: There is an increased incidence of adverse cardiovascular outcomes, including higher readmission rate, higher mortality rate and shorter survival in people undergoing cancer treatment in rural environments. Rural cancer patients demonstrated a high burden of cardiovascular risk factors.

Relevance: We report on the cardiovascular outcomes of patients receiving chemotherapy at a rural Australian hospital compared to all patients admitted to the same hospital during the study period. This study highlights the potential cardiovascular impacts cancer treatment has on patients on a long-term basis. We noted a high rate of subsequent readmission for AF and ACS in the cancer treatment group. The cancer group demonstrated a higher mortality rate, as well as shorter survival. Furthermore, we noted the high burden of underlying cardiovascular risk factors in those patients undergoing cancer treatment in this rural environment, including smoking history, alcohol consumption, hypertension and high cholesterol. Our study also demonstrated the relatively high rate of prior cardiac hospitalisations in patients having cancer treatment. Our study addresses the two biggest global killers: cancer and cardiovascular disease, focusing on the rural and regional centre and illustrates the health challenges of rural populations. The need for ongoing cardiovascular care in cancer patients is now articulated in international guidelines, previously has been advocated in consensus statements and within the literature. However, given the challenges of local availability of staff, differing geography, funding arrangements and different health systems, a ‘one-size-fits-all approach’ remains a challenge.

In the context of increased rates of frailty and chronic disease among older people, there is a need to develop generic age-friendly, integrated primary care models that improve health outcomes for older people. However, there is little evidence about how age-friendly integrated care models that are sensitive to the challenges and heterogeneity of rural regions can be developed. This presentation will identify processes that facilitated and hindered successful co-design of a rural age-friendly integrated care checklist, which drew on the Indigo 4Ms Framework as a model. The Indigo 4Ms Framework is a rurally specific model of care for older people based on the Institute for Health Improvement’s 4Ms Framework, which has been modified for use in Australian rural settings through drawing on Australian and international best-practice evidence and lived experiences of rural older people and stakeholders. It structures and prioritises care for older people in rural settings across four interrelated core elements (the 4Ms): what Matters, Medications, Mobility and Mental health. When implemented together, these four areas and their associated actions can improve safety and quality of care for older people and reduce costs of care.

A process evaluation was conducted on co-design activities associated with the development of the rural age-friendly integrated care checklist. First, a co-design team (n=34) was convened, which comprised older people and staff working in health, aged care and health education from the Upper Hume region in rural north-east Victoria. Co-design processes were developed using co-design guidelines produced by the New South Wales Agency for Clinical Innovation. The co-design team participated in five workshops between April and November 2022 that encompassed building a co-design team, developing preparedness for co-design and gaining understanding from lived experiences, identifying opportunities for improvement, and designing a multidisciplinary model of care (the checklist) inspired by the Indigo 4Ms Framework. Data collection methods included written materials generated by participants during co-design workshops, anonymised and aggregated demographic data about co-design team members and their attendance, and observations of co-design workshops collected as researchers’ field notes. Co-design reports and outputs generated by the project team were also added to the data set. From this data, information on project inputs, activities and outputs were extracted, grouped thematically and critically analysed.

Findings suggest that particular inputs (skills, expertise and best-practice guidelines) are particularly important for structuring and responding to the iterative nature of co-design activity, and in ensuring rurally sensitive outputs were developed. The Indigo 4Ms Framework was found to provide a readily understandable structure for guiding co-design activities. However, COVID-19 impacted on project team staffing and the co-design team’s participation, and project staff needed to remain flexible and think reflexively throughout the co-design process. The findings provide an illustration of a real-world rural co-design project and thus may offer valuable insights for other rural communities and services engaged in participatory approaches to developing resources and delivering rural services.

Introduction: COVID-19 compounded existing barriers to health care for rural patients. We completed a retrospective review of patients receiving Pharmaceutical Benefits Scheme (PBS) subsidised biologics during the pandemic at a Modified Monash Model 3 dermatology practice. Our clinic is a rural private practice situated in Dubbo, New South Wales, which functions as a ‘fly-in fly-out’ service. The closest private dermatology practice is situated in Orange which is 150 kilometres away and the nearest public dermatology department is 370 kilometres away. Throughout the pandemic, patients receiving biologics were offered the option of telehealth or rescheduling in-person appointments.

Results: We conducted a retrospective chart review of all patients receiving biologics from January 2020 to June 2022. In total we identified 45 patients on biologic therapy during this time frame. Thirty-eight were on biologics for psoriasis, six for atopic dermatitis and one for chronic spontaneous urticaria. Thirty-seven (82%) patients had changes in appointment scheduling due to the pandemic but none of these patients had a disruption in their access to their biologic therapy. Teledermatology was employed in 30 (67%) patients. Twelve (27%) patients were started on biologics during the pandemic, 15 (33%) continued with their existing therapy and 18 (40%) patients switched biologics. Three patients elected to cease treatment without specialist consultation. In each case, the dermatologist petitioned the PBS to advocate for continuing subsidised access and grace was provided each time. Overall, 42 (93%) of our patients did not experience delay in receiving their regular biologic therapy during the pandemic. Thirty-three (73%) patients elected for their next consultation to occur via telehealth.

Discussion: Telehealth has been shown to be an effective tool for remote medical care. Factors which contributed to successful continuation of care include the establishment of item numbers for telehealth, the efficacy and safety of biologics, the established accuracy of EASI and PASI on photography, and remote access to pathology. In this setting, pre-existing investment in infrastructure and the evolution of Medicare structures stopped geographic barriers encumbering access to care. We advocate for ongoing investment into electronic infrastructure which supports and promotes telehealth. The utility of telehealth can be applied beyond the pandemic to patients in rural and remote communities to bridge geographic barriers and provider shortages. Our experience is instructive in the provision of dermatologic services to regional patients.

Objective: Colorectal cancer has notable geographic inequities in Australia, with higher mortality rates in remote and rural areas. This is exacerbated by lower participation in the National Bowel Cancer Screening Program (NBCSP), which provides access to colorectal cancer screening test kits for all Australians aged 50–74. The NBCSP is successful in both the early detection of colorectal cancer (leading to higher survival rates) but also the detection and removal of precancerous lesions, preventing a cancer developing. People in remote and very remote areas of Australia have NBCSP participation rates of 36.9% and 26.5% respectively, well below the national average of 43.8%.

The NBCSP test kit is less accurate at high temperatures, necessitating a ‘hot zone policy’; kits are not sent when an area’s average monthly temperature is above 30°C, based on historical data by postcode. Australians affected by the hot zone policy, predominantly those in rural and remote areas, have a reduced window of possible screening months and are therefore susceptible to potential NBCSP disruptions. Conversely, these areas may benefit from well-timed interventions to improve NBCSP participation.

This study aimed to identify population groups most impacted by the hot zone policy and estimate the potential impact of disruptions to the NBCSP or targeted interventions to improve NBCSP participation.

Methods: The number of individuals eligible for screening in areas affected by the hot zone policy was estimated. The correlations between hot zone areas and remoteness, socioeconomic level and Indigenous status were calculated. Using a calibrated and validated model of colorectal cancer and screening in Australia, the potential impacts of changes to the NBCSP were estimated in hot zone affected areas and compared to unaffected areas.

Results: Over a million eligible Australians live in areas affected by the hot zone policy. These areas are more likely to be remote or rural, have lower socioeconomic status and have higher proportions of Indigenous populations. Predictive modelling estimated that a three-month disruption to screening would increase colorectal cancer mortality rates up to 4.1 times more in hot zone policy areas versus unaffected areas. However, a targeted intervention to increase NBCSP participation could decrease mortality rates 3.4 times more in hot zone policy affected areas versus unaffected areas.

Conclusion: People in rural and remote areas are one of the key population groups affected by the hot zone policy. These areas would experience disproportionately negative impacts from NBCSP disruptions, but would also benefit from well-timed interventions to promote NBCSP participation. Continued work to improve the NBCSP with consideration for the hot zone policy could improve colorectal cancer outcomes for people in rural and remote Australia.