Concurrent Speakers

Background: The Benchmarque Group is a Registered Training Organisation (RTO No. 21824) specialising in the development and delivery of nationally accredited clinical skills programs. Earbus Foundation of Western Australia [Earbus] is a WA-based Children's charity that targets middle ear disease in Aboriginal and at-risk children in Western Australia.

Having been funded to deliver the Otitis Media Management Program in regional and remote Australia, the Benchmarque Group felt more could be done to embed participants’ learning beyond the classroom. When participants returned to work in their own communities, there were occasions where students had limited opportunities to immediately put the training into practice, build confidence and clinical competence in the area of ear health. Earbus delivers full-service ear health clinics in regional WA and has been successful in reducing the incidence and impact of otitis media in the communities in which they work. While working in these regions, Earbus had discovered that more work needed to be done to build local capacity to identify and manage the disease in Aboriginal children between Earbus visits.

In 2018 the Earbus Foundation of WA and the Benchmarque Group have launched an innovative pilot project aimed at combining traditional learning with practical experience in an attempt to tackle otitis media at a community level. The organisations have combined expertise and resources to create an enhanced learning curriculum for Aboriginal Health Workers working in regional and remote areas, with the initial pilot of the project occurring in the Pilbara in 2018.

Methodology: The Benchmarque Group and Earbus Foundation have created a model of collaboration which sees students attend the Benchmarque Group’s Otitis Media Management Program. Following completion participants then accompany Earbus in the field to consolidate the learning through practical experience at one of Earbus’ mobile ear health clinics with a cohort of Aboriginal children. Participants receive direct at-elbow supervision and support from an experienced paediatric Audiologist, as well as GP, Nurse and ENT Specialist input.

Conclusion/discussion: The educational and professional value of this unique immersion in ear health is significant and long lasting. In addition, the project has an inherent multiplier effect as participants use their enhanced skill set and experience to educate and support other regional colleagues. This presentation will discuss an evaluation of the pilot and plans for the future expansion of the project into other regions of WA.

Background: Respiratory diseases represent the main reason for paediatric inter-hospital transfers in urban and remote areas. Nasal high flow (NHF) therapy is a simple method of oxygen delivery that provides additional respiratory support to patients with acute respiratory failure. It is proven to be effective and has been safely used outside intensive care settings in tertiary and regional hospitals. Although there is a desire to use NHF therapy in remote hospitals in Australia, the safety and value of using NHF where retrieval to intensive care services requires air retrieval and potential time delays, is unknown.

Aim: The aim of this study is to explore the safety and efficacy of implementing NHF therapy for infants with bronchiolitis in remote Torres and Cape hospitals.

Proposed methods: This study will use a sequential mixed methods design. Using a modified Delphi technique, an expert panel will establish agreed clinical guidelines on NHF therapy implementation. Once the NHF therapy guidelines have been established training will be provided to staff. A comparison cohort study will audit the clinical outcomes of all infants presenting with bronchiolitis to Weipa, Cooktown and Thursday Island hospitals for a 12 month period and compared with outcomes for all presentations in the 12 months prior to NHF therapy implementation.

Issues/dilemmas: The expert panel and subsequent audit evaluating clinical outcomes post-implementation is a reasonably established research process. The challenge in developing the guidelines will be in ensuring fair and equal input from all panel members. Suggestions on how to negotiate potentially opposing ideas and agendas and to sort opinion without evidence from more knowledgeable input will be sought. This project involves staff training on NHF and the developed guidelines for use. Advice is sort from conference delegates on the most pragmatic way to evaluate knowledge translation in a highly mobile, casual workforce where the research is conducted over an area physically difficult to access.

Dementia is not a specific disease; rather, it is a group of conditions characterised by the gradual impairment of brain function. It commonly affects people’s ability to think, remember and reason, as well as affecting their personality and impairing other core brain functions such as language and movement. The condition is degenerative and irreversible (Australian Institute of Health & Welfare).

Dementia affects everyone in a different way, however it does not always take away your capacity to make your own decisions, especially in the earlier stages of the condition.  By supporting people with dementia to live a life that makes sense to them we can reduce negative responses and actions.

This presentation will cover off on the following elements:

• the critical importance of engaging with the person as early as possible in the dementia journey to ensure that their wants, needs and wishes are understood recorded for future access
• understanding who the person is and acknowledging how they want to live their life are the first steps in becoming a good ‘voice’ of someone with dementia.  It is not what we think they need in their life—it is what they want!
• recognition, inclusion and empowerment for people with dementia will ensure that their remaining life is lived with purpose, dignity and understanding
• how this approach has changed the lives of people with dementia who have moved in to Glenview and will underpin the way future dementia care is delivered within Korongee Village.

“Make decisions with me, not about me.”

This paper appreciatively highlights a personal journey of life-long recovery from bipolar affective disorder (BPAD).

The observations and musings shared in this paper aim to demonstrate the power of one; namely, how I, as an individual who is prepared to be vulnerable by being empathic and compassionate, can not only make an emotional investment in my personal recovery but also make a significant contribution to the establishment and maintenance of a caring, soulful community that unconditionally embraces diversity with awe and wonder. This journey is best described as a human-centred longitudinal project that continues to evolve and emerge through constancy of purpose and consistency of approach. It is a strengths-based journey that requires acceptance, self-compassion, stamina, conviction and resilience. The road is not always well signposted, but a mindful life has a habit of pointing the way in an unexpected but emphatic way.

Prior to my diagnosis I developed a career as a social-ecologist. I worked in Europe and Australia in various fields, including mixed farming, floriculture, intensive and broadacre vegetable production, the cotton and wine industries and the agrochemical industry. In the late 80s my interest in human development led me to spend some time in Papua New Guinea where I worked with subsistence economies in the province of Morobe. But it was the Australian wine industry that was sufficiently imaginative and bold to provide me with a ‘safe place for unsafe ideas’.

The diagnosis of BPAD was simultaneously liberating and disabling. Upon disclosing my diagnosis I lost my professional and social network. However, I quickly came to realise that ‘authenticity’ is very important for self-esteem and instrumental in facilitating post-traumatic growth, and productive, collaborative participation in the community. Mental health advocacy became my vocation and calling. Significantly, as a social ecologist specialising in sustainable wellbeing and resilience I came to understand that ‘… health is created and lived by people within the settings of their everyday life …’ (Ottawa Charter for Health Promotion 1986). This profound revelation highlighted sustainability as a biopsychosocial and spiritual endeavour that was best informed by the medical humanities and narrative medicine.

This ongoing autoethnographical work has led to authentic discussions with the Department of Social Inquiry of La Trobe University with the aim of progressing the research theme, ‘Mental Health Literacy, Woundedness and Spiritual Wellbeing—Human-Centered Narratives Informing Personal Recovery and Leadership in the Mental Health and Substance Use Sectors’.

Background: There is an increasing focus on placing health students in sites outside of metropolitan areas to encourage the uptake of careers in rural and remote Australia. While there has been a significant and growing body of research on the impact of non-urban training for medical students, less is known about nursing and allied health students with very little research emerging from remote areas. This research project seeks specific information on the impact of placements in the Northern Territory in influencing a health professional’s work location in the 10 years post-graduation.

Allied health and nursing student placement numbers in the NT have been steadily growing with the increased focus and funding through the Rural Health Multidisciplinary Training Program (RHMTP). RHMTP supported placement in the NT have grown from 357 in 2016, 422 in 2017 to 506 in 2018. Students have come from 26 Australian Universities undertaking studies in nursing, midwifery and 14 allied health professions. Placements have occurred in hospitals, community health centres, schools and clinics; run by government, non- government and private agencies; located in Modified Monash Model (MMM) areas classified as outer regional (MMM5) remote (MMM6) or very remote (MMM7).

Aims: The aim of this study is to track nursing and allied health professionals who undertook one or more pre-registration placements in the Northern Territory. Understanding where these professionals then chose to practice may inform how placements are offered and supported, what types of students are best suited to experience the remote workforce and where effort should be concentrated to build the future workforce.

This research is a ten-year tracking study of the work practice locations of nursing and allied health students who complete a Northern Territory work integrated learning placement. The study will also investigate the factors that contribute to the work location decisions of the participants; and to determine if, and how, a Northern Territory placement influenced career decision-making.

Methodology: This research is a longitudinal cohort study with the primary objective to undertake a ten-year tracking study of the work practice locations of nursing and allied health graduates who completed a Northern Territory work integrated learning placement as a student. It will collect data at multiple points in time in order to investigate the factors that contribute to the work location decisions; and to determine if, and how, a Northern Territory placement influenced subsequent career decision-making.

The research will use a pragmatist theoretical framework which facilitates the researchers to select the best methods for answering the research question rather than being constrained by the limitations of a particular paradigm.

Over the ten-year period we will use two surveys tailored to two specific participant groups to collect the data to answer our research questions. The first is a student evaluation of NT placement survey which has been a routine part of the Flinders NT quality assurance program for many years. The survey is also used nationally by University Departments of Rural Health across Australia. This survey targets students who have undertaken NT placements. The second survey has been purpose-developed to track work location and the influences on work location decisions. This survey targets health professionals known to have undertaken NT placements as a student.

Conclusion: There are many factors which influence decisions on where to live and practice a health career. This research is seeking input from others in the field as to what are the most influential drivers in making these decisions. This will then inform the study design, seeking to gain information over 5-10 years on the impact of student placements and other factors on taking up a remote health career.

There is currently no consistent method of tracking students for 10 years post-graduation. Following nursing students in their careers can be done potentially using AHPRA data. Tracking the allied health professions will be more difficult with 10 professions not currently registered through AHPRA, so other methods will need to be employed. Input will be sought regarding methods of recruiting and tracking students over 10 years.

Understanding where these professionals chose to practice can inform how placements are offered and supported, what types of students are best suited to experience the remote workforce and where effort should be concentrated to build the future workforce.

Participation in this session will aim to garner ideas from those also in this field on appropriate methodologies as well as draw on experience of undertaking tracking studies over time.

Thinking about publishing research on rural and remote health?

Want to know more about peer review and the pathway to academic publication?

Interested in becoming involved with the journal as a reviewer or in some other capacity?

Would you like to explore ways to increase the impact of your research and publications?

Meet the editors of The Australian Journal of Rural Health in a special session designed to clarify publishing procedures and improve your chances of being published in our journal and others.

Editor in Chief Russell Roberts and Associate Editors will be available to discuss the editorial policies and priorities of AJRH and answer your publishing questions.

New and established authors are welcome!

Now in its 25th year of publication, AJRH provides research information, policy articles and reflections related to health care in rural and remote areas of Australia.  Since its inception, AJRH has contributed significantly to the publication of research reports and expert opinion on rural and remote health.

Background: Aboriginal children in the Kimberley/Pilbara region of Western Australia (WA) experience dental decay at more than 3 times the rate of non-Aboriginal children, the majority of which remains untreated. A simple alternative, Atraumatic Restorative Treatment (ART), approach to manage dental decay using principally hand instruments to prepare the cavity and without local anaesthesia in children has been shown to be successful. The approach reduced the need for specialist care, and was clinically successful, acceptable by children and parents, and cost-effective. This approach has implications for dental services delivery in rural and remote communities where access to dental care is poor. The aim of the study was to test the feasibility of the ART model of care in rural and remote communities of the Kimberley in WA.

Methods: The study design was a pragmatic two-armed, delayed intervention, cluster RCT. Communities with the expected number of children (n=15) in the target age (0-6-year-old) were invited to participate. Participating communities were randomised into the early intervention (test) or delayed intervention (control) arm of the study. Participating parents completed a questionnaire and the children provided with a baseline dental health assessment. Early intervention children were offered dental treatment. Delayed intervention children were advised to seek care through the standard care options available to the community and will be offered dental treatment as part of the study at the 12-month follow-up. The primary outcome was the number of children provided with the needed dental treatment and/or referred for specialist dental care.

Results: Twenty-six communities were selected and the majority of communities (n=25) have agreed to participate. Wide ranging community consultation and presentation of the study proposal was undertaken which included face-to-face meetings with the CEOs of the Aboriginal Controlled Health Organisations in the Kimberley as well as Chief Executive Officers (CEO) of the selected communities and Chairpersons of the community councils. An Aboriginal study reference group was formed with representation from the local Aboriginal Health Organisations. As at the end of June 2018 recruitment has occurred in 12 communities (n=150) with participation ranging from 6-24 children.

Challenges: Consultations with the community representatives and the CEOs and the community councils was well-received and the study proposal was supported, however, engagement at the individual level remains challenging. High mobility of the families also presented challenges in the provision of treatment and for follow-up.

An outbreak of infectious syphilis began in northern Queensland in January 2011, extending to the Northern Territory in July 2013, the Kimberley in Western Australia in June 2014 and since November 2016 the Western, Eyre and Far North regions of South Australia. Since the commencement of the syphilis outbreak in 2011 to 31 July 2018, there have been 2,228 cases of infectious syphilis and 14 congenital syphilis cases associated with the outbreak regions of northern and central Australia.

In December 2017, the Australian Health Ministers Advisory Council (AHMAC) endorsed a National Strategic Approach and Action Plan to address the disproportionately high rates of syphilis and other blood-borne viruses and sexually transmissible infections in regional and remote Indigenous communities. The Action Plan was developed in consultation with affected jurisdictions, NACCHO and key stakeholders.

The Australian Government has committed $8.8 million in funding over three years (2017-18 to 2019-20) to be delivered through Aboriginal community-controlled health services (ACCHS) in the outbreak regions. The types of projects funded include:

• workforce supplementation and implementation costs for the roll out of the ‘Test and Treat’ model, including point-of-care test and treatment medication, negotiated on a case by case basis with each ACCHS in the outbreak region
• development and roll out of a ‘train the trainer’ model to upskill the existing and the supplemented workforce in both the ‘Test and Treat’ model and sexual health in general
• culturally appropriate health, communication and education materials.

The Department of Health established an Enhanced Response Unit to coordinate the Australian Government’s contribution to the Action Plan. The Unit worked closely with NACCHO, state and territory public health authorities, and ACCHS across the affected areas to develop locally-relevant models to rollout a phased approach to the response. Close collaboration between Health and the ACCHS sector, led by NACCHO, was fundamental for the design of this response.

Every aspect of this activity followed a bottom-up design methodology, in which the selection of sites, development of specific on-the-ground workforce models, and organisation of regional coordination happened in partnership between the services and Commonwealth and state and territory governments. Extensive consultation, including workshops in four states and territories was fundamental for the planning of the staged rollout.

In this presentation we will outline the specifics of this innovative co-design model, and the strengths of meaningful partnership between government departments and the Aboriginal community-controlled health sector.

The World Health Organization (WHO) recognises that health and well-being are strongly influenced by social and economic factors known as the social determinants of health (SDoH). Defined as the conditions in which people are born, grow, live, work and age, these circumstances are shaped by the distribution of money, power, and resources at global, national and local levels.

Widespread evidence links poverty and disadvantage with poor health outcomes, particularly in the area of chronic disease and mental illness. The prevalence of chronic conditions such as cardio vascular disease, diabetes and hypertension along with depression and anxiety is much higher in people who experience low socio economic circumstances.

People working in chronic care, especially in rural areas, know firsthand how the social, cultural and economic environments in which their clients live and work impact upon the cause and management of chronic conditions. Faced with huge issues such as poverty, unemployment, isolation, limited access to services, inadequate housing and education and low health literacy, the challenges for health professionals can seem insurmountable. What can be done when so many of the social determinants appear to be outside the health system?

The Agency for Clinical Innovation (ACI) is one of the Pillars of NSW Health working to improve health outcomes through collaboration and innovation. The ACI’s Chronic Care Network is made up of over 700 clinicians, health professionals, cares and consumers from metropolitan and regional NSW who are committed to improving the lives of people living with chronic conditions.

The Network was keen to explore the sharing of knowledge and the development of further approaches to tackle the social determinants of health and decided to start with a website dedicated to exploring the relationship between chronic disease and social determinants. The anticipated audience is predominantly clinicians but, potentially, also consumers and anyone else interested in SDoH. The site is designed to provide basic information to define the social determinants of health; provide links to services and other resources most importantly, to show-case projects where success has been achieved. This final component can guide and inspire clinicians to view their practice through a different lens. By sharing and celebrating significant work already being undertaken locally, nationally and internationally and by thinking about influences outside of health, clinicians can also contribute to make a real difference in people’s lives.

Background: Medication errors are associated with poor clinical outcomes including higher risk of hospital readmission. It is also important for emergency physicians to receive accurate medication histories for patients presenting to the emergency department (ED).

Aims: To quantify the accuracy of medications listed in GP patient referrals to a regional ED, ultimately to inform improvement of GP to ED transfer of care.

Method: A single-site, observational, diagnostic accuracy study undertaken in an Australian regional hospital between 1 June 2015 and 30 May 2016. GP medication lists in referral letters of patients presenting to ED compared to those recorded by pharmacists taking a Best Possible Medication History from the admitted patient. Discrepancies include omissions, false inclusions, dose and frequency and route of administration errors, class discrepancies and omission of dose/frequency information. Each discrepancy was given a risk rating by calculating the consequence and likelihood of occurrence using a risk assessment matrix. The severity of consequences was assessed by an emergency medicine clinician and rated as insignificant, minor, moderate or major, the likelihood of occurrence was rated as rare, unlikely, possible, likely, almost certain.

Results: A total of 563 patient records were scrutinised with 118 (21%) of these containing a medication discrepancy. Inclusion was the most common (42.1%) followed by exclusion (21.5%). The likelihood of each consequence occurring was mostly rare (36%) or unlikely (43%). The majority (75.8%) of discrepancies were considered low risk. Fifty-five patients (10%) had more than four medication errors. The consequences of five (0.9%) discrepancies were considered to be of major severity, involved two patients. One patient had five medications listed on their GP referral, including insulin and a beta-blocker which they were not taking; the BPMH found the patient was taking four other medications including a NOAC and a steroid. The second patient had one medication listed in the GP referral which the patient was not taking; the BPMH found the patient was taking six medications, including Gliclazide and Metformin. 78 (66%) moderate discrepancies involved 43 patients. 10 extreme risk ratings involved four patients. In most instances the referring GP was the patients usual GP.

Discussion: 20% of patients referred to ED by their GP and subsequently admitted to hospital had medication discrepancies. Scheduling patients taking regular medications for six monthly review may assist in ensuring what medications the patient is taking are consistent with the GPs record.

Background: Western NSW Local Health District covers 31% of NSW, and provides publicly funded health services to 3.6% of the NSW population.  While robust multidisciplinary team care improves health outcomes, the delivery of efficient clinical care and equitable access to services has been impeded by low levels of Allied Health (AH) staffing combined with a widely dispersed population.

Approach: An innovative, rural Virtual Allied Health Service (VAHS) to develop, implement and evaluate telehealth service delivery models in the disciplines of Dietetics, Pharmacy, Physiotherapy, Psychology, Occupational Therapy, Social Work and Speech Pathology was created.  Each telehealth model aims to enhance access, improve quality and safety, enrich the patient experience, and strengthen efficiency and effectiveness for targeted AH services.

Significant benefits have been realised as the VAHS has increased patient and community access, improved quality and safety, and demonstrated positive patient, clinician and family experiences. Examples of local outcomes include:

• a reduction in falls at Nyngan Multipurpose Service (MPS) with the virtual malnutrition service
• reduced hospital acquired pressure injures to zero at Nyngan and Rylstone MPSs
• improved accreditation performance in sites without onsite pharmacy
• positive experiences reported by patients
• increased access to grief and loss and advocacy social work services.

These models enable patient / client access to a wider range of AH services than would previously have been provided in their home communities.

Outcomes: The VAHS pilot results indicate increased access to AH services, improved safety through interventions that prevent and ameliorate hospital acquired complications, and positive patient, clinician and family experiences.

This project is an innovative, flexible approach to care which successfully leverages enhancements in digital technology.

• minimal resourcing provides for innovation and freedom to experiment
• collaboration and co-design between clinicians and managers has facilitated trial of agile assessment and therapy models for AH services which have not been provided before in this way in NSW
• workforce models (combining virtual and delegated care) support local employment opportunities.

Take home message: This project delivers more than using telehealth to extend business as usual practice. It delivers patient centred, responsive and agile AH services to vulnerable communities. The longer term impacts are significant, not only on access to AH services, but on the sustainability of small rural health services and communities.  It supports a growing specialist workforce, through skill and career development opportunities in rural healthcare which will be realised as this project continues.

The health effects of climate change are evident today, with rural Australia particularly vulnerable owing to increasing extreme heat and bushfires, changed rainfall patterns and challenges to livelihoods. Future climate projections represent a major threat to public health in Australia and worldwide. However, tackling climate change offers significant opportunities for improvements in health (Watts et al, 2015). Rural health professionals are optimally placed to be at the forefront of this change.

Recognition of the social and environmental determinants of health is an essential foundation of healthcare. It is crucial that Australian health professionals are aware and empowered to integrate climate and health considerations into their professional practice. Health professionals’ respected position in the community empowers the profession to offer leadership in climate change mitigation by reducing carbon emissions, and to advocate for policies which safeguard and promote a healthy, sustainable Australia.

This workshop will offer health professionals an evidence-based overview of the health impacts of climate change with a focus on those relevant to rural communities in Australia and vulnerable populations including the elderly, children and those with chronic diseases. It will then lead into a discussion around the unique role of the health professional in advocacy, awareness and community engagement, and provide some tools and direction to further develop these skills. The workshop will cater for a range of knowledge bases, and is essential for those wishing to further their expertise and agency in tackling this public health issue.

Aims: The GP Hybrid / Telephone Program delivers a cardiac rehabilitation (CR) program in collaboration with the patient’s general practitioner (GP), offering patients eight allied health consults, risk factor education, patient support and ongoing reviews by combining both the chronic disease GP Management Plan (GPMP) / Team Care Arrangement (TCA) and the Country Access to Cardiac Health (CATCH) telephone program.

Methods: All country SA patients eligible for an outpatient CR program and who attend a GP clinic involved with the GP Hybrid program can be referred. Eligible patients are contacted by a CATCH CR nurse for enrolment and, in coordination with their GP, the practice nurse is informed and develops a GPMP/TCA with the patient.

A nursing assessment is conducted by a CATCH CR nurse. The telephone program is conducted over seven weeks with three CR nurse calls, three allied health calls, followed by 6 and 12 month review calls.

Relevance: The CATCH telephone program commenced in 2013 to increase the uptake of CR in one region of SA for those patients unable to attend traditional face-to-face programs. The GP Hybrid program was established in March 2017 with expansion of CATCH CR service provision across country SA.

The GP and practice nurse oversee the GP Hybrid program process and the telephone program provides education and support calls addressing cardiac risk factors and recommended lifestyle changes. Up to eight allied health consultations are available at low or no cost to the patient. Videoconferencing capability is available at some sites.

Results: There are nine GP clinics in the program and 61 patients referred to date - 40 patients completed, 11 current patients, 6 awaiting enrolment and 4 declined.

There are high ‘commencement’ and ‘completion’ rates and patient health outcomes are demonstrating medication adherence, no hospital readmissions and clinical outcomes meeting Heart Foundation guidelines.

Conclusions: The GP hybrid program provides patient advocacy through a collaborative care approach between the CR nurse, GP and practice nurse. The GPMP/TCA ensures long-term management of the patient’s cardiovascular disease and other chronic comorbidities. There is a transparent patient-centred approach to patient’s health management, engaging all stakeholders and correspondence provided to the patient, GP and Cardiologist.

Acknowledgement: Integrated Cardiovascular Clinical Network (iCCnet) CHSA gratefully acknowledges that this service is supported by funding from Country SA Primary Health Network through the Australian Government's PHN Program.

An increasingly interdependent world economy means that differences across regions and within countries can often be greater than differences between countries. Nowhere is this more evident than in the Australian context. In regional, rural and remote (RRR) Australia the differences between regions can be stark – large regional cities; tiny remote settlements; differing population densities; a plethora of differing economic drivers; unique settlement patterns and highly dynamic demography. The differences could well be summed in the sentence: ‘If you’ve seen one country town, you’ve seen one country town.’

In 1970s and 1980s changes occurring at the national and global level and the impact of policies introduced in Australia were keenly felt in RRR Australia. The deregulation of industry and opening up of markets, the floating of the Australian dollar and the removal of trade tariffs and the privatisation of previously state-owned and operated services have all had impacts at the regional level. In the context of this presentation, the privatisation of state services has been especially significant. Increasing adoption of market-based funding approaches has failed (dismally) to take into account the differences between urban and RRR Australia, and the differences between regions, nor the subsequent challenges associated with those differences. Why, for example, do we continue to apply market models where there is clear market failure? Why do funders assume that seeking economies of scale and applying competitive tendering processes have the same outcomes in vastly different operating environments? For many service providers across RRR Australia, these are questions and challenges that are faced daily.

This presentation firstly highlights some of the challenges of applying market models in RRR Australia, and then steps through some alternative approaches that could mitigate these challenges at the same time as providing more cost-effective service delivery.

The Western NSW Primary Health Workforce Planning Framework Project was a significant undertaking across 2017–18. The critical highlights of this 12-month project included: a) successful engagement of 50 organisations involved in primary health care delivery across the vast region; b) development of an evidence-based Primary Health Workforce Planning Framework (the Framework) tailored for the region; c) identification of immediate priority actions; and d) resourcing commitment, including the creation of a dedicated position for a Partnership Coordinator, to bring the Framework and Priority Actions to life. The project was designed with a robust, ethics approved, methodology which included literature and policy reviews, theming of verbatim transcripts of over 40 executive and clinical lead interviews and workshop consultations.

The primary collaborators have been Western NSW Primary Health Network (WNSW PHN), the Western NSW Local Health District (WNSW LHD) and Far West Local Health District (FWLHD), Bila Muuji Aboriginal Corporation Health Service and NSW Rural Doctors Network (RDN) with additional support from the Aboriginal Health and Medical Research Council of NSW (AHMRC of NSW). The Primary Health Workforce was defined as all professional cohorts working to provide and support primary care service, including medical, allied health, nursing, Aboriginal Health Workers, Practice Managers and Health Administrators.

The Western NSW Primary Health Workforce Planning Framework and 2030 Western NSW Primary Health Workforce Priority Actions acknowledge the unique challenges of providing primary health care in Western NSW and the importance of providing timely access to quality and safe health care services, regardless of where people live. Equipped with a robust understanding of the challenges and potential solutions, the necessary tools and resources, and a willingness to work together to enable positive action, the collaboration is well placed to facilitate future action.

The project has resulted in a 2-year co-funded collaborative action plan to support primary health workforce recruitment, retention and long-term planning / succession across the scope of service providers in the region including private practice, state government, NGOs, Universities and importantly the Aboriginal Community Controlled Sector. The plan is divided into the following six action areas outlined in the Framework: 1.  Recruitment; 2. Retention; 3. Addressing Need - best outcomes for rural people; 4. Strong Partnerships; 5. Professional Development and Training; and 6. Strengthen Coordination

Background: Epilepsy is a complex neurological condition characterised by recurrent, unprovoked seizures. Estimated prevalence of epilepsy is 1%, equating to approximately 250,000 Australians. To date, however, there is a relative scarcity of research investigating the impact of epilepsy in rural and remote communities in Australia.

Epilepsy onset occurs most commonly in childhood or older adulthood, but it can occur at any age, and in any population, due to variation in underlying cause. Causes of epilepsy can include genetic mutations, neurodegenerative conditions, head injury, stroke, or infection. In major cities, a neurologist or epileptologist will typically manage epilepsy, alongside a GP. Given the high rates of comorbidity between epilepsy and mental health conditions such as anxiety and depression, a psychologist or neuropsychologist may also be involved. The scarcity of specialists in rural and remote areas therefore restricts patient access to optimal treatments and information about advances in medication and new treatment options. Suggestions from the literature on ways to improve the treatment of people living with epilepsy in rural or remote communities has included better education for pharmacists working with Indigenous people, as well as online modules for patients to promote better self-management.

An extremely important profession in rural and remote communities are nurses, with an estimated 70,000 members of the Australian Nursing and Midwifery Federation living and/or working in rural and remote areas. Nurses also play a key role in the Stronger Rural Health Strategy. However, there is currently little formal understanding of the role that nurses play and/or their understanding of epilepsy. Ensuring the appropriate education of Primary Health Nurses (PHNs) regarding the impact of and best management of epilepsy could therefore promote better health and quality of life outcomes for people living with epilepsy in rural and remote settings.

Proposal: Epilepsy Australia (EA) is a national coalition of not-for-profit organisations supporting people living with epilepsy. This involves direct client support, as well as education and training for schools, health professionals, and families around the impact and best management of epilepsy. The Epilepsy Foundation, the organisation for Victoria and New South Wales, recently developed an accredited PHN training program; however, this program was developed with input from PHNs working predominantly in metropolitan areas. The aim of this study is therefore to conduct an empirical investigation into the experiences of PHNs working in rural and remote areas in order to inform the utility and translation of our epilepsy education and training programs.

Method: This study will be undertaken in two stages. The first stage will involve desktop review of the literature examining cultural factors, policy, logistical and ethical issues relevant for working with people with epilepsy in rural and remote areas.

The second stage will be a qualitative investigation of the experiences and perspectives of nurses and primary healthcare providers who work with epilepsy in regional, rural and remote locations. In order to achieve this, we will consider collaborating with organisations that support the health of rural and remote and ATSI individuals. This stage of the project will be considered as a Masters project in collaboration with The University of Melbourne.

Introduction: While the majority of births in Australia occur in hospitals with maternity services, it is inevitable that some women will present in established labour to health facilities without midwives or other appropriately qualified staff. These unexpected presentations pose challenges for the woman, her family and the health workforce. In 2016, 69 women gave birth in 32 Queensland Health facilities without maternity services; approximately 90% of these births occurred in rural and remote settings.

Methods: The development, implementation and evaluation of the Imminent Birth Education Program for non-midwives practising in rural and remote non-birthing facilities in Queensland employed a participatory action approach. A state-wide steering group was established and consulted on all stages of the project. The project consisted of three distinct phases:

1. Development of an online, evidence based component of the education program.
2. Pilot testing the online component and development and pilot testing of the face-to-face workshop and facilitator’s guide.
3. Promotion, implementation, monitoring and evaluation of the Imminent Birth Education program throughout Queensland.

Results: The Imminent Birth Education Program for non-midwives practising in rural and remote non-birthing facilities in Queensland was developed, piloted and evaluated. The education package comprises an online component, 3.6-hour Imminent Birth workshop and a facilitator guide for a midwife to facilitate the course. By July 2018, 639 health professionals completed the online course, 54 health professionals were trained to facilitate the face-to-face workshop and 114 non-midwives completed an onsite workshop. The Imminent Birth Education Program was accessed by health professionals in all 16 Queensland Hospital and Health Services.

Conclusion: The education program resulted in improved knowledge of the non-midwifery workforce to assist and support women who present when birth is imminent. It has decreased levels of anxiety about providing clinical care to women who present at non-birthing facilities when birth is imminent and improved ability to provide women who present when birth is imminent with safe, evidence-based clinical care.

This presentation will present on Tasmanian Aboriginal Health Services’ delivery of comprehensive primary health care. General practitioners (GPs) and registered nurses (RNs) are supported by Aboriginal health workers (AHWs). The health workers provide an important link between clinical practitioners and the community.

AHWs provide clinical staff with family information and back ground that may not been in the patients notes. They also support patients to attend appointments by providing transport and support at appointments. AHWs also home visit patients to follow up nonattendance at appointments, provide emotional support and encouragement to the patient.

A Launceston AHW and GP complete monthly home visits to clients identified as high risk but for whom barriers exist, inhibiting their access to health care. The home visits have been hugely successful in supporting the patients to attend clinical appointments at the AHS and specialist services. The AHW has been successful in gaining access to the patients which the GP would otherwise not have had.

Health practitioners within Tasmanian Aboriginal Health services, access internal referral pathways including midwives, child health nurses, counsellors, child psychologists, paediatricians physiotherapists and diabetes educators. Staff also refer patients to outside services not provided internally.

As an example of how the comprehensive primary care model works in practice the presenters will discuss the approach of the (Launceston) Aboriginal Health Service in managing hepatitis C treatment.

There are strong connections between clinical services and heritage and cultural programs for clients accessing Tasmanian Aboriginal Centre programs and the AHS. The palawa kani language and rrala milaythina-ti, Strong on Country programs have supported connections and improved social and emotional wellbeing outcomes for patients.

The palawa kani name of the project, rrala milaythina-ti, means strong in country. The title of the project captures the links between our community, our country, and the emotional and social wellbeing of each of us and all of our community.

There are many celebrations throughout the Tasmanian Aboriginal community calendar supporting connections to community. The putalina Festival, Preminghana camp and Generation Cup provide community with opportunities to be together and for some these events provide contact with family members from around the state they may not see at any other time of the year. These events are opportunities for health staff to deliver health promotion programs in a social environment.

In 2013 Telehealth was identified in the Western New South Wales Local Health District Strategic Plan as an enabler to improve the equity of access for the regions smaller vulnerable communities, many with known aging populations and younger aboriginal communities. Telehealth was seen as an opportunity to improve the equity of access to the specialist clinical resources that are available at the larger rural communities of Dubbo and Orange and Bathurst.

In 2015 the Western NSW LHD Board engaged KPMG to develop a three year strategy using Telehealth technology to improve accessibility to clinical services and decrease travel for patients and staff.

The expansion of the electronic Medical Record within WNSWLHD included improved bandwidth connections and enhanced wireless networks. This was used to increase Telehealth access and introduce wireless, portable videoconference carts thought the LHD. A partnership with the ACI to pilot a web based platform that could link directly to our partners or patients own devices.

By January 2018 there had been a remarkable increase in Telehealth device usage in hours in Western NSW for both traditional videoconference devices and web based products. As well as the number of Telehealth enabled services.

Telehealth enabled clinical services have improved LHD wide access to care. This has been across government agencies, with contractors and non-government service providers. Other providers are also able to access services using WNSWLHD platforms either physically in WNSWLHD facilities or though their Telehealth Platform, or via WebRTC.

Innovations included using Telehealth to enhance postnatal care, allowing Mothers and Babies to return to smaller communities earlier, placing a Medical Officer to review patients prior to transfer, linking patients in smaller communities to have access to cardiopulmonary rehab, improving malnutrition screening , enhancing physiotherapy services, providing psychology outreach service to patients own devices, linking sexual health services by providing access to Sydney based counselling services. Patients accessing Specialists through their General Practice have the advantage of a better integration of care, with the patient’s GP being able to contribute to, and be informed of the patient’s plan of care.

The Telehealth Strategy has been respectful and empowering of small rural communities many of which were consulted when developing services so patients don’t have to leave their community to access care. The WNSW Telehealth Strategy has enabled the provision of high quality health Care for rural populations which is a direction of the NSW Rural Health Plan Towards 2021.

Mental health service delivery to children in rural and remote areas faces many challenges including attracting and retaining staff, continuity of care, poor accessibility and limited consumer choice.

Royal Far West has teamed with a number of different service partners in health and education seeking solutions to meeting the mental health needs of children in rural and remote areas With improvements in internet capacity across Australia, internet based therapy has become a viable mode of delivery for mental health services. Royal Far West has developed a number of innovations in telecare including mixed mode service delivery, gamification of therapy resources and introduced interactive, child friendly therapy packages to ensure children are offered engaging and stimulating interventions.

A randomised controlled trial of telecare vs face to face demonstrated that the outcomes for internet based therapy are comparable to face to face delivery. Consumer satisfaction evaluations have demonstrated that the services are well received, and in some instances preferred. Further, our service partners have been able to provide mental health services to those children who would not otherwise be able to access services.

To conclude, internet based service delivery models are safe, effective, consumer friendly, accessible and provide service choice to children in rural and remote regions of Australia.

Overview: The position of resident medical officer (RMO) is often the decisive point when many young doctors choose their future career pathway, and although universities in rural Australia offer rural placements during the undergraduate period, there are very limited options for recent graduates wishing to pursue a career in general practice. Historically, the Prevocational General Practice Placements Program (PGPPP) was introduced at a time when there was not enough demand for GP training places and offered a suitable experience; however, it was discontinued by the Department of Health in 2014, redirecting the funding towards the expansion of the Australian General Practice Training program (AGPT).

Methods: A new program for hospital RMOs to experience a thirteen-week placement in general practice was developed through a partnership between the Launceston General Hospital (Tasmanian Health Service), HR+ (Rural Workforce Agency for Tasmania) and a private practice (Scottsdale, TAS) in 2016, and started as a pilot in 2017.

Results: At the date of writing of this paper eight RMOs have participated in the program and have completed entry and exit surveys. All of them have rated their experience in the program from ‘Good’ to ‘Excellent’. All the participants were assessed by an independent Medical Educator who has found their progress to be consistently good and assisted the participants in identifying areas of improvement. One of the participants of the 2017 cohort has now joined the AGPT and two participants of the 2018 cohort will follow this trend. Considering the success of the program, an expansion to other areas of Tasmania has been developed and started in 2019.

Conclusions: Early exposure to general practice is desirable during the training of recent medical graduates; offering first-hand experience to those interested in this field of specialty, and to encourage other hospital-based junior doctors to consider general practice as a career choice; we present a straightforward and economically viable model that can be implemented in other areas of regional Australia where development and strengthening of a locally trained medical workforce is a priority.

Spanning 1,727,000 km² and with a population of nearly 5 million people, 40% of whom live outside major cities, Queensland continues to pursue health equality and equity. Sometimes, very appropriately, an option for improvement can come from the people most affected.

To improve or idealise patient care, clinicians in rural and smaller centres often seek collegial and expert clinical advice and support from larger site clinicians by telephone. Queensland is fortunate having invested in integrated telehealth technologies throughout the state, including equipment primarily located in rural and remote facility resuscitation areas. Rural communities and clinicians asked whether this technology could be used for such ad hoc consultation’s to ‘add a visual’—it happens for an outpatient endocrinology clinic 800kms away, then why not when the local doctor calls the base hospital for advice? Why wasn’t it occurring and how do we reduce barriers and increase utilisation? Whether it could be done in a way that enhanced patient safety through simplified requesting and connecting, minimised work impact on isolated clinicians, and importantly, aligning with individual hospital processes within different health services. From this, the Telehealth Emergency Management Support Unit (TEMSU) was born.

This presentation offers an overview of how TEMSU evolved into a 24/7 service, supporting over 165 sites in 13 Hospital and Health services, and continues to expand. Examining generalist/acute presentation models of care will lead to appreciating the flexibility of applying TEMSU models to a vast variety of clinician-to-clinician interactions including: paediatrics, nurse-to-nurse, midwifery, mental health, wound care, deaf interpreting, multi-disciplinary team handovers, aged care, etc. TEMSU contributes to, and complements, existing local networks of clinicians who, while separated by distance, are working together to achieve better patient care. There will be opportunity to touch on the experience of growing a unique acute telehealth service, the barriers, successes, surprises and failures, including what we would/will do differently. Equally, how other areas could apply some aspects of our experience to their patient groups.

TEMSU is not the panacea for the rural-urban health disparity, nor tyranny of distance. However, it has a place in the suite of options available to rural Queensland clinicians and their patients for support and advice.

Expansion in student enrolment numbers across the tertiary sector over the past decade has meant that record numbers of nursing and allied health graduates are currently looking for employment. There is emerging concern however that nationally, the health workforce may be entering a phase of oversupply. In some disciplines, the number of health care professionals trained will exceed the job opportunities available. The potential upside to this oversupply is that positions in rural and remote areas could become more attractive to graduates who have not previously considered a career path outside of larger cities. But are these jobs really out there? How can rural health services integrate relatively inexperienced graduates within their workforce?

The employment situation in rural Australia is a complex milieu. At one extreme we hear the plea from some employers: ‘I’m so desperate, I'll take anyone!’. At the other extreme its ‘no experience, no job’ often because the training and support required for a new graduate can be resource intensive and so difficult to arrange.

Whilst many important rural health workforce initiatives are aimed at ‘growing your own’, rural origin students enrolled in nursing and allied health courses may also find it difficult to get jobs in smaller rural health services on graduation where work demands can be high and scopes of practice very broad.

Drawing on recent health professional job vacancy data, ABS census and graduate outcomes data, we explore how many and what type of vacancies are available for recent graduates in Tasmania. Some of the challenges faced by recent graduates in finding and securing a position and the experiences of employers in recruiting, supporting and retaining new graduates will be also discussed.

This review addresses an important rural health workforce issue. As recruitment and retention within rural areas remains problematic for many health professions, quantifying employment opportunities for recent graduates and understanding their employment expectations is critical to workforce planning. Similarly, the recruitment experiences of employers provides information useful to policy makers, health service and education providers on the preparation of health graduates and what may be useful to enable their transition to successful employment.

Recognising the challenges faced by all stakeholders can help identify opportunities to enhance the employability of new graduates in rural areas, foster their interest in pursuing a rural career path and, in the longer term harness their potential to make a significant contribution to rural health outcomes.

Cultural awareness training is widely used to address health inequities across multicultural populations. However, the literature on the effectiveness of this training in influencing health outcomes is inconclusive. Given the national priority for health equity across urban, rural and remote settings, deeper insight into the understandings, attitudes and beliefs of health practitioners regarding First Nations’ Peoples wellbeing is critical to closing health gaps.

This paper reports selected preliminary findings from an on-line survey disseminated to allied health, nursing and related discipline practitioners and students who had ever undertaken cultural awareness training during their careers or studies. Survey questions elicited demographic data, free text data on ‘Major Health Issues’ and ‘Health Systems Issues’, as well as self-reported degrees, respectively, of preparedness to engage with First Nations’ Peoples, willingness to advocate for health equity and readiness to actively promote health system change.

Thematic analysis of free text data fields suggested broad categories of ‘Diseases’ and ‘Social Determinants’ in the Major Health Issues field and ‘Culturally Safe Health Care’ in the Health Systems Issues field. The literature related to each of these broad categories was reviewed to develop appropriate reference frameworks based on evidence. Content analysis was then undertaken on free text survey data and results compared to respective reference framework evidence to assess the consonance of respondents’ reported perceptions.

Overall, respondents reported greater willingness to engage with First Nations’ clients and patients, having completed cultural awareness training. For the influence of professional or social connectedness with First Nations’ Peoples on practitioner preparedness to engage, the data strongly suggests that one or more connections can have significant impact.

Preliminary findings also suggest substantial incongruence in both nature and scale between practitioner perceptions of Major Health Issues and the Disease Burden / Social Determinants framework evidence, highlighting significant ‘blind spots’ in practitioner knowledge. For Health Systems Issues, survey respondent perceptions demonstrated similar incongruence with the reference framework evidence, with similar implications

These findings highlight the need for greater knowledge in the health practitioner workforce of the major issues impacting on Australian First Nations’ Peoples’ health and a greater appreciation of the systems factors limiting Australian First Nations’ Peoples’ engagement with government and private health services. The evidence of the positive effect of connectedness between Australian First Nations’ Peoples and health practitioners, the unexpected ‘power of one’, could be an important element of transformative change.

In 2018, discussions concerning the settlement of migrants and refugees in regional and rural locations is increasingly relevant to discussions of Australia’s migration program as well as broader considerations of regional infrastructure and development.

To be sustainable, regional settlement requires that migrants are adequately supported in their new homes, and that the receiving community is in the best possible position to meet the needs of vulnerable people arriving in their location.

With this in mind, settlement must be viewed through a place-based lens that empowers local communities to provide services and support wherever needed. To inform this approach, the Settlement Council has developed a set of National Settlement Services Outcomes Standards which provide key indicators for successful settlement services across nine priority areas. Health and Wellbeing of new arrivals is one of these nine priority areas, and requires that clients are engaged through effective and responsive primary prevention and early intervention initiatives that encourage health and wellbeing.

Access to appropriate, affordable and quality health services is crucial for new arrivals. These range from specific services dealing with torture, trauma and other conditions associated with the circumstances leading up to a migrant or refugee’s arrival in Australia, through to general medical assistance and intervention.

New arrivals must be supported to navigate the Australian health systems and understand their rights. Equally important, is the provision of information about maintaining health and wellbeing—both physical and mental, as migrants settle into life in Australia.

This presentation will analyse the key requirements for successful health care services in regional and rural locations that meet the National Settlement Services Outcomes Standards.

It is proposed that this could take the form of a general paper presentation, or alternatively, as a series of presentations as part of a concurrent session. If this were the preferred option, we would undertake to secure the involvement of potential presenters from the following possible sources:

• Refugee Health Networks
• Regional Australia Institute
• Migrant Resource Centres and/or Settlement Service Providers engaged in regional/rural settlement
• health care consumers with lived experience.