Concurrent Speakers

The Mobile Surgical Unit has been operating in New Zealand for 17 years and has performed 24 000 procedures. This 20-meter-long 42-ton truck and trailer unit travels on a regular cycle around—taking five weeks to get around the whole country.

In many rural community’s health services are closing or reducing. With patients having to travel long distances to receive treatment. The mobile surgical unit has replaced several old operating theatres in rural hospitals that were costly to maintain and were being used only occasionally. The surgical unit was built in New Zealand at a cost of $5.5NZD and is now providing the state-of-the-art operation room.

Sharing this expensive capital equipment around 24 different rural communities and utilising the local rural staff to work in it when it comes to town it has created more equitable access to healthcare in rural New Zealand.

Background: Portland District Health (PDH) has made a commitment to remove sugary drinks from site an initiative to enhance community health outcomes. The commitment highlighted that cordial was also being added to the water to mask issues with taste. Wannon Water (WW) recognizes that whilst the town water supply is safe and complies with the Australian Drinking Water Guidelines, there is a significant proportion of customers who are dissatisfied with the taste. PDH and WW identified the opportunity to improve the taste of water supplied in the hospital which would help the hospital deliver their primary objective of removing sugary drinks. The project is a pilot which will provide valuable data to support considerations for improving the taste of water for the whole of the township.

Simultaneously, Health organisations in the region made a commitment to remove sugar sweetened beverages from site leading to an increase in potable water consumption.

Aim: To present the collaboration between our health service (PDH) and our local water corporation (Wannon Water), enabling the provision of Great Tasting Water to not only the PDH community, but also the broader Portland community. To present baseline data from the evaluation research that is also taking place in conjunction with Deakin University, including water and sugary drink consumption, and sales data of beverages within the facility. 

Methods: The partnership links into the SEA Change Portland initiative (collective impact approach to obesity prevention) a community collaboration using systems thinking framework to improve health outcomes. Using group model building (GMB); key community leaders and members were invited to subsequently devise possible actions that would lead to increased water consumption.

Media activity alerted Wannon Water to the idea that PDH was looking to work in collaboration with community to drive initiatives and significantly improve strategic public health outcomes.

Results: Baseline data is still being collected. It will be analysed and presented at the conference. Post-installation data will be collected 6-months post-installation, and will not be available at the time of the conference.

WW have committed to install a $100,000 reverse osmosis plant into the facility and install public drinking fountains as part of their corporate vision to go ‘beyond water for strong communities’.

Conclusion: A collaboration with a health organisation and a water authority has led to major infrastructure investment at a regional health service resulting in all departments having improved water taste, and also two fountains for public use.

If rural and remote health care providers are unable to effectively engage with national initiatives to embed research into health service delivery, there is a risk that this will contribute to a further widening of the gap in patient experience and outcomes between rural/remote and metropolitan areas of Australia.

There is global recognition that the integration of research with health service delivery can deliver a more efficient and effective health system and improve patient outcomes. Within Australia, a number of key policy initiatives are driving research activity in the health care sector. These include the Medical Research Future Fund (MRFF), the National Health and Medical Research Council’s Advanced Health Research Translation Centres (AHRTCs) and Centres for Innovation in Regional Health (CIRHs) and the allocation of funds for research to public hospitals as a component of National Health Reform Agreement funding.

The $20 billion MRFF has a mandate to support research in the health system and stronger partnerships between researchers, healthcare professionals, governments and the community. MRFF disbursements have been provided to NHMRC designated AHRTCs and CIRHs, which recognize leading centres of collaboration that excel in health and medical research and the provision of research- and evidenced-based health care. CIRHs were established to explicitly recognize centres of direct relevance and benefit to regional and remote areas of Australia and to date there have been only two CIRHs designated, in comparison to 7 AHRTCs (predominantly based in metropolitan areas). It has yet to be seen whether the CIRHs are an effective means to engage rural and remote hospitals in collaborative research activities.

The provision of funding for research to public hospitals as part of the 2011 National Health Reform Agreement may also create disparities in research engagement between rural/remote and metropolitan health care providers. Despite a commitment to Activity Based Funding for research, it is likely that research will be funded under block arrangements, largely informed by existing levels of research activity. This could potentially limit the scope of rural and remote healthcare providers to increase their research activity and enforce any existing gaps in research engagement between rural/remote and metropolitan public hospitals.

This paper will investigate the potential inequities that may be created by these and other related policy initiatives in engaging rural and remote healthcare providers in research and innovation activities.

Rural and remote Australia continues to experience worse health outcomes and poorer access to health services compared to inner metropolitan Australia. Geographic maldistribution of the health workforce is a significant barrier to access to health services in rural and remote communities. A key mechanism to address this maldistribution and to produce graduates with regional, rural and remote career intentions has been to provide students with positive clinical placement experiences in these settings. There have been a number of national initiatives to support health and medicine students to undertake regional, rural and remote clinical training opportunities, funded by the Commonwealth government through programs such as Health Workforce Australia, the University Rural Departments of Health, Rural Clinical Training and Support and Clinical Training Funding and most recently the Rural Health Multidisciplinary Training Program.

Despite these and other initiatives, providing students with positive clinical placement experiences in these settings remains an ongoing challenge. The cost of providing, safe, quality, clinical training within regional, rural, remote settings and geographically isolated services is more expensive than providing equivalent training in metropolitan settings, and securing adequate supervision for students is often difficult. This is particularly relevant for allied health students, where accreditation requirements can prevent inter-professional supervision and practice, which is often the only viable supervisory model in rural and remote locations.

Within northern Australia, James Cook University (JCU) has a long history of commitment to developing a professional, work-ready workforce to service the health needs of rural, remote, tropical and Indigenous Australia. JCU developed the first of the new medical schools in Australia in 1999 and has rolled out a range of health professional programs including: clinical exercise physiology, dentistry, occupational therapy, nursing, pharmacy, physiotherapy, psychology, speech pathology and sports and exercise science. JCU has an explicit mission to address the health workforce needs of northern Australia and operates a distributed regional education model that provides significant regional, rural and remote clinical placement experiences for students. This paper will explore the key barriers and facilitators to providing safe and effective clinical placements in rural and remote locations and the impact of these placements on the rural and remote workforce, particularly within northern Australia.

How do community theatre develop links in community which strengthen people and social capital, promote wellbeing and challenge social determiners?

By creating linkages between individual participants and wider organisational partnerships to make collective, collaborative theatre work. Community theatre necessitates a strength-based approach. People dancing, painting, reading, designing, playing together.

Tropical Arts makes innovative theatre by developing and working with inclusion practices. We are better together because diversity is our aesthetic and our lived experience. Tropical Arts strives to find new ways to include participants. We partner with service organisations to bring more people and resources to the production.

The Real Inclusion Project evaluated the Tropical Arts’ ‘Twelfth Night’, the 10th annual Shakespeare at the Tanks production in October 2018. The findings of this evaluation have a particular focus on our continuing work with Inclusion.

This abstract presents the approaches Tropical Arts takes to Inclusion. The presentation documents mages of the production and behind the scenes. Our presentation will deconstruct the who, what, why and how of inclusion practices, in a playful and practical way.

Inclusion as a process

The evaluation address many subjects relevant to inclusion processes, such as:

• Can everybody be included and contribute creatively?
• What barriers are there to inclusion and how do we overcome them?
• What are the benefits for participants, wellbeing in a regional community?
• How does the vision grow as the play evolves?
• How does the theatre making process create, develop and sustain linkages?
• Why is language and culture important?
• Why theatre and Shakespeare?

Loneliness

‘Loneliness has been associated with a range of poor mental, physical and socio‑economic outcomes, including low self-esteem, suicide, depression, heart disease and poor physical health.’

Tropical Arts Vision is to include as many people as possible under the umbrella of Theatre. A particular feature of our work is with the Deaf Community of Cairns and our theatre productions are unique in their diversity:

• 60+ actors and associated families and networks.
• 10 actors Deaf Community
• 10 actors with a disabilty
• 10 actors over 50
• 10 child/youth actors
• 8 paid theatre maker professionals
• 30+ volunteers
• 5 international actors or assistants
• 5+ language groups
• 15 Indigenous or CALD participants
• 1400 audience capacity + roving performance to a possible 4000 crowd.

This presentation is especially relevant for people interested in inclusion and how to do it.

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.

Learning objectives

• Development of a sustainable Women’s health service in rural and remote regions.
• Community participation in implementing a new health service and the resulting community benefits.

Activities and methods: Many rural and remote Qld communities have no women’s health services providing consultations across areas such as cervical screening, complex contraception, and management of gynaecological and sexual health issues. Problems can be complex and the need for confidentiality very high. Many women need to travel over 1000km to see a clinician for a consultation and for subsequent treatment.

True Relationships and Reproductive Health (True), a specialist in reproductive and sexual services, supported by CheckUp and the Department of Health, has implemented a Women’s health Service for Queensland’s rural and remote communities where no such service exists.

Outcomes and results: From commencement of just six pop-up clinics True is now providing pop-up services to fifteen communities. Community support has been phenomenal with one community fundraising to ensure all equipment needs were met in the local clinic. Appointment scheduling is supported at the local level and True’s clinics are always booked out well ahead of the visits.

Clients appreciate the confidentiality which the service provides, while still being delivered locally. Clients report that they now undertake these important health checks, which in the past had been neglected due to the travel and costs involved.

True’s pop-up clinical model has proved to be cost effective, sustainable service with 100% of clients reporting that they are highly satisfied with the service.

Conclusion: The health benefits of proactive management mean that chronic disease can be prevented and less ill health days reported. Delivering a service into a local community overcomes reported barriers and ensures access to appropriate care for community members. Naturally, this supports the wellbeing and economic benefit for both the community and the individual.