Concurrent Speakers

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Mark Eager
Mobile operating theatre: creating equity in rural New Zealand communities
Biography

Mark Eager has a background in nursing, he has worked in the commercial sector, and has been Mobile Health’s Chief Executive for 12 years. Mobile Health brings healthcare closer to home with the mobile surgical unit. The ‘bus’ travels on a five-week cycle around New Zealand, operating in 24 rural towns from the top of the country to the bottom. The bus has been on the road for 17 years and has operated on over 24 000 patients. The organisation also runs another mobile unit that follows the same mission, providing lithotripsy treatment (blasting kidney stones by shock waves) on the mobile medical bus around the country. Mobile Health also runs the New Zealand Telehealth Resource Centre; assisting health professional implement telehealth in their practices nationwide. The organisation also provides medical education via these telehealth links.

Abstract

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.

Kelly Edwards

First-time presenters First-time presenters

Improving public health through great-tasting water
Biography

Kelly Edwards is presently the Health Promotion Manager for the Portland District Health Organisation. She is currently in the Great South Coast of Victoria working with key partner Global Obesity Centre at Deakin University around fostering and building partnerships with communities in the aim of empowering them to develop and sustain obesity prevention efforts. Having been working in the prevention space for approximately four years, Kelly is part of the collaboration backbone support for the SEA Change Initiative, leading a systems approach to preventing childhood obesity. Empowering the community to make changes to the environment making the healthy choice the easy choice, using the collective impact framework to bring organisations together with a shared agenda. She has been currently working with GLOBE at Deakin University on supporting this practice through evidence and building local capacity through asset-based community development and ensuring that the process and action is researched and evaluated. Kelly holds a Bachelor of Commerce Majoring in Marketing and Management and has been working for the past nine years in Community Development with Committee for Portland, with a view to advocate and facilitate the future development of Portland.

Abstract

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.

Presentation | Paper
Bonnie Eklom

First-time presenters First-time presenters

Barriers and opportunities to clinical placements in regional, rural and remote settings
Biography

Bonnie Eklom works in the Division of Tropical Health and Medicine at James Cook University as a Policy Officer, where she co-creates and supports the development and delivery of key projects, particularly those relating to enhancing collaborative research activity between the University and the health sector in northern Queensland. This includes the development of the Tropical Australian Academic Health Centre, a research collaboration between James Cook University, five hospital and health services in northern Queensland and the Northern Queensland Primary Health Network. She also supports initiatives addressing health workforce capacity in rural, remote and tropical communities. Her PhD study investigates geographic variations in efficiency and productivity of hospital and health services across Queensland. Bonnie has previously worked at IPAustralia in patent examination and in grants management at the National Health and Medical Research Council. She has a comprehensive understanding and interest in the innovation and health research environment in Australia, with a particular focus on health research and delivery in rural, remote and tropical areas.

Abstract

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.

Presentation | Paper
Bonnie Eklom

First-time presenters First-time presenters

Inequities in research engagement between rural/remote and metropolitan health care providers
Biography

Bonnie Eklom works in the Division of Tropical Health and Medicine at James Cook University as a Policy Officer, where she co-creates and supports the development and delivery of key projects, particularly those relating to enhancing collaborative research activity between the University and the health sector in northern Queensland. This includes the development of the Tropical Australian Academic Health Centre, a research collaboration between James Cook University, five hospital and health services in northern Queensland and the Northern Queensland Primary Health Network. She also supports initiatives addressing health workforce capacity in rural, remote and tropical communities. Her PhD study investigates geographic variations in efficiency and productivity of hospital and health services across Queensland. Bonnie has previously worked at IPAustralia in patent examination and in grants management at the National Health and Medical Research Council. She has a comprehensive understanding and interest in the innovation and health research environment in Australia, with a particular focus on health research and delivery in rural, remote and tropical areas.

Abstract

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.

Presentation | Paper
Velvet Eldred

Arts in health Arts in health

Case studies of transformation through inclusive theatre making: doing Shakespeare in Cairns
Biography

Velvet Eldred has a Bachelor of Arts (Theatre QUT), Grad Dip of Counselling, Grad Cert in Expressive Art Therapies (Sophia College) and is a facilitator for Drumbeat program. Running and creative workshops for 25 years, Velvet works across cultures, industries, communities, age groups and abilities to give voice to participants. Velvet was awarded the Cairns 2012 Woman of the Year Award. She has state and local council recognition with awards in education and the arts. She is a passionate about using the arts as a vehicle to build community capacity. Velvet currently works at Red Cross and on the board of Arts Nexus and Tropical Arts.

Abstract

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.

Presentation
Christopher Etherington
Accuracy of medications in GP referrals to emergency departments
Biography

Chris Etherington is a junior doctor in his first year of professional practice in the north-west coast of Tasmania. He is currently undertaking placement in Queenstown General Practice/West Coast District Hospital on the west coast after spending his last two years of clinical school in the rural clinical school in Burnie. With an interest in rural general practice, emergency medicine and research he is hoping to pursue a career in rural medicine in his home state of Tasmania.

Abstract

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.

Presentation
Alice Evans
Pop-up women’s health service for rural and remote communities
Biography

Alice Evans is an experienced executive having worked in the health and health technologies sector as a board chair, CEO, physiotherapist and manager. She is currently CEO of True Relationships and Reproductive Health (True) and is also a Director of Curae Technology and FPAA and prior Chair of Cardihab. Alice has also worked as a leader in the mining sector, where she was an executive Director and General Manager for GroundProbe, which delivers safety systems globally. Alice consults to the University of Queensland Business School as an Industry Lecturer. Alice was awarded an MBA from the University of Qld in 2012, winning the Director’s Award for Leadership and the Academic excellence prize highlighting her ability to take theoretical concepts and apply these to business. In addition Alice holds a Bachelor of Physiotherapy (B. Phyt); Graduate Certificate of Executive Leadership (GCEL), and is a graduate of the Australian Institute of Company Directors (GAICD). In 2016 Alice was awarded the MBA Alumni Ambassador Prize recognising her business and community leadership. Alice is frequently called upon to deliver addresses for peak bodies on organisational transformation, strategy and cross-cultural negotiation.

Abstract

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.

Paper