Concurrent Speakers

Inequitable health outcomes for remote and rural Australians are linked to poor access and utilisation of healthcare services. Without a comprehensive knowledge of existing service locations, relative to population, governments and non-government organisations find it difficult to allocate resources to facilitate better access to primary health care and other health services, and to determine what constitutes ‘reasonable’ service access. The RFDS has developed a Service Planning and Operational Tool (SPOT) to inform decisions on where services should be located, relative to need, by mapping existing services and overlaying these with population data. This presentation will identify the most underserved areas of rural and remote Australia.

Background: Cardiac arrest occurs in over 25, 000 Australians every year. In the event of cardiac arrest, CPR alone has low rates of effectiveness. However, when provided in combination with defibrillation, survival rates increase significantly—reported to be up to 30%. Defibrillation needs to be administered quickly in the event of cardiac arrest, ideally within 3 minutes, but this is often not possible in rural and remote areas where there are limited health facilities.

A contributor to cardiac arrest can be chronic heart disease (CHD). Australians in remote areas are 1.6 times more likely than those in major cities to be hospitalised for, and 1.3 times as likely to die from, CHD. Indigenous Australians are overrepresented in these statistics. This is further demonstrated in demand for our emergency aeromedical retrievals, via which 112 patients per week, or 16 patients per day, are transported to receive definitive care in a tertiary hospital.

Aim: Responding to these research findings and interest from our communities, we commenced national roll-out of portable Automated External Defibrillators (AEDs), funded by corporate giving from a national partner. The primary aim of this AED project, the first of its kind in Australia, is to reduce the number of people who die from cardiac arrest in remote and rural Australia by improving access to AEDs for first responders.

Method: Over two years of retrieval data was analysed to identify the locations most commonly attended in response to a patient experiencing cardiac arrest, along with national data relating to prevalence of CHD. We mapped these locations, and combined with local knowledge from our service managers, identified the best locations for provision of an AED.

Results: Remote and rural locations in South Australia were identified as a high priority, and are the first for roll out of the portable AEDS through this program. It was determined that this program would most optimally be delivered in line with our medical chest program, which provides medications to approved custodians in areas where pharmacies are not easily accessible.  To date, 80 AEDs have been provided in remote and rural South Australia, along with a self-developed training program to ensure people in those communities are confident to use the AEDs.

This presentation will briefly explore the research that lead to the development of this program; the partnership approach leveraged to purchase the AEDS; the implementation methodology; and, results of the first year, including case studies.

In 2016, RDHS launched a pilot project titled ‘The Ripple Effect of Ethnicities’ (TREE) that was designed to support multiculturalism in Robinvale. The TREE Project was founded to meet the gap in cultural tolerance and acceptance posed by the lack of community events for multicultural community members to engage in. Research indicates that people from diverse cultural backgrounds in rural settings are more vulnerable to social isolation in their community which in turn results in a high incidence of mental health markers amongst these groups. In addition, the lack of community engagement amongst the multicultural communities also resulted in limited representation of their voices in the health decision making process in the Robinvale community. To manage this, the TREE Project was developed as a soft entry approach to social inclusion and mental health to encourage community engagement of the multicultural communities in Robinvale. The main objective of the TREE project was to provide a meaningful platform for people from multicultural communities to engage in the Robinvale community with a clear vision towards improving their psychosocial health and wellbeing.

A 16-week cultural skills exchange program that was conducted with multicultural community members wherein participants nominated a skill inspired by their culture and taught it to the rest of the group. The skills exchange program consisted of 9 participants and 2 companions from different cultural groups. A range of different cultural skills were shared through this program, including Italian pasta making, Indian saree tying, Fijian basket weaving, Philippino spring roll making etc.

A multicultural festival was hosted by RDHS in Robinvale on 5 November 2016 that was attended by more than 700 people. The festival aimed to bring together people to celebrate the ethnic and cultural diversity of the community through the use of arts, crafts and food.

In 2017 RDHS received a High Commendation from the Victorian Multicultural Awards.

Another multicultural festival was conducted in 2017 and we are currently in the planning stage for the 2018 festival.

As part of the TREE Project our Manager People and Culture is conducting English conversation classes after hours two nights per week. The manager has donated his time to this activity, which has seen up to 20 participants enjoying the learning environment provided in our conference room. These classes are provided free of charge and the participants range from Thailand, Vietnam, Cambodia, Laos, China, Hong Kong, Taiwan and Afghanistan.

This is the story of our journey embracing collaboration and working together to improve the health and well-being of the Gundjitmara people and those people living and working on Gundjitmara country in Southwest Victoria.

Our journey starts with understanding and respect and these themes underpin everything that we do.

The first part of the journey is understanding—it is vital for mainstream health organisations to take the time to listen and learn about the ways the traditional custodians of the land have managed their people’s health and wellbeing. The Gunditjmara peoples of Southwest Victoria have successfully thrived for many generations before colonisation and have many lessons learnt to share. Conversely opportunity the understand the mainstream health role provides insight into how organisations can effectively work together.

Over the last five years in the south-west of Victoria health care providers and traditional owners have joined forces to develop the Ka-ree-ta Ngoot-yoong Wat-nan-da strategy.

Simple initiatives include:

• monthly yarning sessions
• traditional names for initiatives and across organisations
• key events celebrated including Naidoc week with a calendar of events
• friendly and welcoming organisations

• all official flags flying at the building entrances
  • signage to acknowledge the Gunditjmara elders in organisations
  • local made gift bags for Aboriginal patients

• art competition—artwork symbolising the Ka-ree-ta Ngoot-yoong Wat-nan-da strategy, used on name badges, website and stationery
• orientation program with opportunities to go on country with traditional owners
• all babies born on Gunditjmara country receive a locally designed cot card and bib.

These simple initiatives have established a respectful framework to leverage off. The Ka-ree-ta Ngoot-yoong Wat-nan-da strategy with the guidance of our traditional owners is now starting to solve some of the more wicked problems with more complex initiatives

These include:

• Gunditjmara elder appointed to the Board of Management at Portland District Health (PDH) – PDH Aboriginal staff member on the Aboriginal Health Service (AMS) Board.
• PDH developing an Aboriginal and Torres Strait Islander (ATSI)employment plan has increased the % of ATSI employees from 0 to 2.5% of the total workforce.
• Established career pathway entry level positions for nursing and allied health careers
• Contract with local AMS to provide 24/7 support to ATSI patients in hospital. (fee for service arrangement)
• Aboriginal health workers part of the care team at PDH.

• Jointly appointed general practitioner between local AMS and PDH.

Since 2012 PDH has seen the numbers of Aboriginal and Torres Strait Islander patients seeking services increase by over 60% annually the organisation is no longer bypassed but is valued as a health care provider in the local Gunditjmara community.

The Ka-ree-ta Ngoot-yoong Wat-nan-da strategy is a deadly partnership initiative working effectively to improve the health and well-being of the local communities.

Aboriginal and Torres Strait Islander people living in rural and remote Western Queensland are more likely to experience chronic and mental health issues, and this experience may impact negatively on other areas of their life, including their social and emotional wellbeing. However, it is also recognised that a strong sense of identity and connection to culture, language, family and community, and to lands, seas, and ancestors, and to a spiritual dimension are all strengths for Aboriginal and Torres Strait Islander people and key to improved health, and social and emotional wellbeing.

Nukal Murra means ‘plenty hands’ and underpinned by an Alliance Contract that provides open book accounting and shared program domains, including a number of Commonwealth PHN Programs. The Alliance comprises: of the Western Queensland Primary Health Network (WQPHN) and the four regional Aboriginal and Torres Strait Islander Community Controlled Health Services (AICCHS) including; the Mount Isa Aboriginal Community Controlled Health Service (Gidgee Healing); Cunnamulla Aboriginal Corporation for Health; Charleville and Western Areas Aboriginal and Torres Strait Islanders Community Health Limited; and Goondir Aboriginal and Torres Strait Islander Corporation for Health Services.

Key principles of the Alliance include equality, self-determination, self-management, and partnership and collaboration amongst the members. The Alliance objectives aim to drive greater service alignment, integration, cultural integrity and community engagement across the catchment. Leverage from the cultural intelligence and infrastructure of ACCHOs, it aims to empower people with health issues to be better engaged in their care journey through the provision of culturally informed approaches to care. It does this by tailoring service delivery approaches and harmonisation workforce and innovation across provider and community settings, including mainstream settings.

The Nukal Murra Alliance introduces a contemporary focus on outcomes for Aboriginal and Torres Strait Islander people through an innovative contracting and commissioning approach through the WQPHN. It requires significant investment in relationship capital to create the right environment for innovative agreements, co-design and shared outcome measures. It must also respect the rights of individual organisations, and orientate these community controlled networks to a universal and consistent approach across the vast landscape that is Western Queensland. Early evaluation of the impacts of the Nukal Murra Alliance highlight a significant increase in access to care and better integration.

Introduction: In Tasmania, a rural state, 23% of the population is over 60 years of age, and 7% aged ≥65 years live in residential aged care. When residents are dependent on others for feeding and oral care, these co-dependencies place them at great risk for aspiration pneumonia, hospitalization and increasing frailty. Accreditation standards and Principles of Care stipulate the provision of evidence-based oral care. However, oral care is frequently delegated to personal care assistants (carers) who may not be informed of the evidence guiding care, nor appreciate the impact of poor oral health on function, overall health, and quality of life. Australia’s National Oral Health Plan emphasizes the value of an interprofessional approach where the different professionals invested in residents’ health work together to support nurses and carers in providing effective oral care.

Method: An interprofessional team of a speech pathologist, dentist, pharmacist, and nutritionist assisted nurses and carers to screen 142 residents and evaluate findings. The following measures were used: Oral Health Assessment Tool, Mini-Nutritional Assessment, Yale Swallow Protocol, and the EuroQOL-5D-3L. Consenting residents then participated in a 3-month program of 2-minutes of teeth cleaning after meals, or daily cleaning of dentures. A subgroup of randomly selected residents provided oral swabs to monitor oral microorganisms. The screening process then was repeated. Chest infections in the 6 months prior to the initiation of the study, during, and at the conclusion of the study were documented. 

Results: From the initial screening, 78% of residents warranted referral to a dentist; 57% were at-risk for malnourishment; 13% were actually malnourished; and 70% failed or refused the swallow protocol, indicating difficulty with, or apprehension about, swallowing thin liquids safely. Self-reported quality of life ranged from 34-95% (M=65%). Many residents were taking multiple medications that appeared to have been prescribed prophylactically and which had potentially adverse effects on saliva and gastrointestinal function. The 3-month period of 2-minutes of teeth brushing will conclude in August, followed by repeat screening in September (2018). Pre-and post-data will be available for this presentation.

Discussion: Actively involving residents, carers, and nurses with an interprofessional team has provided valuable insight into issues of concern that need to be addressed to promote and maintain residents’ oral health. All team members have gained additional understanding of the importance and impact of oral health. The organization hosting the study has implemented a policy to screen residents’ oral health upon admission and periodically.

Attracting and retaining well trained direct care workers to support people living in residential care and those who are on support packages in their homes, is an increasing challenge in many rural health services. In the Riverland of South Australia, the community and the local health service have come together to meet this challenge in a very innovative way.

The local Health Advisory Council (HAC)—a group of community members responsible for managing the assets and fundraising of our health service- resolved to offer scholarships to our local residents to gain Certificate III Personal Support (Ageing and Home & Community). We hoped to provide an incentive to attract the right person to undertake the training, with a nationally registered training program and our health service oversight of the students. We wished ensure a steady supply of appropriately trained people from our community to meet our workforce needs—both within the residential facility and the community and develop this into the ‘transition of care’ for our community members moving in to a residential facility? Most importantly, we wished to have the students trained on site in our hospital complex, and in collaboration with our local health and community services, using a high quality Registered Training Organisation (RTO).

A process was put in place to seek expressions of interest from RTOs to provide the training. Theoretical training was to take place on site, enabling students to work with local equipment and work placements undertaken within the residential home and local community. Local staff were able to provide input into the curriculum to ensure the content included aspects important to our local needs and the future direction of consumer driven care.

Criteria was established for the scholarship application process and interviews held to select successful candidates. Training for the inaugural group commenced on site, in July 2018. The students complete the course by December and their success will drive this concept into the future.

Importantly, the trial will inform the continuation and expansion of this initiative in the region, but it can also inform state and national workforce policy to support local ‘grow your own’ sustainable, fit-for-context workforce solutions in partnership with community.

Focusing on a continuity of care model, this initiative will create employment opportunities for appropriately trained workers to support the elderly people who are transitioning from home to residential care. This program is an excellent example of how the community, the local hospital service, community health service and Local Health Network (LHN) are working ‘better together’ to create an employment pathway designed to meet the needs of our community.

This presentation will provide an overview of the Rural Australia Dying to Talk Pilot conducted by Palliative Care Australia in collaboration with the Country Women’s Association of Australia in 2017-18.

The aim of this pilot was to increase the level of knowledge about the importance to plan ahead and talk about death and dying. PCA’s Dying to Talk Discussion Starter guides people through a personal reflection on their values and how those values might be reflected in their care at the end of life. The evaluation of the Pilot reveals a change in participants comfort in talking about death and dying, and plans to discuss their preferences with family or friends. The evaluation provides an insight into why women in rural Australia have not had these conversations, and add weight to the argument that talking about death together is an important piece missing from our communities.

The presentation will provide an overview of the results from the Pilot, and present new data on post-pilot follow up—did attending one meeting to talk about death, dying and personal preference within the CWA meeting setting result in a longer term impact for individuals?

The National Programs project has invested in training specialists in rural and remote areas. It is an investment that is paying dividends and the positive role it has played in developing Emergency Medicine training in Alice Springs and Tennant Creek is a story of success. It is a model that could be mirrored for training other groups, such as health care professionals in nursing, midwifery and allied health.

The Specialist Training Program (STP) was the first initiative. It provides funding for training Specialists in rural and remote areas. We have been running this program in Alice Springs for about a decade - and it is working. At this point in time, five of our newly graduated ED Specialists (FACEM) have trained in Alice Springs under this program and returned to work full time and live in Alice Springs. It is challenging to get Specialists to move out of the cities and live in rural and remote areas, and this is for Specialists of all medical colleges. A program that has delivered a significant number of Specialists returning to where they training in the bush is a remarkable achievement and success of the program.

The second initiative was the Emergency Medicine Education and Training (EMET) program. This has completely transformed the care provided at Tennant Creek hospital. Not only has the care improved, but the staffing has stabilised leading to a reduced reliance on locums. This program is a modest investment of funds, but one that has resulted in a sizeable return through money saved in aeromedical transfers, locum costs and the cost of poor care.

The third program, the Integrated Rural Training Program (IRTP) provides funding and incentives for trainees to complete the majority of their training in rural areas. This has just commenced, but we have already filled the position with an enthusiastic registrar who is committed to rural Specialist practice. It is an exciting development and promises to produce results.

The personal struggle of writing and living in dark themes.

People diagnosed with cancer who live in remote or very remote areas of Australia are 35% more likely to die within 5 years of a cancer diagnosis than those living in highly accessible areas. To address this problem, effective and sustainable strategies focused on assisting more rural Australians to access optimal cancer treatment and adopt healthier lifestyles during and after cancer treatment (so that they can better manage side effects and reduce their risk of cancer reoccurring), require implementation.

As part of a body of multi-disciplinary behavioural research focused on addressing this, and building upon her clinical experience from working with people affected by cancer, as well as from lived experience from growing up in a remote community, in April-June 2018 Dr Kate Gunn undertook a Churchill Fellowship to ascertain pertinent research questions that are likely to translate into sustainable interventions and improved outcomes for this disadvantaged group of cancer survivors. Information was gathered from the World Rural Health Conference in New Delhi, as well as visits to Macmillan Cancer Support in London and over 30 universities, cancer control organisations, treatment centres and non-government organisations across the Netherlands, Canada and United States, including the National Cancer Institute and American Cancer Society.

This resulted in the generation of rurally-relevant research questions for testing in the Australian setting relating to for example, a) the delivery of chemotherapy close to home in rural and remote settings, b) lay and nurse-led patient navigation specifically for rural and remote patients and c) the sustainable delivery of supportive care interventions via the internet and telehealth networks, for those who face barriers to accessing traditional face to face support. These strategies, which have successfully improved rural cancer outcomes in other contexts, and the new research questions for Australia that have been generated from them, will be outlined and discussed with the audience, with the view to generating interest and scholarly debate in this area of research, collaboratively prioritizing research questions and finding new interested partners to help take the work forward.

While addressing rural-urban cancer disparities using culturally appropriate methods is currently receiving much attention in the United States, rural Australians affected by cancer would benefit from more funding and effort being directed towards multi-disciplinary, translational research in this field. This rogano presentation will be an important step in facilitating that process.