Concurrent Speakers

Objective: This two phase study aimed to explore the influence of a university rural curriculum and clinical placements on pharmacists’ choice to practise in a rural or remote area.

Design: A sequential mixed methods approach, involved the design of both a questionnaire and semi structured in-depth interviews to collect quantitative and qualitative data.

Setting: Regional, rural and remote practice areas according to the Pharmacy Access/Remoteness Index of Australia classifications.

Participants: 92 pharmacists, from varied areas of practice, working in rural and remote locations across Australia, participated in the study.

Main outcome measures: University curriculum and clinical placements, during the degree and their influence on the current rural workforce.

Results: Two-thirds of the current rural pharmacy workforce’s choice of practice location has been significantly influenced by positive rural placement experiences. Rural practice was however not included in the curriculum for 50% of the rural workforce, although graduates from regional universities have experienced up to 80% more exposure to rural curricula. Rural origin was also not found to be a significant determinant of rural practice, while rural lifestyle, family commitments, remuneration, career opportunities and other contractual agreements have had a greater influence than university education.

Conclusions: Although the positive influence of rural placements has been identified, there is still a way to go in terms the development of a meaningful rural curriculum. This highlights that the universities have a role to play in addressing this issue to produce graduates who are better prepared for the opportunities and challenges of rural pharmacy practice.

Steve Jobs said ‘The most powerful person in the world is The Storyteller’, yet rural and regional communities have work to do if they are to step into this power.

Research from The Grattan Institute suggests a top-down approach, relying only on public policy to promote growth outside capital centres isn’t working. CEO John Daley told the Australian 'If you’re in a regional area, you may be unhappy that the dominant culture of the country is increasingly less like your town'. This is compounded by the rapid delocalisation of traditional media meaning regionals stories and voices are disappearing from the national conversation leaving little opportunity for city-based and international health professions to hear, see or read REAL stories about life in these areas, and as a result base their knowledge on stereotypes or outdated experiences.

We believe a bottom-up approach, that equips rural and regional communities, the medical professionals who live and work there, the medical students and their patients with the skills and a platform to share their stories, will provide better engagement, understanding and aspiration for the regional way of life.

A coordinated approach to telling and sharing these stories would be the catalyst to attracting and retaining both undergraduate students and qualified medical professionals in rural and regional areas, and the first step to improving health outcomes and neutralising the inequities.

Rural communities and organisations need to embed a strong storytelling system into their everyday roles, understand the science behind good storytelling, be skilled up to tell these authentic stories for most impact and understand the best methods for distribution.

The overall impact stretches far beyond workforce issues and speaks to the protection of rural and regional culture, fostering pride of place and promoting regional prosperity. Further to this, the implementation of storytelling systems provides a vast resource to draw upon and drive down the collective bill for time and resources spend on advocacy and funding applications.

Delegates will hear from a storytelling expert who’s collected and shared more than 20,000 stories from rural and remote areas of Australia. They will get an understanding of why storytelling is the fastest and most effective way to influence people and policy and the steps they need to take to start identifying, making and sharing the sorts of stories from their communities that are likely to influence change.

Arts and health is a growing area of interdisciplinary practice and research that has been recognised through the recommendations of the national rural health alliance. The arts are known for supporting recovery in hospital environments by reducing pain, anxiety and stress, as well as supporting community engagement and social connectedness, through giving people the opportunity for self-expression and a collective voice.

This paper will present current literature about the use of the arts and storytelling to benefit people with chronic kidney disease (CKD). In particular, the paper will explore the role of the arts in understanding and investigating the stories of people who regularly receive haemodialysis treatment. Most renal dialysis patients attend 3 times weekly with each treatment lasting 4 to 5 hours. People who live with kidney disease are more likely to experience anxiety, depression and social isolation. They report experiencing dis-empowerment, dependency on experts and medical technology, heightened vulnerability, and restrictions and challenges in everyday life.

The paper will examine the role of art programs in renal dialysis, considering music, writing, craft, painting, drawing, poetry, theatre, film and story. Studies in this area have investigated the effectiveness of the arts to improve mood, reduce anxiety, enhance quality of life factors, and to ease discomfort while undergoing dialysis treatment. Arts-based methods have also been used to understand the lived experience of patients and communicate this to the broader community.

The paper will describe a current research project at the Nephrology South Renal Dialysis Unit in Hobart. It will also consider implications about the contribution that arts programs and arts-based methods may make to improving the wellbeing for people with kidney disease and increasing community understanding about this condition.

Relevance: The increase in demand for headspace services in Tasmania has identified a need to review, and potentially refine and improve demand and intake management processes. The need for a review was identified in discussions between Primary Health Tasmania and commissioned providers for headspace services in Tasmania: The Link Youth Health Services based in Hobart and Cornerstone Youth Services based in Launceston. As per the ASGC remoteness area classification, Launceston and Hobart classify as inner regional areas (RA2). Young people accessing headspace centres however also come from outer regional and remote regions. It was identified that increased service demand and comparatively small funding increases make service intake processes and waiting times difficult to manage. It was reported that staff at headspace centres are experiencing increased workloads and are frustrated with not being able to provide timely services when young people need them. Increasing demand for service and limited access to alternative mental health service providers, adds additional pressure on headspace services to continuously review their practices and develop innovative models of care that improve efficiency and client access.

Methods: In June 2018 Primary Health Tasmania commissioned Brockhurst Consulting to review intake and assessment processes, report on innovative intake and assessment models currently used in youth organisations in Australia and provide recommendations of improvements for consideration.

Results: Key findings that are going to be presented:

• summary and analysis of current intake and assessment systems and processes in youth organisations in Australia
• recommendations for improvement of intake and assessment processes taking into consideration the local context.
• recommendation of a draft implementation plan to assist service providers with the practical steps on how to implement recommendations, including the implications of any suggested changes on current policies, procedures, workforce requirements and systems.

Background: In Victoria, there are 13 incidents of abuse or violence towards paramedics every day. Despite this high incidence, there have been very few studies looking at paramedics’ experiences of occupational violence. The aim of this study was to explore the experience of paramedics; highlight the risk factors and impact of occupational violence; and determine appropriate interventions aimed at the reduction or prevention of violence in their workplace.

Methodology: Six rural and four metropolitan Victorian paramedics who had experienced occupational violence were interviewed. Interview recordings were transcribed verbatim and underwent thematic analysis based on an interpretive phenomenological methodology.

Results: Three main themes emerged from paramedics’ description of their experiences:

• Risk factors—Common risk factors for violence were novice paramedics, the physical and mental health of the perpetrator, and normalisation of violence in communities.
• Impact—Paramedics described: mild to moderate physical injuries, significant psychological issues, social isolation and reduced confidence in their clinical practice after violent incidents.
• Recovery—Recovery after incidents of violence was dependant on several factors. These include peer support and debriefing, having a sense of justice and resolution, time and returning to work.

Discussion

• Many risk factors for occupational violence are universal and not specific to rural or metropolitan environments.
• In addition to these universal risk factors, rural paramedics operate in isolated environments where support may be unavailable or delayed.
• The normalisation of violence reduces the recognition of violence and action taken to prevent it.
• Current interventions generally focus on paramedics. Interventions should also include the perpetrators of violence and the environment paramedics work in.

Conclusion

• Violence against paramedics is increasingly considered normal in any environment.
• The impact of violence on the health and clinical practice of paramedics is significant.
• Rural paramedics have added complexities working in isolated environments.

Background: Many people living with severe mental illness experience cognitive and functional impairments that affect their ability to live independently and quality of life. People with psychosocial disability require support with aspects of daily living, and to engage in vocational, social and leisure activities. These essential support services are funded by state and federal programs, including the NDIS.

Increasingly, daily support services are provided by NGO organisations. While the relevant clinical knowledge of individuals’ care needs may be understood by community mental health services, this is often not transferred between acute and community mental health services to those providing direct care. This creates ‘the missing middle’ phenomena and has been shown to lead to poor outcomes, including frequent presentations to hospital, loss of housing and poor quality of life.

Description of the SSCOT programme: In 2016, Marathon Health’s Partners in Recovery program, based in central west NSW commenced the PIR Clinical Coordination Program (later renamed SSCOT). With an NSW Ministry of Health Innovation Grant, this program recruited experienced allied health clinicians to complete multi-disciplinary assessments with individuals, in order to develop Shared Care Plans and provide individualised training for direct care workers. This clinical and care needs information also supported individuals with the NDIS access and planning processes. At a systems level, the capabilities of key organisations in the region were assessed and a training package developed for direct care workers, focussed on understanding and practically supporting people with cognitive and functional impairment.

Outcomes, key learnings and policy issues from the SSCOT programme: Twenty-four adults with severe mental illness completed the SSCOT process. Some significant improvements were noted on measures of wellbeing and community engagement (e.g. WHODAS, HoNOS, LSP, WEMWEBS). A raft of qualitative data from individuals, family members, clinicians and direct care providers showed the program had made an important difference in increasing the capabilities of direct care providers and the quality of care received. This paper will showcase this innovative approach to assessment and care planning and focus on describing key learnings and policy issues important for future development of quality services in community mental health in rural settings.

The Tackling Indigenous Smoking (TIS) program has been funded by the Australian Government Department of Health (DoH) since 2010, as part of the ‘Closing the Gap' initiative. In 2015, a revised version of the program was launched, which committed to supporting regionally funded organisations to deliver evidence-based activities designed in consultation with local communities. In an innovative move, this support was to be delivered through an independent entity, the National Best Practice Unit for Tackling Indigenous Smoking (NBPU TIS).

Sourced through an open tender process, NBPU_TIS operates as a consortium led by Ninti One Ltd., a not-for-profit Indigenous business registered with Supply Nation. Consortium partners include the University of Canberra Centre for Research and Action in Public Health (CeRAPH) and Edith Cowan University’s HealthInfoNet. The Unit provides program funded organisations with a range of support including evidence-based resource sharing, information dissemination, advice and mentoring, workforce development, and training in monitoring and evaluation.

Funding an independent National Best Practice Unit represented a new step for DoH, one which has provided opportunities as well as challenges to those involved in the process. We describe how the program has been transformed since 2015, particularly for teams working in rural and remote communities, and the impact it has had on the health and wellbeing of Aboriginal and Torres Strait Islander people living in rural and remote areas. We also consider in detail how the voice of Aboriginal and Torres Strait Islander people has influenced policy-makers thinking in relation to the program.

We demonstrate that the success of the program is underpinned by collaboration within and between communities, organisations and services. We argue that this systems orientated approach to Population Health Promotion is the only way forward if we are to address the unacceptable health inequities experienced by Aboriginal and Torres Strait Islander people living in rural and remote communities. We explore how the insights gained from the work of NBPU TIS with the regionally funded organisations can influence future policy and action to enable better access and equity to relevant services and ensure that we continue to be ‘Better Together’.

Mining new cultural experiences at the edge of the world.

Aims: The My Health PoCiTT (MHP) program has been developed as a tool to provide extra resources to GPs to manage their chronic disease patients in rural and remote settings.

Methods: The MHP program has two individual, however strongly linked support tools for general practice – Point of Care Testing (PoCT) and Virtual Home Monitoring (VHM). Through a collaboration with Country SA PHN, MHP was developed to offer additional support to Health Care Homes Practices in country SA.

PoCT offered are NT-proBNP, HbA1c, Lipids, CRP and Urine Albumin Creatinine Ratio (ACR).  Consumables are provided free of charge with a payment to the practice to cover the nurses’ time to perform tests. Training is performed on-site and testing is performed within a quality framework. On-going support is provided.

GPs identify chronic disease patients who are suitable for VHM. Interviews have been developed for heart failure, COPD, diabetes and hypertension, in consultation with specialists. Peripherals (BP, oximeter, scales, blood glucose and/or thermometer) are collected via Bluetooth with each interview along with clinical questions related to the patient’s condition(s). Results outside the limits set by the GP are referred back to the practice for follow-up.

Relevance: Timely access to pathology results improves management of patients, in particular those with chronic disease, and prevents additional visits to the practice.  The results from this program can help to build the evidence for a PoCT rebate in general practice. Home monitoring has been shown to reduce hospital admissions and enable patients to have a more active role in the management of their disease.

Results: Implementation of the program began in June 2018, with a total of 6 practices enrolled by mid-August. To date, a total of 165 PoCT tests have been performed across all sites (21 NT-proBNP, 54 HbA1c, 20 Lipids, 44 CRP and 26 Urine ACR).

43 patients have commenced on VHM, 24 have diabetes, 20 hypertension, 13 heart failure and 5 COPD. The amount of interviews relayed back to the practices for follow-up is approximately 114 /month (18 requiring urgent review and 96 for non-urgent review).

Conclusions: Both services have been very well received. By offering mainstream rural general practices PoCT and VHM technology, the GP has additional tools and support to manage their chronic disease patients, in turn improving patient outcomes.

Australians living in rural and remote areas generally experience poorer health and welfare outcomes, including poorer access to health services than people living in metropolitan areas. For carers living in rural or remote areas, additional issues may include social isolation, lack of transportation, lack of information, less opportunities for education and literacy, and economic impacts due to environmental factors and urbanisation.

The Australian Longitudinal Study on Women’s Health has recently produced a report (currently under embargo) describing the patterns of caregiving by Australian women across the life course. The strengths of the ALSWH study are having over 20 years of data, a sample size over 57,000, and being the largest nationally representative study of women in Australia with continued representative participation from women in rural and remote areas. We used data collected from women aged 18-97 years and analysed the socio-demographic factors (including area of residence) associated with caregiving patterns, and the impact of caregiving on social, employment and health outcomes of caregivers including their health service use. The aim of this presentation is to overview some of the findings from this report by firstly describing regional differences in:

• provision of unpaid care for others with disability, frailty or illness
• the experiences of women simultaneously providing care to more than one generation, (also referred to as ‘sandwich caregivers’)
• the health and health service use of caregivers (including MBS and PBS services).

Second, as a currently relevant issue for women, we will present the analysis of use of formal and informal child care by 2500 women with children aged up to 12 years living in different regional areas. Area of residence was classified using the Modified Monash Model, with categories 1-7 representing major city, large regional, medium-large regional, medium regional, small regional, remote, very remote, respectively. In our analysis, distinct regional differences in women’s use of these services and their perceptions of availability, convenience and costs were found, with multivariable analyses showing the independent effect of area of residence on use of formal and informal child care use, after adjustment for key sociodemographic confounders. The quantitative findings will be supplemented with the findings of a qualitative analysis of the women’s freely written comments which provide context and depth to the experiences of rural women caregivers. Finally, implications for public health policy for rural women caregivers will be canvassed.

For Indigenous children leaving their community in the Northern Territory for admission to hospital in Alice Springs, there are numerous challenges. In addition to fear of medical procedures and the foreign environment of a hospital, feelings of isolation and disconnection to country are commonly reported as increasing the anxiety for children and families. The Starlight Children’s Foundation (Starlight) have been working with local partners on an Arts in Health initiative to address this issue.

As an organisation, Starlight works in partnership with clinicians to support health outcomes in Indigenous communities in the NT and WA, utilising creativity, performance and principles of positive disruption to engage with children. The organisation adopted a collaborative model through the Healthier Futures Initiative, working to support health professionals as they undertake a range of interventions such as targeted heart and ear checks or more general screening programs. This model has allowed Starlight to build relationships with the communities they visit and gain insights into the challenges faced when a child is hospitalised. Starlight team members have the additional perspective of seeing children both in their community and then in the hospital environment, highlighting the differences of experience and comfort levels for families.

The ‘Deadly Threads’ project was developed in answer to two specific challenges faced within the Alice Springs hospital—the high percentage of 5- to 12-year-old children being admitted from remote communities without anything to wear during their stay; and the feelings of discomfort and disconnection to their culture and country that affects the children within the hospital setting.

As one step in addressing these issues, Starlight used their extensive Arts in Health experience to create patient pyjamas for the children, featuring inclusive Indigenous designs. Considerations was given to the designs needing to be encompassing for children coming from across a broad range of communities in Central Australia and collaboration was undertaken, with multiple stakeholders including hospital staff, local Aboriginal liaisons and cultural advisors, as well as the children themselves.

This presentation will discuss key features of the ‘Deadly Threads’ project, with a focus on the role of collaboration in ensuring the success of it. It will look at the challenges that arose during the development and outline how they were addressed. It will discuss whether intended outcomes, such as an increase in connection, cultural pride and individual confidence, were achieved. It will also share the broader impact of the project on the hospital community.

Social and physical harms associated with alcohol and other drug (AOD) use are greater for Aboriginal and Torres Strait Islander people than non-Indigenous people and contribute to a significant burden of disease and injury for Aboriginal and Torres Strait Islander communities. When family and community members are involved in the prevention and treatment for people with AOD issues (sometimes known as ‘natural helpers’), the outcomes for an individual are often better. Evidence based information and resources about AOD are important tools to assist these natural helpers to reduce harmful AOD use in their communities.

The Alcohol and Other Drugs Knowledge Centre has developed an online Community Portal to provide this much-needed information. This presentation will describe the use of focus groups and user surveys to determine if the Portal is meeting the needs of its users, and to guide the redevelopment of the Portal.

Qualitative data will be collected from focus groups in Perth, Adelaide and Sydney in 2018 to determine the current information needs of Aboriginal and Torres Strait Islander communities. The look and ease of navigation of the Portal are other important components which will also be investigated. Feedback from the focus groups will be themed. Themes that remain within the parameters of the project will be used for updating the Portal.

The Community Portal will be updated based on the advice and direction from Aboriginal and Torres Strait Islander people who are the target audience and users. A culturally appropriate online resource that provides evidence based information about AOD can assist in empowering Aboriginal and Torres Strait Islander people working to reduce harmful AOD use in their communities.

Empowering art narratives through creative innovation, facilitation, connectivity and reflective practice.

Queensland is in the midst of ground-breaking legislative change! Through amendment to the Health (Drugs and Poisons) Regulation 1996 (Regulation), significant changes will enhance the role of many health professionals in Queensland.

Aboriginal and Torres Strait Islander Health Practitioners, doctors, nurses, and dentists working in rural and remote Queensland will notice most benefit. Aboriginal and Torres Strait Islander Health Practitioners working in isolated practice areas in Hospital and Health Services, and Aboriginal Community Controlled Health Services, will be authorised to use scheduled medicines according to drug therapy protocols, and health management protocols, and as defined in an individual practice plan.

Assisting the transition to new arrangements are a range of supporting tools, including a governance framework, Practice Plan template, and clinical assessment tools. These tools were developed through a successful collaboration between Queensland Health Workforce Strategy Branch and the Rural and Remote Clinical Support Unit.

This presentation will focus on the rigorous governance structures established, first steps taken, coordination undertaken, outcomes of the pilot in various trial sites, and challenges encountered. It will also consider the development and promotion of associated structural changes required to implement the Aboriginal and Torres Strait Health Practitioner role, and outline the risks identified along with strategies undertaken to mitigate these to achieve the successful implementation of this role in Queensland. The presentation will outline the communities involved and the numbers of Aboriginal and Torres Strait Island people directly and immediately impacted throughout the trials.

Across Australia, a quiet revolution has seen community lawyers leaving their traditional shopfronts to work from the most unlikely of settings: in hospitals and community health services. Health justice partnerships are collaborations between health and legal services that bring lawyers into the healthcare team to address the underlying drivers of poor health. Health justice partnerships tackle the intersecting health and legal problems in people’s lives, from mould in public housing causing respiratory problems or credit and debt exacerbating stress and diverting people from meeting their healthcare costs, through to family breakdown, family violence, child protection concerns and elder abuse.

From only a handful in 2014, health justice partnerships now number over 50 across Australia. They are operating in hospital and community health services; in capital cities and regional centres. They are providing legal assistance to patients broadly; while also targeting the needs of priority populations.

The paper will facilitate discussion with conference delegates about the opportunities to develop health justice partnerships further in regional and rural communities. Drawing on the recently released foundational report into the health justice landscape from the national centre for health justice partnerships, it will outline the range of services that are currently working in health justice partnerships; how these partnerships operate; and the kinds of problems they are addressing. It will explore the role that health justice partnerships play to achieve both systems change, through small-scale reforms at the local level that can have a significant impact for immediate patient communities; and systemic change, bridging the gaps in service siloes through which people who are vulnerable to complex or compounded need routinely fall.