Arts in health
A graduate of the Victorian College of the Arts, Julie Waddington has been directing and producing theatre for over 20 years. While in Melbourne, Julie worked as a director, dramaturg, production manager and teaching artist with companies such as St Martin’s Youth Arts Centre, The National Theatre, istheatre, La Mama, Melbourne Theatre Company, Short & Sweet Festival Melbourne and the Arts Centre. From 2007 to 2010 she was the Artistic Director and CEO of Riverland Youth Theatre, a nationally and state funded regional youth arts organisation. Julie has worked for most of Tasmania’s performing arts organisations, including the Tasmania Theatre Company, Ten Days on an Island and Salamanca Arts Centre. Currently Julie is Associate Producer at Tasmania Performs. Her recent directing credits include e-baby (Co-Director – TTC), How to Hold Your Breath (Loud Mouth Theatre Co), Taming of the Shrew (Hobart Repertory Theatre) and Construction of the Human Heart (TTC Associates Program). As mum to two young children and trying to juggle the mental load of motherhood alongside maintaining a creative practice, Julie initiated the seed creative development project MENTAL: the mother load in 2018 with fellow artist mums, Mel King, Bryony Geeves, Marrie McLean and Rebecca Thomson. Stage Two of the project will take place in 2019.
A creative documentary performance exploring the beauty, grotesque and poetic in the madness and mundane of motherhood.
Over her 30-year career in health Julia Waddington-Powell has held senior clinical and non-clinical roles across both the private and public health care sector; developing a strong interest in communicable disease, emergency management and disaster preparedness with a particular focus on health service resilience. As the Operations and Emergency Management Coordinator for Country Health SA, Julia has been involved in a number of major incidents affecting the SA Health system most notably as a part of the incident management team for CHSA during the state-wide power outage. In addition to her interest in emergency management, she has been involved in the development of operational projects in relation to patient flow, which fostered a passion for the integrity of the patient journey between metropolitan and country health services. In 2017 she was involved with the Royal Adelaide Hospital move, which required system wide coordination and collaboration under extraordinary circumstances; providing a rare glimpse into what can be achieved for patient flow through an integrated patient-centred system.
Access to tertiary level health care for patients living in rural and remote areas can present significant personal, financial and logistical challenges particularly in the context of the widely diverse geographical nature of South Australia.
A network of rural primary health care providers often guide the patient as they navigate the complex non-linear organic nature of the health care system however the lack of established consistent and coordinated connectivity between country and metropolitan health services means that the patient journey is often plagued by delays—relying on personal relationships between clinicians and ad hoc demand management strategies to facilitate access to specialised tertiary services rather than a system wide architecture designed to effectively and safely manage patient flow.
Long standing silos within the health care system are in part supported by a rigid governance structure of policies and protocols providing a valuable set of parameters and rules for patient flow; however a number of levers are required to enable a patient centred approach and strengthen system wide demand management strategies to support patient flow across an organic non-linear system.
The Country Health Patient Flow Framework offers a simple and adaptable patient flow architecture underpinned by best practice principles of care coordination, safety and quality and patient centred service delivery. The elements of the framework wrap progressively around the patient as the purposeful and empowered driver of the care pathway which values the contribution and feedback of the consumer experience, describes processes related to capacity and demand management across the system, and incorporates a range of quality measures to provide a quantitative feedback loop to inform ongoing improvements in the flow.
The Framework is based on a centralised flow model developed in 2017, which capitalised on strategic and operational partnerships between Country Health and Metropolitan services and played a pivotal role in the realisation of additional capacity across the system to support the ‘ramp down’ of the Royal Adelaide Hospital (RAH) and subsequent hospital move.
The development of the Framework fosters ongoing collaborative efforts across the system—between the rural and remote and tertiary level health care services, mutual understanding and trust between metropolitan and country clinical teams and fostering innovative and flexible solutions to support demand and capacity management. One system—better together.
Vicki Wade has close to 40 years’ experience working in health in many roles, including nurse educator, clinical nurse consultant in cardiology, manager of a state-wide Aboriginal vascular health program, Area Director of Aboriginal health, researcher and cultural leader of the Heart foundation. Vicki is a strong advocate for her people and followed her matriarchal lineage as her grandmother was a healer and helped with the Noongar women in birthing on country, in the mission and later reserves south-west of Perth. Her mother was one of the first enrolled nurses in Perth and her daughter is carrying on the tradition as a doctor. Vicki is well known across Australia and is well respected for the work she has done in helping to close the gap. She sits on the National Close the Gap steering committee and is a board member of the Congress of Aboriginal Nurses and Midwives. Vicki hopes that the work she does will see her grandchildren have better opportunities that she and her family were afforded.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are preventable conditions which have been eliminated from developed countries globally. It is therefore of great concern that Australia has one of the highest rates of ARF in the world, primarily affecting Aboriginal and Torres Strait Islander peoples living remotely. ARF is caused by an autoimmune response to a group A streptococcal infection, with recurrent episodes causing heart valve damage known as RHD. RHD is a chronic often fatal disease, affecting mainly children (5 -14 years) who suffer many years of crippling and debilitating health conditions. There are many complex social and cultural factors contributing to this disparity, including delayed access to care, cross-cultural miscommunication, racism and discrimination.
Rheumatic Heart Disease Australia (RHDA) believes those with the disease are key stakeholders in helping health services gain a deeper understanding of the lived experience and what this means for service provision. Those with the lived experience acting as Ambassadors can provide great comfort to people who are experiencing social and emotional hardships throughout their often very complex health journey.
Embracing programs that incorporate Ambassadors is showing great benefits for Aboriginal and Torres Strait Islander peoples with chronic disease. There are critical areas along the age and care continuum that would benefit from having Ambassador input. These include; pregnant women or women planning to have a baby, first few years after initial diagnosis of ARF, disengaged young men, transition from children to adult, secondary prophylaxis, those with increasing signs and symptoms of worsening valvular disease, end stage RHD, and palliative care.
The RHDA Ambassador program embraces and supports cultural spirituality while empowering communities. It is based on traditional Aboriginal and Torres Strait Islander culture where complex social structures with roles and responsibilities kept communities functioning safely. Mothers and grandmothers had a shared responsibility to look after all children in the community. Elders helped children grow into adults often in sacred ceremony, helping children navigate the complexities of traditional social structures. The women connected, educated and supported families through teaching spiritual and social connections. These roles have been highlighted within the RHDA Ambassador program.
This paper will describe the progress made on a partnership with community to develop a RHDA Ambassador program and toolkit. Topics explored include culture, the role and support of Ambassadors, resources they require and how to successfully co-design an Ambassador Program.
Dr Luke Wakely is a Lecturer in Physiotherapy at the University of Newcastle Department of Rural Health. He is passionate about equity for rural communities, in particular for rural children and their families. Luke is the clinical mentor for physiotherapy at the Department of Rural Health. His PhD research examined the experience of parenting a premature infant in a rural area and his research interests also include equity of service delivery for rural people with a disability. Luke also has a Masters in Paediatric Physiotherapy and continues to work clinically as an APA titled paediatric physiotherapist in private practice.
Aims: This paper aims to invite greater understanding of the lived experience of parenting premature infants in rural and remote Australia.
Methods: Parents of premature infants who resided in a range of rural and remote locations participated in semi-structured interviews asking about their experiences parenting a premature infant. Participants were also asked to bring to the interviews a photograph or memento which represented the experience of parenting a premature infant for them. Interview data were analysed thematically with phenomenology of practice the guiding methodology for data collection and analysis.
Relevance: Rurally residing families have higher rates of preterm births compared to their metropolitan counterparts yet have poorer access to support services.
Yet, there are very few studies to inform clinicians working with rurally residing families who are parenting premature infants about their particular needs and the impact of their rural location on their parenting. Indigenous Australians experience preterm birth at nearly twice the average rate and this is the first study to include the perspectives of Aboriginal mothers.
Findings: Thirteen mothers and three fathers who resided in a range of rural and remote settings. Four mothers identified as Aboriginal. The prematurity of the infants ranged from 24-weeks to 34-weeks gestation at birth. From these experiential accounts the Practice of Parenting K.I.D.S. model emerged. This model was developed to invite further understanding and reflection on facilitators and barriers to supporting parenting of premature infants. Within this model were a number of forms of distance that if increased would narrow the intersubjective space for the practice of parenting. The forms of distance were a way of describing the barriers, stressors or events confronting these families.
Conclusions: The experience of parenting a premature infant was traumatic for these participants and they described additional stressors particular to residing rurally. By using the Practice of Parenting K.I.D.S. model to reflect on their interactions with parents of premature infants, particularly those from rural areas, health professionals may be able support these families more effectively and empathetically during their parenting experience.
Professor John Wakerman is the Associate Dean Flinders NT. He has worked for the past three decades as a remote GP, educator and remote and rural health services researcher. He is a past Chair of the National Rural Health Alliance.
Introduction: All Australians should be able to reasonably access high quality comprehensive primary care that meets their needs. This is demonstrably not the case in relation to remote-living Indigenous people who have high levels of morbidity, mortality, limited access to primary care and high hospitalisation rates. Access is related to health workforce maldistribution.
Anecdotally the upsurge of short term staffing in remote communities, over recent years, has had some undesirable effects. There has been concern about cost and quality of care, particularly related to continuity of care in a complex, cross-cultural environment. Some studies have suggested that high numbers of short-term nurses contribute to stress encountered by remote area nurses (RANs). However there has been little empirical evaluation of this phenomenon.
We undertook a comprehensive study of short-term staff in 53 remote NT Government clinics with the aim of providing quantitative and qualitative information to inform ongoing policy development and practice in remote health service delivery. This paper summarises the findings of this work and focuses on the policy implications.
Summary of main findings: Our analysis found an extraordinarily high turnover of remote area health staff. The turnover (at clinic level) of RANs was 148% per annum and for Aboriginal health practitioners (AHPs) was 80% per annum. We estimated that 15% of RANs were directly employed by agencies, but this is a substantial underestimate as many agency RANs were employed on temporary government contracts.
This workforce instability has a detrimental impact on resident staff, on continuity of care, on effectiveness of care and on patient satisfaction. It also has an impact on the cost and cost-effectiveness of services. Higher turnover was associated with significantly higher hospitalisation rates (p<.001) and higher average health costs (p=.002), while higher use of agency nurses had a low (15%) probability of being cost-effective. An additional 10% of turnover annually equates to an increase of $6 per consultation. If resident RAN and AHP turnover were decreased from 128% to 40% per annum, this would decrease cost per consultation by $50, which is equivalent to an NT-wide saving of $21m.
Policy implications of findings:
There is an urgent need to stabilise the remote health workforce to ensure effective, efficient and culturally safe services. How? A piecemeal approach won’t work. The paper will detail a systemic approach that deals with:
- funding of remote services
- leadership and management
- community engagement
- culturally safe practice
- training pathways
- flexible retention strategies.
Professor Judi Walker holds a part-time professorial position in the Faculty of Medicine, Nursing and Health Sciences at Monash University. She is Adjunct Professor, Faculty of Health, University of Tasmania and Faculty of Health, Federation University. Judi is principal co-investigator of the Hazelwood Long Term Health Study, which is investigating the health impact of the 2014 Hazelwood open-cut brown coal mine fire in the Latrobe Valley, Victoria. She is also Project Lead of the GP-led Anticipatory Care Project in Ulverstone, Tasmania, to assist people with, or at risk of developing chronic illnesses to manage their conditions better. Judi is a non-executive Board Director, Latrobe Community Health Service, Victoria, Board Deputy Chair, Board Quality and Safety Committee Chair, and Board Governance Committee Chair. She was a member of the inaugural Governing Council, Tasmanian Health Service and Chair of the THS Partnerships subcommittee until the Council was abolished on 30 June 2018. Judi seeks to use the experience gained over the years to serve regional communities. In February 2018 Judi was diagnosed with breast cancer and, following surgery, has been undergoing a range of treatments with promising outcomes.
A soapbox is an ideal medium to broadcast important knowledge gained when I, a long-time rural and regional health service representative and rural health academic, was diagnosed with breast cancer. Over the past year I have experienced surgery, chemotherapy, radiation therapy and currently endocrine therapy at a new regional cancer care service in north west Tasmania.
While the passion of the moment may dictate otherwise, the plan is to outline, firstly, my role in the long process of development of this centre. This included devising and implementing processes to ensure future health professionals would be sourced from the region, trained and guaranteed to return for service. Secondly, I will refer to my role as a member of the health service’s governing body, which included commissioning the linear accelerator and officiating at the bi-partisan opening ceremony of the Cancer Centre. Thirdly, I will describe my role as chair of a statewide partnerships committee working to ensure rural health consumers in Tasmania are supported, sustained and heard.
In summary, I will share the heart-stopping process of diagnosis, my understanding of what that diagnosis involved and the joy and gratitude at recognising faces from surgical ward to cancer care centre staff who helped me through, day by day, over the past twelve months. It was a privilege and an honour to be in the care of health assistants, volunteers, the amazing McGrath breast care nurses, all nursing and medical staff and radiation therapists, medical scientists and allied health professionals. Now I better understand what a difference all the dedicated and caring employees of the health service machinery make to cancer patients’ experiences, despite the increasing pressures they face.
I have many stories to share and tips to pass on, including the do’s and don’ts of being a rural cancer patient, what not to take for granted, and how to be both respectful and chastened. Learning how to be kind to myself was the biggest lesson learned, helped along the way by people who are not just FTEs and names on lists to be scrutinised in order to balance the budget.
My experience of being on the other side of the fence will shape any future engagement I may have with health services, and in a very different light. The knowledge gained has assisted me in understanding what really goes on for cancer patients in regional and rural areas. It is an ongoing lesson for me in patience, humbleness and gratitude.
Tara Walker is a registered nurse who has made rural/remote health her career choice for the last 20 years. Tara offers skills in remote health service management, education and clincial experience. Tara has managed multi-purpose health facilities in western New South Wales. She did a Masters in Business to provide a structure to her management skills. She was successful in getting funding for clinical projects during her management roles, which assisted the health of the local communities. She was also involved in the evaluation of these projects. Tara has taught nursing at Southern Cross University. She was Director of Primary Health Care with the University of Sydney in Broken Hill, which was responsible for delivering the Diploma and Advanced Diploma in Indigenous Primary Health Care. Her current role is with the University of Sydney, as Director of the North West academic centre, based in Bourke, managing health student placements across five towns. She has authored a book entitled ‘Infectious Diseases in Children’, published by Ausmed. Tara maintains her clinical skills, she currently works at Bourke Health Service. Tara did her PhD in 1999, which was in child health with a clinical focus.
The North West Academic Centre was established in 2017. It is a hub of the University Department of Rural Health in Broken Hill. It is staffed by two people, a clinical nursing academic and a student support officer. The centre supports health students from all universities who choose to come to the North West area for placement. The Centre covers the towns of Cobar, Bourke, Brewarrina, Walgett and Lightning Ridge.
To date, the tribulations have been a 100% growth in placement numbers as well as actual disciplines. Initially there were only nursing students but now there is medicine and allied health with pharmacy due to start in 2019. The level of community engagement has increased with students participating in all community activities, as well as the longer term placements doing a community based project. Orientation processes have improved for students at all sites. Orientation was not reliable but now there is a guarantee students get an orientation.
Some of the trials include the lack of information and technology support at start up time. There was miscommunications which led to delay in network access for a period of time. There was no access to budget information so there was no indication how the finances were, as well as times of disruption from our own roles due to ‘housekeeping’ issues. There was also the ongoing need to educate home universities and the community about our role in the North West area.
There was a change of staff recently which led to a refresh of the Centre. The changes will be to focus on providing sustainable supervision. Remote ‘long arm’ supervision models will be developed for the allied health disciplines. The Centre will have more of an academic focus as opposed to just student placements. A Project Officer has been recruited to work on ethics proposals as well as develop a sustainable orientation model for all sites.
The most important overarching feature of the progression of the Centre is ensuring its’ way forward is reflective of community need, and features inclusivity as a value.
First-time presenters Top 20 abstracts
Raelene Ward is a descendant of the Kunja people from Cunnamulla. She has been a practising nurse for the last 28 years, is a qualified Registered Nurse, Researcher and Senior Lecturer in the Bachelor of Nursing program at the University of Southern Queensland in Toowoomba. Raelene has also completed a Masters in Health and more recently a PhD in Aboriginal suicide. She has a wealth of experience, knowledge and skills in undertaking research with Aboriginal people and communities bringing into these projects well established networks and rapport with many diverse communities. Raelene continues to establish a profile in suicide prevention in Aboriginal communities producing a number of publications, including peer-reviewed journal articles, opinion pieces in the Nursing Review, major reports, contributing chapters in several different nursing and education texts books within Australia.
Background: There is a paucity of information related to Aboriginal and Torres Strait Islander presentations, within Australian Emergency Departments (ED). This knowledge gap is limiting the ability of health services to optimise care for this important section of the population.
The primary aim was to describe the differences, if any, between Aboriginal and Torres Strait Islander people and non-Indigenous adults (aged 16+) presenting to the ED of South-West Queensland in terms of Age, Gender, Mode of Arrival, Medical Insurance status, Triage Category, Diagnosis and discharge status.
Method: A retrospective comparison of characteristics of all presentations over a two-year period (2016 and 2017) to EDs in the 16 hospitals of the Darling Downs Hospital and Health Services region (DDHHS).
Results: Overall, there were 250,742 ED presentations, an average of 343 presentations every day. Even though Aboriginal and Torres Strait Islander people form 4% of the overall population in the DDHHS catchment area, they accounted for 12% of ED presentations. Aboriginal and Torres Strait Islander people were significantly younger, with females presenting more often compared to non-Indigenous Australians. Also, significant differences were noted in mode of arrival, triage categories, insurance status, wait times and discharge status. Administration of medication was the most common reason for ED presentations for both Aboriginal and Torres Strait Islander people and non-Indigenous Australians.
Conclusions and implications for future research: Significant differences exist in the characteristics of Aboriginal and Torres Strait Islander ED presentations. This research expands our understanding of factors that contribute to Aboriginal and Torres Strait Islander people presenting to ED’s. Detailed exploration of enablers and barriers need to be identified for ED usage by Aboriginal and Torres Strait Islanders. This knowledge could facilitate closing the gap through the improvement in the services provided within EDs, and improve engagement and utilisation of existing primary care services by Aboriginal and Torres Strait Islander people.
Leanne Wells is the Chief Executive Officer of the Consumers Health Forum of Australia. She is a health advocate and service executive with over thirty years’ experience in health and social policy, program and service development. Leanne has held executive positions within federal government and in national and state non-government organisations. Leanne is Board Director of Coordinare South East New South Wales’ Primary Health Network, the Ozhelp Foundation, PainAustralia and the Australian Pharmacy Council. She is the Independent Chair of Coordinare’s Community Advisory Committee. She has several advisory appointments, including the Commonwealth’s Primary Health Care Advisory Group, NSW Agency for Clinical Innovation’s International Expert Advisory Committee and the Primary Care Committee of the Australian Commission for Safety and Quality in Healthcare’s Board. Leanne has tertiary qualifications in communications and business. She is a member of both the Australian Institute of Company Directors and the Australian Institute of Management.
A contemporary Australian health system must be characterised by partnerships with consumers. Partnering with consumers is about healthcare organisations, healthcare providers and policy makers actively working with consumers to ensure that health policy, information, systems and services meet their needs. Recognition of the need for a more active role for consumers in healthcare is gaining momentum.
Currently in Australia, emphasis is being given to the role consumers and communities can play in the governance of PHNs and local hospital networks, with some accompanying investment in recent years to provide governance training. However, there is a considerable way to go in harnessing the role consumers can play as agents of change in the health system. According to Alison Trimble, 2018 (King’s Fund, UK )“Consumers are renewable energy and the secret ingredient to transformational change within the health and care system”. Collaborative practice underpins co-design and is essential to implementing current health reforms in Australia.
The King’s Fund,(an independent charity in the UK) have developed a program Collaborative Pairs which is designed to support the development of the mindset and practices that underpin the culture of shared leadership and partnership and, specifically, joint clinician-consumer approaches to program and service development. The program consists of five one day sessions undertaken over a five month period to enable pairs to work on a shared work challenge in between sessions.
The Consumers Health Forum of Australia in collaboration with Western NSW Primary Health Network (PHN)and three other PHNS and the Australian Commission on Safety and Quality in Health Care (ACSQHC)are implementing Collaborative Pairs as part of a National Demonstration Trial in Australia. As one of the largest rural and remote PHNs in Australia, Western NSW PHN is well placed to test the program in a rural and remote context.
This paper will provide an overview of the Collaborative Pairs Program, the model being implemented in the National Demonstration Trial with a specific focus on Western NSW. The challenges and opportunities of delivering a world class innovative program in a remote location will be discussed as well as the need to build capacity of both consumer and clinical leaders to work together in rural and remote Australia. The importance of collaborative practice and the ways that it is being practiced, supported and integrated in Western NSW as compared to other more urban sites will also be discussed.
Sally West is a Clinical Education Coordinator and Lecturer in Remote Health for the Centre for Rural and Remote Health, Weipa site, James Cook University. Her current research is evaluating the implementation of nasal high flow therapy in the remote context and translating the evidence for this therapy into a remote context. Sally is a registered nurse and has worked clinically in rural and remote communities for the past seven years. Prior to this she worked in specialty units such as: infectious disease, emergency and paediatrics within Queensland. Sally has completed a Masters of Public Health majoring in Communicable Disease Control, a Masters of Nursing majoring in Clinical Education and a Graduate Certificate in Disaster and Refugee Health.
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.
Jayne Westling is the Principal Project Manager within the Clinical Planning team of Country Health SA Local Health Network. Her key roles are to provide project management for initiatives within the renal and emergency clinical areas in country SA. Key projects have included the development and implementation of the Mobile Dialysis Unit (the Renal Truck) and the South Australian Virtual Emergency Service (SAVES). Jayne has a background in speech pathology, working in rural NSW for 10 years prior to returning to SA. Jayne grew up in rural SA and has a passion for ensuring rural residents receive the best health care available, whether that be by traditional face-to-face services or through innovations in telehealth care.
Over the last ten years Country Health SA has increased its renal services with the aim to allow rural patients requiring haemodialysis be treated as close to home as possible. Opening new haemodialysis units, redeveloping and expanding existing units, providing support and respite to home dialysis patients as well as implementing new services such as the Mobile Dialysis Unit, Country Health SA has seen a doubling of the number of locations that haemodialysis can be provided in rural and regional South Australia and a doubling of the haemodialysis treatments provided. This has saved many rural patients from having to move away from their home town for their treatment as well as saving many hours of travelling, resulting in a reduction in the impact that kidney disease has on their everyday life.
Country Health SA has 12 satellite haemodialysis units spread across the rural and regional parts of the state, with 57 chairs, they are now treating over 190 patients each year. In 2017/18 there were around 25,500 treatments provided in country SA. The Mobile Dialysis Unit visits the remotest parts of the state, ensuring Aboriginal patients are able to return to their home communities safely, enabling them to reconnect with their people and their land. The introduction of tele-health services has provided another avenue for patient care, once again ensuring patients only travel when they really need to. Investments have been made in nursing staff training, development and retention to ensure the dialysis services provided in country SA are equal to those provided in metropolitan Adelaide.
Central coordination has been key to the success of the program over the years, a small multidisciplinary team focused on the planning of services and clinical service provision has provided leadership and direction for renal services in Country Health SA. Relationship building with metropolitan services and clinicians has also been a key success factor. Clinical support for the country dialysis units is provided by metropolitan based Nephrologists who also all provide visiting services to the units. Senior nursing support is available for the units for assistance with clinical decision making and problem solving when extra support is required. Nurse training is strongly supported and facilitated by the central team. Importantly the metropolitan team does not expect the local service and/or local GP will manage the acute dialysis related issues and therefore facilitate patient transfer as quickly as possible.
Top 20 abstracts
Monika Wheeler is passionate about increasing the community’s access to quality health care and empowering community members and health professionals to influence improvements to the health system. As a commissioner at the North Coast Primary Health Network, she is driving health system improvement in collaboration with the Local Health Districts, Aboriginal Medical Services and general practices. Monika has over 15 years’ experience leading social policy strategy and health service delivery, and holds a Master of Public Policy from the University of Sydney. She has worked at the local, state and national levels in government and not-for-profit organisations. In her earlier career Monika worked as an adviser for Anthony Albanese MP and later for Tanya Plibersek MP during the Rudd and Gillard governments. Among her achievements as an adviser, Monika was responsible for leading the development of Australia’s first-ever National Plan to Reduce Violence against Women and their Children on behalf of Minister Plibersek in 2008–2010. Monika has been with the North Coast Primary Health Network for six years.
Every winter, there is a surge in health care demand both in the community and hospitals. Older people and the vulnerable are most at risk. The Northern NSW Winter Strategy has demonstrated the feasibility of implementing an integrated response seasonal demand in a rural general practice setting.
In February 2017 a joint project between the North Coast Primary Health Network (NCPHN) and Northern New South Wales Local Health District (the LHD) was conceived to develop a more integrated strategy to better respond to vulnerable patients’ health care demands over winter. Aims and strategies were developed through a co-design process with managers, clinicians and patients.
Self-selected general practices were provided with modest incentives for additional nurse-led proactive care for their frail/vulnerable patients for a 17 week program covering the influenza season in 2017. LHD Chronic Disease Management nurses prioritised Winter Strategy patients and actively communicated with general practices. A public health campaign was also run to increase influenza vaccine uptake and respiratory hygiene practice by the public. Mixed methods were used to evaluate the patient and clinician experience of the program.
Findings from the evaluation demonstrated strong interest from primary care teams. Clinicians reported improved patient care and professional satisfaction. A global patient reported measure of health (PROMIS-10) did not show significant change. A locally developed patient reported experience measure showed high patient engagement and satisfaction at the start of the program and no significant change at the end in the limited sample with paired data. Use of Sick Day Action Plans was well received and was continued beyond the conclusion of the program. The program also helped to establish practice nurses as chronic care coordinators in a number of sites.
In 2018 the Winter Strategy was run again with learnings from the previous year incorporated. A longer lead time for practices to prepare for the implementation phase, reduced administrative burden for general practices, health coaching education for practice nurses and greater integration between primary and acute care services was pursued. A more rigorous approach to the evaluation was also implemented with the NSW Health Agency for Clinical Innovation and the George Institute for Public Health partnering to analyse hospital utilisation data and the pairing of hospital and patient/clinician experience data.
Sharon Whiteman has worked in the field of health and wellness for almost 40 years. She was an intensive care unit nurse for 20 years, and has run a business focusing on nutrition for a further 18 years. Sharon has been involved with the LDAA since its inception in 2009 and fulfilled the role of president from 2013 to 2017. She has 25 years' experience leading teams of volunteers from all walks of life, who have appreciated her calm manner, commitment to staff development and engaging style. Despite being a recovering patient herself, Sharon has been a tireless campaigner of justice for patients of Lyme disease and Lyme-like illness. She’s an endless source of inspiration for her team.
An estimated half a million people are suffering from a Lyme-like illness in Australia. Many of them cannot obtain basic medical care. They are chastised, ridiculed and suffer intolerable discrimination. Many are told it’s all in their heads.
This situation exists because of legacy thinking, dogmatic denial, ignorance in research and the extensive apathy of policy makers to properly investigate the phenomena. The impacts affect real people; these are the ‘abandoned ones’ and this is their story.
We are a small yet powerful registered charity and Australia’s peak patient body. We are all volunteers who advocate on behalf of patients for accurate information about all aspects of the illness, well-researched prevention programs, research and clinical studies, patient support and appropriate diagnostic and treatment guidelines.
In this session we’ll set out the barriers that impede the science, cripple the policy makers and exasperate the lack of communication and collaboration in Australia. The issues that surround the Lyme disease debate in Australia are complex, but it’s crucial the medical and research communities recognise both the complexity of the issue and the illness and the burdens they impose upon individuals, their families and society.
By working together, we can acknowledge the warning signs, leapfrog old thinking, apply the best that modern medical technology has to offer and design solutions for what is lauded as the first epidemic of climate change before it reaches your backyard!
We bring you the voices of the ‘abandoned ones’.
Clare Wilding is an experienced researcher, occupational therapist, and academic. Most recently, Clare has been working as a research fellow with the John Richards Centre for Rural Ageing Research on projects that explore technology use by older people. She is currently researching how technology can be used to increase support for rural carers of people living with memory loss and dementia and how to create dementia-friendly online communities. Clare’s research interests are broad, encompassing rural ageing, technology, occupational science, health promotion, managing chronic illness and disability, knowledge exchange, qualitative methods and mentoring. Previously, Clare has worked as a lecturer in occupational therapy and as a practitioner providing therapy services to people with mental illness.
Aims: The Virtual Dementia Friendly Rural Communities (Verily Connect) project is a trial of online technologies to increase support for rural carers of people living with memory loss and/or dementia. This project aims to develop an online supportive community that carers can access any time and any day of the week.
Methods: Twelve rural communities across Victoria, New South Wales, and South Australia are trialling Verily Connect strategies of carer peer support groups that meet via video-conference and a tailor-made website and mobile application (app) that helps carers to connect to each other and to services. The project is being implemented and evaluated using a randomised stepped-wedge cluster design and mixed methods of data collection.
Relevance: In rural areas, carers of people living with dementia may have difficulty obtaining peer support due to wishing to maintain privacy, low numbers of others in a similar situation in their community, and/or for reasons of preference about with whom they discuss sensitive personal issues. Geographical distance from larger population centres, which provide more anonymity and choice of confidantes, makes obtaining targeted support challenging. The Verily Connect project is testing whether using online communication strategies can increase support for isolated rural carers.
Results: The project is currently underway. Preliminary results indicate that despite potential benefits in using online technologies, there are challenges for carers in finding the time and motivation needed to learn about and use these technologies.
Conclusion: In addition to trialling the effectiveness of online technologies for supporting rural carers, it is vital to find ways to secure awareness of and buy-in by potential users, so that any benefits can be maximised.
Mary-Anne Williams has a BA in Nursing Science and a Graduate Diploma in Communicable Diseases. She has been employed at the Aboriginal Health Council of South Australia (AHCSA) since 2009. Her achievements during this time include: Inaugural Immunisation Excellence Award (University of SA), implementation of pandemic influenza infection control plans in twelve Aboriginal community-controlled health services in SA, co-author of the SA Aboriginal Pandemic Plan, and SA mass vaccination plan, development of 'Adult Health Checks Made Easy' resource (winner of a national Excellence in Indigenous Health Award for Improving Access to Primary Health Care). In addition, as a clinical educator Mary-Anne has assisted with delivery of Aboriginal Primary Health Care Certificates at AHCSA over the past six years. Mary-Anne is currently the coordinator of the Maternal Health Tackling Smoking Program at AHCSA, where there has been a reduction of 13.3% of pregnant Aboriginal women smoking since 2011 in SA.The aim of the program is to have healthy babies born to healthy mothers in smoke-free environments. Mary-Anne has a keen interest in all Aboriginal maternal health programs and currently is the representative for the National Aboriginal Community Controlled Health Organisation on the National Immunisation Committee.
Background: The Aboriginal Health Council of South Australia (AHCSA) is the peak body for Aboriginal health in South Australia (SA) and is committed to ensuring all Aboriginal people enjoy a high quality of health and wellbeing. In late 2017, an outbreak of meningococcal W in central Australia and in parts of SA affected mostly young Aboriginal and Torres Strait Islander people.
Meningococcal disease is an uncommon but serious infection. The initial outbreak response led by SA Health offered community-wide vaccination to two regions where increased cases had been detected. Subsequently a time-limited SA Health funded program was made available to Aboriginal people aged one to 19 years in regional and remote SA. Delivery of the funded vaccine program to the population at risk was largely the responsibility of primary health care providers. Rural and remote Aboriginal health services are frequently under-resourced and support was required to make these vaccinations accessible to Aboriginal people across SA.
Aim: Support the coordination and delivery of meningococcal ACWY vaccination programs in Aboriginal community controlled health services (ACCHSs) in regional/remote SA.
Method: AHCSA public health staff consulted with local ACCHSs, councils and schools regarding support needs to ensure people were aware of and had access to the vaccine during the funded program. Analysis of support requirements was completed for each region and funding sourced.
Results: AHCSA collaborated with Umoona Tjutagku Health Service and coordinated the Coober Pedy regional response. Vaccines weren’t available prior to a three day, AHCSA supported clinic, where 130 people were vaccinated. At Pika Wiya Health Service in Port Augusta, 32 people were vaccinated prior to four-day clinics where an additional 325 people were vaccinated. In Whyalla at Nunyara Aboriginal Health Service, 154 clients were vaccinated prior to the AHCSA supported three-day clinics where a further 164 people were vaccinated.
Discussion: The funded program in SA responded to increased numbers of Aboriginal young people with the meningococcal W strain including two communities where an outbreak was declared. In this situation it is important to ensure as many people as possible are vaccinated in a short time period which requires activities beyond ‘usual’ primary care. This required stakeholders to work in partnership with local communities to increase capacity and ensure equitable access. Collaboration and extensive planning resulted in successful mass vaccination clinics across SA. Working ‘better together’ with Aboriginal communities was imperative to ensure tangible access to this time-limited vaccine.
Rod Wilson is a founder and Director of Community Owned Primary Health Enterprises (COPHE), which specialises in providing innovative service and financial modelling for primary health organisations. He has extensive experience in the Australian health sector having been CEO of three Victorian Community Health services and a Medicare Local. Rod is a specialist in primary health planning in both the public and private sector. He has developed a range of innovative primary health products and ideas that have been influential at a policy and practice level. Rod is a former executive member of the Australian Healthcare Reform Alliance and has written and presented extensively about development of more sustainable and effective integrated primary health services.
Primary health planning has largely been left to the Primary Health Networks to lead and develop.
This has been difficult for PHNs which have been focused on commissioning of services, health needs analysis and service and workforce mapping.
The absence of a primary health plan has been of concern to the Gippsland PHN Victoria which covers a large area and is spread across eastern regional and rural Victoria.
The Gippsland PHN decided that in order to more rigorously and effectively purchase services, address gaps and respond to health needs a primary health plan for its catchment should be developed.
Noting the disparate and idiosyncratic nature of its catchment the Gippsland PHN is developing its plan through a series of micro place based plans in each local government area and town in its catchment.
Several of these plans will be developed in 2018.
The plans focus on building the capacity of public and private providers to
- respond more effectively to key issues confronting the health system such as avoidable hospital admissions; Emergency Department presentations; increased chronic illness and mental health issues
- build the service and financial models which improve sustainability and effectiveness of the system but especially medical practices
- develop evidenced based best practice integrated primary health teams
- benchmark minimum baseline adequate levels of primary health service throughout its catchment
Conclusion: Primary health planning is a significant gap in the Australian healthcare system. Gippsland PHN is taking steps to address this issue in its own catchment
- develop understanding about the need for primary health plans
- explain how they were developed in Gippsland PHN
- demonstrate the benefits for practitioners and patients
Activities, interventions, methods, innovations: The presentation will explain clearly the method undertaken to develop the plans including achieving support from all levels of government, private and public providers, GPs, hospitals and other practitioners.
Outcomes results: A completed primary health plan will be presented and an analysis of the strengths and weaknesses of the process and the plan.
Dr Brooke Winzer is the Chief Physiotherapist at Northeast Health Wangaratta (NHW), a 241-bed sub-regional hospital in the Hume region of Victoria. Brooke leads a team of 26 physiotherapists, along with her job-share partner, Erin Anderberg. Brooke is currently the site coordinator of two clinical trials at NHW and is supervising an Honours student from Charles Sturt University. Brooke also educates allied health, nursing and medical staff on topics including physical activity and cancer; oxygen therapy; non-invasive ventilation; chest physiotherapy and Spirometry. Previously, Brooke has been a sessional lecturer at The University of Queensland (Brisbane) and Charles Sturt University (Albury). Brooke completed a full-time PhD at The University of Queensland (School of Medicine) in 2012. Her thesis, titled 'The Effect of Exercise on Cancer Risk Factors in Males with Barrett’s Oesophagus', included three publications in international journals (Cancer, Causes & Control, BMC Cancer and PLOS ONE). She was also successful in obtaining $85,436 in competitive grant funding for the project.
Aim: A multidisciplinary tracheostomy resource team was created at Northeast Health Wangaratta (NHW), a 241 bed sub-regional health service in Victoria. Established in early 2018, the team includes a consultant physician, anaesthetist, critical care nurse, speech pathologist, physiotherapist and nurse educator.
The team is responsible for reviewing all tracheotomy patients and providing them with a comprehensive tracheostomy management plan. This service model aims to ensure that all NHW patients with a tracheostomy receive safe, best-practice care, delivered in a coordinated way.
Method: To gain the necessary skills, team members attended four-days of training at Austin Health (Melbourne) under the supervision of the eminent multidisciplinary Tracheostomy Review and Management Service (TRAMS), with funding from a NHW Travelling Scholarship.
Relevance: Maintaining a skilled workforce in tracheostomy care is a significant challenge for regional hospitals given that such patients are complex to manage and present infrequently. Coupled with the potential for serious adverse events (e.g. tracheostomy obstruction, accidental decannulation), tracheostomy patients represent a high risk population in regional settings.
To overcome these challenges, a multidisciplinary team was created at NHW to ensure the right care was delivered to the right patient, at the right time. This team received support and training from Austin Health.
Results: Team members found the training program at Austin Health immensely valuable, and benefits included:
- increased confidence in tracheostomy-related skills and clinical decision making
- greater understanding of how a multidisciplinary tracheostomy team operates, including the specialist skillset each discipline contributes to the team
- development of relationships with TRAMS clinicians – facilitating opportunities to gain advice in the future
- obtaining copies of Austin Health tracheostomy resources e.g. policies, guidelines, posters, e-learning packages
- greater awareness of mandatory equipment requirements
- a team bonding experience.
In the four months following the training, the team achieved the following:
- officially launched and promoted the service to NHW clinicians and visiting medical officers
- created a tracheostomy policy (outlining the model of care including safety aspects)
- created bed-side tracheostomy emergency posters
- reviewed and updated all tracheostomy-related equipment
- developed a staff training calendar inclusive of simulations, lectures and practicals to increase tracheostomy skills across the NHW workforce—particularly targeting Critical Care Unit and Emergency Department.
Conclusions: Working together as a multidisciplinary team is essential to deliver comprehensive and safe tracheotomy care to regional patients. Partnering with an expert metropolitan tracheostomy service made the development of this team possible.
Kylie Woolcock is Policy Director at the Australian Healthcare and Hospitals Association, a national peak body for public and not-for-profit hospitals and health care providers. Members span hospitals, primary care, community care, aged care, individual clinicians and state/territory hospital departments, providing a unique opportunity to advocate for health care that is effective, equitable, patient-centred and sustainable. While a pharmacist by background, she works with a broad range of health professions and health services, facilitating cross profession activity to increase collaboration and innovation, optimise patient outcomes, maximise efficiencies and achieve a sustainable health system. Kylie has a strong interest and diverse background in areas associated with health workforce reform, including competence and competency standards; credentialing for extended scopes of practice; recognition of advanced practice; policy development for regulation and/or funding of services; accreditation of higher education providers; assessment of overseas trained practitioners; development of support staff; education and continuing professional development.
Introduction: Allied health professionals are integral to the delivery of high quality multi-professional services that address the health needs of rural and remote communities. Responding to the broad range of healthcare needs of these communities requires a strong reliance on teamwork, multi-disciplinary and inter-professional practice and a range of service delivery strategies.
Health services have increasingly recognised that rural generalism can be considered an area of practice with a definable skill set, including both clinical and non-clinical capabilities that, although not unique to rural and remote practice, are important for these settings.
Supporting the development of allied health professionals through education and training is one of three components of an Allied Health Rural Generalist (AHRG) Pathway that aims to address some of the known challenges for small allied health workforces delivering services to widely dispersed populations in rural and remote locations. Other components critical to the Pathway are use of service delivery strategies such as telehealth, delegation to allied health assistants, extended scopes of practice and partnerships; as well as workforce and employment structures that support recruitment and retention.
Methods/strategy: Through 2018, the Australian Healthcare and Hospitals Association, on behalf of Queensland Health, developed an accreditation system for education programs that support early career allied health professionals to meet the challenges of delivering services in rural and remote areas. It has the primary purpose of supporting health services and commissioning agencies implementing the AHRG Pathway to identify education that meets organisational needs.
Development drew on:
- previous stages of the rural generalist strategy, including the AHRG Education Framework, that had been developed in close consultation with health services
- existing profession-specific and inter-professional frameworks, and
- extensive consultation with stakeholders in the education and healthcare sectors and wider community.
Outcomes: Four resources have been developed to support the accreditation system. They are the AHRG:
- Competency Framework
- Education Framework
- Program Accreditation Standards and Evidence Guide
- Program Accreditation Handbook.
Also developed were governance and business resources to support the establishment of an entity for the accreditation system.
Conclusion: When implemented, the accreditation system will assist health services and commissioning agencies to identify education programs that address the learning and development needs of early career allied health professionals in rural and remote communities. Implemented together with service delivery strategies appropriate to the setting and supportive workforce and employment structures, access to allied health services can be improved for rural consumers.
Nicky Wright is a social worker who currently coordinates and supervises social work students undertaking a rural placement in Broken Hill. Nicky’s pathway to social work began with an interest developed during many years of working in early childhood and later in welfare roles within a range of NGOs. In more recent years her practice interest has been in the field of mental health and the role that the creative arts can play in holistic health care.
Rural populations are confronted with disadvantages and inequities that detrimentally impact health and wellbeing. This same population can also experience a higher incidence of adverse social and emotional experiences across the life span. Whilst a number of services provide traditional programs to address these challenges, there is an increasing recognition of the value of the creative arts as an alternative way to enhance wellbeing.
In 2016, the Broken Hill University Department of Rural Health (BHUDRH) responded to the wellbeing needs of children in far west NSW through engaging with Holyoake in the establishment of the DRUMBEAT program into the Broken Hill community. DRUMBEAT is a groupwork program focused on improving social connection, emotional regulation, relationship skills and resilience.
The program was initially delivered within schools by teaching staff and social work students undertaking their field education placement in the region. The program has now expanded to include: community based mental health services; the use of DRUMBEAT as a student supervision tool by occupational therapy and speech pathology academics; and extended geographically to the southern regions of the Far West Local Health District. This extension has been supported by regionally located BHUDRH academic staff and social work students through funding from an external grant.
Whilst evidence exists on the positive impacts of DRUMBEAT for participants, less evidence describes the experiences of program facilitators. As social work students take a leadership role in the delivery of the program within the region, an exploration of their facilitation experience is being undertaken. A qualitative study has been designed to explore the personal and professional impacts of DRUMBEAT facilitation, including how involvement in the program may contribute to social work students achieving their learning goals. Findings from this study will inform BHUDRH decisions about the scope of future placement activities and contribute to an understanding of facilitator experiences more broadly.
Preliminary findings indicate that students value their involvement in DRUMBEAT through: exposure to an alternative, creative tool for engagement with service users; insights gained into non-verbal communication and self-expression; learning about groupwork, including challenges and the professional and personal skills necessary for group work to be effective; development of skills and knowledge broadly applicable to their future practice; and participation in an enjoyable placement experience.
Martina Wyss had a 10-year nursing career, half of which was spent in the intensive care unit, in her native Switzerland, before joining Primary Health Tasmania in 2015. By this time, she’d already gained experience and expertise in community services development and population health planning. She’d also completed a Master of Public Health degree from the University of Tasmania, during which she wrote a thesis on organisational health literacy in general practice settings. In her current role as Manager, Health Service Design, Martina manages youth mental health, suicide prevention and rural health portfolios.
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.