Concurrent Speakers

This presentation will showcase the innovative approaches being taken to building workforce capacity in aged, primary and palliative care for older Australians through the End of Life Directions for Aged Care (ELDAC) project.  This project aims to promote changes in advance care planning and palliative and end-of-life care that reduce avoidable hospital admissions, with shortened stays, and improved quality of care for people supported in residential and community aged care programs. In particular, we will address the ways in which ELDAC is addressing the needs of the aged, primary and palliative care workforce in regional, rural and remote settings.

Since its launch in mid-2018, ELDAC is focused on:

• specialist palliative care and advance care planning advice to aged care providers and GPs providing health care for recipients of aged care services
• linkages between aged care services and palliative care services
• palliative care skills and advance care planning expertise of aged care service staff and GPs providing health care for recipients of aged care services
• improving the quality of care for aged care recipients, prevent unnecessary hospital admissions, and shorten hospital stays.

We will explore how ELDAC is practically implemented through four interrelated streams:

• capacity building resources comprised of five online, interactive toolkits:
  • residential care
  • home care
  • primary care
  • legal
  • working together
• technological innovations through the development of the ELDAC Dashboard
• policy roundtables to inform decision-makers about key policy and planning issues
• service and sector development through facilitation of partnerships between aged, primary and palliative care services.

The numbers of suicide and self-inflicted injuries in the Kimberley are amongst the highest in Australia and are over 7 times higher than the state average. They are the leading cause of death for Kimberley youth between 16 and 24 years of age. Within the remote Kimberley region of Western Australia, of the 15% of adults who have a diagnosed mental health problem only 8% have accessed mental health services. Despite the high need for psychology services, there are very few clinical psychologists in the Kimberley and referred patients are on long waitlists

The Kimberley Rural Health Alliance (KRHA), a newly established University Department of Rural Health, is collaborating with Murdoch University and a number of local organisations to support clinical psychology students to expand the delivery of mental health services in the Kimberley. As there are very few accredited psychologist supervisors working in the Kimberley region it is very difficult to organise clinical placements for psychology students. The KRHA cultural security officer provides students with cultural training, mentoring and support.

KRHA is piloting a program in which clinical psychology students are placed within organisations that do not currently have psychology services, such as an Aboriginal Drug and Alcohol rehabilitation centre and an Aboriginal Community Controlled Health Service. Psychology students are integrated within the primary health care setting, often locally supervised by the senior Aboriginal health workers, whilst also receiving remote supervision by videoconference from a clinical psychologist at a city based university. This is a unique and innovative, non-traditional way to supervise clinical psychology students, which allows psychology students to be placed in culturally safe settings where there is client need.

There is an interprofessional emphasis in these placements, in which students work together with local health workers to develop and implement psychological services appropriate to the needs of the community as well as enhancing their own learning and practices in culturally responsive ways. This may include undertaking assessments, as referred by GPs and health workers, and implementing evidence informed interventions with individuals, families or in groups, that are adapted as appropriate to the local context, with input from local services.

This clinical psychology placement program is currently being evaluated for student and client outcomes and community impact. This presentation will share evaluation data and outline the challenges and some potential solutions to increasing psychology services in remote Australia and enhancing cultural responsivity in psychology training programs.

Background: Understanding cumulative exposure to temperatures is important for assessing vaccine viability. Cold chain monitoring systems in Australia do not monitor cumulative exposures for individual vaccines from point of manufacture to administration. Remote Australia poses additional challenges to vaccine integrity due to vast geographical distances, extreme environmental temperatures, disjointed supply routes and interruptions to power supply.

Aim: This study aims to quantify individual vaccine exposure to temperatures outside the cold-chain recommended temperature range (2-8°C) from dispatch to the point of administration.

Method: Sixty electronic temperature monitors were attached to individual vaccines dispatched from a remote hospital pharmacy department to remote clinics between November 2017 and March 2018. Monitors were returned with vaccine administration details and cumulative exposures to temperatures outside of the recommended range (2-8°C) were assessed.

Results: Monitored vaccines were distributed to 13 different clinics, travelling an average of 243 km (range 2.9 km to 521 km), all in non-refrigerated vehicles and often on dirt roads. Thirty one (51.7%) temperature monitors were returned, 17 (28.3%) of these were accompanied with complete administration records. All 31 monitors that were returned recorded temperature excursions above 8°C during packing at the pharmacy department, transportation to and/or during storage at the clinic. The average peak temperature exposure was 18.1°C (range 9.4°C to 27.3°C) and average cumulative time above 8°C was approximately 19 hours. Thirty (96.8%) of the cumulative temperature exposures were acceptable according to the local protocol; one episode of freezing was recorded by the monitor that was not identified by the clinic’s monitoring system.

Conclusion: Temperature excursions outside of the recommended cold chain occurred frequently, however most cumulative temperatures were acceptable according to the local protocol. This study did not capture data on vaccine cold chain prior to arrival at the pharmacy department. Future studies should include cumulative temperature data from vaccine manufacture to the point of administration to accurately quantify vaccine viability. Electronic temperature monitors are useful in identifying areas for improving the cold chain and should be considered with regular audits to test the performance of cold chain management systems.