Poster Presenters

Many rural areas struggle to retain medical specialists. This study aimed to describe factors that contribute to workforce retention and attrition in one region.

Specialists currently employed by the health service were invited via email to participate. Specialists who had left the service were randomly selected and also emailed an invitation. Tape-recorded semi-structured interview were conducted. Interviews were transcribed verbatim and thematically analysed.

Twelve interviews were conducted with stayers and 10 with leavers. Professional/workplace factors were more important than social or location factors in retention decision-making.

Tipping points were excessive workloads, collegial relationships and management issues, being offered more attractive positions, family pressure to live in a metropolitan area, educational opportunities for children and lack of contract flexibility. Those who were able to find the appropriate balance to suit their preferred way of working tended to stay in the service.

Onerous workloads, particularly on-call, resulted in exhaustion and burnout, and were an impetus to leave the service. There was recognition that excessive on-call demands were a result of a lack of critical mass, impacting on-call rostering. An inequitable distribution of the clinical workload, and the absence of senior registrars in most specialities also contributed to burnout.

Professional relationships among specialists appear important in determining whether people stay or leave. This emphasises the importance of harmonious collegial relationships within small hospitals.

Financial remuneration was not a primary factor in retention decision-making, however, there was acknowledgement of the need to ensure equitable pay scales. Flexible employment contracts, including statewide positions, flexible leave and financial incentives for efficiency were identified as ways to improve retention. Increasing CPD payments/leave was considered important to improving equity and reducing isolation.

Specialists who stayed had family connections in the area, rural backgrounds, a preference for rural living and established strong social connections within the local community. In contrast, the social isolation of family members was an impetus to leave for some.  As specialists do not usually have a pre-existing social connection to the area, it is important for the health service to organise socialising opportunities and support for specialists and their families.

To retain specialists, rural health services should ensure a professionally rewarding, harmonious work environment, without onerous out-of-hours demands. Specialists should have autonomy over workloads, access to flexible contracts, appropriate financial remuneration, access to CPD and feel valued. New specialists and their families should have additional support to assist with social integration.

This project aimed to implement an efficient and effective way to capture patient feedback after attending an Urgent Care Centre (UCC). The project is part of a larger innovation project involving four rural health services in North Central Victoria.

A review of the models of care in the four UCCs identified information about patient experience as a gap. Investigation of viable options to capture feedback concluded that SMS text message would be a low cost and efficient method of sending a patient experience monitor to patients. There was also an indication that it would yield a higher response rate than traditional mail out surveys or e-mail surveys.

The Project Team developed a detailed guideline for administering the survey to patients taking into account relevant Privacy Law and industry practice. Clear patient inclusion and exclusion criteria were defined. Implementation of the Patient Experience Monitor was centrally coordinated by the Project Team and consistent across all partner sites. Paper based surveys (with reply paid envelopes) were also provided as an option for patients. An SMS web-texting service was commissioned to send the text messages and message templates were customised for each health service. 

The Patient Experience Monitor includes three questions. Patients are asked to rate the care received, indicate how they knew about the UCC service and are given the option to make further comment using ‘free text’. Patients are provided with the details of a person at the relevant health service to contact if they want to discuss their experience directly. The text message received by the patient links them to Survey Monkey where they complete the Monitor and the project team access the Survey Monkey data to analyse results.

Results have indicated the UCC SMS patient experience survey is a viable method to capture feedback, with a 40% overall response rate. Rating of patient experience across the four sites has been consistently high. The Project Team have provided regular reports to each UCC to use in their quality improvement system. Individual patient comments have provided feedback on staff, the facility amenities, wait times and the availability of tests and GPs. The SMS Patient Experience Monitor has potential to be replicated at other rural UCC services.

Background: Each year, the Australian General Practice Training (AGPT) program offers 1,500 new training places for medical graduates wishing to pursue a career in General Practice in Australia. The AGPT program is three to four years of full-time training offered in urban, regional and rural locations nationally, delivered by Regional Training Organisations across 11 training regions in Australia.

Research in medical education and training is important to increasing training capacity and to improving educational outcomes. A vibrant research culture involves participation at all levels of general practice training – medical educators, GP supervisors and GP registrars.

In keeping with a theme of the conference, this Regional Training Organisation believes it can do better together in how it shares knowledge and information of what works to help achieve healthy communities.

Aim: This poster outlines a strategic research approach being used by the Regional Training Organisation to inform training and education for regional and rural general practice.

Approach: The RTO’s research plan to inform the development of education and training has three broad strategies:

• Collaborate—doing research in partnership with other Regional Training Organisations, universities and stakeholders builds collective research capacity
• Embrace—creating a research culture through involving registrars in Regional Training Organisation research projects and encouraging registrars to do research
• Evaluate—knowing that what we do, we do well.

The poster provides noteworthy examples in each of these strategies:

• Collaborate—examples of doing research in partnership with other Regional Training Organisations, universities and stakeholders, including: designing and validating educational assessment tools; exploring the experiences of GP registrars providing care for older patients with chronic disease; and developing opportunities for interprofessional education and training.
• Embrace—examples of involving registrars as investigators on Regional Training Organisation research projects and encouraging registrars extend their skills by doing their own research and critiquing others’ research.
• Evaluate—examples of how medical educators have evaluated aspects of the training program that focus on improving educational outcomes for registrars.

Relevance: A multi-pronged approach to building research capacity is important when training and education for general practice is delivered across diverse regional and rural areas, which often have limited resources to support research activities.

Adolescent health-care is an area of medicine that has been overlooked in Australia. Rural health services have commonly been focused toward an aging population and research is needed to redirect attention to the preferences and care needs of young people. The aims of this research were to identify the barriers for adolescents accessing health services in a rural setting and to identify features of an accessible, inclusive, youth friendly service.

Participants were recruited in two rural areas of South Australia, the Barossa Valley and the Fleurieu Peninsula. Secondary schools were approached and students between the ages of 13 and 18 were invited to complete an anonymous 27-item online survey. Quantitative and qualitative questions included health issues of concern, current healthcare access and strategies that may improve healthcare and accessibility for young people. Views and concerns regarding their experiences when accessing healthcare and how to improve their experience were also collected. One hundred and forty-six surveys were completed including 56% female and 39% males. Almost all participants were aged between 13-17 years with slightly higher representation from 14 and 17 year olds. Just over half (58.2%) listed a GP as their preferred first health-care contact, followed by pharmacy (39.7%) and psychology (23%). Approximately two-thirds (68.5%) thought it helpful to see the same GP in subsequent visits. Hoping the problem would go away, not feeling comfortable and feeling embarrassed were reported as being the biggest barriers to visiting the GP when needed.

Emotional wellbeing, substance use and sexual health were reported as the most important topics for adolescents to discuss with a GP. The practice of GPs raising certain topics even it wasn’t the purpose of the consultation was also deemed helpful. Interestingly adolescents did not indicate a strong preference for the age and gender of the GP. Participants instead valued good listening skills, non-judgmental behaviour and the use of appropriate age-specific language.

In summary, this research confirmed that GPs play a key role in the provision of care for rural adolescents. Continuity of care appears to be important, and future research might explore youth engagement and appropriate relationship building strategies for health professionals. GPs may need specific training in the provision of adolescent healthcare due to expectation of youth-appropriate care.

Aim: To examine attitudes and barriers from the perspectives of food outlet staff in providing breastfeeding friendly store environments in a rural target area in North-East Victoria.

Method: The study used a mixed method design through face-to-face interview questions and scaling of survey response categories. The study scope was all 18 food outlets within the target area. Stores were recruited through direct visits and the provision of an information sheet explaining the study. The pre-tested, self-developed survey examined staff attitudes and barriers to providing breastfeeding-friendly store environments. Additionally, researchers audited the in-store environment using the eligibility requirements for registration to the Australian Breastfeeding Association (ABA).

Relevance: Supporting breastfeeding is one of four community identified priority areas for the study site. The associated Local Government Area (LGA) had a lower rate (52.1%) of fully breastfed infants at three months than the Region (56.4%) in 2014/15. Breastfeeding is a known influencer of health into adulthood. Social acceptance and promotion of breastfeeding is a crucial factor in a mother’s desire to breastfeed in public spaces. This study is the first step in improving the provision of supportive environments for breastfeeding mothers.

Results: The study achieved 100% participation (n=18) of available food outlets. Results showed 78% of participants (n=14) believed it was important to support breastfeeding in the community. Five (5) outlets were registered with the ABA and displayed the ABA sign. Self-identified barriers for food outlets to support breastfeeding included; space for prams (n=2), seating for mothers (n=3), and lack of customer and staff support (n=4). Some (n=2), felt breastfeeding should take place in private or a separate place rather than in-store.

Conclusion: Breastfeeding friendly environments were important to a majority of staff in the food outlets participating in the study. Understanding the perceptions of the food outlet staff enables work to develop partnerships and increase the number of stores registered with the ABA, supporting more mothers to feel comfortable to breastfeed in public.

Background: Professional isolation is major reason why rural medical specialists leave their practice to work in cities. Recognising this, the Support for Rural Specialists in Australia (SRSA) program, an Australian Government funded program managed by the Council of Presidents of Medical Colleges aims to support the Continuing Professional Development (CPD) and peer support needs of rural specialists. This is achieved by providing individual grants and training via online learning programs. Funding round one (FR1) has been completed and Funding round two (FR2) is currently underway.

Method: A post-CPD activity online survey was conducted for FR1 and FR2 to establish whether key outcomes were met. Specifically, applicants were asked to demonstrate the identified need at a ‘local’ level in context of individual educational needs, to enable key knowledge/skills attainment and transfer. Key outcomes areas are: the ability to integrate learning to a wider context, the ability to contribute to and demonstrate sustainable changes in practice, and the relative ‘cost effectiveness’ / ‘value’ of their chosen CPD activity.

Results: High level feedback from FR1 has showed that with respect to remoteness most grant recipients practiced in locations rated as RA2-Inner regional to RA3-Outer regional (n=98, 88%), while remaining recipients were from RA4-Remote and RA5-Very remote (n=14, 12%). The types of CPD activities favoured by the program were courses/workshop (n=90, 62%), conference/ASMs (n=52, 36%), and clinical attachments/mentoring (n=4, 3%). With respect to learning objectives 85% (n=96) of respondents ‘strongly agreed’ that participation in an approved CPD activity helped them meet their personal learning objectives. 96% (n=108) of respondents agreed that participation in the CPD activity helped maintain their practice standards. Overall 78% (n=88) respondents found the grant application process was ‘easy’ or ‘very easy’; and finally, 59% (n=66) of respondents said they would not have attended their proposed CPD activity without the financial support of the Program

Conclusions: FR1 has been successful and received well by rural specialists. The post-CPD activity online survey has demonstrated that the program is meeting the needs of its target audience, however improvements can be made to target rural specialists in smaller Colleges and more rural specialists in the MM6-7 regions.

Case Study: Insights from the ‘Can’t Intubate Can’t Oxygenate (CICO)/Advanced Cardiovascular Life Support (ACLS)’ workshop facilitated by a SRSA grant applicant.

‘Excellent way to support regional and remote specialists who have limited peer support and educational options’—pathologist and general medicine

A key recommendation of the World Health Organization is that the management of mental health problems be based in primary care. For severe and complex mental health problems, a shift towards service delivery in primary care reduces stigma and social exclusion and allows for participation in normative life processes. The recognition and appropriate treatment of people with mental health problems in the primary care setting, however, varies, often due to a lack of support and governance. Collaborative care, whereby primary care and mental health providers share resources, skills, knowledge and decision-making to provide person-centred care is an increasingly supported model.

The Royal Flying Doctor Service - South Eastern Section (RFDSSE), has been funded by the Western NSW Primary Health Network to provide the Mental Health Nurse Support (MHNS) Service to GPs to support individuals with severe and complex mental illness within the primary care setting, through co-location with General Practice, Aboriginal Medical Services and Community Mental Health. The service operates within a collaborative, multi-disciplinary, flexible and integrated stepped care model, with the GP at the centre of care and with strong governance and clinical support.

This current study seeks to evaluate the implementation and outcomes of the MHNS Service, from the perspective of the clients (service users) and the providers involved. A mixed methods approach is being used, including clinical record audit, as well as questionnaires, interviews and focus group discussions with both clients and providers. The facilitators of, and barriers to, implementation of the service are being explored, along with the physical and mental health outcomes of clients and the cultural safety of the service in the context of the collaborative care model. The results are expected to shed light on whether the MHNS service is meeting the holistic health care needs of people with severe and complex mental illness in the primary health care setting and describe client and stakeholder recommendations for service improvement.

In short, there is tension between models of primary mental health care. Evaluation of innovative programs is needed to inform best practice and ongoing improvement of mental health care for individuals in the primary health setting. It is expected that this project will contribute to the ongoing evaluation and improvement of the MHNS service as well as to the evidence on holistic, integrated and stepped-care models of service delivery within Primary Care for people with a severe and complex mental illness.

In early 2018 the Upper Hume Primary Care Partnership (UHPCP) commenced a project to develop a catchment wide evidenced based consumer needs driven system for the prevention, early identification and management of chronic obstructive pulmonary disease (COPD). Although the project’s outward focus appeared to be on the chronic disease of COPD, the project’s focus was largely about exploring collaborative opportunities and partnership development for sustainable and meaningful systems change.

Of all ambulatory care sensitive conditions, COPD had been identified as the leading cause of hospitalisations throughout the catchment. An earlier project had also identified that there was no catchment wide planning for primary care service delivery and workforce utilisation, and no agreement about service delivery priorities. This resulted in inequitable access to health services.

A collective impact methodology was used, reflecting the belief that all stakeholders need to work together to enhance capacity for system change. In line with the PCP’s strategic function of promoting partnerships and capacity building, the PCP took on the Backbone role of bringing key players together and coordinating initiatives. A steering committee was formed to provide strategic governance. Consumer participation and empowerment was paramount, thus consumers were equal partners on the steering committee, alongside CEOs and senior managers from health services, psychosocial services, the PCP and DHHS.

The use of co-design principles was integral to the project. Consumer forums were undertaken to gather consumer input and guide initiative directions. A working group was also established to develop a model of care and to inform the steering committee. Representation was based on people’s experiences and knowledge, rather than representing their workplace. Besides consumer representation, partners for change came from beyond the mainstream health services with representation from private pharmacists, practice nurses and psycho-social services. This helped to break down the traditional medical model approach to COPD and has led to the models’ foundations for COPD management being holistic and not just the responsibility of public health services.

Using collective impact and co-design has also ensured system change was not just about explicit and easily measured changes such as policies, procedures and resources. It has allowed for the focussing on and measuring of the less explicit factors such as building relationships and connections, recognising and addressing power dynamics, and transforming attitudes and assumptions.

Progress to date indicates that holistic and sustainable system change is occurring, not just tinkering around the edges of the current system.

Introduction: The adolescent pregnancy rate in rural Victoria is concernedly high. This study sought to determine if health care professionals considered the roles of adolescent males when tackling this persistent issue.

Methods: Eight health care workers and educators from a regional Victorian town participated in a focus group where they discussed their experiences and perceptions of the adolescent males’ role in reducing adolescent  pregnancy rates.

Results: Four major themes emerged from the data:

• Gender stereotyping—‘sowing their wild oats’  and ’boys will be boys’ were offered as explanations for lack of adolescent male engagement.
• Adolescent males as health consumers—adolescent males are poor consumers of health and ‘invisible’ in this space.
• Complexity of issues—low socio-economic status, rurality and illicit substances are considered contributing factors.
• Focus on fatherhood—discussion diverged frequently from talking about pregnancy prevention to the adolescent male’s potential role as unintended fathers.

Discussion

• Health care professionals and educators in this rural region, do not consider adolescent males’ to be relevant in this context and their focus is neither on male adolescents nor on pregnancy prevention but on supporting the adolescent mothers with unintended pregnancies.
• Adolescent males were identified as a cohort that is very difficult to engage in any kind of health care strategy let alone one that is focused on pregnancy prevention and unintended pregnancy. This lack of interaction with health care, correlates with traditional masculinity norms that reinforce beliefs around the male body being strong.
• Participants interpreted  the behaviour of the adolescent males in this rural region as typically ‘boys being boys’ who were ‘sowing their wild oats’.
• Not only does this traditional masculinity seem to be accepted as normal in this rural region but the focus group participants did not believe that it was within their power to positively impact on this ideology.

Conclusion

• Acceptance of traditional masculinity behaviours as an explanation for perceived adolescent male behaviour by health care professionals, only serves to perpetuate gender stereotypes and does not help to address this significant issue.
• The responsibility for finding these invisible and hard to reach young men, rests in the professional duty of the health care professionals and educators.
• Health professionals need to alter their current thinking and begin to develop more inclusive practices so that the significant issue of prevention of adolescent unintended pregnancy can be addressed.

Introduction: Preventable hospital admissions are admissions that are avoidable if timely and adequate primary care had been provided. In 2015–16, in Australia there were nearly 680,000 such admissions representing 6% of all hospital separations and 2.7 million bed days. People in regional, rural and remote areas have higher levels of socio-economic disadvantage, higher rates of chronic disease and poorer access to health care than people living in major cities. The aim of this research was to describe the rates and characteristics of preventable hospital admissions for oral health-related conditions, by remoteness area.

Methods: The Australian Institute of Health and Welfare provided hospital admissions data for patients admitted for an oral health-related condition 2010/11-2014/15.  The data were analysed by age, sex, length of stay, reason for hospitalisation, funding source and Australian Statistical Geography Standard (ASGS) remoteness area (RA1-Major City to RA5-Very Remote).

Results: There were 316,937 hospital admissions for oral health-related conditions over the five-year period. The rate of potentially preventable oral-health related hospital admissions ranged from 2.45 to 2.54 per 1,000 population in RA1 during the 5 year period. Rates were highest among those living in RA4 (3.92-4.14/ 1,000) and RA5 (3.87-4.40/1,000). Dental caries was the most common reason for oral health-related potentially preventable hospital admissions (1.44/1,000). Rates of admissions due to caries were highest in RA4 (2.2-2.3/1,000) and RA5 areas (2.3-2.5/1,000).

Conclusions: Preventable hospital admissions for oral health conditions was higher in remote and very remote than other areas.

The Starlight Children’s Foundation (Starlight) delivers programs in partnership with health professionals, to support children, adolescents and their families who are living with a serious illness, disability or health condition. The organisation has deliberately adopted a collaborative model, recognising the value in utilising our expertise in engagement, positive distraction and play, to work alongside clinicians to support health outcomes in regional and remote areas.

This presentation will outline a number of case studies highlighting the way in which a non-profit organisation can support health professionals and intervention programs to ensure better clinical and psychosocial outcomes across rural Australia. It will discuss the method and efficacy of programs such “Captain Starlight” (professional performers, who work with medical teams to help engage with or distract patients depending on the needs of the situation), and the Livewire program which supports regional adolescents via an online peer community.

There will also be a discussion of the collaborative nature of Starlight’s Healthier Futures Initiative, which helps children in remote Aboriginal and Torres Strait Islander communities through an integrated care approach. Working with a range of primary health care teams, Starlight has been at the forefront of initiatives to improve major concerns such as heart and ear health in this vulnerable population in remote areas. By engaging with at risk children through creative interactions, Starlight has helped improved retention at clinics, promoted prevention and early intervention. The rapport built with children and families has also been reported to alleviate anxiety in children who travel from community to be hospitalised in metropolitan facilities, with the highly visible Captain Starlight providing a much-needed sense of connection and familiarity.

Additional benefits of the partnership approach to be discussed include assisting to enhance the relationship between the community and health professionals. By working with the youngest members of the community, the program aims to facilitate a change in attitude towards healthcare, creating a positive, anxiety-free experience.

This paper will provide practical insights into a successful on-the-ground service delivery by a non-profit organisation using a collaborative approach to help achieve clinical outcomes. It will draw out lessons learnt from partnering with a range of organisations and highlight the impact of the approach on children and young people in rural and remote communities. Overall, this presentation will showcase an innovative and highly successful program model that demonstrates the value of a community organisation partnering with clinicians to enhance the rural healthcare experience.

Going Rural Health is a Commonwealth funded initiative that supports rural nursing and allied health student clinical placements, via support of students, rural health services, and the health workforce. The program operates in three regions of Victoria; Ballarat and Grampians, Shepparton and Goulburn, and Wangaratta and Hume regions.

Each region has developed student clinical placements that, in addition to providing varied quality clinical experiences, also improve patient access to local health services. These ‘Service Learning’ placements have proved to have many benefits to health services, placement supervisors, health professionals, and clinical placement students, but importantly also to clients, patients and the local community.

These placements have been successfully implemented at varied locations, including health services, nursing homes, primary care agencies, community NGOs, primary schools, kindergartens, and home visits to farms.

Aged care facilities have been the main focal point and one of the most successful service learning placements to date, since many rural areas have an aging population, and often limited hospital services, but usually have at least one nursing home with limited allied health services. One such site had no regular allied health presence, except for limited visits for pain management, but programs developed by an interdisciplinary allied health student clinical placement team had a big impact on the residents in the areas of speech and communication, mobility and strengthening, and lifestyle and wellbeing. This project also helped the nursing home begin to implement Montessori principles and improve the quality of life of their residents.

Primary schools and kindergartens have been other settings where the students have fitted in well, at multiple sites. Starting with physiotherapy only, and evolving to multidisciplinary placements, the students have implemented screening programs and therapy services for underprivileged children who otherwise would have had little or no access to these services.

Outpatient and outreach services have also benefited from students on clinical placement. Students have been involved in various projects, including teaching lifestyle skills to the homeless, assisting with rehabilitation exercise programs, reducing long waiting lists for outpatient allied health services, and providing intensive therapy—that otherwise wouldn’t have been possible—for patients in the community.

This poster will outline some of the success stories across our regions, via photographs, case studies, interviews and stories, and feedback on the impact on client health and wellbeing as a result of the program.

Aims: The Australian Institute of Health and Welfare monitors the health and welfare of rural and remote populations. A recent feature article in Australia’s Health 2018 brought together information to present a picture of the health of Australians living in rural and remote areas as well as influencing factors. This included information on demographic profile, risk factors, chronic conditions, disease burden, deaths and access to health care.

Methods: AIHW drew on range of data sources, including those based on administrative and survey data. Where appropriate, data were age-standardised to allow for more comparable estimates across remoteness areas.

Relevance: The details of this presentation will help provide context for other presentations and general discussions at the National Rural Health Conference.

Results: Australians living in rural and remote areas face unique challenges due to their geographic isolation, and often have poorer health and welfare outcomes than people living in Major cities. The proportion of adults engaging in behaviours associated with poorer health—such as tobacco smoking and excessive alcohol consumption—is higher in rural and remote areas than in metropolitan areas, as is (generally) the prevalence of chronic conditions. These poorer health outcomes may be due to factors such as disadvantage in education, employment opportunities and income. Rural and remote Australians also have higher rates of potentially preventable hospitalisations and overall hospitalisations, which may be due to poorer access to medical specialists and primary care professionals.

Conclusions: There are disparities in the health status, determinants of health and access to healthcare services across remoteness areas in Australia. Information on the health of rural and remote Australians can be used to address these disparities by informing health policy, research and analysis and health care funding arrangements.

Limitations with assessing the implications of remoteness on health include the interactions between remoteness, low socioeconomic position and the higher proportion of Indigenous Australians in many of these areas compared with Major cities. There is also scope to enhance the availability and coverage of health data in rural and remote areas.

Objective: To evaluate the appropriateness of plain abdominal X-ray (AXR) requests in adult patients presenting to a Victorian regional emergency department (ED).

Method: A retrospective chart review was performed of all adult patients with a plain AXR requested by ED medical staff in a regional healthcare centre in Victoria, Australia in 2016. Patient demographics, ED disposition and any further imaging results were extracted from the medical record. Indications for x-ray and clinician seniority were determined from the radiology request slips signed by the treating emergency doctor. Appropriateness of imaging was determined by comparing the indication for abdominal radiograph to local evidence-based guidelines.

Results: 109 episodes of plain AXR requests met the inclusion criteria. Of these, 40 were considered inappropriate according to clinical guidelines. Overall, 36% (39/109) had normal or non-specific findings and 42%(46/109) demonstrated faecal loading, while 22% (24/109) identified pathology. 33 patients had further imaging, mostly with computed tomography (CT). Junior staff were responsible for most of the AXR requests.

Conclusion: In our regional hospital ED, over one third of AXRs requested for adult patients were inappropriate according to clinical guidelines. AXRs have a low diagnostic yield and frequently do not reduce the need for further imaging. The use of a clinical practice guideline and junior staff education may increase the appropriate use of plain AXRs in the regional ED setting.

Improving the quality of health services means working together for change. Managers are the key drivers of change in health services. Yet, the pathway to manager often occurs by default, either being ‘last man standing’ or through natural attrition. CRANAplus recognised the ‘churn’ of the remote workforce influences the unintended career pathway for many clinicians becoming operational managers. As a consequence, operational managers often see themselves, first as a clinician and second as a manager. Thus, being inadequately prepared as managers to meet the contextual challenges associated with their responsibilities in managing remote health services. Hence, it is a tough gig for managers without the essential grounding in management competencies.

The implementation of the National Standards for Health Services in 2013, was the impetus for CRANAplus’ National Standards Project. The Project Report’s findings supported CRANAplus’ viewpoint that there was a lack of consistency in the standard of healthcare and that while improvements were needed broadly; it was imperative that there was a focus on the health workforce.

In 2015, a workshop was held with managers who identified key skill deficits and advocated for context specific professional development. In particular, advocating for a much-needed short course for remote and isolated area managers, for compliance in clinical governance and a focus on change management leadership skills.

Working together, CRANAplus and representatives from the remote sector developed a 12-week Remote Management Program (RMP) which consists of online modules; a two-day workshop and a nominated workplace CQI project. In partnership with James Cook University and the Australasian College of Health Service Management (ACHSM), CRANAplus took a CQI approach to examining the outcomes of the RMP with a view to learning how to continue to meet the needs of remote managers.

This paper shows that by working together, a short-course professional development program specifically designed to meet the needs of remote and isolated managers can be implemented. The paper shares the process of the successful implementation the RMP and some of the key findings from preliminary research.

The implementation process took a collaborative approach to program design and delivery. The partnership with ACHSM further emphasised the benefits of working together to support managers in developing their competence with clinical governance. The paper concludes by sharing the lessons learned so far and how CRANAplus will work with remote managers so that they can continue to develop the essential competencies to drive change.

Aboriginal and Torres Strait Islander children have one of the highest rates of middle ear disease in the world. In some remote communities, up to 91% of children are affected. Hearing loss is associated with poor physical, social and psychological outcomes, with strong links to low educational attainment, which can later impact on employment opportunities, and increased risk of incarceration. People residing in remote and rural communities also experience unique challenges in accessing healthcare, such as distance and time away from home, and the cost of travel. Reports show that many public outpatient and surgery waiting lists are unreasonably long with patients from remote and rural communities often failing to attend appointments or waiting years for surgery.

Timely and appropriate surgical access for Aboriginal and Torres Strait Islander people in remote and rural communities who have hearing conditions that require surgical treatment is therefore essential to improving quality of care and health outcomes.

In 2015, a program was developed to improve access to ear surgery and support culturally appropriate pathways for Aboriginal and Torres Strait Islander people, with a focus on those living in remote and rural communities. The program, which has facilitated access to ear surgery for over 200 Queensland children, was delivered in collaboration with local stakeholders to identify and overcome barriers to surgery and reduce health inequities, improve patient support and the surgical journey, and reduce surgical waiting times for those who need it most.

The program implements a ‘group surgery’ model of care that recruits the assistance of local Aboriginal Community Controlled Organisations and health workers to support the patients to book and travel to appointments, complete paperwork and provide education about the procedure and follow-up care, while the program funds the travel, accommodation, the surgeon and facility fees.  

In 2017, an evaluation was conducted via stakeholder surveys and interviews to measure ear surgery outcomes and determine whether the program is successful in overcoming barriers to access to surgery in comparison to the current public surgical pathway. 

The evaluation showed that patient comfort and confidence was enhanced by travelling with their community and patients demonstrated greater knowledge about their condition and treatment. By overcoming financial disincentives for providers and patients, the program achieved better access and more timely care.

The program is delivering improved outcomes by offering a model of care that overcomes key cultural, geographic and systemic barriers to accessing timely surgical treatment, through stakeholder collaboration and flexible funding.

Aims: The WA Country Health Service (WACHS) undertook an audit in 2016 which identified opportunities to increase support to patients prescribed oral cancer therapy, to improve self-care and safe self-administering of treatment. In order to address this, a nurse led clinic utilising telehealth was implemented. The service aimed to improve quality and safety, increase patient support and improve access and completion of treatment.

Methods: Patients under the care of Fiona Stanley Hospital (FSH) Medical Oncology Department, who were prescribed oral cancer therapy were eligible for referral into the service. The service was trialled between September 2017 and April 2018. Interventions delivered through the service included delivery of education sessions to patients and carers, assessment of baseline vital signs and diagnostics, medication history, toxicity assessments and management, ordering diagnostic investigation and prescribing of supportive treatments, among others.

Relevance: Oral cancer treatments are increasing in number and complexity, and often involve novel toxicity profiles. Additionally, there is an increased risk of drug interactions while taking oral cancer therapy. As such, there is a need to ensure patients prescribed oral cancer treatment have access to support for education, assessment and toxicity/symptom management.  

Results: During the intervention phase, 41 patients (average age 62 years) from five regions across country WA were referred to the service. 180 outpatient service events (43% using telehealth) were provided with an average of 4.3 interventions per patient. The most common diagnoses in the cohort were colorectal, breast and lung cancer, and 64% of patients had multiple comorbidities. Capecitabine was the most common oral chemotherapy protocol. 100 percent of patients who completed the post service evaluation strongly agreed the nurse practitioner helped them to manage their treatment at home.

Conclusion: Patients living in rural areas who are prescribed oral cancer therapy require support to help ensure safe self-administering of treatment. This project explored the number and nature of patients referred to a nurse practitioner for support while receiving oral cancer therapy. The trial identified opportunities to increase patient and carer education, improve monitoring and management of toxicities, and increase rates of treatment completion, through the use of telehealth to assist country patients receiving oral cancer treatment.

One of the most significant challenges in providing diabetes care to rural Tasmanians has been the management of multiple programs funded from different sources, with no clear referral pathway.

To improve access and equity to diabetes care, and to improve the efficiency and effectiveness of services, Diabetes Tasmania linked programs funded by different Commonwealth and State sources to provide a range of streamlined and complementary services which can be accessed through a single referral process. This Integrated Care Pathway consists of a number of interventions designed to provide access to targeted, evidence-based diabetes self-management education. The components of the service model include the National Diabetes Services Scheme, group education programs, telephone health coaching and one on one diabetes and dietetic clinical consultations. Each of these interventions provides specific education and support for people at different times in their individual diabetes journey.

One of the key features of the model is the inclusion of all programs on a single referral form, embedded into general practice software. This allows quick and easy referral of eligible patients to programs by general practitioners (GPs) and allied health professionals. In addition, a visually appealing pictorial overview of the referral process was provided to GPs to inform and remind them of the service options available. Targeted engagement with GPs to promote the new pathway has led to improved patient engagement with services and positive health outcomes. This includes increased participation in group programs and telephone coaching, significant reduction in diabetes distress and increased diabetes empowerment as well as high patient reported satisfaction.

This initiative has highlighted that improving access to health services requires a simple and streamlined referral system, together with regular and dynamic engagement with rural communities, including general practice, community nurses and people with diabetes.

The Integrated Care Pathway is evidence that we can do better in providing access to the right kind of diabetes care, at the right time, for people in rural areas by streamlining services, irrespective of funding source, and by simplifying and improving the referral process to allow more people to benefit from a range of services specific to their needs.

To build on the strengths and outcomes of this initiative Diabetes Tasmania intends to continue evaluating and responding to the unique needs of small communities through concerted engagement with key community members.

This presentation aims to highlight the potential benefits of telehealth, an increasingly important technology that enables healthcare providers to reach all Australians. We will also outline the journey Telstra Health has undergone to try to solve one of the most complex and challenging issues in the Australian healthcare system today – how do we effectively bridge the health services gap between residents in rural and remote areas and those in major cities?

Telstra, including Telstra Health, has a proud history of working to provide eHealth technologies and the telecommunications infrastructure needed to connect and better serve the needs of all Australians, especially those located in rural and remote areas. With Australia’s unique and vast landscape, we believe that telehealth, the remote management and delivery of healthcare, will play an integral role in overcoming some of the most difficult challenges facing rural and remote healthcare in Australia including: inequality of access, closing the gap in Aboriginal and Torres Strait Islander health outcomes and life expectancy, the growing burden of chronic disease, a rapidly ageing and geographically dispersed population, as well as maintaining safety and quality of service delivery in the face of workforce supply issues.

Since 2016, Telstra Health’s telehealth business has collaborated with a number of different health providers and funders to develop and evaluate new models of eService Delivery, designed to address the types of challenges that contribute to the poorer health status of rural and remote Australians. This presentation will showcase the telehealth innovations that have resulted in measurable improvements in access to health care in rural and remote communities, as well as the learnings that have helped us, and our partners, to deliver even better telehealth experiences. Through case studies we will examine the different drivers for change in each of our partner organisations, along with the design elements of our products and approaches to implementation that have led to improvements in the efficiency and effectiveness of telehealth-enabled models of care.

The provision of holistic family centred healthcare for young people and their families is paramount for all healthcare users inclusive of those living in Rural, Remote and Indigenous communities.

The Quality of Care Collaborative Australia Project (QuoCCA), aims to build capacity in the provision of paediatric palliative care in identified communities. The QuoCCA project consists of a time sensitive, “Pop up” model of care. This patient led model of care aims to build and enhance the local healthcare communities existing knowledge and strengths. This is achieved through time specific, care focused and specialised sustainable education sessions surrounding paediatric palliative care and advanced care planning. This education makes it possible for specialist teams to come together with local teams to support the young person and family receiving palliative care whose final wish consists of returning to rural home towns or to country.

For Indigenous Australians, the connection to their country is intrinsic to their identity. This cultural connection can be challenged when required to receive specialised care at tertiary healthcare settings in major cities. This means the support required for these indigenous families is specific and specialised. When Indigenous families are faced with no further treatment options for their child, returning to country is not only paramount for the child and immediate family, but for the entire indigenous and rural community.

This presentation will focus on the case of a young indigenous baby with a life limiting condition who’s parental need to return to country and the arms of their mob initiated a supportive response through the QuoCCA project. This response ensured that they returned to country in a timely manner. The community and healthcare workers were empowered through specialist education and support to ensure that the end of life for this baby occurred in a way that was supportive, sustainable and respectful of her indigenous culture.

Chronic pain is Australia’s third most costly health condition, generating billions of dollars of avoidable health expenditure every year. Effective management requires a biopsychosocial approach, which is best achieved through inter-professional collaboration. While best practice treatment principles are now well established and pain-specialised services exist in most city areas, sustainable service development in rural and remote Australia has been complicated by a range of factors including geographical isolation, high rates of staff turnover and limited access to specialised clinical experience.

Successful inter-professional treatment models for chronic pain do exist and share a number of key features in common. We outline a process for the design and implementation of innovative chronic pain services, in rural and remote Australia. Aligned with current literature and informed by practice, this poster reviews the characteristics of innovative allied health services and proposes a model, (currently being piloted in the Northern Territory), to design and implement innovative pain management interventions, aimed at reducing the impacts of chronic pain in rural and remote populations, where recovery is complicated by unique psychosocial and systemic barriers.

In particular, a process of service definition, financial analysis, stakeholder profiling and operational risk management is proposed, to identify local needs, consider business context, draw on existing organisational structures and knowledge, ensure service sustainability and embed an inter-professional practice approach to reduce the risk of long-term disability. Key learnings are reviewed, with recommendations for policy to support innovative service inter-professional service development in rural and remote communities.

Introduction: The optimal care pathway (OCP) for people with oesophagogastric (OG) cancer defines the optimal times between key stages in the patient journey, such as diagnosis and first treatment. The aim of this study was to determine the extent to which the OCP for people with OG cancer could be mapped across one public hospital and one private hospital located in the Loddon Mallee region (LMR) of Victoria.

Method: The cohort for this analysis comprised all patients who were newly diagnosed with OG cancer (International Classification of Diseases and Related Health Problems [ICD]-10 diagnosis codes C15 and C16) at two LMR hospitals over the 18-month period 1/7/16-31/12/17. Eligible cases were ascertained using data from the Victorian Cancer Registry. In preparation for retrospective auditing, the service system and data systems were mapped to identify the best source of data for each key OCP field. Six key OCP dates were then obtained from the paper and electronic records kept in the two regional health services. The proportions of dates captured were calculated.

Results: Overall, 62 OG cancer patients were included in this data mapping exercise. The proportion of OCP dates captured ranged from 84% for date of first specialist appointment to 100% for date of OG cancer diagnosis. In order to achieve this extent of data capture, auditors invested significant time and effort in reviewing eight structured and unstructured hospital databases as well as paper-based medical records. Consistency checks and data cleaning were also required.

Conclusion: While it is currently possible to map the OCP timelines for most OG cancer patients at the two regional hospitals, there is a considerable amount of work involved in obtaining key dates from multiple data sources. The Loddon Mallee Integrated Cancer Service is in the process of advocating for the inclusion of key OCP dates in electronic medical records and repositories at regional hospitals.

Health science is inherently visual in nature. All health science disciplines, to varying degrees, make use of images, shapes, patterns, infographics, graphs, and data visualisations to illustrate concepts. This occurs through the act of observation—one of the defining features of both science and art. It has been apparent throughout history that observations made from an artistic perspective can complement those made from a scientific perspective. Indeed, when the arts are incorporated into the scientific method, the inductive reasoning, logic, pragmatism, and precise terminology of science may be enriched by the inspiration, intuition, aesthetics, and emotion that characterise art.

My interest in combining health science with art, particularly poetry and photography, stems from my diverse professional background. In addition to my role as an adjunct research associate at Monash University School of Rural Health, I am a data and quality specialist, writer, poet, and visual artist. As part of my arts practice, I have drawn upon my background in health science and my experiences of living and working in the Goldfields region of Victoria to help visualise rural health through the arts.

When visualising rural health, I employed a multi-art approach encompassing concrete poetry, haiku, and digital photography. Concrete poetry is a mode of graphic art that focuses on the visual appearance of words, including typography. Concrete poetry about science can capture readers’ attention and reinforce the information being conveyed in words. Haiku, on the other hand, is a minimalistic Japanese poetic form. While digital photography produces actual photographs, haiku can be described as ‘written photographs’ in that they evoke visual imagery that is memorable and, traditionally speaking, related to nature.

Using these three art forms, I created four artworks about rural health that have subsequently appeared in literary and health publications. I will show and discuss each of the four artworks in my presentation. Firstly, ‘Bosisto’s Eucalyptus Drops’ is a haiku that evokes three separate yet related visual images: the Australian bush, a naturally-derived pharmaceutical product, and a person experiencing a positive health outcome. ‘The Pharmacokinetics of Paracetamol’ is a concrete poem that visually represents the movement of a widely accessible non-prescription drug through the human body over time. ‘The Day Grandpa Passed’ and ‘Goldfields Health’, meanwhile, are contemplative digital photographs taken in a regional hospital and a rural botanical garden, respectively. By presenting and discussing these four artworks, I will demonstrate my multi-art approach to visualising rural health.

The premise: Insulin is a temperature and light sensitive medication. It is provided in a managed Cold Chain from manufacturer, wholesaler and pharmacy to the patient. The standard PBS supply quantity may be a few as six weeks (>175 units per day) and a many as 40 weeks (<25 units per day). These storage conditions vary greatly as does the ‘room temperature’ depending on the season and facilities available in the individual’s home. There is anecdotal evidence that some ‘outlier’ BSL readings could be due to inappropriate storage.

The goals

• To supply Insulin in an appropriate quantity based on the individual’s use and requirements.
• To provide a ‘Cold Chain’ monitoring system for all Insulin products for the home.
• To educate diabetics and their carers on the appropriate storage and life of Insulin.
• To dispose of unused and out-of-date Insulin products appropriately and safely.

The pitch: In Tamworth and Moree to identify clients in our pharmacies on Insulin. To invite people to join our trial to:

• Educate Community Nurses, Aboriginal Health Workers, patients and carers in the cold chain management of Insulin
• Tailor a suitable supply program for Insulin in a quantity suitable for their scheduled usage
• Identify a suitable Insulin storage and transfer system to meet the environmental conditions
• Monitor the temperature of the at home, reserve stored Insulin daily
• Record and monitor BSL with a view to identify any irregular levels and any connection to a batch or individual pen of their Insulin supply.
• Dispose of unused, damaged or out-of-date Insulin by return to the pharmacy the RUM process.

This process would be supervised by a pharmacist. The University of Newcastle Rural Health program would provide students and lecturers to review data and help identify all issues in this process.

Chronic pain is Australia’s third most costly health condition, generating billions of dollars of avoidable health expenditure every year. Effective management requires a biopsychosocial approach, which is best achieved through inter-professional collaboration. While best practice treatment principles are now well established and pain-specialised services exist in most city areas, sustainable service development in rural and remote Australia has been complicated by a range of factors including geographical isolation, high rates of staff turnover and limited access to specialised clinical experience.

Successful inter-professional treatment models for chronic pain do exist and share a number of key features in common. We outline a process for the design and implementation of innovative chronic pain services, in rural and remote Australia. Aligned with current literature and informed by practice, this poster reviews the characteristics of innovative allied health services and proposes a model, (currently being piloted in the Northern Territory), to design and implement innovative pain management interventions, aimed at reducing the impacts of chronic pain in rural and remote populations, where recovery is complicated by unique psychosocial and systemic barriers.

In particular, a process of service definition, financial analysis, stakeholder profiling and operational risk management is proposed, to identify local needs, consider business context, draw on existing organisational structures and knowledge, ensure service sustainability and embed an inter-professional practice approach to reduce the risk of long-term disability. Key learnings are reviewed, with recommendations for policy to support innovative service inter-professional service development in rural and remote communities.

Background: Eating disorders are defined as excessive and persistently disturbed eating or eating-related behaviours that lead to changes in the person’s consumption of food to a degree that is harmful to their health and well-being. Hospital admission due to eating disorders are rare, however they are often extended and require a specialised and multidisciplinary approach. Eating disorders are very important diagnoses in paediatric populations that can have long-lasting effects in many facets of life. It is therefore crucial that initial assessment, management and follow-up care be optimised.

Aim: To assess the management, discharge planning and outcomes of paediatric patients admitted to the Doris White (Children’s) Ward, ARRH

Methods: Retrospective audit assessing patients aged under 18 admitted to ARRH for whom the primary reason for admission was an eating disorder from January 2013 to December 2017. Data was taken from IPPM medical record coding; paper and electronic medical records were examined. The CEDD Eating Disorders Toolkit (2008) was used as a gold standard of assessment and management. Aspects of initial assessment, investigation, management and follow-up were audited in comparison to this guideline.

Results: Following exclusions, there were 10 admissions due to eating disorders in the 5-year period audited. They were all female with a median age of 16.5 (11-17). The median body-mass index (BMI) on admission was 16.9, with 40% below the fifth centile for BMI. 60% were medically unwell (as per CEDD guidelines) on admission. 20% of admissions had a documented postural blood pressure and heart rate, with inconsistent documentation of investigations. Despite a high proportion of medically unwell patients, most (70%) were fed orally, with two receiving nasogastric feeds and one failed nasogastric tube insertion. One patient had psychiatric involvement during admission. Social work and psychology were involved in all admissions; physiotherapy in 70%. All admissions had documented multidisciplinary team (MDT) meetings involving goal setting. There was one re-admission within two weeks.

Conclusion: Appropriate patients were admitted, with incomplete assessment within the first 24 hours. There was encouraging multidisciplinary teamwork, however multiple medically unstable patients were not fed nasogastrically as per guidelines. There was inadequate psychiatric support due to lack of service in the rural setting. Follow-up planning was well carried out and there were good outcomes, with only one re-admission within two weeks.

Background and aims: Acute pain management services (APMS) are associated with significant decreases in postoperative pain. However, such services in regional/rural areas are not well recognised and there is paucity of published findings on their experiences. We address this gap by sharing our experiences during the first three years of establishing and running such a service in regional Queensland.

Methods: All data collected routinely by the APMS were reviewed to assess treatment modalities, efficacy of treatment using numerical rating scales (NRS), side effects including post-operative nausea and vomiting (PONV), pruritus, respiratory rate (RR) < 8 bpm, hypotension and neuraxial complications. Patients were classified according to the treating clinical discipline/unit: general surgery, gynaecology, medical, obstetric and orthopaedic. Pain was assessed according to the highest reported pain score.

Results: During the study period (July 2012 - June 2015), 3678 patients referred were received and 8486 pain management modalities. The most frequent management modality received was oral medication (74.3%), followed by patient-controlled analgesia (PCA), (57.0%), and obstetric epidural (33.8%). Overall, 26.8% of patients reported no pain, 27.5% had mild pain, 26.3% had moderate pain and 19.4% reported severe pain. Reported pain scores varied widely by discipline. Almost 1 in 4 orthopaedic patients reported severe pain levels.

Those who received oral medication or a PCA reported PONV (12.8% and 16.7%, respectively) as the most frequent side effect. The most frequent side effect for continuous infusion was sedation (18.2%). Respiratory depression was reported for 0.4% of patients with naloxone administered to 0.3% of patients.

Mild sedation scores were reported for oral medication (7.3%), and PCA (10.6%). Severe sedation was reported for (0.03%) of oral and (0.1%) of PCA patients. The incidence of RR < 8 bpm and hypotension were negligible (both below 0.4%). Neuraxial interventions were well tolerated with the incidence of infected epidural site and backache at 0.1%.

Conclusion: This regional study shows patients undergoing orthopaedic and general surgical procedures report severe pain compared to other procedures. Recovery units have specific unit protocols for management of pain and PONV. Guidelines or protocols for general and surgical units may aid with earlier identification and decreased incidences of PONV, sedation and severe pain. Lessons learnt will help establish such services in regional/rural areas.

The provision of holistic family centred healthcare for young people and their families is paramount for all healthcare users inclusive of those living in Rural, Remote and Indigenous communities.

The Quality of Care Collaborative Australia Project (QuoCCA), aims to build capacity in the provision of paediatric palliative care in identified communities. The QuoCCA project consists of a time sensitive, “Pop up” model of care. This patient led model of care aims to build and enhance the local healthcare communities existing knowledge and strengths. This is achieved through time specific, care focused and specialised sustainable education sessions surrounding paediatric palliative care and advanced care planning. This education makes it possible for specialist teams to come together with local teams to support the young person and family receiving palliative care whose final wish consists of returning to rural home towns or to country.

For Indigenous Australians, the connection to their country is intrinsic to their identity. This cultural connection can be challenged when required to receive specialised care at tertiary healthcare settings in major cities. This means the support required for these indigenous families is specific and specialised. When Indigenous families are faced with no further treatment options for their child, returning to country is not only paramount for the child and immediate family, but for the entire indigenous and rural community.

This presentation will focus on the case of a young indigenous baby with a life limiting condition who’s parental need to return to country and the arms of their mob initiated a supportive response through the QuoCCA project. This response ensured that they returned to country in a timely manner. The community and healthcare workers were empowered through specialist education and support to ensure that the end of life for this baby occurred in a way that was supportive, sustainable and respectful of her indigenous culture.

Orange Health Service (OHS) is reasonably well equipped with specialised equipment, yet this pool is poorly managed, stored and maintained, resulting in inefficiencies, inappropriate prescriptions and unnecessary hiring of external equipment.

Planned and unplanned admissions of bariatric patients are becoming more prevalent, representing an increased risk to the organisation in terms of staff and patient injury, equipment acquisition and maintenance, and cost of service (increased staffing, increased length of stay, greater need for specialised training).

In 2017, a Bariatric Interest Group was formed via expression of interest to staff with 12 members and an executive sponsor.

This group is currently being transformed into a Specialist Multi-Disciplinary Consultancy Service which will provide individualised assessments and recommendations regarding the appropriate manual handling and equipment needs of all bariatric patients entering OHS. This service is accessed via a referral hotline (alpha numeric phone number is B-A-R-I or 2274) and backed up overnight and weekends by clear guidelines around the handling and equipment needs of new patients until a formal assessment by the team is performed.

Stage 1 of the project is now underway. This entails the objective identification of patients with bariatric needs arriving in the Emergency Department using newly purchased hospital bed and wheelchair scales, and a locally accepted definition of “bariatric”. Education has been delivered to the Emergency Department staff in regards to the measurement process and appropriate documentation in the electronic medical record.

A BASK (Bariatric Action Starter Kit) has also been developed and placed in the Emergency Department, containing specialised equipment (large gowns, bariatric hovermatt, large blood pressure cuffs, identification band extenders and more).

Initial collaboration with the Health Information Department and Clinical Coders suggests that the identification in the electronic medical record of patients with bariatric needs may result in a higher complexity code under Activity Based Funding, which would in turn attract significant increases in funding for a particular patient’s episode of care.

There is potential for this consultancy service to be replicated in the other two base hospital facilities within Western NSW Local Health District, with peripheral facilities to be supported via Telehealth. A common loan pool of specialised equipment is also being investigated which will accessible by all facilities. These strategies will ensure that patients with specialised needs will be assessed, treated and handled in a more consistent and equitable manner across the District.

A key recommendation of the World Health Organization is that the management of mental health problems be based in primary care. For severe and complex mental health problems, a shift towards service delivery in primary care reduces stigma and social exclusion and allows for participation in normative life processes. The recognition and appropriate treatment of people with mental health problems in the primary care setting, however, varies, often due to a lack of support and governance. Collaborative care, whereby primary care and mental health providers share resources, skills, knowledge and decision-making to provide person-centred care is an increasingly supported model.

The Royal Flying Doctor Service - South Eastern Section (RFDSSE), has been funded by the Western NSW Primary Health Network to provide the Mental Health Nurse Support (MHNS) Service to GPs to support individuals with severe and complex mental illness within the primary care setting, through co-location with General Practice, Aboriginal Medical Services and Community Mental Health. The service operates within a collaborative, multi-disciplinary, flexible and integrated stepped care model, with the GP at the centre of care and with strong governance and clinical support.

This current study seeks to evaluate the implementation and outcomes of the MHNS Service, from the perspective of the clients (service users) and the providers involved. A mixed methods approach is being used, including clinical record audit, as well as questionnaires, interviews and focus group discussions with both clients and providers. The facilitators of, and barriers to, implementation of the service are being explored, along with the physical and mental health outcomes of clients and the cultural safety of the service in the context of the collaborative care model. The results are expected to shed light on whether the MHNS service is meeting the holistic health care needs of people with severe and complex mental illness in the primary health care setting and describe client and stakeholder recommendations for service improvement.

In short, there is tension between models of primary mental health care. Evaluation of innovative programs is needed to inform best practice and ongoing improvement of mental health care for individuals in the primary health setting. It is expected that this project will contribute to the ongoing evaluation and improvement of the MHNS service as well as to the evidence on holistic, integrated and stepped-care models of service delivery within Primary Care for people with a severe and complex mental illness.

Introduction: Attention-deficit hyperactivity disorder (ADHD) is a commonly diagnosed neurodevelopmental disorder that originates in childhood, and is described as pervasive, persistent, disabling pattern of inattentiveness, overactivity and/or impulsivity that commonly responds to stimulant treatment. The disorder may be profoundly impairing, and when untreated, is associated with reduced occupational functioning and emotional problems including anxiety and depression, but also obesity. The estimated worldwide prevalence of ADHD is 5.29-9%.

Method: To investigate the change of ADHD treatment in two regional Paediatric Departments between years 1997 to 2016 an audit of stimulant prescribing records from Orange (OBH) and Bathurst (BBH) Base Hospitals was performed.

Results: An average number of scripts per patient was 7.3 in BBH and 5.6 in OBH. Prescription writing rate per patient in BBH was 1.56 scripts per patient per year and in OBH 1.45 scripts per patient per year. The average age when the first script was provided was 9.8-10.5 years, and the last script was provided at an average age of 12.8-13.3 years. Diagnosis of ADHD requiring treatment was made 4.8 times more frequently in boys than girls. The first daily dose prescribed was 9.4-15.2 mg/day for dexamphetamine (DEX), 34mg/day for lisdexamphetamine (L-DEX) and 22-35 mg/day for methylphenidate (MPH); at the same time average maintenance doses for DEX was 14.8 mg/day, L-DEX 40.5mg/day and MPH 32.9 mg/day. For patients whose weight was available the dose for DEX was 0.11-0.91 mg/kg/day, L-DEX 0.27-2.16 mg/kg/day and MPH 0.08-2.22 mg/kg/day. DEX was the more commonly prescribed medication in the earlier years until 2005 when MPH became more prescribed stimulant; and since 2015 paediatricians started using L-DEX. Finally, treatment with MPH had a positive effect on weight z-score in underweight individuals and negative effect on overweight individuals.

Conclusion: In summary, the results were comparable and reinforced the findings of previous studies. An exciting new finding is that treatment with MPH long-term was associated with the increased weight of the underweight and healthy weight subjects and reduced weight of the overweight subjects.

Aim: To examine attitudes and barriers from the perspectives of food outlet staff in providing breastfeeding friendly store environments in a rural target area in North-East Victoria.

Method: The study used a mixed method design through face-to-face interview questions and scaling of survey response categories. The study scope was all 18 food outlets within the target area. Stores were recruited through direct visits and the provision of an information sheet explaining the study. The pre-tested, self-developed survey examined staff attitudes and barriers to providing breastfeeding-friendly store environments. Additionally, researchers audited the in-store environment using the eligibility requirements for registration to the Australian Breastfeeding Association (ABA).

Relevance: Supporting breastfeeding is one of four community identified priority areas for the study site. The associated Local Government Area (LGA) had a lower rate (52.1%) of fully breastfed infants at three months than the Region (56.4%) in 2014/15. Breastfeeding is a known influencer of health into adulthood. Social acceptance and promotion of breastfeeding is a crucial factor in a mother’s desire to breastfeed in public spaces. This study is the first step in improving the provision of supportive environments for breastfeeding mothers.

Results: The study achieved 100% participation (n=18) of available food outlets. Results showed 78% of participants (n=14) believed it was important to support breastfeeding in the community. Five (5) outlets were registered with the ABA and displayed the ABA sign. Self-identified barriers for food outlets to support breastfeeding included; space for prams (n=2), seating for mothers (n=3), and lack of customer and staff support (n=4). Some (n=2), felt breastfeeding should take place in private or a separate place rather than in-store.

Conclusion: Breastfeeding friendly environments were important to a majority of staff in the food outlets participating in the study. Understanding the perceptions of the food outlet staff enables work to develop partnerships and increase the number of stores registered with the ABA, supporting more mothers to feel comfortable to breastfeed in public.

Background: Long-term medical management plays an important role in determining chronic disease outcomes and contributes to the overall health and wellbeing of patients. Adherence to follow-up care is essential to ensure treatment efficacy, promote positive recovery and to protects against future health complications. Worldwide, adherence to medications and medical management for chronic disease is poor (averaging 50% in developed countries), and evidence suggests that adherence is even poorer in rural environments where access to healthcare and resources is reduced. To date, there is limited research examining how factors that impact on adherence are influenced by the rural context.

Aim: This study aimed to synthesise current evidence relating to factors that have been identified to impact on adherence among rural populations diagnosed with chronic conditions. Secondly, it sought to compare this evidence to the current adherence framework provided by the World Health Organization, with a purpose of determining whether factors impacting on adherence for rural populations differ significantly from those impacting general populations.

Method: A systematic scoping review was conducted, following the Joanna Briggs’ Institute guidelines for scoping reviews, on English language literature published from January 1990 to March 2018. Twenty-five included studies reported on factors impacting on adherence or engagement in health behaviours or medical management following diagnosis of a chronic condition.

Results: An iterative analytic process was adopted to categorise identified individual factors into common themes/dimensions. Six distinct dimensions were identified: socio-demographic, clinical, treatment, patient-related, health system and supportive factors. A comparison of these rural specific dimensions with those outlined by the World Health Organization, highlighted some key differences primarily with respect to the role and relative importance of supportive factors, and factors associated with distance to health care facilities and services.

Conclusions: Whilst there was no difference in the individual factors identified within rural populations in comparison with those outlined by the World Health Organization to impact on adherence, preliminary evidence within the rural literature suggests that the relative importance, inter-relationships and role that these factors play in influencing adherence behaviours in rural contexts may differ. Future research should seek to better understand the specific factors at play within the rural context. Such knowledge will be critical in informing the development of focused policies and procedures, targeted support services, practical educational resources and effective intervention strategies to improve adherence behaviours in rural populations.

Adolescent health-care is an area of medicine that has been overlooked in Australia. Rural health services have commonly been focused toward an aging population and research is needed to redirect attention to the preferences and care needs of young people. The aims of this research were to identify the barriers for adolescents accessing health services in a rural setting and to identify features of an accessible, inclusive, youth friendly service.

Participants were recruited in two rural areas of South Australia, the Barossa Valley and the Fleurieu Peninsula. Secondary schools were approached and students between the ages of 13 and 18 were invited to complete an anonymous 27-item online survey. Quantitative and qualitative questions included health issues of concern, current healthcare access and strategies that may improve healthcare and accessibility for young people. Views and concerns regarding their experiences when accessing healthcare and how to improve their experience were also collected. One hundred and forty-six surveys were completed including 56% female and 39% males. Almost all participants were aged between 13-17 years with slightly higher representation from 14 and 17 year olds. Just over half (58.2%) listed a GP as their preferred first health-care contact, followed by pharmacy (39.7%) and psychology (23%). Approximately two-thirds (68.5%) thought it helpful to see the same GP in subsequent visits. Hoping the problem would go away, not feeling comfortable and feeling embarrassed were reported as being the biggest barriers to visiting the GP when needed.

Emotional wellbeing, substance use and sexual health were reported as the most important topics for adolescents to discuss with a GP. The practice of GPs raising certain topics even it wasn’t the purpose of the consultation was also deemed helpful. Interestingly adolescents did not indicate a strong preference for the age and gender of the GP. Participants instead valued good listening skills, non-judgmental behaviour and the use of appropriate age-specific language.

In summary, this research confirmed that GPs play a key role in the provision of care for rural adolescents. Continuity of care appears to be important, and future research might explore youth engagement and appropriate relationship building strategies for health professionals. GPs may need specific training in the provision of adolescent healthcare due to expectation of youth-appropriate care.

Background: Professional isolation is major reason why rural medical specialists leave their practice to work in cities. Recognising this, the Support for Rural Specialists in Australia (SRSA) program, an Australian Government funded program managed by the Council of Presidents of Medical Colleges aims to support the Continuing Professional Development (CPD) and peer support needs of rural specialists. This is achieved by providing individual grants and training via online learning programs. Funding round one (FR1) has been completed and Funding round two (FR2) is currently underway.

Method: A post-CPD activity online survey was conducted for FR1 and FR2 to establish whether key outcomes were met. Specifically, applicants were asked to demonstrate the identified need at a ‘local’ level in context of individual educational needs, to enable key knowledge/skills attainment and transfer. Key outcomes areas are: the ability to integrate learning to a wider context, the ability to contribute to and demonstrate sustainable changes in practice, and the relative ‘cost effectiveness’ / ‘value’ of their chosen CPD activity.

Results: High level feedback from FR1 has showed that with respect to remoteness most grant recipients practiced in locations rated as RA2-Inner regional to RA3-Outer regional (n=98, 88%), while remaining recipients were from RA4-Remote and RA5-Very remote (n=14, 12%). The types of CPD activities favoured by the program were courses/workshop (n=90, 62%), conference/ASMs (n=52, 36%), and clinical attachments/mentoring (n=4, 3%). With respect to learning objectives 85% (n=96) of respondents ‘strongly agreed’ that participation in an approved CPD activity helped them meet their personal learning objectives. 96% (n=108) of respondents agreed that participation in the CPD activity helped maintain their practice standards. Overall 78% (n=88) respondents found the grant application process was ‘easy’ or ‘very easy’; and finally, 59% (n=66) of respondents said they would not have attended their proposed CPD activity without the financial support of the Program

Conclusions: FR1 has been successful and received well by rural specialists. The post-CPD activity online survey has demonstrated that the program is meeting the needs of its target audience, however improvements can be made to target rural specialists in smaller Colleges and more rural specialists in the MM6-7 regions.

Case Study: Insights from the ‘Can’t Intubate Can’t Oxygenate (CICO)/Advanced Cardiovascular Life Support (ACLS)’ workshop facilitated by a SRSA grant applicant.

‘Excellent way to support regional and remote specialists who have limited peer support and educational options’—pathologist and general medicine

Background: The hospital is at present under redevelopment, experiencing significant bed shortages and fast discharges. There are few quiet areas to access trees, sun, fresh air or group activities. The Diversional Therapy Service provides activities that support the social, emotional, physical, psychological and cognitive function of those referred. A project was proposed to extend the service to more patients to provide a distraction from illness, improve patient and staff well-being and improve the physical environment. The project needed to be easily accessible and affordable.

Evidence based research shows that knitting is therapeutic. It can reduce depression, distract from chronic pain, increase social inclusion, fights loneliness and isolation while protecting future mental health. Knitting also meets varying functional abilities regardless of age, culture, religion, sex, gender, ability or disability.

While universally accepted moments of joy are often found in colour, symmetrical patterns, round shapes and a sense of abundance such as the effect of a yarn bomb. And environments in which people experience joy are linked to healthier lives.

Method: Yarn bombing is street art. It is knitting for ordinary objects in the environment to create something of beauty. It is an activity that is low cost, easily implemented, meets the functional ability of many and is an opportunity to create joy. The project was open to everyone in southern Tasmania. Patients, staff and people in the community knitted for twenty-six trees, two water fountains, a bike rack, pedestrian railing, and various pieces of hospital equipment. Some participated by contributing a few stitches while others were enormously creative and prolific. Wards formed groups as a therapeutic intervention.

Results: The project has had an overwhelming positive response. Around 100 people participated by knitting or donating wool or joining a group. Knitted items came from as far away as New Zealand, Melbourne and northern Tasmania. The yarn bomb has brought joy and life to an otherwise grey area of the hospital. Positive feedback has been received on how wonderful it looks, how joyous the project has made people feel and how therapeutic it has been for ill relative.

Conclusion: Knitting together for a common goal, in a meaningful activity found the community working together to turn the ordinary into something extraordinary. The benefits of a diversional therapy project that extends further than those referred to the service can create numerous positive outcomes.

Going Rural Health is a Commonwealth funded initiative that supports rural nursing and allied health student clinical placements, via support of students, rural health services, and the health workforce. The program operates in three regions of Victoria; Ballarat and Grampians, Shepparton and Goulburn, and Wangaratta and Hume regions.

Each region has developed student clinical placements that, in addition to providing varied quality clinical experiences, also improve patient access to local health services. These ‘Service Learning’ placements have proved to have many benefits to health services, placement supervisors, health professionals, and clinical placement students, but importantly also to clients, patients and the local community.

These placements have been successfully implemented at varied locations, including health services, nursing homes, primary care agencies, community NGOs, primary schools, kindergartens, and home visits to farms.

Aged care facilities have been the main focal point and one of the most successful service learning placements to date, since many rural areas have an aging population, and often limited hospital services, but usually have at least one nursing home with limited allied health services. One such site had no regular allied health presence, except for limited visits for pain management, but programs developed by an interdisciplinary allied health student clinical placement team had a big impact on the residents in the areas of speech and communication, mobility and strengthening, and lifestyle and wellbeing. This project also helped the nursing home begin to implement Montessori principles and improve the quality of life of their residents.

Primary schools and kindergartens have been other settings where the students have fitted in well, at multiple sites. Starting with physiotherapy only, and evolving to multidisciplinary placements, the students have implemented screening programs and therapy services for underprivileged children who otherwise would have had little or no access to these services.

Outpatient and outreach services have also benefited from students on clinical placement. Students have been involved in various projects, including teaching lifestyle skills to the homeless, assisting with rehabilitation exercise programs, reducing long waiting lists for outpatient allied health services, and providing intensive therapy—that otherwise wouldn’t have been possible—for patients in the community.

This poster will outline some of the success stories across our regions, via photographs, case studies, interviews and stories, and feedback on the impact on client health and wellbeing as a result of the program.

Introduction: Documented evidence of the burden of disease in rural communities, an absence of transport to larger support towns, lack of sustainable infrastructure and an aging population, compounded by a limited capacity of the medical workforce to cover after-hours services results in significant rural health service gaps. An innovative Nurse Practitioner locum service, implemented in Victoria addresses these gaps offering high quality healthcare provision for patients presenting to small, rural health facilities. Additionally, strategies to support nursing staff in the Acute and Residential Aged Care sectors to address concerns for patients experiencing a deterioration in functional status have been implemented and are proving invaluable for the upskilling of the rural workforce.

Brief description: The nurse practitioner led model of health care delivery has been implemented in several small rural health facilities over the past 12 months and is proving beneficial in meeting the healthcare needs of the respective communities. Growing need for high quality, equitable, accessible, and efficient healthcare delivery for rural communities has been the driver for the initiation of innovative models that can collaboratively address the service gaps in a manner which is both clinically and fiscally sustainable.

Methodology: Action research methodology underpinned all facets of this interdisciplinary model of care. Both qualitative and quantitative data were collected using tools specifically developed for the project. Statistical and thematic data analysis processes informed the results.

Conclusion: Results indicate that the Nurse Practitioner Locum service is surpassing all stakeholder expectations; the providers of the care, the multidisciplinary health care team and community members. It has also proven beneficial for empowering the rural health workforce with the nurse practitioners offering active role modelling and mentoring for staff in clinical and leadership facets of the service. The nurse practitioner model of healthcare delivery in the rural sector has proven to be a seamless, safe and collaborative model of healthcare delivery. A healthcare model that is replicable for other small rural health services.

Australian rural health service models are commonly adapted from metropolitan or international health service models and are not specific to the unique health care needs and requirements of Australian rural and remote communities. It is well documented that the medical workforce has limited capacity to cover after-hours service provision for small rural health facilities (Humphreys et al 2002). Alternative models of health care service delivery are required in these sectors to address the difficulties experienced by isolation both geographically and demographically.

Nurse practitioner led models of care have been effective in ensuring the community’s health care needs are achieved in a timely, accessible manner, and are of a high quality. These models have been replicated in several rural facilities. Nurse practitioners are well positioned to offer alternative, flexible solutions to the growing health care demands in rural sectors.

This poster discusses the impact evaluation of a recently implemented nurse practitioner led model of care in a rural Victorian public health facility. Employed over a 60-hour period each weekend the nurse practitioners were responsible for the health care needs of all patient presentations. While predominantly based in the urgent care centre the model the role extended to the acute ward and adjacent aged care facility. The results indicated that nurse practitioners were able to autonomously practice across the full spectrum of their scope of practise, effectively providing the local community access to a seamless model of health care delivery which provided early identification for high acuity presentations, timely intervention, and appropriate referrals. This model of health care was able to meet the needs of the health service and the rural community.

Future research should explore the rural community sentiment for these alternative models of care and how these roles can be extended to address other shortages in health care service delivery for rural Australia.

The Starlight Children’s Foundation (Starlight) delivers programs in partnership with health professionals, to support children, adolescents and their families who are living with a serious illness, disability or health condition. The organisation has deliberately adopted a collaborative model, recognising the value in utilising our expertise in engagement, positive distraction and play, to work alongside clinicians to support health outcomes in regional and remote areas.

This presentation will outline a number of case studies highlighting the way in which a non-profit organisation can support health professionals and intervention programs to ensure better clinical and psychosocial outcomes across rural Australia. It will discuss the method and efficacy of programs such “Captain Starlight” (professional performers, who work with medical teams to help engage with or distract patients depending on the needs of the situation), and the Livewire program which supports regional adolescents via an online peer community.

There will also be a discussion of the collaborative nature of Starlight’s Healthier Futures Initiative, which helps children in remote Aboriginal and Torres Strait Islander communities through an integrated care approach. Working with a range of primary health care teams, Starlight has been at the forefront of initiatives to improve major concerns such as heart and ear health in this vulnerable population in remote areas. By engaging with at risk children through creative interactions, Starlight has helped improved retention at clinics, promoted prevention and early intervention. The rapport built with children and families has also been reported to alleviate anxiety in children who travel from community to be hospitalised in metropolitan facilities, with the highly visible Captain Starlight providing a much-needed sense of connection and familiarity.

Additional benefits of the partnership approach to be discussed include assisting to enhance the relationship between the community and health professionals. By working with the youngest members of the community, the program aims to facilitate a change in attitude towards healthcare, creating a positive, anxiety-free experience.

This paper will provide practical insights into a successful on-the-ground service delivery by a non-profit organisation using a collaborative approach to help achieve clinical outcomes. It will draw out lessons learnt from partnering with a range of organisations and highlight the impact of the approach on children and young people in rural and remote communities. Overall, this presentation will showcase an innovative and highly successful program model that demonstrates the value of a community organisation partnering with clinicians to enhance the rural healthcare experience.

Established in July 2017, the national Regional Training Hub (RTH) program has been operational for just over 12 months. The national Regional Training Hubs program is one of a number of Commonwealth initiatives designed to improve the health of people living in rural, regional and remote Australia by providing opportunities for Australian trained medical students and junior doctors in rural, regional and remote locations for better teaching, training, recruitment and retention. RTHs are building on the rural training network already established through the Rural Health Multidisciplinary Training (RHMT) program in Rural Clinical Schools and University Rural Health departments.

This interim review will demonstrate how RTHs, working together, are already making a measurable difference to rural health and will attempt to predict the impact of Hub activities based on results to date. It showcases the role of the Regional Training Hubs program across Australia.

The network of twenty six Training Hubs across Australia have demonstrated a practical impact on health in rural areas both singularly and collectively. Preliminary findings suggest that already the brokering drive from RTHs is supporting existing health organisations to deliver better rural health outcomes. We intend to show that Regional Training Hubs have improved rural study and training for medical students and junior doctors and helped them develop their rural medical career and that they are providing support to rural trainers and supervisors.

Aims: The Australian Institute of Health and Welfare monitors the health and welfare of rural and remote populations. A recent feature article in Australia’s Health 2018 brought together information to present a picture of the health of Australians living in rural and remote areas as well as influencing factors. This included information on demographic profile, risk factors, chronic conditions, disease burden, deaths and access to health care.

Methods: AIHW drew on range of data sources, including those based on administrative and survey data. Where appropriate, data were age-standardised to allow for more comparable estimates across remoteness areas.

Relevance: The details of this presentation will help provide context for other presentations and general discussions at the National Rural Health Conference.

Results: Australians living in rural and remote areas face unique challenges due to their geographic isolation, and often have poorer health and welfare outcomes than people living in Major cities. The proportion of adults engaging in behaviours associated with poorer health—such as tobacco smoking and excessive alcohol consumption—is higher in rural and remote areas than in metropolitan areas, as is (generally) the prevalence of chronic conditions. These poorer health outcomes may be due to factors such as disadvantage in education, employment opportunities and income. Rural and remote Australians also have higher rates of potentially preventable hospitalisations and overall hospitalisations, which may be due to poorer access to medical specialists and primary care professionals.

Conclusions: There are disparities in the health status, determinants of health and access to healthcare services across remoteness areas in Australia. Information on the health of rural and remote Australians can be used to address these disparities by informing health policy, research and analysis and health care funding arrangements.

Limitations with assessing the implications of remoteness on health include the interactions between remoteness, low socioeconomic position and the higher proportion of Indigenous Australians in many of these areas compared with Major cities. There is also scope to enhance the availability and coverage of health data in rural and remote areas.

Background: Post-stroke depression (PSD) is strongly correlated with poorer outcomes; reduction in efficacy of rehabilitation treatment, cognitive impairment and delayed recovery to premorbid physical and social activity ¹. Currently the Orange inpatient rehabilitation service does not use any screening tool for stroke patients. The stroke patients who are observed by the treating multidisciplinary staff to be depressed are assessed by the medical team and based on the assessment are referred to the psychiatric team. The current data shows that 50% of patients were assessed for post stroke depression by such methods.

Aims: Primary aim is to screen 100% of stroke patients who attend the Rehabilitation Unit for post stroke depression over a 12-month period.

Secondary aim to ensure post stroke depressed patients are identified in a timely manner and are monitored closely and treated appropriately.

Method: Screening tool called Hospital Anxiety and Depression Scale (HADS) was implemented within the first 2 weeks of admission into the Rehabilitation Unit to all stroke patients. If the HADS scores are in the normal (0-7) or borderline (8-10) range, the patient’s mood will be monitored closely by the medical and nursing staff. If the score is abnormal (11-21) then they will be reviewed by the medical team. Due to the complexity of stroke patients, a detailed cognitive and mental health history will be undertaken and all necessary investigations will be performed to rule out any medical related causes impeding the score. Then based on the assessment, if necessary, the psychiatry team will be consulted. All patients with abnormal scores will be referred for Cognitive Behavior Therapy in the Rehabilitation Ward.

Results: The total number of stroke patients admitted to rehab unit were 44 out of which 27 had HADS done. We were unable to screen 17 patients (5 were unwell, 2 were palliated, 2 were transferred out of the unit, 2 refused to participate, 1 unable to do, 3 had short admission and 2 were missed due to staffing issues).

Conclusion: Majority of the patients screened were in the normal range two weeks post stroke this might be due to patients staying in supported environment. Further studies need to be undertaken to assess these patient’s mood and long term health outcomes post discharge from the hospital.

Background: Gestational diabetes mellitus (GDM) is a complex pregnancy related condition with rising across Australia. Regional hospitals are now facing increasing numbers of pregnant women with GDM, due to change in diagnostic criteria and rising rates of maternal obesity. A multidisciplinary management approach for low resource settings is needed to minimise complications.

Methods: This was a prospective descriptive study on the multidisciplinary team clinic approach to managing women with GDM in a small rural hospital on the Mid-north coast of NSW. The clinic involves diabetic education and support, dietician advice and management, obstetric medical care, fetal growth and wellbeing monitoring and midwifery antenatal care. There was a total of 52 women that were managed in this clinic and delivered between the 1^st of January, 2018 and 30^th of June, 2018. Of these, 24 women were included in the study. Data was collected on their maternal risk factors for GDM, and the intra-partum and neonatal outcomes they experienced. The data was used to evaluate the effectiveness of the multidisciplinary management approach at minimising the adverse outcomes associated with GDM.

Results: Preliminary analysis showed outcomes comparable to the National Standards. During the study period, 302 women delivered and 51 (17%) were diagnosed with GDM, which was well above the NSW state average of 12.6%. In the clinic, most of the women were managed with diet alone (41.7%) or a long-acting insulin (45.8%), along with regular dietary advice, diabetic education and blood glucose monitoring. The induction of labour protocol was mandated by the HNE health guidelines for Diabetes in Pregnancy.

Of the 24 women included in the analysis, 58.3% had an induction of labour, 25% had an elective LSCS and 17% went into spontaneous labour. Of the planned inductions, 64.3% had a normal vaginal delivery, 7.1% had an operative vaginal delivery and 28.6% had an emergency caesarean section.

The mean gestation at the time of delivery was 38 weeks (SD 1.17). The mean birthweight was 3241 grams (SD 668g), with 17% of the infants classified as large for gestational age. 54.2% of the infants were exclusively breastfed on discharge.

Conclusion: We present a successful model for the management of gestational diabetes that requires minimal resources. The outcomes for mothers and babies in our study are comparable to the national standards.

Background: The University of Newcastle Department of Rural Health (UONDRH), funded under the Rural Health Multidisciplinary Training program, supports short-term to year-long student rural placements in northern New South Wales. Students live and study in a multi-disciplinary environment with opportunities to engage with the local rural community and participate in interprofessional learning. This paper describes students’ perceptions of their experiences and the impact this has on their intention to work rurally, by comparing outcomes between students from a rural versus an urban background.

Methods: Commencing in 2011, this longitudinal mixed methods study of rural placement experiences and workforce outcomes tracks allied health students from the disciplines of Diagnostic Radiography, Nuclear Science, Nutrition and Dietetics, Occupational Therapy, Physiotherapy, Radiation Therapy and Speech Pathology. Students participating in short or long-term rural immersion placements are invited to participate in the study and have the option of completing one or more of the three components of the study: (i) an end of placement survey (ii) a semi-structured interview and/or (iii) a follow-up survey at one, three and five years after graduation. The results for this paper focus on the end of placement survey data. Rural background was cross tabulated with consideration to work rurally before and after placement. A content thematic analysis was undertaken of the responses to open ended questions about student placement experiences.

Results: Four hundred and forty surveys were completed by 275 students. Pre and post placement rural intention scores were paired for 271 (98.5%) of the students. Of the 127 respondents from an urban background, 69 (54.3%) had a more positive outlook towards rural practice after their placement. Of the 144 students from a rural background 108 (75.0%) considered working rurally before placement increasing to 144 (79.2%) following placement. There was a shift to a more favourable attitude towards rural practice, however the difference in scores before and after placement was statistically significant in the group from an urban background (p=<0.001). Three themes emerged from the thematic analysis and will be presented through the lens of students from rural and urban backgrounds.  

Conclusion: Engaging students in experiential learning in the rural setting is facilitated through positive placement experiences. These results suggest the exposure to rural experiences are having a positive impact on their intentions to practice rurally, for both students from rural and urban backgrounds.

The rates of overweight and obesity in Australia are some of the highest in the world (OECD 2015). In 2014–15, 11.2 million Australian adults (63.4%) were overweight or obese (ABS 2015). Being overweight or obese can have serious negative health consequences, and can lead to cardiovascular disease (mainly heart disease and stroke), type 2 diabetes, musculoskeletal disorders like osteoarthritis, and some cancers (NHMRC 2013).

In 2014-15 the Hunter New England & Central Coast Primary Health Network (HNECC PHN) had the third highest adult obesity rate of the 31 PHNs across Australia (AIHW 2016). The HNECC PHN has identified obesity and over weight as the most significant preventable health issue facing general practice, their patients and the broader community. Addressing the increasing prevalence of unhealthy weight has been adopted as a priority strategy to impact the growing incidence of chronic disease in the region.

Achieving and sustaining weight loss is challenging, and general practitioners are well placed to inform patients of the health risks associated with increases in BMI, and the benefits that can be derived from weight loss and lifestyle change. Though patients may be receptive to weight loss advice, health professionals frequently identify a lack of confidence in discussing the issue, and in particular, in initiating ‘difficult conversations’ (Rose et al. 2013).

In attempting to maximise these opportunities for patient engagement, the Healthy Weight Initiative has been devised to increase the confidence and skills of general practice staff in facilitating a weight management program. The program will be implemented using the Healthy Weight Initiative Platform (HWIP). The HWIP is an interactive, online, educational platform that can be used to screen, assess and educate participants, and capture and report on relevant program data. It has in-built educational and lifestyle modification tools focused on sustainable weight management, health risk identification and behaviour modification.

Orange Health Service (OHS) is reasonably well equipped with specialised equipment, yet this pool is poorly managed, stored and maintained, resulting in inefficiencies, inappropriate prescriptions and unnecessary hiring of external equipment.

Planned and unplanned admissions of bariatric patients are becoming more prevalent, representing an increased risk to the organisation in terms of staff and patient injury, equipment acquisition and maintenance, and cost of service (increased staffing, increased length of stay, greater need for specialised training).

In 2017, a Bariatric Interest Group was formed via expression of interest to staff with 12 members and an executive sponsor.

This group is currently being transformed into a Specialist Multi-Disciplinary Consultancy Service which will provide individualised assessments and recommendations regarding the appropriate manual handling and equipment needs of all bariatric patients entering OHS. This service is accessed via a referral hotline (alpha numeric phone number is B-A-R-I or 2274) and backed up overnight and weekends by clear guidelines around the handling and equipment needs of new patients until a formal assessment by the team is performed.

Stage 1 of the project is now underway. This entails the objective identification of patients with bariatric needs arriving in the Emergency Department using newly purchased hospital bed and wheelchair scales, and a locally accepted definition of “bariatric”. Education has been delivered to the Emergency Department staff in regards to the measurement process and appropriate documentation in the electronic medical record.

A BASK (Bariatric Action Starter Kit) has also been developed and placed in the Emergency Department, containing specialised equipment (large gowns, bariatric hovermatt, large blood pressure cuffs, identification band extenders and more).

Initial collaboration with the Health Information Department and Clinical Coders suggests that the identification in the electronic medical record of patients with bariatric needs may result in a higher complexity code under Activity Based Funding, which would in turn attract significant increases in funding for a particular patient’s episode of care.

There is potential for this consultancy service to be replicated in the other two base hospital facilities within Western NSW Local Health District, with peripheral facilities to be supported via Telehealth. A common loan pool of specialised equipment is also being investigated which will accessible by all facilities. These strategies will ensure that patients with specialised needs will be assessed, treated and handled in a more consistent and equitable manner across the District.