Remote Australia Online

A systematic search was undertaken to ascertain the nature, source and extent of funding awarded to research projects that were directed specifically at aspects of rural health over the past decade. Comment is also made on the challenge of obtaining such information directly from databases. The sources investigated were the conventional research funding bodies, hospital trusts and foundations, university funding schemes and government sources. The results of these searches revealed a crude average of 3 million dollars per year from conventional research funding with the remaining sources adding a similar amount in total. Analysis of the data using a framework modified from the Strategic Review of Health and Medical Research in Australia shows that funding is concentrated in the health services and public health areas with a preponderance of funding being directed towards the description of conditions and interventions. Significant levels of funding have been directed towards the National Health Priority Areas.

This article addresses the persistence of sharing in Indigenous Australian domestic moral economies well after hunting and gathering has stopped being the basis of livelihood, by examining the relationship of demand sharing with the more formalised asymmetrical reciprocity found in both pre and post contact life. Understanding the significance of the more formalized asymmetry in the pre-contact situation helps shed light on what happens in the post contact situation, and the independence of sharing from the impact of market forces and utilitarian need.

Background The National Maternity Services Review in 2009 sought to address the ongoing issues of access, workforce capacity and inequalities in health outcomes for women and their babies in rural and remote Australia. The subsequent National Maternity Services Plan describes the type of care that should be offered to all women in Australia. Objective The aim of our study was to better understand the local context and progress in delivering recommendations of the National Plan to improve maternity services for women in remote communities of Far West New South Wales. Design Semistructured questionnaires. Setting Maternity care in Far West New South Wales involves long-standing partnerships between three service providers to provide antenatal and postnatal care to women in remote communities with birthing predominantly occurring at the Broken Hill Health Service. Main outcome measures The degree of information sharing and communication, use of guidelines and policies, the effectiveness of workforce retention strategies and the current level of maternity care provided. Participants Fourteen clinicians and policy makers. Results Participants reported clarity in roles and responsibilities of health staff, the appropriateness of antenatal care policies to the context, confidence in practising to their full professional scope and the existence of quality improvement initiatives across all providers. However, participants also reported being constrained by environmental and organisational factors in regards to risk assessment and referral of pregnant women. Key issues for local health service partners include adherence to antenatal care policies and a need to improve local workforce capacity. Conclusions Local health service partners are demonstrably ready to address the modifiable factors of organisational capacity and interprofessional collaboration in accordance with the recommendations of the National Maternity Services Review.

Aim: The aim of this evaluation was to assess the acceptability, accessibility, and compliance with the 2014 editions of the Remote Primary Health Care Manuals (RPHCM) in health care centres across remote areas of Northern and Central Australia. Method: To undertake a comprehensive evaluation that considered context, the evaluation used a realist evaluation framework. The evaluation used a variety of methods including interviews and survey to develop and test a programme theory. Results: Many remote health practitioners have adopted standardized, evidence-based practice because of the use of the RPHCM. The mechanisms that led to the use of the manuals include acceptance of the worth of the protocols to their clinical practice, reliance on manual content to guide their practice, the perception of credibility, the applicability of RPHCM content to the context, and a fear of the consequences of not using the RPHCMs. Some remote health practitioners are less inclined to use the RPHCM regularly because of a perception that the content is less suited to their needs and daily practice or it is hard to navigate or understand. Conclusion: The evaluation concluded that there is work to be done to widen the RPHCM user base, and organizations need to increase support for their staff to use the RPHCM protocols better. These measures are expected to enable standardized clinical practice in the remote context.

Background Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) contribute to Aboriginal Australian and Torres Strait Islander health disadvantage. At the time of this study, specialist ARF/RHD care in the Kimberley region of Western Australia was delivered by a broad range of providers. In contrast, in Far North Queensland (FNQ), a single-provider model was used as part of a coordinated RHD control programme. Aims To review ARF/RHD management in the Kimberley and FNQ to ascertain whether differing models of service delivery are associated with different disease burden and patient care. Methods An audit of ARF/RHD management. Classification and clinical management data were abstracted from health records, specialist letters, echocardiograms and regional registers using a standardised data collection tool. Results Four hundred and seven patients were identified, with 99% being Aboriginal and/or Torres Strait Islanders. ARF without RHD was seen in 0.4% of Aboriginal and/or Torres Strait Islander residents and RHD in 1.1%. The prevalence of RHD was similar in both regions but with more severe disease in the Kimberley. More FNQ RHD patients had specialist review within recommended time frames (67% vs 45%, χ2, P < 0.001). Of patients recommended benzathine penicillin secondary prophylaxis, 17.7% received ≥80% of scheduled doses in the preceding 12 months. Prescription and delivery of secondary prophylaxis was greater in FNQ. Conclusions FNQ's single-provider model of specialist care and centralised RHD control programme were associated with improved patient care and may partly account for the fewer cases of severe disease and reduced surgical procedures and other interventions observed in this region.

This paper examines the implication of language and education policies for the indigenous minority populations in two contrasting multicultural and multilingual post-colonial nations, Australia and Malaysia. By comparing and contrasting ethnolinguistic and educational policies in these two diverse nations, this paper explores how indigenous minorities have been positioned within each nation’s quest for meeting the challenges of becoming multilingual and multicultural nations. The authors argue that although both countries promote multicultural ideals, they fall short in their acknowledgement of the dignity of difference for their indigenous communities. Thus, the authors assert that educational and language policies for indigenous peoples must acknowledge the importance of difference and therefore include indigenous cultural ways of knowing, being and doing to achieve successful educational outcomes.

Cyber safety encompasses the protection of internet users from online risks and security breaches, including cyberbullying, identity theft, invasion of privacy, harassment, and exposure to offensive, illegal or inappropriate material (ACMA 2010). While the more dramatic and disturbing aspects of cyber safety are often quick to capture public attention, these are symptomatic of a range of issues related to developing online capacities and ‘digital citizenship’ (GIER 2011, p. 16). The Swinburne Institute for Social Research is investigating safety and wellbeing as they relate to communication technologies, in remote Aboriginal communities and towns. Telstra is funding the project as an action within the ‘Connection and Capability’ priority focus area of its Reconciliation Action Plan 2015–18. This summary report describes the outcomes of the needs-analysis phase of the project, conducted from September 2015 to June 2016, which involved seeking feedback on these issues from a cross-section of Northern Territory Aboriginal people living in a regional centre, a larger community and a smaller settlement, with different histories of exposure to Information and Communication Technology (ICT). Our research suggests that there are particular mobile phone practices and internet uses among remote Aboriginal people in the Northern Territory that are leading to identifiable cyber safety problems. Some of these practices, and the resulting issues, appear to be different from those experienced by other segments of the Australian population. Significant aspects of this internet use include: • Internet access is predominantly mobile-only. • There is a high level of sharing of devices. • Prepaid mobile broadband is preferred. • Facebook and AirG/Divas Chat dominate social media use. The main cyber safety issues emerging from the research can be grouped into three categories: inappropriate content and comments, privacy issues, and financial security and management.

Kimberley Girl encourages personal ambition and community leadership, and utilises family networks to help young women grow and evolve. Private benefits (to the individual) translate into public benefits (to the community and nation) through enhanced employment prospects and the expansion of participants’ ambitions. In 2011 we conducted a full evaluation of the Kimberley Girl program, involving an in-depth qualitative analysis of the program’s impact on participants’ lives, and an economic assessment of its public and private benefits (Rennie & Potts, 2011). We followed a similar method for this evaluation, which included interviews with 30 participants from the 2016 cohort (the Broome heats and the final including six participants from the Pilbara), and observation of the personal development workshops (see Appendix A, page 12, for full research methodology).This report confirms many of the findings of the 2011 evaluation. In addition, we delve deeper into what we see as a key element of the Kimberley Girl program: confidence-building. The term “feeling shame”emerged strongly in our 2011 evaluation, but was not well understood in policy and development realms. For this report, we asked the 2016 participants to help us define the term. Participants described what it means to be held back by self-doubt, fear and shyness, and posited theories as to why it is a common and shared feeling amongst so many Aboriginal girls and young women. By digging deeper into the concept of feeling shame, this report provides a fuller account of Kimberley (andPilbara) Girl’s main benefit – confidence-building – and how this benefit can translate into tangible outcomes (see Appendix D, page 29, for a discussion of “shame versus confidence”).

Aboriginal Australians living in remote communities are likely to be “mobile only” users. The sharing of devices among kin is common and linked to demand sharing practices that stretch back to presettler times. While sharing can produce benefits (acting as a form of insurance), it can also lead to privacy-related problems among this group, including illicit use of banking and social media accounts via shared devices. In this article, we examine the ways in which the aspect of Aboriginal sociality known as relatedness is interacting with online privacy frameworks designed for individual device use and device management. The findings suggest that the sociotechnical frameworks of platforms and devices do not accord with cultural dynamics, including obligations to others. Moreover, efforts by individuals and Elders to avoid privacy-related problems are leading to digital exclusion in various forms, from the deliberate destruction of devices to whole communities opting out of mobile infrastructure.

Introduction: Western NSW (WNSW) is one of the most vulnerable regions in Australia with a fractured service network and poor health outcomes. A strategy to transform current services into a patient centred, coherent system of care is well into its third year with WNSW Local Health District (LHD) leading the way as a NSW Health Integrated Care Demonstrator Site. A range of district-wide and locality-based integrated care initiatives are being implemented to better connect providers to improve health outcomes for the region. Methods: The WNSW Integrated Care Strategy is being implemented using a collaborative partnership approach between the LHD, the Western Primary Health Network, and Bila Muuji Aboriginal Health Services. The vision of the strategy is: To transform existing services into an integrated WNSW system of care that is tailored to the needs of our rural and remote communities, and improves access to care and health outcomes, with particular focus on closing the Aboriginal health gap. A key element of the strategy was the establishment of local demonstrator sites to test new models of care at a locality level. Local Leaderships Groups were established at each site and tasked with developing and implementing locally led integrated models of care tailored to their identified local health needs. Features of the demonstrator site models of care include: GP-led multi-disciplinary team based care standardised risk stratification process to target identified cohorts comprehensive assessment to address medical and social care needs shared care planning health and social care coordination multi-disciplinary case conferencing. Results: Over two and a half years the strategy has: established a Health Intelligence Unit providing a ‘one-stop-shop’ for health care data, analysis, advice and support established nine local demonstrator sites focusing on chronic disease management, the first 2000 days of life and dementia. strengthened the connection between care providers in a locality appointed local Health and Social Care Coordinators based in primary care development of risk stratification criteria introduced primary care based multidisciplinary case conferencing. Early analysis of the enrolled cohort is indicating an improved health journey, improved health outcomes and a reduction in acute care utilisation Discussion: A key objective of the strategy was to develop sustainable models of care that are easily and rapidly transferable to other sites and localities. We consider the learnings from our experience in transforming our local health system transferable to other contexts, with suitable tailoring to local funding, delivery and accountability environments.

Objective: Fly-in, fly-out (FIFO) and drive-in, drive out (DIDO) work practices have been central to the resource sector in Australia for many years. While research considering the impacts of this lifestyle on mining workers is emerging, comparatively little is known about the experiences of FIFO/DIDO health professionals. The lack of information on FIFO/DIDO psychologists may be detrimental to both the communities serviced by them and the profession in terms of developing appropriate workforce planning and training for psychological service delivery in rural and remote areas. This qualitative study therefore aimed to explore the experiences of FIFO/DIDO psychologists. Method: Semi-structured qualitative interviews were conducted with 10 psychologists living in metropolitan South Australia and working in rural and remote areas. Interviews were conducted by telephone, face-to-face, or in a group. Data were analysed using thematic analysis. Results: While participants reported experiencing similar challenges as resident rural psychologists, including diverse and complex cases and a lack of referral options, they also reported unique challenges, advantages, and support needs as FIFO/DIDO psychologists. These were encompassed by the themes of “Living away from home” and “Working away from home,” which included two sub-themes: “Limited time” (referring to the limited time spent in the rural setting) and “Professional isolation” (factors associated with working away from professional supports). Conclusions: This study may assist in recruitment and retention of FIFO/DIDO psychologists by providing insight into what is required in the role and may inform training and models of rural and remote psychological service delivery.

Aim: Health workforce geographical maldistribution is a persisting global issue linked to inequitable access to health services and poorer health outcomes for rural and remote populations. Anecdotal reports suggest that the primary health care (PHC) workforce in remote NT Indigenous communities is frequently characterised by undersupply, high turnover, low stability and high use of short-term (agency) staff. A lack of reliable quantitative studies limits evidence available to guide workforce policy improvements. This study seeks to quantify current resident PHC workforce supply, turnover and retention in remote NT communities with a predominantly Indigenous population. Method: Analysis of NT Department of Health 2013-2015 payroll and financial datasets. Main outcome measures: staff headcounts, annual turnover rates, 12 month stability rates, 12 month survival probabilities, median survival, and ratio of agency nurse full time equivalent (FTE) to number of nurse positions in each remote clinic Results: In 2013-2015, 53 remote health clinics were staffed by NT Department of Health personnel. Most clinics were small, with a median of 2.0 NT Department of Health employed nurses, 0.6 Aboriginal Health Practitioners, 2.2 other employees providing or supporting PHC. On average, there was an additional 0.4 FTE agency employed nurse also providing PHC in each centre. Few communities had a resident doctor. Mean annual turnover rates were extremely high, irrespective of whether turnover was defined as no longer working in any remote clinic (66%) or no longer working at a specific remote clinic (128%). Stability rates were low, with less than a fifth of nurse and Aboriginal Health Practitioner employees still working in a specific remote clinic 12 months after commencing. On average, staff in remote clinics stayed less than 6 months. A substantial proportion of nurse positions were filled by agency nurses. Conclusion: Health services in remote, predominantly Indigenous NT communities are small and currently experience very high nurse and Aboriginal Health Practitioner turnover, low 12 month stability rates and considerable use of agency nurses. Further, there are substantially fewer Aboriginal Health Practitioners providing care in these remote communities than the available positions. These staffing patterns, also found in other remote settings in Australia, not only contribute to a lack of continuity of care for vulnerable remote Indigenous populations with complex health care needs but incur higher direct costs for providing primary care services, thereby compromising both long term service sustainability and population health outcomes. To address these deficiencies it is imperative that investments in implementing, adequately resourcing and evaluating staffing models which stabilise the remote primary care workforce occur as a matter of priority.

In the mid 1970s HC Coombs was a major promoter of the idea behind the CDEP scheme: that rather than pay lots of Aboriginal people in remote areas unemployment benefits it would be more constructive for them to be employed part-time by local Indigenous organisations to undertake socially useful tasks. From this simple idea was born one of the most significant and, in time, one of the largest Indigenous-specific programs Australia has seen, the Community Development Employment Projects scheme. The birth was not easy and neither has been the subsequent life of what I have called, with great licence, Coombs’ bastard child.

Learning objectives and outcomes relevant to aims: Awareness of the known challenges of project implementation Identification of relevant seminal literature underpinning organisational capacity building Understanding how integrating Reconciliation Action Plans with organisational capacity building strategies leads to sustainable adaptive change; inclusive workplaces; and culturally proficient service delivery. Understanding the importance of innovation in obtaining cross-organisational ‘buy-in’: Case study approach Evidence that the practice achieved its objectives: Increased staff satisfaction amid change and uncertainty; reduced turnover rate; Increased proportion of staff identifying as Aboriginal and/ or Torres Strait Islander 25% to 32% of total workforce in six months; and increased productivity and efficiency. Practical implications: Rapid and frequent reform to health; aged care and disability services has led to increased contestability; short-termed funding agreements; and increased funding and job uncertainty. Organisations such as North and West Remote Health as a not for profit company limited by guarantee has responded by seeking to increase organisational capacity through a long-term in-house approach to increasing efficiency, cultural proficiency and workforce development in remote and Aboriginal primary health care. Originality and innovation Integrating the NWRH Reconciliation Action Plan (ratified by Reconciliation Australia) with an organisation capacity building strategy. Adopting an internal sustainability approach through an in-house train-the-trainer program. Obtaining buy-in through an Expression of Interest approach across the whole organisation with criteria based upon cross-level representation; cross-region representation; and cross-cultural representation. Preparedness to listen to confronting feedback as an executive and board group; and facilitating cross-site travel for face-to-face meetings. Avoiding off-the-shelf products. Lessons learned: The fundamental lesson is the need to take a long-term approach through an in-house train-the-trainer model for organisational learning and sustained improvement in staff retention. We have learned the practical importance of agile project management methodology and the importance of obtaining board and executive support and commitment. Implementation is challenging and Implementation science as a new area of research has subsequently been identified as applicable to this project and will be considered in future stages.

National, state, and local policy objectives promote the provision of patient-centred high-quality palliative and end of life care for all rural and remote residents, either at home or as close to home as possible. In the far west of NSW there is a specialist palliative care service, however not every dying person requires or will access specialist palliative care. The successful specialist Model of Care has been modified for implementation in generalist settings as a palliative approach to care. The Far West Palliative Approach aims to improve the quality of life and experience of dying for all patients and their families through early identification, assessment and treatment of pain and other physical, psychological, social, cultural, and spiritual needs, respecting their care preferences, and supporting their carers and family in bereavement. Providing a palliative approach to care has been shown to be cost effective and improve patient outcomes including effective pain management, fewer hospital admissions, and dying in the place of their choosing. The Approach was originally implemented within three Residential Aged Care Facilities in Broken Hill. Operationally, it is focused on: improving clinical care for all patients/residents approaching the end of their lives building and maintaining a skilled rural and remote workforce with increased skill, knowledge, and confidence to provide a quality palliative approach to care enhancing communication, integration, and collaboration across rural and remote healthcare sites and services. Earlier analyses have demonstrated a change in care for all of their residents including increased coordination of care, improved advance care planning, reduced unnecessary hospital admissions, increased number of residents dying in their ‘home’, more timely referrals to the specialist service, and greater confidence within the facilities to manage end of life care. This Approach will be progressively adapted for local fit and implementation into other health service sites and settings within the Far West and other rural Local Health Districts. An evaluation will report on the adaptation, implementation, and impact of the new approach.

Objective: The objective of the study was to improve pathology services in selected remote health centres from the Northern Territory (NT) through the implementation of a quality managed point-of-care pathology testing (POCT) service. Design: Study of the efficacy of the POCT service after 1 year and qualitative survey of POCT device operators. Setting: The study was set in thirty-three remote health centres in the NT administered by the NT Department of Health. Participants: Remote health centre staff at participating remote health centres participated in the study. Interventions: The introduction of the i-STAT device to perform on-site POCT. Main outcome measures:The main outcome measures used in the study were the number of remote staff trained, volume of testing performed and satisfaction of POCT device operators. Results: One hundred and sixty-four health professional staff were trained to perform i-STAT POCT during the first year of the program. A total of 2290 POCT tests were performed on the i-STAT. The volume of testing consistently increased across the year. Tests for international normalised ratio were the most frequently performed (averaging 70 tests per month). Stakeholder satisfaction with the i-STAT device was high, with a statistically significant improvement in satisfaction levels with pathology service provision being reported after the introduction of POCT. Greater than 80% of respondents stated POCT was more convenient than the laboratory service and assisted in the stabilisation of acutely ill patients. Conclusions: The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability.

The concept of ‘remote’ has intensified a fundamental misunderstanding of widespread rural Aboriginal situations. More, it has served to mask the causality for current problems, which will remain intractable until causality is effectively addressed. This commentary re-examines how ‘remote’ is produced, both by and within the dominant state and society and, by means of a reconsideration of demand sharing and long-distance travel, from and within Aboriginal communities. On that basis new kinds of confrontational engagements with the production of remote are suggested.

In our big beautiful country where the population is spread over vast and in places very remote areas, traditional educational services are not able to be provided to all students. Since 1971 the Isolated Children’s Parents’ Association of Australia, ICPA (Aust), has represented families living in rural and remote regions of Australia. Our goal is to achieve equity of educational opportunity for all geographically isolated children and thus ensure they have access to a continuing and appropriate education determined by their aspirations and abilities rather than the location of their home. Due consideration must be given to factors which affect the delivery of and access to education by these children, factors which do not necessarily need to be considered within the context of metropolitan education. Children may be educated in small rural schools, by distance education, attend boarding schools or school term hostels and sometimes have access to early childhood services. Tertiary students whose family home is in rural and remote Australia frequently must live away from home to access further education. The financial cost to families educating children in these locations continues to rise and can be attributed to many leaving these areas. ICPA continues to provide government with evidence of the inequalities through thorough research and direct input from grassroots members. For many of our member families the only access to education for their children is to study by distance education. A fascination to some, a chore to others, distance education schooling has long been the only option for education in rural and remote Australia. At the latest Federal Conference held in Perth, WA, ICPA launched the Distance Education Resource video showcasing the modern technology filled isolated classroom and this has received an overwhelming response from media and the public. ICPA welcomes any opportunity to highlight the challenges geographically isolated children face and the latest developments as we continue to strive towards achieving the following: accessing affordable early childhood learning and care equity of access and assistance for students with specific learning needs recognition of the financial impact on families who must provide a distance education tutor access to reliable and affordable communication services urgent financial assistance to overcome the unsustainable costs associated with accessing boarding school education for students who must live away from home in the secondary years affordable pathways to accessing tertiary studies.

Introduction: The Northern Territory (NT) Point-of-Care Testing Program commenced in 2008 in over 30 selected remote health centres in the NT. Using the Abbott i-STAT point-of-care testing (POCT) device, pathology results are immediately available at the health centre enabling immediate diagnosis and treatment or monitoring of a wide-range of acute and chronic conditions. Background: In 2015, under the direction of the NT Department of Health, the program was expanded to every remote health service providing equity of access to this diagnostic tool for all remote Territorians. The large scale rollout, doubling the program’s size to 72 remote health services, required careful planning and innovation. Methods: The rollout was coordinated by a team of scientists, professional practice nurses and doctors who make up the NT POCT Program Management Committee. Strategies to rollout the program included: accessible training options including weekly teleconference training sessions; development of a website providing 24/7 Territory-wide access to training materials including videos; on-site visits to provide initial device set-up, training and coordination; and the development of an innovative method for monitoring the number and type of tests performed to assist with consumable ordering (a primary obstacle for remotely located health centres). A cost effectiveness evaluation of the program was conducted, funded through a grant from the Emergency Medicine Foundation. Patient cases from 6 remote health centres where the availability of POCT ruled out the need for an emergency medical retrieval were reviewed to determine cost savings. Results were extrapolated using prevalence data for each condition to give an NT-wide estimate of cost savings. Clinical effectiveness of POCT was also examined. Results: In the initial 6 months of the rollout, 158 new remote staff were trained as device operators with survey respondents expressing high satisfaction with the quality of training. The analytical quality of POCT results in this primary care setting remained stable during the rollout period and was of equivalent standard to a laboratory. Improvements in outcomes for acutely ill remote patients were identified through POCT enabling more rapid diagnosis and treatment. Indicative cost savings through preventable medical evacuations using POCT are substantial (millions per annum), with final results to be released in October 2016. Conclusion: This POCT program serving remote communities can be translated to other areas of remote Australia and internationally due to its significant cost savings through prevention of unnecessary medical retrievals and positive impact on patient outcomes and increased patient safety.

The aims of National Disability Insurance Scheme (NDIS) are to provide long-term, person-centred care and support to all Australians with a significant and ongoing disability, including individuals with an acquired brain injury (ABI). The scheme has significant potential to provide equitable opportunity of access to health and disability services. Historically, however, service provision in remote and outer regional areas of Australia lags behind more densely populated centres. Aboriginal and Torres Strait Islanders living with disability are already significantly marginalised. Further to this, people with an ABI are very often misunderstood and overlooked by disability services, health professionals and governments, and frequently fall victim to the criminal justice system. This paper provides an overview of the state of ABI disability for Aboriginal and Torres Strait Islanders in remote and outer regional settings, and the present sets of barriers they face to obtaining quality care and effective interventions. A significant opportunity has emerged with the advent of the NDIS but equitable benefit can only be achieved if additional and specialised measures are devised and implemented to appropriately screen for, and assess, incidence of ABI; disability services are appropriately resourced to overcome the pre-existing disadvantage, and education, training and recruitment of Aboriginal and Torres Strait Islanders with the NDIS is undertaken to lead attitudinal changes in community to disability and health services. This paper concludes with recommendations for the NDIS to meet its laudable objectives.

Background: Government healthcare spending for Indigenous Australians is higher than for non-Indigenous Australians yet it does not appear to be impacting health outcomes equitably, especially in more remote areas. The defined region of Northern Australia is characterised by decentralised populations and has a high concentration of Indigenous people compared with southern Australia. Recent research has highlighted the need for investment in Northern Australia. The only Australian standard for economic evaluations of healthcare is the Pharmaceutical Benefits Advisory Committee (PBAC) guidelines, which recommend use of national data, such as Pharmaceutical Benefits Scheme (PBS) data. These data are more likely to be under-recorded and health services underutilised by Indigenous patients compared with non-Indigenous patients. Indigenous Australians also may have distinct health models that differ from mainstream Australian services. For these reasons, validated economic evaluation of healthcare is critical to deliver the best allocation of scarce resources for Indigenous communities in Northern Australia. Aim: This study aimed to determine how health service use and costs are captured and quantified in economic evaluations for remote and regional Indigenous populations in Northern Australia. Methods: A systematic review of health service economic evaluations involving Indigenous Australians within Northern Australia was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of records published from 2010 to 2016 was conducted from PubMed, Scopus, government and non-government databases. Thematic analysis was performed on evaluations that met inclusion criteria. Results: Sixteen evaluations met the inclusion criteria from an initial 515 records identified. These studies used disparate evaluation methods. Most evaluations were performed from a state or territory perspective. Only seven evaluations captured patient data that extended outside of a state or territory source. There was no health service data capture using national data sources. Only two studies used a comprehensive societal perspective. Few studies considered Indigenous patients’ perspectives. Conclusions: Despite the needs identified for robust economic evaluations for Indigenous peoples in Northern Australia, recent evaluations have not been conducted consistently or with sufficient consideration of federal, societal and Indigenous consumer perspectives. Uncoordinated evaluations from state and territory perspectives have led to the underutilisation of established guidelines. Barriers identified, such as unlinked patient PBS data, also limit the ability of governments and researchers to conduct comprehensive economic evaluations. Methodological consistency in economic evaluations of healthcare is recommended and will lead to improved, quantifiable comparisons of health services for Indigenous patients within, and outside the health sector.

Background: Rural and remote birthing services have been closing for several decades. The rationale behind these closures are often concerns about safety, economic resources, and professional indemnity. Many developed nations have experienced similar trends in closure of rural birthing services. These closures have considerable implications for patients, communities, clinical workforce and health services in rural areas. Many non-metropolitan community members continue to lobby for the reinstatement of local birthing care as they seek safe, equitable service access and high quality care. After many years of closures, the state of Queensland in Australia has seen increased interest and success in restarting remote birthing services. There are significant challenges to be overcome for any birthing service to recommence, including: ensuring appropriately skilled workforce, consideration of community expectations, equipment availability, navigating health system requirements and the politics of the time. Those wishing to reopen a rural birthing service would benefit from understanding the essential tasks and processes required to restart services and the enablers and barriers to achieving this. Analysing and collating this data from a number of services into a ‘toolkit’ may assist the direction of other remote health services seeking to reopen birthing care after a period of closure. Aim: This paper outlines results from the first case study of a reopened birthing service in a remote northern Queensland health service. Methods: A qualitative, case study approach was employed to investigate key enablers, barriers, tasks and processes associated with reopening a remote birthing service. Purposive sampling was used to identify key stakeholders and actors throughout the system including clinical and support staff, local service managers, community advocates and relevant district managers. These actors were invited to participate in individual semi-structured, in-depth interviews during which they discussed the experience of reopening the birthing service from their perspective; highlighting enablers, challenges, and important influences. Interviews were transcribed and analysed using an iterative, thematic technique. Results: Qualitative analysis of the results found key enablers, barriers, tasks and processes can be categorised into thematic groups; the largest of which were associated with workforce, funding and safety. These will be discussed in light of the timeline for reopening: from initial groundwork required to start the process, service reopening and then ongoing concerns after the service recommences. The contextual factors surrounding the service recommencing are presented from community, staff and political perspectives.

Utilising strengths based approaches that build on Aboriginal and Torres Strait Islander knowledges and perspectives, our national Indigenous allied health organisation and our partners are collaborating to develop models of health workforce development that are flexible, community driven and aim to provide local solutions to local health workforce problems in remote/rural Australia. One such model under development through a collaborative effort between partners across sectors and disciplines, is a school based traineeship program in the Northern Territory (NT) that will enable, encourage and support local NT Aboriginal and Torres Strait Islander students to pursue a career in health. With the first cohort planned for 2018, the program currently known as ‘The NT Health Academy’, is a model of health workforce pathway development that aims to engage Aboriginal and Torres Strait Islander students to stay in the school system and graduate with Year 12 qualifications, whilst also completing a Certificate III in Allied Health Assistance and gaining job ready skills. It is not our role to determine health workforce solutions for local communities, it is rather our role to facilitate conversations, opportunities, strategies and solutions at a local level to meet the needs of those who require equitable access to culturally responsive healthcare. Therefore the process involved in progressing this workforce development model is equally as important as its potential outcomes. We actively engage in ways of knowing, being and doing that demonstrate Respect for Centrality of Culture, Self-Awareness, Proactivity, Inclusive Engagement, Leadership, and Responsibility and Accountability. Central to the success of this model is engagement with local Aboriginal and Torres Strait Islander individuals, families and communities to drive and sustain it over time. This project, whilst important, is just one solution that has been developed through inclusive community engagement to meet local health workforce needs. There is no one-size-fits-all approach to workforce development, and targeted investment is required nationally to enable further cross sectoral collaboration and authentic community engagement to develop health workforce solutions in other remote and rural areas. Flexible career development pathways, with multiple entry and exit points dependent on the needs of communities and aspirations of individuals, will be required. Providing ongoing support, opportunities and choices to local Aboriginal and Torres Strait Islander peoples in remote and rural Australia to pursue careers in health, across a diverse range of disciplines, will be essential in order to build a sustainable health workforce for the future.

Objective: As the first professional contact for most Australians with mental health concerns, general practitioners (GPs) are often considered the “gateway” to accessing psychologists. Understanding GPs’ views of psychologists is therefore of great importance to the profession. GPs serve a particularly important role in mental health in rural and remote areas given the lack of other services; however there has been limited research investigating the relationship between psychologists and GPs in rural areas. This study aimed to investigate rural GPs’ perceptions of rural psychologists. Method: Semi-structured qualitative telephone and in-person interviews were conducted with 13 GPs working in rural and remote South Australia. Data were analysed thematically. Results: Three main themes were identified: Psychologists are useful/helpful; working with psychologists can be challenging; and psychologists are not well understood. Rural GPs held mostly positive views about psychologists and their value in providing professional support and reducing GP workloads. However, GPs’ understanding of psychologists’ training and expertise varied considerably, with most reporting gaps in their knowledge. Challenges included limited access to psychologists and communication barriers. Communication was considered to be enhanced by co-locating psychology services within the GP practice, which was also considered to be a valuable educational opportunity for GPs. Conclusion: While rural GPs held largely positive views of psychologists, they may require further support in understanding what psychologists can offer and promoting psychology to their patients. Results may assist in improving communication between rural psychologists and GPs and inform strategies to improve rural GPs’ understanding of psychologists’ skills and training.

Access to quality health care providers continues to be challenging in rural and remote regions of Australia. The shortage of medical practitioners has been the principal focus of research and policy initiatives. There is, however, limited understanding of how nursing and allied health students and graduates choose locations to practice. This qualitative study, provides additional information about rural practice decision making process of urban trained allied health and nursing students and graduates. The research team was a collaboration across three University Departments of Rural Health in [names of States and Territories withheld for blind review]. A review of the last 10 years of Australian literature on nursing and allied health rural and remote recruitment informed the development of semi-structured interviews. Three groups of participants (n=85), students (n=36), graduates (n=34) and industry stakeholders (n=15) were interviewed. The student and graduate interviews focussed on perceptions of rural and remote, the impact of clinical experiences and the perceived advantages and challenges of working in a rural or remote location. Stakeholder interviews explored factors that impact on recruitment including policies and strategies that support or mitigate this process. Urban-based allied health and nursing students begin to think about employment from the middle years of their studies. Location decision making within these professional groups is influenced by a complex interplay of many influencing elements, non-professional and professional. For urban trained allied health and nursing students and graduates, connectedness to people, place and community, seeing a career pathway and having an opportunity to experience living and working in a rural or remote area are central to their decision making. However, all participant groups commented on how the generally negative portrayal of rural and remote practice mitigates against relocating to non-metropolitan areas. Key recommendations arose from the findings and will be shared in this presentation to inform future decision making and recruitment strategies for rural and remote practice. These included, among others: marketing rural and remote practice from a positive perspective, particularly the professional benefits providing financial and other support to nursing and allied health professionals to relocate from metropolitan locations developing clearer and professionally rewarding career development opportunities and pathways increasing the emphasis on innovative, extended scope of practice roles.