Remote Australia Online

Background: Eye care is but one of the many specialist health care services provided within Aboriginal Community Controlled Health Services (ACCHS) and remote community health centres. Achieving positive eye care outcomes for these visiting services requires pro-active collaboration and two-way learning. Gaining and maintaining this stakeholder engagement can be challenging, but is a fundamental aspect of health system strengthening. Aim: To support eye care improvements in the Katherine region of the Northern Territory, two Non-Government Organisations (NGOs) have been working together over four years to strengthen links and facilitate regional collaboration. This presentation shall identify processes that were constructive. Methods: Upon feedback from the ACCHS, and observation of coordination challenges, key stakeholders articulated the need for intentional work to support collaboration. This information was considered: regional service mapping service delivery data available coordination workforce service gaps performance of the system patient and community perspectives. The regional eye care system was strengthened by: increasing services addressing gaps in the local and regional eye health coordination workforce continuous quality improvement (both service and system level) developing a work plan with stakeholders training in eye care checks and referral pathways. Results: Eye care service delivery and access increased and patient pathways improved. Stronger relationships developed, communication strengthened and engagement with eye care by ACCHS increased. This system-level improvement was also noted as a positive trend in stakeholder-rated performance, gauged via an Eye Care Systems Assessment. Discussion: Improved coordination, integration and strategic alignment of projects was achieved using participatory methods. Taking a strengths-based approach, the various challenges for eye care (e.g. competing health priorities, accessing data, waiting lists, patient access barriers) were viewed as opportunities for improvement that were achievable by working together. A shared work plan articulated the “common vision”, prioritised activities, set targets, and listed responsibilities. This was developed following structured conversation which invited individual perspectives then considered these in light of the broader stakeholder perspective. Helpful processes included an Eye Care Systems Assessment, focus-group guided enquiry, a polling process called ‘dotocracy’, and critical reflection. Importantly, these structured approaches happened on an existing platform of collaboration and trust between the stakeholders. Relevance and conclusion: Celebrating achievements, embracing challenges and engaging widely were important aspects. The approach and tools are potentially helpful to apply in other regions, not only for eye care but for other specialty areas that must integrate with primary and tertiary care to achieve outcomes.

Issue addressed: Diabetes is associated with significant depression, which can result in poorer clinical outcomes, including increased mortality. Little is known about the prevalence of depression among Torres Strait Islander adults with diabetes. Methods: Self-reported depression was measured using the Patient Health Questionnaire (PHQ)-9 translated into Torres Strait Creole, and associations with socioeconomic, behavioural and clinical indicators in Torres Strait Islander adults with diabetes in five remote Torres Strait Islands were examined. Results: Seventy-three men and 115 women completed interviews. The median PHQ-9 score was 5.5 (IQR 0–7); 42% of respondents scored 0–4 (none-minimal), 46% scored 5–9 (mild) and 12% scored 10+ (moderate-severe). Mean HbA1c was 8.3% (67.4 mmol). HbA1c was not related to PHQ-9 scores (b = 0.20, P = 0.323), however exercise in hours (b = −0.34, P < 0.001) and screen time in hours (b = 0.11, P < 0.001) were significant predictors of depression after adjusting for other study variables. Conclusions: This sample of remote living Torres Strait Islanders reported relatively low rates of depression compared with national samples, and depression was not related to glycaemic control. Exercise and screen time were the strongest predictors of depression based on PHQ-9 scores. This represents an opportunity for health promotion. So what?: These findings provide an indication of the health impact of physical activity in rural and remote communities. Local health and education services, councils and sporting bodies should work collaboratively to promote sustainable physical activity programs.

AIM: This paper is a report of a study to examine the social discourses of nursing within health care as these produce understandings about autonomy for Nurse Practitioners, where autonomy refers to the ability of Nurse Practitioners to practise as professionals in their own right. BACKGROUND: Nurse Practitioners were recently introduced to the nursing career pathways in Australia. Despite a plethora of international information, the role implementation in rural and remote Australia is slow with a number of influences emerging to hinder progress. METHOD: Critical discourse analysis was used to examine the differences between policy and the reality of implementation. The notion of autonomy was used to explore texts in policy documents relating to Nurse Practitioner authorization and published between 1995 and 2006, and these were compared with the experiences of nurses working in Nurse Practitioner positions. FINDINGS: Policy texts indicate support for advanced practice and the autonomy of Nurse Practitioners. The process for authorization; however, has constraints which support nurses' progress but also hinder it. Subsequent acceptance of Nurse Practitioners has also been problematic as colleagues struggle to understand the role within the current healthcare system. CONCLUSIONS: There is a significant gap between the rhetoric of policy and the implementation of Nurse Practitioner roles in rural and remote Australia. Whilst policy supports the notion of autonomy, the experiences of nurses indicate a mere shift in the traditionally-accepted boundaries of nurses' roles. Evidence from the United Kingdom and United States of America suggests that the findings in this study are relevant internationally as well as nationally.

Objectives We examined the logistical challenges of conducting an outreach, secondary prevention program for adults discharged from Alice Springs Hospital following an acute presentation of cardiovascular disease. Design and Setting This represents a sub-study of the Central Australian Heart Protection Study (CAHPS). Clinical, logistic and demographic data were used to examine the characteristics of outreach visits in the intervention arm of the study. Participants Fifty subjects initially allocated to the intervention arm of the trial were studied. Main outcome measures Completion of scheduled, plus additional outreach visits according to the intervention protocol. Results The majority of subjects presented with an acute coronary syndrome (44/50 (88%)) and 31 (62%) were of Indigenous ethnicity. However, Indigenous subjects being younger (53.1 ± 11.1 versus 58.0 ± 11.0 years non-Indigenous) had a more complex risk factor and co-morbid profile, with significantly more diabetes (77% versus 26% P < 0.001), hypertension (81% versus 53% P = 0.04) and renal failure (52% versus 21% P = 0.03). Community of origin of Indigenous subjects was 230 ± 208 km from the hospital versus 61 ± 150 km for non-Indigenous subjects (P = 0.004). Indigenous subjects missed a significantly higher number of scheduled visits at six months (1.39 ± 2.14 versus 0.16 ± 0.50 visits; P = 0.02). However, multivariate analyses suggested that distance did not influence successful completion of visits. Conclusions These early findings from CAHPS are invaluable to understanding and improving the feasibility of secondary prevention programs for Indigenous adults living with heart disease in remote communities.

Background: The MBS Review Taskforce is undertaking an independent clinician-led review of the Medicare Benefits Schedule (MBS). This is the first comprehensive review in 30 years of the 5,700 items covered in the MBS. The priority with this Review is to ensure that the items on the MBS are aligned with contemporary clinical evidence and practice and improve health outcomes for all Australians. The Taskforce will also seek to identify any services that may be unnecessary, outdated or potentially unsafe. The Taskforce is committed to providing recommendations to Government that will allow the MBS to deliver on each of these key goals: affordable and universal access best practice health services value for the individual patient value for the health system. The clinical review of MBS items, ranging from consultations, procedures and diagnostics is carried out by discipline specific clinical committees and working groups. At the same time the MBS Principles and Rules Committee appointed by the Taskforce are reviewing the enforceable rules and regulations underpinning the MBS so they are up-to-date and support contemporary clinical practice. To date, more than 300 clinicians and approximately 40 Clinical Committees and working groups have been reviewing the items, line-by-line. Rural and remote consultation: A key part of the Review is continuing and widespread consultation with rural and remote health professionals and patients. Our community consultations have highlighted the diversity of needs of patients in urban and rural and remote Australia and the need for different methods of supporting rural and remote clinicians and their patients as they access care. Rural and remote consultation will continue to be integral to the MBS Review process and feedback on the impact of the recommendations in rural and remote Australia is invited and welcomed. This feedback will be closely considered by the Taskforce Clinical Committees and the Taskforce when final recommendations are delivered to government. Professor Bruce Robinson, Chair of the Taskforce, has been on the road this year in QLD, NT and Tasmania listening to the unique challenges facing health professionals and patients in rural and remote Australia with further plans for more rural consultations in 2017. We will report progress of the General Practice and Primary Care Clinical Committee.

Many central Australian Aboriginal settlements have recently gained access to mobile phones and the Internet. This paper explores ways in which Aboriginal people engage with this technology outside of institutional settings. Drawing on long-term research among Warlpiri, I reflect on people's responses to earlier communication media such as the two-way radio and radio–telephone and compare them to patterns of use emerging around new technologies. Attending to the social landscape surrounding the uptake of new media and the social networking site ‘Divas Chat’, I consider how transformations in material structures of communication interact with changing demographics, embodied socio-spatial relations, sorcery beliefs and mobility to reinforce, refigure and/or disrupt patterns of conflict and connectedness that hitherto have structured Warlpiri relational ontology. I suggest that the way people engage with these technologies illuminates and intensifies fault-lines arising from contradictions between older established social orders and changing relations with the state and modernity.

Summary This chapter contains sections titled: Abstract The Granting of Native Title and the Management of Rock Art and Cultural Heritage But It's Too Complex to be Aboriginal Art? What is Special About the Canning Stock Route Art? Martu Views on Rock Art Recording, Dating, and Analysis of the Rock Art Management Issues on the Canning Stock Route Known General Impacts on the Canning Stock Route Documented Impacts on Tangible and Intangible Cultural Heritage Indigenous Protected Areas, Conservation Values, and Rangers on Country Toward Sustainable Future Visitation to Canning Stock Route Rock Art Locales References

Objective To determine whether people seen by the Far North Queensland Specialist Medical Outreach Service (SMOS) with chronic kidney disease (CKD) and proteinuria were treated according to established guidelines. Design Audit of SMOS clinical reports from 18th May to 27th July 2012. Clinical markers were compared with the Caring for Australians with Renal Impairment and National Heart Foundation management guidelines. Setting Reports covering primary health care centres located in remote communities of Cape York Peninsula and Torres Strait, Far North Queensland. Main outcome measure(s) The proportion of people with CKD and proteinuria on appropriate renoprotective treatment with an angiotensin-converting enzyme inhibitor (ACE-inhibitor) or angiotensin-2 receptor blocker (ARB). The proportion of people with CKD and proteinuria reaching blood pressure targets as per National Heart Foundation guidelines. The proportion of people with stage 4 CKD appropriately referred to a specialist renal service. Results One hundred and eighty-six clinical reports were reviewed; 48 people had markers of CKD. Forty-five of the 48 (94%) had been prescribed an ACE-inhibitor or ARB according to management guidelines. Nineteen of the 48 (40%) had blood pressures within the target range. Four of six people with late-stage CKD (stage 4 or 5) had been referred to a specialist renal service. Conclusions This audit confirms the high rate of CKD in the people of Far North Queensland, although this is a highly selected sample. It shows appropriate prescribing of renoprotective treatment in most cases. However, it also highlights the need for a more vigorous approach to blood pressure control.

Summary The Wuthathi people from the Shelburne Bay area on the north-east coast of Cape York Peninsula have been displaced from their ancestral homelands since the late 1930s. Despite not having a permanent presence, Wuthathi have continued to access their ancestral country and connection remains unbroken. Through both Native Title and the Queensland Government’s land tenure reform process, much of the Wuthathi homelands will be returned as either Aboriginal freehold land or as Aboriginal-owned national park. Wuthathi have Native Title over their sea estate that includes the exclusive use of a number of islands. The completion of Native Title and tenure reform will allow Indigenous management to return to the landscape from which it has been absent for nearly 100 years. In preparation for their return to country, the Wuthathi developed an integrated culture and conservation programme over 8 years ago that addressed cultural and natural conservation imperatives. Wuthathi are now moving into the implementation phase where Native Title has been determined. This study presents outcomes of a workshop, held in October 2010, that identified a range of barriers preventing sound ecological and cultural land management. For example, while funding for multiple land and sea cultural and natural resource management projects is secured, operational funding, management infrastructure and resources are lacking. With Wuthathi people dispersed across many hundreds of kilometres and no permanent infrastructure on country, planning and executing current management projects are severely limited.

The WA Primary Health Alliance (WAPHA), Country Primary Health Network (PHN) has been tasked with ensuring that health services delivered in their regions are required, equitable and affordable. The commissioning of chronic disease and mental health services in three PHN regions (Midwest, Goldfields and South West) afforded the opportunity to challenge long-standing service delivery models, to ensure services were being delivered appropriately and to those in most need. Each region tailored the look of potential new services to the needs of their communities, with engagement and collaboration being paramount to achieving the common goal of equity and value for money for these services. To ensure all voices were heard, a community forum was held in each major centre throughout the regions so that the community had an opportunity to discuss their health needs and where perceived gaps were in service provision. Country WA PHN staff also met with general practitioners, representatives from the WA Country Health Service, non-Government organisations, the Police, Shires and community groups, to hear their views on current and potential health services for their district. Cognisant of the fact that funding partners would, potentially, add value to possible new services, staff met with various organisations, such as, the Department for Aboriginal Affairs, the Department of the Prime Minister and Cabinet and the Mental Health Commission. Service providers for a particular region were given the opportunity, in a forum setting, to discuss their services and how better they could interact with each other to negate duplication. Following this extensive consultation, areas of un-met need were identified. Ideas on how to address these were taken to the various government and non-government organisations, ensuring, that where possible, existing partnerships were maintained and strengthened. In the Midwest, one area of need was the provision of an Aboriginal AoD worker. This worker would complement an existing position by being the opposite gender, for cultural reasons. After negotiation with service providers, a consortium was used to employ the worker to ensure that as many clients as possible have access to this position. The Midwest is just one of seven regions across Country WA, all with unique characteristics, each requiring different approaches. The presentation will compare the approaches taken in the Midwest, South West and Goldfields and explore the key elements (similarities and differences) in each approach.

This publication reports on the inquiry into the crisis of Aboriginal youth suicide in Western Australia. The report covers an introduction and background to the inquiry, how Aboriginal suicide is different, risk factors for Aboriginal youth suicide, culture and identity, community empowerment, strategy and governance, collaboration and coordination, improving effectiveness of service delivery and recommendations. (Abstract from Australian Indigenous HealthInfoNet.)

Summary The Arafura Swamp is a globally significant wooded wetland in central Arnhem Land providing important habitat for migratory birds and fish. It is, however, threatened by saltwater intrusions from rising sea levels and a range of other threats including some cattle grazing, inappropriate fire regimes and feral plant and animal invasions. Three Indigenous Ranger groups are working to address these management issues but need stronger levels of support to be able to secure ongoing and long-term management solutions for this important wetland.

Indigenous community-based monitoring has been a central feature in many international attempts to improve monitoring of and local adaptation to environmental change. Despite offering much promise, Indigenous community-based monitoring has been underutilised in natural resource management in Australia, particularly within the remote, semi-arid rangelands. This paper discusses contextual social and environmental factors that may help to explain this apparent deficiency, before critically analysing key stakeholder perceptions of the roles for, and challenges of monitoring in the Alinytjara Wilurara Natural Resources Management region in the north-west of South Australia. The analysis guides a discussion of responses to better integrate monitoring in general, and Indigenous community-based monitoring in particular, into regional environmental management approaches. We argue that community-based monitoring offers a range of benefits, including: better coordination between stakeholders; a heightened ability to detect and respond to climatic trends and impacts; the effective utilisation of Indigenous knowledge; employment opportunities for managing and monitoring natural resources; and improved learning and understanding of rangeland socio-ecological systems. Identified opportunities for spatial and temporal community monitoring designed for the Alinytjara Wilurara region could be of value to other remote rangeland and Indigenous institutions charged with the difficult task of monitoring, learning from, and responding to environmental change.

SummaryIndigenous ecological knowledge can inform contemporary water management activities including water allocation planning. This paper draws on results obtained from a 3-year study to reveal the connection between Indigenous socio-economic values and river flows in the Daly River, Northern Territory. Qualitative phenological knowledge was analysed and compared to quantitative resource-use data, obtained through a large household survey of Indigenous harvesting and fishing effort. A more complete picture of Indigenous resource-use and management strategies was found to be provided by the adoption of mixed methods. The quantitative data revealed resource-use patterns including when and where species are harvested. The qualitative Indigenous ecological data validated results from the quantitative surveys and provided insights into harvesting and resource management strategies not revealed by the discrete time-bound surveys. As such, it informed the scientific understanding of patterns of resource use and relationships between people, subsistence use and river flows in the Daly River catchment. We recommend that natural resource managers, researchers and Indigenous experts prioritise collaborative projects that record Indigenous knowledge to improve water managers’ understanding of Indigenous customary aquatic resource use.

We critically analyse the ways in which a particular gambling space, Lasseters Hotel Casino, Alice Springs, Northern Territory, has incorporated the marginalised Aboriginal population of central Australia into the market economy as consumers, despite the failure of the market and the state to provide meaningful inclusionary alternatives in the realm of production. We explore the ways in which this gambling space has evolved as a synthesis between the imperative of capital accumulation on one hand, and the demands for the reproduction of Aboriginal social life on the other. We examine the dialectical relations between technology and consumption practices, the ideology of chance, and racialised regulation that, in combination, produce a contradictory space of economic exploitation and social inclusion. We argue that the casino has achieved something that the state has failed to do across remote Australia, that is, provide an inclusionary space for Aboriginal people within society, albeit an economically exploitative one.

EMET is an Australasian College of Emergency Medicine program that is aimed at supporting and training the non-specialist workforce who in the Great Southern make up 92% (61 of 66) of the permanent medical workforce staffing Emergency Departments. The program has been instrumental in building relationships between hospitals, providing high quality education resources and offering the ability to fund Specialists to work in the rural sector in an environment where there has been a freeze on recruitment. Albany was one of the first hospitals in WA to become a hub site in 2012. Before that time, there was little co-ordination between the 5 hospitals in the region, a large area in the South of the State serving a population of around 60,000. Education and training was piecemeal and referrals of patients to the Regional Resource Base (Albany) was at times suboptimal. Stemming from a change in model of the Emergency Department in Albany, the Specialist-led department has utilised EMET funds to make 70 visits per annum on average to the smaller sites of Kojonup, Katanning, Mount Barker and Denmark. The Nursing posts at Bremer Bay, Ravensthorpe, Gnowangerup, Jerramungup and Hopetoun have all been visited bi-monthly on average. The funding has helped the department grow from one main FACEM educator to four, enabling Albany to gain accreditation for training Emergency Medicine Registrars rurally. A stand-alone post has been created for GP Registrars to work full-time in Albany for 6 months and gain the Emergency Medicine Certificate. This has seen 3 successful candidates, of which 2 plan to settle in the area permanently. A Simulation training program has been instigated which goes out to each hospital in the Great Southern in turn over the year, educating and training. This knowledge of local capability helps the specialist in the Regional Resource Centre (RRC) gain a true appreciation of local logistics, aiding handovers and transfers from smaller site to the RRC. Initial problems with the approach have stemmed from the smaller sites viewing the education as interrogational, pressured and intimidating, but the relationships built between the permanent Specialists in the region and the non-specialist practitioner have erased these fears and has led to 7 non-specialists seeking out current upskilling in the RRC. This is a program that has transformed Emergency Care in the Great Southern and there are a myriad of opportunities to take it further.

Being able to estimate kidney decline accurately is particularly important in Indigenous Australians, a population at increased risk of developing chronic kidney disease and end stage kidney disease. The aim of this analysis was to explore the trend of decline in estimated glomerular filtration rate (eGFR) over a four year period using multiple local creatinine measures, compared with estimates derived using centrally-measured enzymatic creatinine and with estimates derived using only two local measures.The eGFR study comprised a cohort of over 600 Aboriginal Australian participants recruited from over twenty sites in urban, regional and remote Australia across five strata of health, diabetes and kidney function. Trajectories of eGFR were explored on 385 participants with at least three local creatinine records using graphical methods that compared the linear trends fitted using linear mixed models with non-linear trends fitted using fractional polynomial equations. Temporal changes of local creatinine were also characterized using group-based modelling. Analyses were stratified by eGFR (<60; 60-89; 90-119 and ≥120ml/min/1.73m2) and albuminuria categories (<3mg/mmol; 3-30mg/mmol; >30mg/mmol).Mean age of the participants was 48years, 64% were female and the median follow-up was 3years. Decline of eGFR was accurately estimated using simple linear regression models and locally measured creatinine was as good as centrally measured creatinine at predicting kidney decline in people with an eGFR<60 and an eGFR 60-90ml/min/1.73m2 with albuminuria. Analyses showed that one baseline and one follow-up locally measured creatinine may be sufficient to estimate short term (up to four years) kidney function decline. The greatest yearly decline was estimated in those with eGFR 60-90 and macro-albuminuria: -6.21 (-8.20, -4.23) ml/min/1.73m2.Short term estimates of kidney function decline can be reliably derived using an easy to implement and simple to interpret linear mixed effect model. Locally measured creatinine did not differ to centrally measured creatinine, thus is an accurate cost-efficient and timely means to monitoring kidney function progression.

Aim: To examine processes of aged-care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care. Method: A qualitative study involving 11 semistructured interviews with aged-care assessors and two focus groups with Aboriginal community members. Results: This paper reports four major themes concerning how needs assessments relate to realities of service delivery: cultural perspectives on aged care, context of service delivery, equity and access to services, and program (mis)alignments. Conclusion: Disparities exist between assessment recommendations and service availability, with a potential mismatch between Aboriginal understandings of needs, interpretations by individual assessment staff and program guidelines. Incorporating a conceptual framework, such as the International Classification of Functioning, Disability and Health, into service guidelines to ensure structured consideration of a person's holistic needs may assist, as will building the capacity of communities to provide the level and type of services required.

During austral summer 2015-16, prolonged extreme ocean warming events, known as marine heatwaves (MHWs), occurred in the waters around tropical Australia. MHWs arose first in the southeast tropical Indian Ocean in November 2015, emerging progressively east until March 2016, when all waters from the North West Shelf to the Coral Sea were affected. The MHW maximum intensity tended to occur in March, coinciding with the timing of the maximum sea surface temperature (SST). Large areas were in a MHW state for 3-4 months continuously with maximum intensities over 2°C. In 2016, the Indonesian-Australian Basin and areas including the Timor Sea and Kimberley Shelf experienced the longest and most intense MHW from remotely sensed SST dating back to 1982. In situ temperature data from temperature loggers at coastal sites revealed a consistent picture, with MHWs appearing from west to east and peaking in March 2016. Temperature data from moorings, an Argo float, and Slocum gliders showed the extent of warming with depth. The events occurred during a strong El Niño and weakened monsoon activity, enhanced by the extended suppressed phase of the Madden-Julian Oscillation. Reduced cloud cover in January and February 2016 led to positive air-sea heat flux anomalies into the ocean, predominantly due to the shortwave radiation contribution with a smaller additional contribution from the latent heat flux anomalies. A data-assimilating ocean model showed regional changes in the upper ocean circulation and a change in summer surface mixed layer depths and barrier layer thicknesses consistent with past El Niño events.

Aim: To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. Methods: A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy. Results: Among 301 participants (33% male), gradable image rates were 78.7% (n =237) for diabetic retinopathy and 83.1% (n =250) for diabetic macular oedema, and 77.7% (n =234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19–86) years and known diabetes duration 9.0 (0–24) years. The prevalence of diabetic retinopathy was 47% (n =110) and for diabetic macular oedema it was 14.4% (n =36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n =38): 14.1% (n =33) for clinically significant macular oedema, 1.3% (n =3) for proliferative diabetic retinopathy and 0.9% (n =2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases. Conclusions: A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of ‘any’ diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. This article is protected by copyright. All rights reserved.

Rural and remote communities often have complex and diverse mental health needs and inadequate mental health services and infrastructure. Information and communication technologies (ICTs) provide an array of potentially innovative and cost-effective means for connecting rural and remote communities to specialist mental health practitioners, services, and supports, irrespective of physical location. However, despite this potential, a review of Australian and international literature reveals that ICT has not attained widespread uptake into social work practice or implementation in rural communities. This article reviews the social work literature on ICT, draws on research on tele-psychology and tele-education, and provides suggestions on how to enhance engagement with ICT by social workers to implement and provide mental health services and supports tailored to community values, needs, and preferences that are commensurate with the values of the social work profession.

Objective: To identify the current scope of Tele-Derm, the types of dermatological complaints experienced in the rural primary care setting, and to assess the quality of patient clinical information provided to the consultant dermatologist. Design: Retrospective case analysis. Setting: Tele-Derm National is an initiative of the Australian College of Rural and Remote Medicine and has been providing online educational and consultational services in dermatology to doctors Australia-wide for over a decade. Participants: Patient cases that were submitted to Tele-Derm for specialist dermatologist advice. Interventions: Audit of submitted cases. Main outcome measures: The types of patient presentations and reason for submission for specialist opinion were analysed. The quality of clinical information provided was also evaluated. Results: A total of 406 cases submitted over 2012–2013 were analysed. Most patients were from the outpatient setting with ‘rash’ or dermatitis (66%). Almost one-third of patients were paediatric cases. The average time from submission to dermatologist reply was 5.5 hours. Clinical photos were provided in 83% of cases and 73% of these were assessed as being of good quality. Management advice was provided in 77% of cases, of which reference to the case-based learning modules on Tele-Derm was made in 21% of cases. Patient outcome was largely unknown (83%). Conclusion: This study identified some of the common dermatological complaints presenting to rural and remote primary care doctors in Australia. The unique addition of professional development in Tele-Derm can be used as an adjunct to advice provided to the rural doctors seeking advice for patient management.

Infection with hepatitis B virus (HBV) is common in Aboriginal Australians, but current seroprevalences in Northern Territory communities are unknown. We performed an audit of HBV serology on a convenience sample of 112 adults at an East Arnhem Land Health Service. Complete HBV serology was only available in 26 (23%) patients. Evidence of HBV exposure (core antibody-positive) was found in 43 of 68 (63%) patients tested, and current HBV infection (surface antigen-positive) was found in nine of 76 (12%). HBV is an incompletely defined, under-resourced and substantial public health problem in Aboriginal Australians.

The results of the CSIRO National Telehealth trial were recently released and very widely publicised. In a Before and after Controlled Intervention (BACI) design involving >230 patients, the keynote results included a reduction of 46% in the rate of expenditure on medical services after one year, a 53.2% reduction in the rate of admission to hospital and a 70- 76% reduction in the rate of LOS. Patient acceptance of the technology was >83%, and >89% of care coordinators would recommend telemonitoring services to other patients. The return on investment, calculated as the ratio of net benefit to net cost of providing the telemonitoring service was estimated to be between 5-6 times. These results strongly suggest that new models of care for the management of chronic disease in the community, based on at home telemonitoring and care coordination can improve healthcare outcome and reduce hospitalisation in both urban and rural and remote settings. Longitudinal vital signs data and periodic patient administered clinical questionnaires provide powerful tools for early identification of an exacerbation of a patient ’s condition and permit the early mobilisation of clinical resources to avoid unnecessary hospitalisation. In this paper we consider the consequences of this trial for the delivery of health services in rural and remote communities and discuss whether at -home or community health centre based telehealth could alleviate the impact of clinical shortages, overcome the tyranny of distance and facilitate better patient self -management and healthcare outcomes. Given the lack of clinical specialists in rural and remote communities, the ability to connect to specialists in urban and regional centres becomes a critical necessity. Whilst traditional telehealth systems provide a good baseline for the provision of tele monitoring services, are they sufficient to support remote specialist consultations in emergency settings? We will discuss a blueprint for telehealth solutions for mobile community nursing as well as telehealth services that can be delivered from community health centres under remote medical supervision.

The WA Country Health Service (WACHS) received funding in 2011 under the C losing the Gap initiative for implementation of the State- wide Specialist Aboriginal Mental Health Service (SSAMHS). Funding for the program will continue until 30 June 2018. In 2012 an additional thirty -two Aboriginal mental health staff were on the ground and complimented the existing fourteen Aboriginal staff. The Aboriginal mental health workforce now comprises approximately 10 per cent of the entire workforce in regional and remote community mental health services. There are seven WACHS regions; the Kimberley, Pilbara, Goldfields, Midwest, South West, Wheatbelt and Great Southern. Each region has made decisions locally about the implementation of the program and receives support from WACHS Central Office Mental Health and specifically the Senior Program Officer — Aboriginal Mental Health. The WACHS model is one of Aboriginal Mental Health Workers (AMHW) and multidisciplinary professionals working together within mainstream mental health services to improve outcomes for existing and newly referred Aboriginal mental health consumers. The program has several objectives; to improve access and provision of specialist mental health services for Aboriginal people and improve the capacity of WACHS mental health services to meet the needs of Aboriginal people in a culturally appropriate framework. To meet these program objectives several regions have undertaken work that supports, acknowledges and recognises the Third Space. By operating in this “third space” , clinicians and Aboriginal mental health staff are able to benefit from mutual learning and improve the service provision to the Aboriginal community, family and individuals. Aboriginal cultural engagement with the service in both client numbers and occasions of service has markedly increased since the program commenced. There has been Improvement s in cultural competency of non- Aboriginal workforce and cultural security of mainstream services. The details of specific strategies will be discussed further in the paper.