Centre for Remote Health - Collected Works

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    Beyond therapy: the multiple benefits of using a service-learning model to enhance paediatric therapy in a remote area school. An evaluation of physiotherapy student placements at a school for children with additional needs in Central Australia, 2019
    (Flinders University, 2020) Beadle, Rosalind; Farthing, Annie;
    In 2019, physiotherapy students in their final year of university study provided two four-week blocks of intense physiotherapy services at Acacia Hill School (AHS) in Alice Springs. This school is the only education facility which caters specifically for children with additional needs in Central Australia. Of the 93 pupils at the school, 67% identify as Indigenous and 30% are in out of home care. These children are some of the nation’s most vulnerable. This service-learning placement emerged in response to a dearth of physiotherapy services for pupils and their families at AHS. A lack of government-funded resourcing combined with a problematic transition for many families onto the National Disability Insurance Scheme (NDIS) had resulted in some school-aged children with significant neuro-disability not having had access to critical physiotherapy for up to five years.
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    Ruralization of students’ horizons: insights into Australian health professional students’ rural and remote placements
    (Dove Press, 2018-01-31) Smith, Tony; Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie
    Introduction: Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions. Methods: Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results: The core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions. Conclusions: The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and enhancing rural health workforce recruitment, retention, and capacity building.
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    Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings
    (BioMed Central, 2017-03-23) Bailie, Jodie; Matthews, Veronica; Laycock, Alison; Schultz, Rosalie; Burgess, C Paul; Peiris, David; Larkins, Sarah; Bailie, Ross Stewart
    Background Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care. Methods De-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005–2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015–16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement. Results Stakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included: strong Indigenous participation in the PHC service; appropriate team structure and function to support preventive care; meaningful use of data to support quality of care and CQI; and corporate support functions and structures. Conclusion The framework should be useful for guiding development and implementation of barrier-driven, tailored interventions for primary health care service delivery and policy contexts, and for guiding further research. While specific strategies to improve the quality of preventive care need to be tailored to local context, these findings reinforce the requirement for multi-level action across the system. The framework and findings may be useful for similar purposes in other parts of the world, with appropriate attention to context in different locations.
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    Caring for country and the health of Aboriginal and Torres Strait Islander Australians
    (AMPCo Pty Ltd., 2017-07) Shultz, Rosalie; Cairney, Sheree
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    Economies through Application of Nonmedical Primary-Preventative Health: Lessons from the Healthy Country Healthy People Experience of Australia’s Aboriginal People
    (MDPI, 2016) Campbell, David
    Abstract: TheWorld Health Organization reports noncommunicable disease as a global pandemic. While national and international health research/policy bodies, such as the World Health Organization and the Australian Institute of Health and Welfare, emphasize the importance of preventative health, there is a continuing distortion in the allocation of resources to curative health as a result of government failure. Government failure is, in part, the result of a political response to individual preference for certainty in receiving treatment for specific health conditions, rather than the uncertainty of population-based preventative intervention. This has led to a failure to engage with those primary causative factors affecting chronic disease, namely the psychosocial stressors, in which the socioeconomic determinants are an important component. Such causal factors are open to manipulation through government policies and joint government-government, government-private cooperation through application of nonmedical primary-preventative health policies. The health benefits of Aboriginal people in traditional land management, or caring-for-country, in remote to very remote Australia, is used to exemplify the social benefits of nonmedical primary-preventative health intervention. Such practices form part of the “healthy country, health people” concept that is traditionally relied upon by Indigenous peoples. Possible health and wider private good and public good social benefits are shown to occur across multiple disciplines and jurisdictions with the possibility of substantial economies. General principles in the application of nonmedical primary-preventative health activities are developed through consideration of the experience of Afboriginal people participation in traditional caring-for-country.
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    Indigenous patient migration patterns after hospitalisation and the potential impacts on mortality estimates
    (Australian and New Zealand Regional Science Association, 2013) Zhao, Yuejen; Condon, John R; Li, S; Guthridge, Steven; Chondur, R
    Abstract: This study analysed interregional migration for Indigenous patients in the Northern Territory, Australia. Individual-level linked hospitalisation data between July 1998 and June 2011 were used to describe the migration patterns and associated factors. Micro-simulations were conducted to assess the impacts on mortality estimates. Indigenous patients were 35% more likely to migrate from remote to urban areas after hospitalisation than in the reverse direction (risk ratio 1.35, 95% confidence interval 1.30-1.41). The likelihood was positively associated with hospitalisations, age and the Central Australia region. Indigenous patients with diabetes, renal disease or chronic obstructive pulmonary disease had higher risks of urban migration. Non-Indigenous patients were included for comparison. The micro-simulations indicated the patient migration may result in a 6% under-estimation of Indigenous mortality in remote and very remote areas and 3% over-estimation of mortality in urban areas. The results are pertinent to a sound understanding of health outcomes across remoteness categories.
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    What is translational research? Background, concepts, and a definition
    (Nova Science Publishers, 2011) Bell, Erica; Harpur, Siobhan; Doherty, Kathleen; Struber, Janet; Davies, Lorraine
    This discussion paper aims to offer an overview and working definition of translational research, appropriate to health. Methods: Using scholarly and applied literature, the paper first identifies key challenges in achieving evidence-based policy and practice. It highlights international policy interest in new approaches to evidence translation and the barriers to achieving sound evidence translation. The paper offers an explicit definition of translational research and explains why it is important to have such a definition. It then elaborates on this definition by identifying and exploring seven distinctive research practices that could be associated with translational research. Findings and conclusions: Translational research is research with a sense of place. Its defining feature is excellence in evidence for a specific context or sphere of action, whether that is health policy for the World Health Organisation or service design for a local non-government organisation. If research is to be translated at all, it needs to be meaningful to many specific contexts, including small and regional contexts. The best promise that translational research offers is of exciting new techniques to achieve rigour and systemacy for such localised ‘real world’ policy, service and practice contexts.
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    Rural pharmacy: Teaching remote area nurses
    (Pharmaceutical Society of Australia, 2014) Speare, Tobias
    Australians in rural and remote areas have shorter lives and higher rates of disease and injury than people in urban centres.1 In addition to having a greater burden of disease, populations in rural and remote areas face increased challenges in accessing appropriate healthcare, including issues related to geography, availability of health professionals, and rural culture.
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    Front-Line Worker Perspectives on Indigenous Youth Suicide in Central Australia: Contributors and Prevention Strategies
    (OMICS International, 2014) Lindeman, Melissa; Kuipers, Willem (Pim); Grant, Laurencia
    ABSTRACT: This paper presents the perspectives of Central Australian workers in relation to Aboriginal youth suicide. Interviews were conducted as part of a project to develop a data collection system and referral pathway for Indigenous youth suicide and suicide attempts. Twenty-two in-depth interviews were conducted with a range of practitioners who have front-line contact in suicide related issues (such as police, primary health, community support, youth services). The interview schedule reflected the project aims, but the transcripts revealed a much broader consideration of the issue. This paper reports on a secondary analysis of the data. The two major themes of salient contributing factors and service prevention strategies provide insights into these workers’ attempts to understand and respond to this issue. There is a need to ensure workers develop and maintain strong networks, are well informed about local socio-cultural factors and skilled to work with local elders, traditional healers and community members, and are well supported in their roles to ensure longevity and relationships. The results contribute to the Aboriginal and Torres Strait Islander suicide prevention sector with particular relevance for remote Australia.
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    A ‘key worker’ model to improve service pathways for Aboriginal people with dementia in remote Central Australia
    (SARRAH Services for Australian Rural and Remote Allied Health, 2014) Lindeman, Melissa; Jensen, Heather; Bell, Diane; Farthing, Annie
    Introduction: The provision of support services to Aboriginal Australians living with dementia in remote communities is complicated by factors such as cross-cultural and language barriers, long travelling distances and often inadequate resources. Poor coordination of services and other problems of service access and lack of service awareness can lead to many unmet needs including delayed assessment and diagnosis. This project builds on a previous research study in the region that highlighted the urgent need for improvements to implementation of recommended service pathways for dementia care. The project aimed to achieve this by developing a model for appropriate ‘case management’ or ‘key worker’ approaches to coordinating. Method: A qualitative study was conducted in 2013-14 that included six in-depth interviews with key informants and thematic analysis. The researchers used the themes to develop a model which was then validated by a local reference group. Results: Our data to date have enabled us to develop a model where one ‘key worker’ takes the lead in the assessment and coordination of provision of services with no expectation that they will provide any services outside their own area of expertise. Implications and conclusion: Significant principles of the ‘key worker’ model include that it is person-centred, culturally safe and contextually relevant. Introduction of the model needs to be accompanied by workforce education so that there is a shared understanding of how care coordination should be implemented ranging from the broad principles (such as culturally appropriate relationships, and service flexibility) through to the more micro elements of the model (such as communication methods between services, record keeping and handover mechanisms). The principles and the process for developing the model are transferrable to other remote service delivery contexts.
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    The (mis)matching of resources and assessed need in remote Aboriginal community aged care
    (John Wiley & Sons, Ltd., 2015) Bell, Diane; Lindeman, Melissa; Reid, John Binda
    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.
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    "People like numbers": a descriptive study of cognitive assessment methods in clinical practice for Aboriginal Australians in the Northern Territory
    (BioMed Central Ltd., 2013-01-31) Dingwall, Kylie M; Pinkerton, Jennifer; Lindeman, Melissa
    Achieving culturally fair assessments of cognitive functioning for Aboriginal people is difficult due to a scarcity of appropriately validated tools for use with this group. As a result, some Aboriginal people with cognitive impairments may lack fair and equitable access to services. The objective of this study was to examine current clinical practice in the Northern Territory regarding cognitive assessment for Aboriginal people thereby providing some guidance for clinicians new to this practice setting. Conclusions Cognitive tests developed specifically for Aboriginal people are urgently needed. In the absence of appropriate, validated tests, clinicians have relied on and modified a range of standardised and informal assessments, whilst recognising the severe limitations of these. Past clinical training has not prepared clinicians adequately for assessing Aboriginal clients, and experience and clinical judgment were considered crucial for fair interpretation of test scores. Interpretation guidelines may assist inexperienced clinicians to consider whether they are achieving fair assessments of cognition for Aboriginal clients.
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    An evaluation of the Australian Football League Central Australian Responsible Alcohol Strategy 2005-07
    (Australian Health Promotion Association, 2009) Wakerman, John; Mentha, Ricky
    In a community context of high alcohol consumption and high rates of interpersonal violence, the strategies implemented were successful in decreasing alcohol consumption and related undesirable behaviours at football games. However, these measures have resulted in unintended consequences: decreased numbers of spectators attending games, decreased canteen sales and falling sponsorship. The decreased revenue has raised serious issues about sustainability of the alcohol intervention, and stimulated discussions with government and others about strategies to maintain this important alcohol reduction policy.
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    Collaborative review of pilot projects to inform policy: a methodological remedy for pilotitis?
    (BioMed Central - http://www.biomedcentral.com, 2008) Kuipers, Willem (Pim); Humphreys, John S; Wakerman, John; Wells, Robert; Jones, Judith; Entwistle, Philip Lonsdale
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    Primary health care delivery models in rural and remote Australia - a systematic review
    (2008) Kuipers, Willem (Pim); Wakerman, John; Humphreys, John S; Wells, Robert; Entwistle, Philip Lonsdale; Jones, Judith
    Background One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993–2006). The study aimed to describe what health service models were reported to work, where they worked and why. Methods A reference group of experts in rural health assisted in the development and implementation of the study. Peer-reviewed publications were identified from the relevant electronic databases. 'Grey' literature was identified pragmatically from works known to the researchers, reference lists and from relevant websites. Data were extracted and synthesised from papers meeting inclusion criteria. Results A total of 5391 abstracts were reviewed. Data were extracted finally from 76 'rural' and 17 'remote' papers. Synthesis of extracted data resulted in a typology of models with five broad groupings: discrete services, integrated services, comprehensive PHC, outreach models and virtual outreach models. Different model types assume prominence with increasing remoteness and decreasing population density. Whilst different models suit different locations, a number of 'environmental enablers' and 'essential service requirements' are common across all model types. Conclusion Synthesised data suggest that, moving away from Australian coastal population centres, sustainable models are able to address diseconomies of scale which result from large distances and small dispersed populations. Based on the service requirements and enablers derived from analysis of reported successful PHC service models, we have developed a conceptual framework that is particularly useful in underpinning the development of sustainable PHC models in rural and remote communities.
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    Responding to health impacts of climate change in the Australian desert
    (2008) Campbell, David; Kuipers, Willem (Pim); Davies, Jocelyn; Smith, Mark Stafford; Wakerman, John; McGregor, Murray
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    Systematic synthesis of community-based rehabilitation (CBR) project evaluation reports for evidence-based policy: a proof-of-concept study
    (BioMed Central - http://www.biomedcentral.com, 2008-03-06) Kuipers, Willem (Pim); Wirz, Sheila; Hartley, Sally
    Background This paper presents the methodology and findings from a proof-of-concept study undertaken to explore the viability of conducting a systematic, largely qualitative synthesis of evaluation reports emanating from Community Based Rehabilitation (CBR) projects in developing countries. Methods Computer assisted thematic qualitative analysis was conducted on recommendation sections from 37 evaluation reports, arising from 36 disability and development projects in 22 countries. Quantitative overviews and qualitative summaries of the data were developed. Results The methodology was found to be feasible and productive. Fifty-one themes were identified and the most important ones of these are presented to illustrate the significance of the method. The relative priorities of these themes indicated that "management" issues were the primary areas in which recommendations were made. Further analysis of themes reflected the emphasis evaluators placed on the need for enhanced management, organisational, personnel and administrative infrastructure in CBR projects. Evaluators consistently recommended that CBR projects should be more connected and collaborative at governmental, organisational, political and community levels. The synthesis also noted that evaluators questioned the emphasis in CBR on project expansion and income generation. Conclusion The application of the synthesis methodology utilised in this proof-of-concept study was found to be potentially very beneficial for future research in CBR, and indeed in any area within health services or international development in which evaluation reports rather than formal "research evidence" is the primary source material. The proof-of-concept study identified a number of limitations which are outlined. Based on the conclusions of 37 evaluation reports, future policy frameworks and implementation strategies in CBR should include a stronger emphasis on technical, organisational, administrative and personnel aspects of management and strategic leadership.