Using technology to recalibrate rural and remote health workforce education

Prof. Sabina Knight1

1James Cook University, Mount Isa Centre For Rural And Remote Health, Mount Isa, Australia


This presentation will discuss the use of technology to support health professional education in remote areas. Australian remote areas are characterised by health workforce maldistribution, vast distances, torrid climate extremes, infrastructure lag and diverse, dispersed populations with high health need and social disadvantage. Much of the northern remote regions of Australia not only typifies these features but also competes with mining for its health career market. Mining offers highly paid jobs with relative low requirements for formal qualifications resulting in a magnification of the health workforce maldistribution.

Exacerbating the situation is high staff turnover. Nurses recruited from metropolitan areas are unfamiliar with the context of practice, the burden of disease, the health services and the cultural context. One full time full time equivalent is not the same effective value as a local experienced full time equivalent placing further stress on health services across rural and remote Australia. Our hypothesis is that local graduates are more likely to be work ready and therefore effectively useful to the service in the first two years.

Remotely located academic infrastructure such as University Departments of Rural Health, regional training, recruitment of rural students into health careers, remote and rural clinical placements and graduate positions together with post graduate generalist programs have been identified as critical elements in successfully building a health workforce in and for a region. Technologically enable facilities enables traditional programs to be delivered to small towns and facilities overcoming access barriers.

The paper will describe the particular strategies necessary for success, notions of what constitutes sustainability and viability in health workforce redistribution and the role of partnerships and the leverage opportunities for innovative nursing education models in underserved and outback areas.




Professor Sabina Knight RN MTH FACN ARLF FCRANA Founding member and past president of CRANA and keen remote health advocate. Director of the Mount Isa Centre for Rural and Remote Health responsible for building health workforce in and for outback Queensland

Continuum of Care – Patient Journey: embedding core business fundamentals under the influence of an e-Enabled Health future

Miss Elizabeth Ellis1

1Telstra Health, Communicare, Adelaide, Australia


Purpose:  e-Enabled health systems influence on Continuum of Care

Nature/Scope:  embedding state of health core business and clinical governance fundamentals such as evidence based best practice, decision support tools for your whole workforce, knowing your population and capacity to deliver services for unique communities with all of the systems you may or may not have at hand in your place both now and in the future.

Issue/problem:  retain focus in eHealth tech on closing the gap mandates on addressing health inequalities, life expectancy and social determinants.

Outcome/conclusion:  Explore the continuum of care/patient journey with an eHealth lens to respond to self and family centred multidisciplinary care.




Telstra Health, Communicare – 3yrs to present:  business consultant, account manager and primary care/clinical governance consultant.

Flinders Closing the Gap Program:  inplement COAG adapted Flinders Model for chronic disease self management and tobacco intervention.

Country Health SA – Aboriginal Health Directorate:  COAG Primary Health Care Programs Manager:  Audits of Aboriginal Chronic Disease, Family Wellness and Aboriginal Health Checks.

Menzies, One21seventy:  CQI program education and facilitator.

Kimberley Aboriginal Medical Service:  Population Health Coordindator

Broome Regional Aboriginal Health Service:  Population Health Coordinator

Bila Muuji Aboriginal Medical Services Inc (Walgett, Bourke, Wellington, Orange, Brewarrina, Orana Haven):  Population Health & ITC Coordinator


Continuous Glucose Monitoring – An opportunity to improve self-management of diabetes in pregnancy and collaborative care: A case study from Far North Queensland

Ms Jennifer Barrett1, Ms Bernadette Heenan1

1Apunipima Cape York Health Council, Manoora, Australia


Pregnant women with pre-existing type 2 Diabetes Mellitus (T2DM) are at a higher risk of adverse maternal and perinatal outcomes and commonly require significant increases in insulin over the course of the pregnancy. Managing these high-risk pregnancies requires collaboration between a range of health professionals including community midwives, Credentialed Diabetes Educators (CDEs), Obstetricians and Endocrinologists. Continuous Glucose Monitoring (CGM) can play a role  in improving glycaemic control for these clients.

A client whose fifth pregnancy was complicated by pre-existing T2DM, proteinuria, essential hypertension and retinopathy was provided with a CGM device from 22 weeks gestation until one month postpartum. The client was identified as a candidate for CGM monitoring by the CDE due to her high-risk pregnancy, food insecurity, frequent hypoglycaemic episodes and her challenges of balancing work and family life with diabetes management. Weekly CGM data was downloaded by the client at her local clinic and transmitted to the CDE who collaborated closely with the regional endocrinologist allowing for regular and timely insulin adjustments. The client demonstrated a marked improvement in glycaemic control as evidenced by her daily insulin requirements decreasing from 30 unit of mixed insulin to 3 units of short acting with carbohydrate meals. She and her family became highly motivated and engaged in her diabetes management and she gave birth, at term, to a  healthy baby.

CGM offers an exciting opportunity to improve diabetes self-management for women with DIP who live in remote areas. Detailed graphic reports increased client awareness of glycaemic excursions and improved inter-professional collaborative care with improved outcomes for mother and infant.




Bernadette Heenan, Credentialed Diabetes Educator, Apunipima Cape York Health Council. BA, Grad Dip Lib Sc, RN, CDE

 Jennifer Barrett, Midwife & Child Health Nurse, Apunipima Cape York Health Council. RN, RM, M. Midwifery, M. Public Health & Tropical Medicine

Orientation to Remote Primary Health Care Manuals

Mr Tobias Speare1, Mrs Lyn Byers1

1Central Australian Rural Practitioners Association (CARPA) Inc., Alice Springs, Australia


The presentation will demonstrate the use of technology in improving orientation to remote health, specifically to the purpose and use of the Remote Primary Health Care Manuals (RPHCMs).

The remote health workforce has been characterised by high turnover, low stability and high use of short-term and agency staff particularly nurses, which has major implication on service delivery. The orientation of new staff to remote health services has historically been poorly executed, with up to 70 % of nurses in very remote areas in one survey stating orientation was inadequate.

The Remote Primary Health Care Manuals, a suite of clinical guidelines for primary health care practitioners in remote and Indigenous health services, guide clinical practice in many areas of rural and remote Australia. They are grounded in evidence based practice and shaped by the practicalities of the remote context.

Remote health services and stakeholders have identified an absence of standardised and appropriate orientation to the correct and proper utilisation of the manuals.

The development of an orientation video to the RPHCMs was undertaken to address the identified need. The Orientation to the Remote Primary Health Care Manuals video is freely available with the aim of improving delivery of health care in remote Australia through improved use of recommended clinical guidelines.

Research projects to ensure on-going evaluation of the Remote Primary Health Care Manuals, including the manual development process and impacts in terms of health outcomes are under way. The orientation video project arose from and will integrate into the Remote Primary Health Care Manual evaluation processes.




The presenters are representatives of the Central Australian Rural Practitioners Association (CARPA), a voluntary organisation involved in primary health care education, training and support of rural and remote health practitioners of various specialities and experience levels.


The Treatment Tracker app: reminders, motivation and challenges for young people at risk of rheumatic heart disease

Miss Catherine Halkon1, Mrs Claire  Boardman1

1RHDAustralia, Menzies School Of Health Research , Casuarina , Australia


Acute rheumatic fever and rheumatic heart disease (RHD) are preventable conditions which have been largely eliminated from developed countries yet Australia has one of the highest rates of acute rheumatic fever (ARF) in the world, primarily affecting Indigenous Australians, many living in remote areas. Treatment Tracker is a smartphone app designed to remind and encourage young people to get their regular benzathine penicillin G (BPG) injections to prevent recurrences of ARF.

ARF is caused by an autoimmune response to a group A streptococcal infection. Recurrent episodes of ARF can lead to heart valve damage known as RHD. RHD is a chronic, often fatal, disease. The regular administration of BPG, known as secondary prophylaxis, is the proven strategy to prevent ARF. Injections must be given at least every 28 days for 10 years or until the person is 21 years old – whichever is longer. A missed injection leaves them risk of repeat episodes of ARF and further heart damage.

RHDAustralia developed the Treatment Tracker app to support young people, most at risk and facing multiple challenges in sticking to their treatment. This paper discusses how the app is designed to motivate people to get their injections and discusses some of the challenges in development specifically in relation to the nature of the treatment regimen; equity and access to technology; reaching and engaging the target audience; and, with still limited evidence of the effectiveness of eHealth technology to improve medication adherence, the importance and challenge of evaluation.




Catherine Halkon is Projects Manager at RHDAustralia, the National Coordination Unit for the Australian Government Rheumatic Fever Strategy, based at Menzies School of Health Research. Catherine he works on the development and implementation of education and training projects and is involved in the operational and strategic management of the project. Catherine has a Masters of International Management and extensive experience in not-for-profit management and research management. Before joining RHDAustralia in 2012, she worked on a number of Indigenous education and training research projects in the Northern Territory, including the management of a large scale literacy intervention project.

Developing a theory of remote area nursing practice

Ms Kylie McCullough1, Professor Anne Williams2, A/Professor  Vicki Cope2, Professor Lisa Whitehead1

1Edith Cowan University, Joondalup, Australia, 2Murdoch University, Murdoch, Australia


The purpose of this poster presentation is to elicit feedback from RANs regarding the preliminary findings of this PhD research.

The aim of the study is to explore and describe, from the perspective of nurses in remote areas: the actions and interactions used to deliver PHC, the contexts and conditions where PHC is applied and to uncover the factors which enhance or inhibit PHC nursing practice. The outcome of this study is to develop a theory which explains the nature and process used by RANs to deliver PHC.

An important factor in the credibility of this research is providing opportunities for nurses to consider the findings in relation to their own practice and to facilitate feedback and collect data relevant to the substantive theory. Ethics permission has been granted to collect data in the form of written and verbal comments. The author intends to display the theory as a poster and encourage feedback in the conference break times. Unfortunately, the poster will not be able to be uploaded electronically due to copyright issues. Publications which arise from this research, including the final theoretical framework, will be made available to CRANAplus.




Kylie McCullough is a lecturer in Primary Health Care at Edith Cowan University in the School of Nursing and Midwifery. Kylie is nearing completion of her PhD research which aims to better understand the way RANs practice Primary Health Care nursing. She has previously worked as a RAN in the NT.

Healthy doctors practise better medicine: supporting the rural & remote health workforce now and into the future.

Mrs Inara Beecher1

1Country SA PHN, Nuriootpa, Australia


It is widely recognised that health professionals who are well balanced and healthy are able to provide higher quality patient care through enhanced empathy, and through being less likely to make mistakes due to stress and fatigue. Unfortunately, health professionals are often more diligent in caring for their patients than they are for themselves. In addition to optimising their health for personal wellbeing, health professionals also have a professional obligation to maintain their own health. Health professionals who are recognised to be particularly at risk of having difficulty accessing care are rural & remote GPs. It is vital for every GP to have their own GP, but can present issues when in a small and sometimes isolated community.

Doctors’ Health SA Ltd (DHSA) is a not-for-profit company established to improve the health of the medical profession for the good of the community. The Country SA PHN has supported the work of DHSA, through its Grant program, to connect and support general practitioners across rural & remote South Australia. DHSA is a comprehensive service that offers clinical services and education programs to support the medical profession across all stages of their careers. The end goal of DHSA activities is to make sure that doctors and students enjoy all of the benefits of on-going prevention, check-ups and GP care that includes providing access to the wider health system. The Country SA PHN Grant has created the opportunity for DHSA to pilot a telemedicine service for rural & remote doctors and medical students on rural & remote placement.

This paper will summarise the DHSA activities commissioned by Country SA PHN and the benefits provided to rural & remote GPs in SA. It will demonstrate how the service operates, the opportunities & challenges and discuss the pilot project utilising telemedicine for increasing service delivery.




With more than 20 years of health care experience, 16+ in Primary Health Care, including a large amount of time in rural SA settings and time spent working closely with Aboriginal communities.  Inara is a Registered Nurse with direct health care experience across primary and acute care.

Fellow of the Leaders Institute of SA, Governor’s Leadership Foundation (GLF) program 2011, Inara is also a Certified Health Informatician Australasia (CHIA), has been Heart Foundation Nurse Ambassador and previous mentor for the University of South Australia Immunisation course.  Inara is very passionate about achieving positive health outcomes for the people of SA.

Barriers to timely discharge: An outer metropolitan General Surgical unit’s experience

Dr Domenic La Paglia1, A/Prof Shiran Wijeratne2

1Western Health, Melbourne, Australia, 2Werribee Mercy, Werribee, Australia



We have conducted a comprehensive audit of 125 surgical admissions over a 3-month period in an outer metropolitan hospital. Challenges faced by our health service include lack of access to critical care beds, lack of availability of specialised services and lack of an integrated digital medical record, which are factors faced by many rural health services. These factors have been shown to cause delays to patient care and have lengthened the average hospital stay, unnecessarily consuming taxpayer funds. This has highlighted several areas where technological advances and implementations could be utilised to streamline processes and reduce delays.

What is happening in your project/ health service/or what has been your experience:

Our health service lacks a critical care facility, meaning any high acuity patients must be transferred in order to receive appropriate care. We face ongoing challenges in securing beds for transfer and there are often lengthy delays as a result. In our audit three patients were shown to have delays to transfer of greater than 24 hours, compromising patient care. Nine patients experienced significant delays while awaiting theatre availability. Multiple patients required transfer for specialised procedures such as ERCP and experienced delays in the process. Many of these delays were a result of inefficient processes which exist to locate an appropriate transfer destination. Furthermore, the lack of any digital medical record to process patient information, discharge letters and summaries and scripts compounded these issues.


The implementation of readily available technology to streamline processes and improve data records would be cost effective and would improve service delivery at public health services in regional Australia.




Dr Domenic La Paglia MBBS DipAnat MPH MSc


Simulation assist nurses working in Rural Australia complete their continuing professional development

Judith Brown1

1Qld Health, Richmond, Australia


Through the innovation of a nursing staff member at Richmond Multipurpose Health service. The facility is able to promote ongoing learning, onsite for nursing staff through Simulation-Based Education (SBE), It can be problematic when living and working in rural and remote areas to complete the mandatory Compulsory Professional Development (CPD) hours due to the tyranny of distance. The pocket is supported locally by nursing and medical staff.  Additionally, the Clinical Simulation Centre at The Townsville Hospital (TTH) and the Clinical Skills Development Service (CSDS) in Brisbane provide support through provision of manikins and delivery. The pocket is in its infancy, with the local Simulation coordinators being trained at CSDS, Brisbane, in November 2016 and the SBE program beginning in February 2017. There are two Simulation Coordinators trained to use the high fidelity equipment, with the provision of training for an additional staff member each year funded through CSDS. CSDS supply the Simulation equipment including manikins and part-task trainers enabling diversity in delivery.  The equipment is freighted by CSDS to Richmond at no cost to the facility.   Lauren Camilleri, Nurse Manager, Clinical Simulation Centre at TTH has been instrumental in assisting us with a site visit and arranging expired stock to be sent to Richmond.  The high fidelity manikin being utilised to run clinical scenarios is a Laerdal Megacode Kelly.  The manikin is operated through the use of a SimPad and monitor.  Other part-task trainers such as QCPR and Airway heads support clinical education and assist in the evaluation of staff maintaining their competency in the Recognition and Management of the Deteriorating Patient. It is envisioned that in the future Simulation Coordinators will be able to facilitate external courses such as Recognition of the Deteriorating Paediatric Patient (RMDPP) and provide support in the delivery of Imminent Birthing for Non-Midwife Training.




Judith Brown is a Rural and Isolated Practise Endorsed Registered Nurse and Child Health Nurse with over 20 years of experience working in Rural Queensland. She is currently working as a Clinical Nurse at the Richmond Multipurpose Health Service.She is currently completing a Graduate Certificate in Clinical Education and is also studying a Master of Nursing (Nurse Practitioner). She enjoys working in rural environments as she feels part of the community. When not working, Judith resides on a cattle station 100km from Richmond. She has two Children who are both at boarding school.

How Clinical Information Systems Can Improve Management of a Neglected Tropical Disease, Crusted Scabies.

Michelle Dowden1

1One Disease, Darwin, Australia

In January 2016 Crusted Scabies was made a Notifiable Disease in the Northern Territory (NT) under the Notifiable Diseases Act NT. Crusted Scabies is notifiable by laboratory on detection of scabies mites. The Centre for Disease Control (CDC) NT is responsible for the public health response.

An essential component of the public health response for Crusted Scabies is CDC informing local health service staff who the clients are with Crusted Scabies and what is required for management including household contacts. Most importantly people who have had Crusted Scabies must have life long follow-up which includes regular skin checks and live in a ‘scabies free zone” to prevent reinfection.

An audit of 488 flies within Clinical Information Systems (CIS) was undertaken. The purpose of the clinical audit was to determine the number of clients with a definite diagnosis of Crusted Scabies (CS) according the CDC case definition. The audit also determined if Crusted Scabies clients had flags and reminders in place for long term follow up and care.

Results. The findings of the audit revealed 85 clients had a definitive diagnosis of Crusted Scabies.

More education is needed around detection, diagnosis and long-term management of Crusted Scabies. The inclusion of electronic prompts within Clinical Information Systems will assist health service staff to provide appropriate, comprehensive and timely of care. In the same way a disease register is able to maintain records of a specific disease or condition for a population.


Michelle is currently the NT Program Director for One Disease.

Michelle is a Registered Nurse Midwife with 25 years experience conducting health programs that focus on good clinical outcomes and the social determinants of health. The main focus of her work has been with remote indigenous communities and other large indigenous health services throughout Australia both in research and service delivery.

Michelle has a strong background and understanding of Continuous Quality Improvement in Indigenous Primary Healthcare both in research and service delivery. She continues to be involved with research and contributes to peer reviewed publications.