Attitudes to Short-Term Staffing and Workforce Priorities of Community Users of Remote Aboriginal Community-Controlled Health Services: A Qualitative Study.

In recent years, there has been an increasing trend of short-term staffing in remote health services, including Aboriginal Community-Controlled Health Services (ACCHSs). This paper explores the perceptions of clinic users' experiences at their local clinic and how short-term staffing impacts the quality of service, acceptability, cultural safety, and continuity of care in ACCHSs in remote communities. Using purposeful and convenience sampling, community users (aged 18+) of the eleven partnering ACCHSs were invited to provide feedback about their experiences through an interview or focus group. Between February 2020 and October 2021, 331 participants from the Northern Territory and Western Australia were recruited to participate in the study. Audio recordings were transcribed verbatim, and written notes and transcriptions were analysed deductively. Overall, community users felt that their ACCHS provided comprehensive healthcare that was responsive to their health needs and was delivered by well-trained staff. In general, community users expressed concern over the high turnover of staff. Recognising the challenges of attracting and retaining staff in remote Australia, community users were accepting of rotation and job-sharing arrangements, whereby staff return periodically to the same community, as this facilitated trusting relationships. Increased support for local employment pathways, the use of interpreters to enhance communication with healthcare services, and services for men delivered by men were priorities for clinic users.

The efficiency, timeliness, health outcomes and cost-effectiveness of a new aeromedical retrieval model in Central Australia: A pre- and post-implementation observational study.

OBJECTIVE: To assess timeliness, efficiency, health outcomes and cost-effectiveness of the 2018 redesigned Central Australian aeromedical retrieval model. DESIGN: Pre- and postimplementation observational study of all patients receiving telehealth consultations from remote medical practitioners (RMPs) or Medical Retrieval and Consultation Centre (MRaCC) physicians between 1/1/2015 and 29/2/2020. Descriptive and inferential statistics measuring system efficiency, timeliness, health outcomes and incremental cost-effectiveness. FINDINGS: There were 9%-10% reductions in rates of total aeromedical retrievals, emergency department admissions and hospitalisations postimplementation, all p-values < 0.001. Usage rates for total hospital bed days and ICU hours were 17% lower (both p < 0.001). After adjusting for periodicity (12% fewer retrievals on weekends), each postimplementation year, there were 0.7 fewer retrievals/day (p = 0.002). The mean time from initial consultation to aeromedical departure declined by 18 minutes post-implementation (115 vs. 97 min, p = 0.007). The hazard of death within 365 days was nonsignificant (0.912, 95% CI 0.743-1.120). Postimplementation, it cost $302 more per hospital admission and $3051 more per year of life saved, with a 75% probability of cost-effectiveness. These costs excluded estimated savings of $744,528/year in reduced hospitalisations and the substantial social and out-of-pocket costs to patients and their families associated with temporary relocation to Alice Springs. CONCLUSION: Central Australia's new critical care consultant-led aeromedical retrieval model is more efficient, is dispatched faster and is more cost-effective. These findings are highly relevant to other remote regions in Australia and internationally that have comparable GP-led retrieval services.

Effect of Age on Speech Perception in Noise Abilities Across Different Stimulus.

Various factors influence speech perception in noise (SPIN): age, hearing loss, cognition, background noise, stimulus redundancy, type of stimulus used, and signal-to-noise ratio. The effect of age on SPIN with different stimuli is yet to be validated in the literature. This study aims to study the effect of age on SPIN results across different stimuli. The study is a cross-sectional study with ninety participants with normal hearing ability. All participants in the study were equally divided into three groups: the children's group aged 8 to 12 years, the adult group aged 18 to 30, and the older adult group aged 55 to 72 years. Speech perception in the background of Kannada speech babble was assessed across three stimuli: monosyllables (CV), phonemically balanced Kannada words, and Kannada sentences. The stimulus was presented at 60 dBSPL binaurally through a calibrated headphone at 0 dB SNR. The result indicated a significant main effect of age on SPIN across syllables, words, and sentences. Further, Mann-Whitney test results revealed a statistically significant difference between the SPIN scores of children and adults for syllables, words, and sentences. Also, a statistical difference was noted in SPIN scores between adults and older adults for syllables, words, and sentences. However, statistical differences between children and older adults were seen only for syllables. The trend showed that the SPIN scores for syllables, words, and sentences improve from childhood to adulthood, while scores deteriorate from the adult to older adult group. A similar trend was seen for all three stimulus types. However, the reduction in the SPIN score using syllables in the older adult group was more noticeable than words and sentences. It can be concluded that there is an effect of age on SPIN abilities across different stimuli. It highlights the importance of age-appropriate SPIN normative for various stimuli.

Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?

BACKGROUND: The COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia. METHODS: Between February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes. RESULTS: Reduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions. CONCLUSION: Telehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote communities to make full use of telehealth consultations. Training and employment of local Aboriginal staff as digital navigators could ensure a culturally safe clinical environment for telehealth consultations and promote the effective use of telehealth services among community members.

Evaluation of a new medical retrieval and primary health care advice model in Central Australia: Results of pre- and post-implementation surveys.

INTRODUCTION: In February 2018 the Remote Medical Practitioner (RMP)-led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC. OBJECTIVE: To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia. DESIGN: There were 103 and 72 respondents, respectively, to pre- and post-implementation surveys of remote clinicians and specialist staff. FINDINGS: Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available. DISCUSSION: Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP-led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills. CONCLUSION: Given the paucity of literature about optimal models for providing pre-hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density.

Optimising medical retrieval processes and outcomes in remote areas in high-income countries: A scoping review.

OBJECTIVE: This scoping review explores the structure and process-level strategies that are associated with medical retrieval outcomes. A secondary aim is to identify the range of medical retrieval outcomes used to assess the performance of remote retrieval services. DESIGN: A scoping review of peer-reviewed literature from PubMed, CINAHL and the Web of Science was undertaken following guidelines set by the Johanna Briggs Institute manual for scoping reviews. All articles were assessed by two reviewers. Themes were derived inductively from the data extracted. SETTING: Medical retrievals in sparsely populated remote locations in high-income countries. PARTICIPANTS: Staff and clients of remote medical retrieval services. INTERVENTIONS: Structures and processes (e.g. resource availability, retrieval staff structures and governance protocols) that aimed to improve medical retrieval outcomes. OUTCOMES: Patient health outcomes and service efficiency. RESULTS: Twenty-four articles were included. Three broad themes, related to the nature of the interventions, were included: optimising prehospital management of retrievals, staffing and resourcing of retrieval services and retrieval model evaluation. Mortality was the most frequently used outcome indicator in these studies, but was not measured consistently across studies. CONCLUSIONS: This review highlights significant gaps in the literature that describes the structure and processes of retrieval models operating in remote areas and a dearth of literature evaluating specific operational strategies implemented within medical retrieval models. The available literature does not meaningfully assist with identifying key outcome indicators for developing a consistent monitoring and evaluation framework for retrieval services in geographically, culturally and demographically diverse remote contexts.

Interventions for health workforce retention in rural and remote areas: a systematic review.

BACKGROUND: Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. METHODS: The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case-control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. RESULTS: Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. CONCLUSION: Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.

Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol.

INTRODUCTION: Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or 'fly-in, fly-out/drive-in, drive-out' health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies. METHODS AND ANALYSIS: This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. ETHICS AND DISSEMINATION: The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.

Measuring successful processes of knowledge co-production for managing climate change and associated environmental stressors: Adaptation policies and practices to support Indian farmers.

Poor access to external resources, and a lack of affordable technologies compatible with socio-economic and ecological settings of rural livelihoods lead to high vulnerability of subsistence farmers to climate change and associated environmental stressors. Traditional knowledge (TK) plays a pivotal role in improving the adaptive capacity of such farmers to cope with these stressors. In India, most of the policies aiming to improve farmers' adaptive capacity are based on a top-down approach and barely consider farmers' TK. Policies can be made more inclusive by mainstreaming stakeholders' perspectives, an approach termed as knowledge co-production. Our study uses a knowledge co-production framework to (i) assess the current state of emphasis on TK and knowledge co-production processes in Indian policies on agricultural adaptation to climate change and associated environmental stressors, (ii) understand the status of TK-led knowledge co-production at the practice level, and (iii) assess the successes and gaps in incorporating TK in agricultural adaptation at the policy and practice levels to manage these stressors. Based on a systematic literature review, we found that despite emphasis on integration of TK, no Indian policy was successful in terms of stakeholder participation and in covering various dimensions of knowledge co-production. Most of the policies covered either two (knowledge gathering and application) or three (gathering, integration and application) dimensions. The term TK was also not clearly defined and it was unclear how to mainstream it into the process for successful outcomes. Co-production process was adjudged to be fairly successful at the practice level in some of the sectors (e.g., management of soil and water resources) where most of the dimensions were covered and stakeholders participated in various steps of co-production. There were significant differences in the success of co-production within (e.g., crop varieties) and between (e.g., crop and natural resource management) the sectors. We found a considerable gap at policy and practice levels on success of knowledge co-production. Insights from the study could help policy-makers to improve policies for the agricultural sector to better adapt to climate change and associated environmental stressors through the recognition and integration of farmers' TK.

Remote health service vulnerabilities and responses to the COVID-19 pandemic.

The rapid response to the COVID-19 pandemic in Australia has highlighted the vulnerabilities of remote Aboriginal and Torres Strait Islander communities in terms of the high prevalence of complex chronic disease and socio-economic factors such as limited housing availability and overcrowding. The response has also illustrated the capability of Aboriginal and Torres Strait Islander leaders and the Aboriginal Community Controlled Health Services Sector, working with the government, to rapidly and effectively mitigate the threat of transmission into these vulnerable remote communities. The pandemic has exposed persistent workforce challenges faced by primary health care services in remote Australia. Specifically, remote health services have a heavy reliance on short-term or fly-in, fly-out/drive-in, drive-out staff, particularly remote area nurses. The easing of travel restrictions across the country brings the increased risk of transmission into remote areas and underscores the need to adequately plan and fund remote primary health care services and ensure the availability of an adequate, appropriately trained local workforce in all remote communities.

Exploring Heat Stress Relief Measures among the Australian Labour Force.

Australia experiences frequent heat waves and generally high average temperatures throughout the continent with substantial impacts on human health and the economy. People adapt to heat by adopting various relief measures in their daily lives including changing their behaviour. Many labour intensive outdoor industries implement standards for heat stress management for their workforce. However, little is known about how people cope with heat at their workplaces apart from studies targeting some specific industries where labourers are exposed to extreme heat. Here, we analysed responses from 1719 people in the Australian labour force to self-reported heat stress and associated coping mechanisms. Three quarters of respondents experienced heat stress at their workplace with fatigue and headache being the two most frequently stated symptoms. Almost all of those who were affected by heat would hydrate (88%), 67% would cool, and 44% would rest as a strategy for coping with heat. About 10% intended to change their jobs because of heat stress in the workplace. We found differences in heat relief measures across gender, education, health, level of physical intensity of job, and time spent working outside. People working in jobs that were not very demanding physically were more likely to choose cooling down as a relief measure, while those in labour intensive jobs and jobs that required considerable time outside were more likely to rest. This has potential consequences for their productivity and work schedules. Heat affects work in Australia in many types of industry with impact dependent on workforce acclimatisation, yet public awareness and work relief plans are often limited to outdoor and labour intensive industries. Industries and various levels of government in all sectors need to implement standards for heat management specific to climate zones to help people cope better with high temperatures as well as plan strategies in anticipation of projected temperature increases.

Quantifying catastrophic and climate impacted hazards based on local expert opinions.

Quantifying the potential costs of catastrophic and climate impacted hazards is a challenging but important exercise as the occurrence of such events is usually associated with high damage and uncertainty. At the local level, there is often a lack of information on rare extreme events, which means that the available data is not sufficient to fit a distribution and derive parameter values for frequency and severity distributions. This paper discusses the use of local assessments of extreme events and utilises expert elicitation in order to obtain values for distribution parameters that will feed into management decisions with regards to quantifying catastrophic risks. We illustrate a simple approach, where a local expert is required to only specify two percentiles of the loss distribution in order to provide an estimate for the severity distribution of climate impacted hazards. In our approach we use heavy-tailed distributions to capture the severity of events. Our method allows local government decision makers to focus on extreme losses and the tail of the distribution. An illustration of the method is provided utilising an example that quantifies property losses from bushfires for a local area in northern Sydney. We further illustrate how key variables, such as discount rates, assumptions about climatic change and adaptation measures, will impact the estimates of losses.

Examining the Effects of Ambient Temperature on Pre-Term Birth in Central Australia.

Preterm birth (born before 37 completed weeks of gestation) is one of the leading causes of death among children under 5 years of age. Several recent studies have examined the association between extreme temperature and preterm births, but there have been almost no such studies in arid Australia. In this paper, we explore the potential association between exposures to extreme temperatures during the last 3 weeks of pregnancy in a Central Australian town. An immediate effect of temperature exposure is observed with an increased relative risk of 1%-2% when the maximum temperature exceeded the 90th percentile of the summer season maximum temperature data. Delayed effects are also observed closer to 3 weeks before delivery when the relative risks tend to increase exponentially. Immediate risks to preterm birth are also observed for cold temperature exposures (0 to -6 °C), with an increased relative risk of up to 10%. In the future, Central Australia will face more hot days and less cold days due to climate change and hence the risks posed by extreme heat is of particular relevance to the community and health practitioners.