Background

The Prevocational Integrated Extended Rural Clinical Experience (PIERCE) is a rural prevocational clinical placement piloted at three Queensland rural hospitals in 2015.

PIERCE is based on the demonstrated successes of Longitudinal Integrated Clerkships (LICs) in undergraduate medical programs where they delivered training outcomes equal or better to traditional block rotations (TBRs) at a regional specialist referral hospital.

Aims

The aim of PIERCE is to increase the Core Clinical Training (CCT) capacity of the Queensland Rural Generalist Pathway (QRGP) and strengthen trainee commitment to rural practice by providing an early, authentic rural clinical experience.

Method

This qualitative study compared the experience and perceptions of Queensland Rural Generalist Pathway (QRGP) prevocational trainees undertaking CCT during a PIERCE placement at a rural hospital with a matched sample of QRGP trainees undertaking CCT at a regional specialist referral hospital. A representative sample of PIERCE supervisors from the three training sites were interviewed to assess the perceived value and impact of the placement on the rural hospital.

Interviews were conducted, transcribed and analysed using thematic analysis. After coding, no new codes were required to explain the results (i.e. data saturation was achieved).

Results

PIERCE provides an authentic rural training experience for QRGP trainees that promotes trainee engagement with and increasingly meaningful “hands-on” contribution as a valued and productive member of the rural medical community. Importantly, PIERCE establishes trainee mentoring relationships with senior rural colleagues that consolidate and strengthen trainee commitment to a rural outcome.

Conclusion

PIERCE provides a valued rural training experience for participating QRGP trainees. It promotes engagement with a rural community and established mentoring. relationships with senior rural colleagues that strengthen trainee commitment to a rural outcome.

1.PIERCE provides a valued rural training experience for participating QRGP trainees.
2. Prevocation Rural Placements promote engagement with a rural community
3. Prevocational Rural Placements established mentoring. relationships with senior rural colleagues that strengthen trainee commitment to a rural outcome.

Background:
Murray PHN (Regional Victoria) ageing population (n=122,521, 65+ years old) is currently living in social isolation (23,5%) and at risk of triple jeopardy (living alone, with a disability, low income, 65+). The region it is also home for the highest predicted prevalence of dementia in Victoria state by 2050 (Mitchell LGA – 1303%) and has observed a 24% increase in Emergency Department (ED) presentation due to dementia and preventable hospitalizations between 2019-20.

Aim:
To improve the end of life care journey of aged people living with life-limiting illness (non-cancer) in 2 Regional Victorian catchments (Goulburn Valley and North East Victoria) and accessing primary care services.

Methods:
The Caring Circle project will use a triad-based approach focusing on education, capacity building and system improvement.
1. General Practices- establish QI data-driven and data-auditing approaches to implement new models of care. Models aimed to optimise identification, recall and early care planning discussions; embed professional development opportunities for improved capacity;
2. Community- increase death literacy by building awareness, improve knowledge and skills to enable community members to act more effectively when someone in their community is dying; connect community with existing services
3. Residential aged care- promote education and capacity building opportunities in clinical deterioration assessment and response.

Results:
Evaluation will focus on three greater areas (death literacy, care outcomes and system improvement) using the death literacy index, de-identified data extraction of population health software, surveys and secondary outcomes measures e.g., changes in staff knowledge and confidence.

Conclusion:
It is assumed strategies will improve how each cohort identify, manage, discuss and support wishes and goals of care of their patients, residents, clients, relatives, community members and their own death literacy.

1. Establish new models to support quality palliative care systems and services in general practices and Residential Aged Care whilst generating data to embed sustainable service improvement
2. Promote early Advance Care Planning discussions and improve care planning capacity of health services to enable timely care management at home and reduce unnecessary hospitalisations
3. Promote community death education and literacy whilst establishing support networks for carers and patients experiencing life-limiting illnesses

Background: There is a strong global agenda to ensure continuity of care for people living with
Non-Communicable Diseases during humanitarian emergencies. Yet, local evidence to validate the effectiveness of NCD response protocols is lacking.
The study explored how a modified Philippine Package of Essential NCD Interventions or PhilPEN can be implemented in a humanitarian setting to facilitate the continuity of NCD care for internally displaced people (IDP) and health systems affected by the terrorist war in Marawi City.

Methods: Using mixed methods, the study documented how NCD care services were restored in temporary government shelters using a bundled package of interventions – Stewards, Health System Support and Service Delivery Design. It was designed to address multiple factors and agents responsible for good implementation based on their dynamic interactions. It was pilot-tested and three interrelated project outcomes – Implementation, Service, and Health- were measured and analyzed at different stages of implementation.

Results: By the end of the project, NCD services were available and accessible in all project sites. Persons living with NCDs have been identified and enrolled in NCD registries. The community-based service delivery platforms increased access, provided coverage, and improved service utilization more than the usual medical mission type of service delivery platforms typical in humanitarian settings. There was continuity of care even at the height of the global pandemic. The project has resulted in good health outcomes and high patient satisfaction. It was turned over to the local health authorities at the end of the project. On follow-up, the community was able to sustain the program 18 months after.

Conclusion: PhilPEN can be successfully contextualized to ensure healthcare access for IDPs living with NCDs in humanitarian settings.

- ensuring access to NCD care
- PEN in Humanitarian settings
- Implementation strategies

Background: Intravenous (IV) iron therapy has been progressively performed with modern formulations in the community practices as well as hospitals, when oral route become impracticality. However, it is not a risk-free procedure.
Objectives: Effective replacement of iron is important to treat iron deficiency and iron deficiency anaemia. Can IV iron be rechallenged with a previous history of reactions?
Methods and results: Five mostly retrospective studies were identified, involving re-exposure of IV iron (total n=1006) from the literature. They were observed and analysed.
Discussion: This short presentation illuminates a plausible rechallenge of this therapy despite with a background of reaction, depending on the nature of reactions, intensity of reactions and use of alternative formulations. In short, re-administration of IV iron therapy with past reaction is plausible with benefits and risks stratification.

1) Rechallenge of IV iron therapy with past reaction is plausible with benefits and risks stratification. 2) Meticulous caution would be required in patients with background of severe hypersensitivity reaction or multiple high-risk factors, even with the use of different formulation. 3) Use of premedication lacks a general consensus, requiring further studies.