Research presentation

Colorectal cancer (CRC) is the third most common cancer in Australia and the second leading cause of cancer death. With 90% of CRC being potentially preventable with early detection, optimal National Bowel Cancer Screening Program (NBCSP) participation is critical for mortality reduction and cost-effectiveness. Currently, participation is suboptimal, averaging at 44%, significantly below the 60-70% target. Participation is further reduced within Australian rural communities. This project aimed to explored rural GP NBCSP experiences to elucidate circumstances unique to rural and regional communities which impact utilisation and access of preventative medicine resources.

Semi-structured interviews with rural GPs were conducted during 2021 within Central Western NSW. Interviews explored GP experiences with the NBCSP and preventative screening; common patient perceptions and how these conversations were navigated; barriers and facilitators for patient participation and recommendations to improve NBCSP uptake.

Data analysis demonstrated that lack of public awareness and media promotion as well as limited health literacy, are crucial barriers in engaging eligible Australians to participate in the NBCSP. GPs also identified that discussing participation with their patients, its requirements and potential benefits, resulted in most patients subsequently utilising immunochemical faecal occult blood testing, either through the NBCSP or through privately purchased kits. Additionally, incorporating preventative screening discussion as part of regular ‘check-up’ appointments was found to normalise the topic and enhanced patient understanding of asymptomatic testing, increasing test uptake and follow-up following positive results.

This study provided a more comprehensive understanding of the barriers and facilitators which impact regional patient NBCSP participation. Improved engagement of regional primary health care could allow for the development of specific strategies to better facilitate GP NBCSP endorsement within non-metropolitan areas. Fundamentally, this will improve patient care and reduce the CRC disease burden within our rural Australian communities, bridging the health gap still defined by postcode.

1. Population health literacy regarding bowel cancer, its risk factors and symptomology, and the subsequent need for asymptomatic screening is very limited.
2. Many patient barriers to bowel screening participation can be mediated by improve patient education and awareness.
3. The role of the GP is paramount in ensuring screening promotion, follow up and advocating preventative healthcare measures.

Research presentation

Western NSW Local Health District (WNSWLHD) is a large rural health district in the state of New South Wales, Australia covering some 247,000km² with approximately 279,000 residents. The District delivers healthcare services via 40 inpatient facilities and over 50 community health centres. Alike many rural health districts, WNSWLHD experiences significant challenges with recruitment and retention of general practitioner visiting medical officers (GP VMOs). The gradual decline in general practitioners per capita and vacancies in the local medical workforce led to rostering gaps and an increased dependency on locum contracts, which was further exacerbated during the COVID-19 pandemic and associated border closures. To counter medical workforce challenges and provide medical coverage for hospitals when VMOs were not available, or Locums were prevented from entering the District, WNSWLHD introduced the Virtual Rural Generalist Service (VRGS). The VRGS is an adaptable and scalable medical model that permits routine and ad-hoc after-hours and/or weekend cover during periods of planned or unplanned leave. The innovate model leverages advances in telehealth technologies to deliver virtual and face-to-face medical consultations to emergency departments and inpatients 24 hours per day, 7 days per week. The service employs 28 skilled Rural Generalists and has provided over 52,000 medical consultations and delivered 1,000 days of face-to-face cover in facilities with ongoing medical cover challenges. During 2021, the service was awarded the NSW Health COVID-19 Grant to conduct a formal evaluation to determine the impact and influence of the VRGS on the rural workforce and assess if the service provides a COVID-19 resilient model of care. This presentation will discuss the VRGS model and evaluation outcomes as they pertain to the values-based healthcare domains; health outcomes that matter to patients, experiences of receiving care, experiences of providing care and effectiveness and efficiency of care.

1. Principles for implementing a safe and high quality virtual medical model to supplement and support the local medical workforce
2. The impact of the VRGS on the local medical workforce, including patient and clinician experiences with virtual care
3. The impact of implementing a scalable and flexible virtual medical model on access to care and health outcomes for rural communities

Rapid impact presentation

Aim
Detail the experiences of a General Practitioner volunteering at the main evacuation centre at Lismore during the flood disaster.

Content
The 2022 floods that occurred in Lismore devasted the local town and surrounding districts. The 14.4m high flood destroyed homes, damaged roads and essential infrastructure, and either displaced or cut off thousands of people.

The impacts of the flood put an enormous strain on the local and regional health system. Medical and pharmacy buildings were damaged, staff were displaced or stranded in their homes unable to attend work, and logistic links for basic supplies cut off.

General Practitioners are well placed as medical professionals to respond in the time of natural disasters. Their intimate knowledge of how their local health system works and interacts, their understanding of the workings of their local community and topography, and broad clinical skills mean they are well placed to support their local community during times of natural disaster. The 2019-2020 royal commission report into National Natural Disaster Arrangements recommended that all levels of government should facilitate greater inclusion of primary healthcare providers in disaster management. Despite this, planning for GPs involvement in disaster response has been ad-hoc and varied.

Goals
1. Understand the skills that GPs can provide during disaster responses
2. How GPs can fit in within disaster response structures

1. Understand the skills that GPs can provide during natural disaster responses
2. Understand the challenges for GPs to fit-in within disaster response structures
3. Planning for the next natural disaster - are your GPs involved?

Rapid impact presentation

Background
Atherosclerotic cardiovascular disease (ASCVD) causes 1 death every 3 minutes in the UK and this costs the NHS in England ca. £7.4 billion per year: this places a significant financial and social burden on society. There is a geographical variation in in addressing elevated lipid profiles with people living in deprived regions in England being 4 times more likely to die prematurely from ASCVD.

NHS England has developed a 10 year long term plan to address this ASCVD risk as it is an area where lives can be saved. The NHS has initially concentrated its efforts on LDL-C reduction. As a practice we have incorporated this approach and extended it to address other additional factors including the triglycerides (TG) risk. Here we detail our experience of addressing the ASCVD risk in secondary prevention including the use of novel medications such as inclisiran and Icosapentyl ethyl.

Question
What actions can be taken to enhance ASCVD reduction with regard to LDL-C and TG risk in rural primary care?

Approach
• Empowerment of our MDT to manage lipid risk through education
• Use of automated searches to find patients to facilitate their review and enhance their risk reduction management.
• Evaluating newly diagnosed cases of CVD, CVA and PAD to ensure prompt risk reduction management.
• Use of multi-channel approaches to educate patients and organise suitable follow-up.

Conclusions
• A proactive approach by the MDT enhances patient identification and optimises their management.
• Automated searches facilitate identification of ASCVD risk patients.
• Enhanced lipid management reduces ASCVD risks and is in keeping with long term national objectives in England
• Our approach reduces health inequalities.
• Using existing IT systems reduces workload burden and enhance provision of best practice medicine to our population.
• Our experience all medications are generally well tolerated.

1. A proactive approach by the MDT enhances patient identification and optimises their management.
2. Using existing IT systems reduces workload burden and enhance provision of best practice medicine to our population.
3. Our experience all medications are generally well tolerated.

Rapid impact presentation

Potentially preventable hospitalisations (PPH) of ear, nose, and throat (ENT) conditions in the Murray Primary Health Network (PHN) region have been found to be higher than the state average of Victoria, Australia (also termed hotspots). The Perils of Place report by the Grattan Institute recommends place-based interventions to target hotspots, warranting further investigation within the Murray PHN. This study aimed to examine the association between patient characteristics and PPH for ENT conditions from 2015 to 2020 in the Murray PHN. More specifically, this research intended to identify the clinically meaningful ENT subgroups of PPH, map the identified postcodes of significance for potentially preventable ENT hospitalisations, and identify the compounding selected patient characteristics of the PPH for ENT conditions. Unit record hospital separation data were obtained from the Victorian Admitted Episodes Dataset. Differences between patients from ‘higher than expected’ postcodes and ‘other’ postcodes (with respect to the distribution of demographic and other patient characteristics) were determined using chi-squared tests for each ENT subgroup. The results were confirmed by logistic regression analyses using resident of a postcode with higher than expected hospitalisations as the outcome variable. There were 4816 hospital separations in the Murray PHN with a primary diagnosis of ENT as defined by the PPH framework in the National Health Agreement. Of the 169 postcodes located in the catchment area, 15 were identified as having higher than expected numbers of upper respiratory tract infection hospitalisations, 14 were identified for acute tonsillitis, and 12 were identified for otitis media. Of the identified postcodes, differential patient factors included 0-9 year old’s, the Indigenous population, and those from culturally and linguistically diverse backgrounds (patients requiring an interpreter and language other than English patients). Further investigation of the identified postcodes is warranted to determine access to and utilisation of primary healthcare services in these regions.

1. An understanding of hotspots in rural areas;
2. An understanding of the potentially preventable hospitalisations of ear nose and throat conditions in the Murray PHN region;
3. An understanding of how to identify the association between PPH conditions and patient characteristics.

Rapid impact presentation

Rural and remote health services are unique given the immense distances between communities, small local populations, and the wide variation in health needs and social determinants within these communities. Compounding these challenges are limitiations to health infrastructure and access to specialised services. Approximately 53% of the clinicial workforce in rural and remote health services within Queensland are registered nurses. In these settings, a nurse is often the first and only healthcare provider and is required to undertake a wide range of clinical care across the lifespan.

Building capacity of the nursing workforce is integral to improving health outcomes in rural and remote communities. Nurses working in this context need to be resilient and resourceful with both generalist and specialised skills, responsive to the needs of communities while understanding the strengths and limitations within the context of practice.

The Rural and Remote Generalist Nurse (RRGN) Project is an investment by Queensland Health which involves the development of a program to provide supports and training for registered nurses specific to the context and needs of communities.

During development of the RRGN Program, considerations were given to existing clinical education, workplace supports, challenges, and lessons from the established Medical and Allied Health Rural Pathways. In developing the program, stakeholder engagement identified opportunities for immersion in rural and remote practice and importance of understanding the individual needs of communities.

The RRGNP is currently being piloted across five Hospital and Health Services within Queensland.

1. Registered nurses make up 53% of clinical workforce in rural and remote, higher than Queensland state average ;
2. Rural Generalist Nurses require broad range of clinical skills to care for individuals across the lifespan;
3. RRNGP is a supportive program that is building capacity of nurses to meet community needs