[Background] Access to medical facilities is important in primary care. To ensure geographic access to medical facilities, the characteristics of districts with poor medical access were examined using spatial statistical analysis. [Methods] All 2,554 administrative census mesh blocks and all 89 hospitals in a Japanese prefecture were included in the study. The population was approximately two million. The enhanced two-step floating catchment area (E2SFCA) method was used to evaluate geographic access to medical facilities. The E2SFCA scores were calculated for all meshes using ArcGIS Pro 3.0 (ESRI, Redlands, California, USA). The Kruskal–Wallis test, multiple comparisons (i.e., the Bonferroni method), spatial autocorrelation analysis and spot analysis (Getis-Ord Gi*) were used for the analysis. [Results] The median E2SFCA score was 4.0 hospitals/100,000 (interquartile range [IQR]: 2.4–5.8/100,000), which was almost equivalent to 4.5 per 100,000 population. Spatial autocorrelation analysis showed spatial agglomeration in the E2SFCA scores (p < 0.001). Spot analysis detected 81 cold spots and 115 hot spots. Median population sizes were 134 (IQR: 76–207), 178 (IQR: 60–389), and 478 (IQR: 227–908) in cold spots, hot spots, and the remaining meshes, respectively (p < 0.001). Median ageing rates in the more than 65-year-old population were 37% (33–43%), 38% (30–48%), and 29% (22–34%) in cold spots, hot spots, and the remaining meshes, respectively (p < 0.001). In multiple comparisons, the population in cold spots was significantly smaller and the ageing rate in cold spots was significantly higher than in the remaining meshes (p < 0.001). [Conclusion] Spatial statistical analysis in the E2SFCA method detected 81 cold spots in 2,554 meshes. These cold spots had smaller populations and higher rates of ageing than the other meshes. Continued discussion is needed on how to ensure access to primary care in depopulated areas with high ageing rates.

At the conclusion of my presentation attendees will take away
1. The two-step floating catchment area method is one of the indicators of geographic access to health care.
2, By using spatial statistical analysis, geographic (spatial) agglomeration can be confirmed.
3, Areas with poor access to medical facilities had smaller population sizes and higher rates of ageing, which indicated that continued discussion was needed on how to ensure access to primary care in depopulated areas with high ageing rates.

Sore throat caused by the bacterium group A streptococcus (GAS) can lead to acute rheumatic fever and subsequently chronic rheumatic heart disease. In Fiji, due to the limited laboratory setting it is recommended to use the Clinical decision rule (CDR) to diagnose GAS and determine whether to treat. The Fiji-specific CDR criteria is: presence of sore throat, plus no runny nose or no hoarseness of voice. This differs significantly from the guidelines in Australia and New Zealand, where throat swabs are more feasible. Antibiotics are the cornerstone of therapy with Benzathine Penicillin G (BPG) as first-line. Clinical practice guidelines are therefore produced to improve the appropriate use of antibiotics.

This study is an audit of the management of probable GAS pharyngitis in Fiji and whether management complies with Fiji clinical guidelines. This was a cross-sectional, single-center study from the 3rd of August, 2022 to the 31st of August, 2022 at Lami Health Center, Fiji on all children aged 5 to 14 years old and adults who presented with a sore throat. A total of 294 participants were included whereby 284 (96.6%) were found to have probable GAS using the Fiji-specific criteria. The study showed a large discrepancy in the prescribing practices used by doctors, with 93.9% (276) not adhering to the guidelines. 56.3% (165) of patients prescribed an oral antibiotic received the incorrect dosage and duration, with 37.5% (110) given both an oral and intramuscular antibiotic. Only 6.1% (18) of patients received the correct antibiotic treatment.

These are alarming numbers particularly given the situation in Fiji, a high-risk setting for rheumatic fever. The high rates of partially treated infections are concerning with the added possibility of antibiotic resistance if not addressed urgently. However, further studies are needed to identify the reasons why doctors do not abide by these guidelines.

1. Recognize the significance of contextualizing guidelines to the local setting.
2. Recognize that guidelines do not guarantee that doctors will adhere to them.
3. Reflect on why doctors do not adhere to guidelines and possible solutions.

Aim
To clarify the usefulness of POCUS in home health care settings where means of imaging tests are limited

Contents
The Covid-19 epidemic has increased the demand for home healthcare in Japan. Home health care is a field with limited medical resources compared to hospital care. Therefore, the quality of medical care that can be provided depends on the experience and skills of the doctor who performs home visits. Since the purpose of regular home visits is daily health management, in many cases it is only a medical interview and a physical examination. However, it is often difficult to determine the diagnosis and treatment policy for medical problems that occur during temporary home visits when sudden changes occur, based only on interviews and physical examinations.

By making good use of pocket-sized echocardiograms, which could only be done with highly skilled examination techniques, doctors can now greatly expand their diagnosis capabilities.A stethoscope is carried around during home visits, but the pocket echo may be able to play an active role as a new form of stethoscope. We will introduce specific cases in which the pocket echo is used in home visits, and report on its use not only in conventional fields but also in new fields such as orthopedics.

Goals
To report cases in which POCUS was useful

1.Home care medicine needs to be provided with limited medical resources.
2.POCUS is useful in home care medicine.
3.POCUS has many possibilities, depending on its use.

Christian Academy of African Physicians (CAAP) exists to support the development of Family Medicine in Africa, addressing health disparities in rural and under-resourced regions. New programs with young faculty need resources for professional development that are relevant, affordable and accessible. CAAP is developing curriculum to support professional development of resident learners, faculty and programme leaders in family medicine. Following the foundational work of Larson et al.¹, a multinational, multidisciplinary group of educators participate in online meetings using a modified Delphi process to identify current issues and future needs. The result of which will create a framework for professional development curriculum for family medicine that is appropriate for the African context: addressing issues of multiculturalism, wholistic care, spirituality, community-oriented care, etc. Importantly, utilising a wholistic approach to faculty development ensures the knowledge, skills and needs of “teacher” and “learner” are considered, leading to maximised mutual development in a profession that comprehends the importance of lifelong learning. Subsequent work will create a portfolio of curricula that is competency based², grounded in the principles of adult learning (i.e. andragogy)³ and is delivered in an online platform allowing global learners to access the course and be recognised with a Certificate of Completion.
1) Larson PR, Chege P, Dahlman B, et al. Future of Family medicine Faculty Development in Sub-Saharan Africa. Family Medicine 2017;49 (3):203-210.
2) Frenk J, Chen L, Bhutta ZA, Cohen J, et. al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 Dec 4;376(9756):1923-58
3) Knowles, M. S., Holton, E. F. III, Swanson, R. A., & Robinson, P. A. (2020). The adult learner: The definitive classic in adult education and human resource development (9th ed.). Routledge/Taylor & Francis Group.

1. Characterise the essential components of curricular development using a multicultural, wholistic approach.
2. Describe an approach to curriculum that provides resources across the continuum of learning in a method that is accessible, relational, affordable, and relevant.
3. Recognise the need for development of the institutional environment that supports continuous professional development of both learners and faculty to encourage life-long learning and teaching roles.

Research presentation

Background
Rural communities need accessible primary care for optimal health outcomes. However, delivering services in rural communities is increasingly challenging due to workforce shortages and metro-centric healthcare and funding models that are not sustainable in rural contexts. Rural communities have strong potential to inform what will work in their context due to their in-depth understandings of local priorities, strengths and opportunities.

Objective
To involve rural communities in the co-design of place-based and evidence-informed models for building sustainable rural health systems, and to identify learnings and develop tools for knowledge translation.

Methods
In rural Victoria, community-based participatory research and co-design research methods were used to develop trial primary care models. The co-design was led by a health service executive steering committee in partnership with rural health researchers. Perspectives from healthcare professionals (n=42), consumers and carers (n=21) were gathered through qualitative interviews. Qualitative content analysis was used to identify priorities and develop descriptive themes. Rigour was enhanced through a process of member checking; and the research procedures were approved by a university human research ethics committee.

Results
Health priorities, system strengths and challenges, and sustainability barriers, enablers and resources were identified. Three models were proposed for building health system sustainability, forming a multi-level systems strategy. These are 1. A strengths-based regional workforce strengthening plan, 2. Models of integrated primary care, and 3. Innovative rural generalist employment models and models of care.

Conclusion
The executive level regional co-planning and design process can be trialled in other rural regions. Trial sites are recommended to be of a similar population size and rurality, and where existing partnerships can be leveraged. Place- and strengths-based co-design was effective for locating finite resources for developing models that were locally supported, aligned to community healthcare access priorities and barriers, and responsive to existing workforce capacity.

1. Describe a co-design process for developing sustainable rural health models.
2. Describe three trial models developed targeting rural health system sustainability.
3. identify key learnings relating to sustainable rural health care model development for knowledge translation

Background
Bangladesh has established more than 13,000 community clinics (CCs) to provide primary healthcare covering a population of around 6,000. The inception of CCs in the country has revolutionized the healthcare delivery to reach the doorstep of people. The provision of healthcare through CCs is truly participatory since the community people donate land for building infrastructure and also involve in management process. The study was conducted to assess pattern of public private partnership in healthcare delivery through participation of community people .

Methods
This quantitative study involving descriptive cross sectional design included 63 healthcare providers, 2,238 service-users and 3,285 community people as household members. Data were collected by face-to-face interview and reviewing records of CCs with the help of semi-structured questionnaire and checklist respectively. The public private partnership was assessed in this particular study by finding community participation in different activities of CCs. Data were analysed using descriptive statistics.

Results
Almost all (96.9%) CCs are located in easy-to-reach areas having good infrastructure. The security of most of the CCs (93.7%) is maintained by community people. Community Groups (CGs) of 88.9% and Community Support Groups (CSGs) of 96.8% CCs are found to be active. In most of the CCs (98.4%), monitoring is done by analysis of monthly reports. All CCs provide referral services for pregnant women. Health care delivery is found to be ‘good’ in more than three-fourths while health education service is ‘good’ in 96.7%. Benefits of CCs as perceived by service users included free drugs (82.1%), free treatment (81.2%).

Conclusion
Public private partnership in primary healthcare delivery through community clinics ultimately plays crucial role in sustainable development of community health by providing quality health care. The study recommends public-private partnership for strengthening CCs .

1.Public private partnership for community health service.
2.Service at door step.
3.Primary health care through community clinic.

Aim: The aim of this research project is to understand the perceptions of rural general practitioners (GPs) in Western Australia regarding the management of metabolic syndrome in rural areas and identify the facilitators and barriers to its management.

Content: Metabolic syndrome is a growing global epidemic with severe health implications for individuals, communities, and healthcare systems. It has also been identified as a significant risk factor for poor Covid-19 outcomes. Rural populations in Australia have a higher prevalence of metabolic syndrome compared to urban populations. Diet and lifestyle interventions are playing an increasing role in the management of this condition with an increasing evidence base for their use. These interventions also avoid the complications associated with the management of metabolic syndrome with pharmacological or surgical methods. While diet and lifestyle interventions for metabolic syndrome can be provided by GPs or allied health practitioners in primary care, the ability to deliver interventions is limited in the rural setting. Costs of interventions are high and access to care is frequently challenging. Given that the incidence of metabolic syndrome is increasing globally including in rural areas, it is imperative that best practice for management of metabolic syndrome is addressed at the level of primary care in a cost-effective and scalable way. Data still to be collected.

Goals: The research aims to explore the specific barriers to delivering interventions for metabolic syndrome in the rural setting and to provide insights into overcoming these barriers to improve health outcomes for patients. The findings of the research will inform the development of targeted interventions to improve the management of metabolic syndrome by rural GPs and ensure that patients in rural areas receive the best possible care.

Data collection pending currently

1. Barriers to the management of Metabolic Syndrome
2. Facilitators to the management of metabolic Syndrome
3. Interventions to address barriers to management.

Regional primary healthcare services need proactive, collaborative and creative solutions to attract, develop and retain the skills, capabilities and talent required to deliver medical services to meet local needs.

Junior doctors, doctors in training and medical students transitioning to the workforce benefit from the tailored individualised support of a mentor to help them navigate the unique challenges of training regionally.

Using a Statewide Regional Medical Mentoring Program as a case study - this presentation will unpack why a holistic, collaborative, regional approach to medical mentoring has been successful in Victoria, Australia.

This regional medical mentoring program has been tested within the rural medical training environment and earnt industry support over the last six years. It offers continuous support and guidance along the full length of the regional training pathway, from medical student to fellowship, with flexibility of use.

The program outcomes indicate mentees’ experience increased confidence, job satisfaction and retention, and commitment to pursuing a career in rural healthcare when supported by a regionally based and experienced medical mentor.

The platform is free for users and matches can be self-directed, with mentoring program length and type determined by mutual agreement of the mentor and mentee.

This collaborative platform provides a practical yet highly strategic means to support meaningful outcomes identified in State and National Medical Workforce Strategies:

Increase the number of regional doctors in training

Reduce barriers for doctors to work and train rurally

Support coordinated and visible ‘end-to-end’ training pathways

Support the regional trainee medical workforce including in Aboriginal and Torres Strait Islander health settings for population parity

Support broader education and experience of generalist skills, and rural and remote clinical practice, during medical school and on training programs

Support informed decision making for regional medical career pathways

Implement and leverage innovation from the National Rural Generalist Pathway

1. Mentoring programs are a critical support to medical students and junior doctors - to stay regional, and transition into rural health workforce and training programs, to effectively support junior doctor wellbeing the mentoring needs to offer flexibility to users across specialty areas and geographic scope of practice, with the ability to self- direct matches and determine the length and style of the mentoring relationship.
2. Mentors are critical to the success of the program and value authentic contribution and relationships to support regional medical trainees. Mentoring can benefit mentors, with practice succession plans via engagement with mentees possible through the program.
3. Multi-agency support for a unified program has ensured sustainability and robustness; a critical element of success. This collaboration has also expanded the breadth and depth of the mentoring opportunities available.

People living with mental illness have poorer physical health, yet they receive less and lower quality health care than the rest of the population – and die younger. This report aimed to improve the quality of life of people living with mental illness by providing equal access to quality health care. By championing physical health as a priority, the report aimed to reduce the life expectancy gap that exists between people living with a mental illness and the general population.

To do this the Project team established a survey that was website based with portal and an integrated set of response options for organisations. The response options included videoconference interviews, phone call interviews, online survey, and downloadable hard copy survey forms. Qualtrics was used to populated data based on the questions in the survey.

The scan achieved a response rate of 73%, which was above the target response rate and significantly higher than the 2018 and 2019 response rates. It was also evident in our findings that 78% of responses incorporated lived experiences into their initiative design, which aligns with Australia’s best practice reforms.
In total the scan revealed 169 activities underway with 104 resources submitted. This is a strong indication of engaging the Australian mental health sector in improving the physical health of people living with mental illness. This is encouraging and indicates that the physical health of people living with mental illness is very much on the reform agenda.

It appears the policy priority of improving the physical health and life-expectancy of people living with mental illness is being actively implemented across Australian mental health. We highlight these findings to emphasise the initiatives displayed, but to provide insight into the sector and pathway forward. We provide sustainable recommendations into the current mental healthcare system.

1) To get an overview of activities/initiatives that organisations around Australia are doing to address mental and physical health.
2) Effectiveness of these initiatives in reducing life expectancy gap in Australia mental health patients
3) Future recommendations for improving wellbeing and physical health for those with a mental health illness

Background: Practice Based Residency Training Program (PBRTP) in Family and Community Medicine (FCM) was introduced by the Philippine Academy of Family Physicians (PAFP) in 2004 as an innovative training strategy that would allow doctors desirous to undergo specialization in-situ while already providing general medicine services in the community. In 2013, the Department of Health (DOH entered into an agreement with the PAFP and issued a policy directive calling for the establishment of PBRTP in all DOH-retained and LGU-owned hospital. Among the early adopters of this mandate was the Province of Northern Samar.

Methods: This cross sectional qualitative study draws on semi-structured interviews and small group discussions among the trainers and trainees of Northern Samar. The study sought to distill the insights and feelings of the respondents on their lived experiences in the province-wide training program and identify best practices in the process.

Results: The homegrown Northern Samar Province Wide PBRTP was given accreditation by the PAFP in 2016. The trainers identified political will as the main enabler for the program’s success. The local leaders enacted policies that provided funding support to maintain the training program and a local scholarship program that guaranteed a continuous pool of trainees.

It has already produced family medicine specialists in the province who shared how their patients were able to benefit instantaneously from their progressive upskilling. They reported a general feeling of satisfaction with the program’s content and mode of delivery. The use of digital teaching innovations allowed the trainees to receive instruction remotely which proved beneficial to the program’s sustainability during the pandemic. The learning sessions served a dual purpose of health system strengthening and the creation a community of practice.

Conclusions: These findings highlights the importance of participatory approaches in creating synergy to address issues as complex as human resource for health development.

- community led interventions
- vital role of trained primary care physicians
- training innovations for continuing professional development of frontline health workers in rural and remote settings