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Objective To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. Design This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. Setting Two sites in Victoria and one in Western Australia. Participants Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. Interventions Not applicable. Main outcome measures Not applicable. Results Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. Conclusions While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families. [ABSTRACT FROM AUTHOR]

Objective This paper examines health reform which has been designed to improve cancer services across Western Australia. Setting Western Australia is a large state divided into nine regions each with differing demographics. The diversity of the state and the distribution of the population over a large area of land create significant challenge in ensuring equality in service delivery. Design A comparison was conducted looking at cancer services in Western Australia pre-2005 and service delivery in 2014. A review of the partnership initiatives and programs provides a clear discussion on the need for coordination of care between service providers. Main Outcome The approach undertaken in Western Australia has seen an increase in the delivery of cancer services closer to the patient's home as well as greater involvement of primary care professionals in cancer care. This work has resulted in demonstrated improvements in patient care and support. Conclusion Services for cancer patients need to be accessible closer to home with distance being an appreciable barrier to treatment access.A statewide approach needs to be developed to ensure all people have equitable access to service delivery. [ABSTRACT FROM AUTHOR]

Introduction Despite strong and growing evidence for the benefits of exclusive breastfeeding to 6 months of age, few infants in developed countries reach this milestone. Although breastfeeding practice and its determinants are well described for women in metropolitan areas, there is limited evidence for rural and regional areas of Australia. This paper describes the influence of advice and support on breastfeeding duration for women in rural areas of Western Australia in the first 6 months of their infants' lives. Methods A cohort of 427 women and their infants were recruited from hospitals in regional Western Australia and followed up for a period of 12 months. Information about feeding methods was gathered in hospital and at a further seven follow-up contacts. Results Women who had attended antenatal classes were less likely to have ceased exclusively breastfeeding before 6 months than those who had not attended classes ( aHR: 0.61, 95% CI: 0.41-0.91). No significant associations were found between provision of information alone and duration of breastfeeding. Breastfeeding advice and support in the first 6 months was most commonly sought from Child Health Nurses, General Practitioners and friends. Conclusions Antenatal group education is effective in supporting breastfeeding duration for rural women and should be a key priority for rural health service providers. Health professionals are common sources of breastfeeding support postnatally, however creating and maintaining positive and supportive social networks for mothers might also contribute to increasing the proportion of rural infants who meet the World Health Organization guidelines for exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Objective There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. Design A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. Setting The Kimberley Mental Health and Drug Service in Broome, Western Australia. Participants Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). Main outcome measures Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. Results Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. Conclusions Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities. [ABSTRACT FROM AUTHOR]

Background This paper aims to assess the barriers and solutions to the delivery of eye care in primary care settings and solutions to improve the use of comprehensive eye care among Indigenous Australians. Design, setting, participants Qualitative, mixed method study participants include Aboriginal community members, and health and eye care providers in urban, rural and remote settings. Main outcome measures Present evidence for health care providers to better understand and address some of the barriers that limit access to eye care in primary care settings. Results Patient perspectives on barriers to accessing eye care and reasons they choose to seek care or not are presented. Health system barriers identified by health and eye care providers are also presented. Additionally, key enablers for improving access to eye care through primary care services are identified. Conclusion Primary health care services have an important role in Indigenous eye health. There is a critical role for primary care in the coordination of the patient journey and cooperating with other services to improve access to comprehensive eye care. Through improved provision of primary eye care, monitoring of Indigenous eye health indicators and supporting patients to access eye care, it is possible to close the gap for vision. [ABSTRACT FROM AUTHOR]

Objectives: The increase in demand for dental care over the next 10 years is expected to outstrip the supply of dental visits in Australia, resulting in an ongoing shortage of dental practitioners. As trends in medicine have shown, the greatest effect will be felt in rural and remote regions, where an undersupply of dentists already exists. It is clearly evident that it is important to provide strategies that will increase the recruitment and retention of practitioners in rural and remote areas. Previous research suggested an increased likelihood for health graduates to choose rural practice if they have a rural background, or were exposed to rural practice during their education. Short-stay (three to four weeks) placements for final-year dental students has been part of dental education in Western Australia for near on a decade. Methods: This paper reflects on the experiences gained from managing this placement program. Conclusions: Short-stay placements are a quality learning initiative but need a high level of planning and a clear vision to be effective. Implications: The key factors in ensuring sustainable, student centred learning is driven through a small core group of staff who have strong direct links with rural and remote communities, students and support providers. The integration of service, education and research goals have played a critical role in sustaining placements. The philosophy underpinning the rural placements needs to be clearly articulated and applied effectively in each step of their implementation and a highly focused customer-service driven implementation is required to make short-stay rural and remote placements effective. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To promote tertiary health careers to rural and remote young people. Design: Qualitative research using large and small group discussions and semistructured interviews. Setting: Fifteen secondary schools in rural and remote Western Australia including five senior secondary schools and 10 district high schools. Subjects: One hundred and twenty students from eight year 10 groups, 35 students from three year 11 groups, 54 students from five year 12 groups, 52 parents, 10 grandparents, 76 teachers and four Aboriginal and Islander Education Officers (AIEO). Results: Students prefer information about the range of health careers to be delivered interactively. Choices to follow a health career at tertiary level were constrained by structural and cultural issues including geographical isolation, financial cost, stereotyping of health professions, insufficient information about the diversity of health careers, obligation to family, community and place and a devalued rural culture. Conclusions: The under representation of rural and remote students in health related university courses needs to be addressed by long-term strategies taking into account both structural and cultural barriers when making career choices. Health policies should include the provision of financial support for rural and remote students and promote a broad range of health careers as challenging and rewarding life choices that offer much needed services to rural communities. What this paper adds: In 1997, only 19.2% of Australian university students came from rural and remote areas, a figure dramatically below the equity reference point of 28.8% of the population living in rural areas derived from the 1996 census data. [sup 1] In 2001, the figure remained steady with 19.1% of rural students attending university. [sup 2] These data highlight the need for developing higher education opportunities for all Australians regardless of where they live. However, despite ongoing concern about attracting rural and remote students to health careers, limited success has been achieved to date. Barriers to students choosing health careers at tertiary level include lack of information about the range of health careers available, the cost of tertiary education for families, social dislocation and a perceived lack of support structure for students at university. These are underpinned by cultural assumptions about gender, occupational roles in rural communities and professed lack of academic ability. Strategies to overcome barriers must be situated within a broad socio-cultural context to understand the complexity of issues underpinning students’ choices. [ABSTRACT FROM AUTHOR]

Objective: Perinatal emotional well‐being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well‐being. This study compares perinatal well‐being between women living in metropolitan and rural regions. Design: Prospective, longitudinal cohort. Participants/setting: Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. Main outcome measures: Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2‐MM3 and 43 in rural to remote MM4‐MM7. The Structured Clinical Interview for DSM‐IV (SCID‐IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post‐natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. Results: The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. Conclusions: Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality. [ABSTRACT FROM AUTHOR]

The article offers information on the 11th National Rural Health Conference to be held at the Perth Convention Centre in Perth, Western Australia, from March 13 to 16, 2011.

Despite significant efforts at a primary care level, at least 35% of people with diabetes fail to meet health targets. It is assumed that these poor results are a consequence of the patient not understanding their disease or not caring. This study seeks to understand what really lies behind poor control. A qualitative study using semistructured interviews was conducted in a primary care setting in rural Western Australia. People living with diabetes for at least two years were specifically selected on the basis of whether they had either 'good' (HbA1c < 7%) or 'poor' (HbA1c > 8%) control. Interviews revealed that people understood only too well their disease and their responsibilities. Frequently, either they did not choose to make diabetes a priority in their lives or were unable to make appropriate lifestyle changes which were demanded for good blood sugar control. Their life/social stresses often influenced their glucose control. Poor control in our study was not related to lack of knowledge but more to how diabetes was prioritised in their lives. Attention to the patients' priorities is required to accomplish improved glycaemic control. [ABSTRACT FROM AUTHOR]

The article discusses the results of a survey on the usage of non-prescribed medications in the medical department of Port Hedland Hospital in Western Australia. The survey obtained non-prescribed medications which include bush medicines, complementary and alternative therapies and over-the counter medicines. The survey's respondents were asked about where they had sought health or medical advice.

Objective: To measure the impact of a 6‐month home‐based behaviour change intervention on reducing the risk of chronic disease as determined by metabolic syndrome status and cardiovascular risk score, and discuss implications for primary care in rural areas. Design: A two‐arm randomised controlled trial of rural adults. Setting: The rural town of Albany in the Great Southern region of Western Australia. Participants: Participants (n = 401) aged 50‐69 years who were classified with or at risk of metabolic syndrome and randomly assigned to intervention (n = 201) or waitlisted control (n = 200) group. Interventions: A 6‐month intervention program incorporating goal setting, self‐monitoring and feedback, with motivational interviewing was conducted. Main outcome measures: Change in metabolic syndrome status and cardiovascular risk. Results: Significant improvements in metabolic syndrome status and cardiovascular disease risk score (−0.82) were observed for the intervention group relative to control group from baseline to post‐test. Conclusion: This home‐based physical activity and nutrition intervention reduced participants' risk of experiencing a cardiovascular event in the next 5 years by 1%. Incorporating such prevention orientated approaches in primary care might assist in reducing the burden of long‐term chronic diseases. However, for realistic application in this setting, hurdles such as current national health billing system and availability of resources will need to be considered. [ABSTRACT FROM AUTHOR]

Problem: Despite acknowledged benefits, the impact of advance care planning on usual care is inconsistent. Design: Quality improvement study. Setting: A Western Australian regional hospital. Key measures for improvement: This project aimed to create a system for storing, accessing and incorporating advance care planning documents in clinical care. Strategies for change: Interventions over 18 months addressed four areas: medical records processes for receiving and processing advance care planning documents; information technology solutions for electronic storage and alerts; clerical staff duties in regards advance care planning documents; and clinician education. Effects of change: There was a 12‐fold increase in advance care planning documents stored electronically and 100% of audited notes had correct filing of advance care planning documents with an alert in place at follow‐up audit. Clinician recognition of the presence of an advance care planning document improved. Detailed examples of interventions are described. Lessons learnt: Repeated exposure to different forms of advance care planning education, in conjunction with simple but effective system changes can make a difference in changing established hospital practice. Final impact of these changes on end‐of‐life care requires further audit. [ABSTRACT FROM AUTHOR]

Objective Rural exposure during medical school is associated with increased rural work after graduation. How much of the increase in rural workforce by these graduates is due to pre-existing interest and plans to work rurally and how much is related to the extended clinical placement is not known. Design This cohort study compared the employment location of medical graduates who professed no rural interest as undergraduates (negative control), with those who applied but did not participate in Rural Clinical School of Western Australia ( RCSWA) (positive control), and those who applied and participated in RCSWA (participants). Participants All 1026 University of Western Australia students who had an opportunity to apply for a year-long rotation in RCSWA from 2004 to 2010, and who had subsequently graduated by the end of 2011, were included. Main Outcome Measure Graduates' principal workplace location ( AHPRA, Feb 2014). Result The three groups differed significantly in their graduate work locations (χ2 = 39.2, P < 0.001). In multivariate analysis, only being of older age at graduation ( OR 2.28 (95% CI 1.40, 3.72), P = 0.001), being from a rural background ( OR 2.99 (95% CI 1.85, 4.85), P < 0.001), being a recipient of a Medical Rural Bonded Scholarship ( OR 3.36 (95% CI 1.68, 6.73, P = 0.001) and actually participating in the RCSWA remained significantly related to rural work ( OR 3.10 (95% CI 1.95, 4.93), P < 0.001). Conclusion After accounting for other factors relating to rural work, RCSWA graduates were three times more likely to work rurally than either control group. These data suggest that RCSWA has a significant independent effect on rural workforce. [ABSTRACT FROM AUTHOR]

Undergraduates who undertake rural placements often choose a rural career. Reluctance from universities to send students to rural settings limits placement numbers. The Western Australian Centre for Rural Health (WACRH) invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities to an Academic Bush Camp. Based on situated learning theory, this camp modelled student programs through experiential learning and structured workshops. It aimed to build relationships and showcase innovative rural learning opportunities. Objective To build relationships and showcase innovative rural learning opportunities. Design An evaluation of a residential camp based on situated learning theory. Setting The camp stated and finished in Geraldton, WA and was centered in Mt Magnet, WA a remote town 600 kilometres northeast of Perth. Participants WACRH invited allied health and nursing academics and clinical placement coordinators from Western Australian (WA) universities. Intervention This camp modelled student programs through experiential learning and structured workshops. Online pre- and post-camp questionnaires included open-ended questions and questions on a 5-point Likert scale. Responses were analysed in SPSS 22 using descriptive statistics and Wilcoxon signed-rank test. Follow-up phone interviews six months later assessed longer-term reflections and changes in student placement practice. Main outcome measures The main outcome measure was whether the camp met participants' expectations, and their knowledge about and interest in WACRH's programs. Results Twelve academics from five WA universities and seven health disciplines attended. Nine had previously lived or worked rurally. The camp met participants' expectations and all would recommend the opportunity to a colleague. Many valued the interaction with community and clinical placement partners and would have preferred more of this. The camp increased awareness of WACRH's programs and benefits of longer rural placements and a service-learning environment. Six months later, participants' familiarity with WACRH's placement model, supports and staff had led to an enhanced willingness to place students. Conclusion Rural academics can influence rural placement intentions by demonstrating the infrastructure, learning and academic support available. A camp experience increases metropolitan academics' awareness of rural placement programs and willingness to encourage student participation. Participants with rural backgrounds appeared more receptive to rural learning possibilities. [ABSTRACT FROM AUTHOR]

Problem Australian Aboriginal children are over-represented on all negative health indicators compared with non- Aboriginal children.Contributing factors to the disparity include the impact of historical events, racism and social determinants of health. Despite the benefits of child health checks, offered through the Medicare Benefit Schedule and community health services, uptake of these is low. Design In 2012, Western Australia Health implemented the Enhanced Aboriginal Child Health Schedule ( EACHS) policy to address specific health needs of Aboriginal children. The Aboriginal Child Heath Project (the Project), was a five-year initiative funded through the Council of Australian Governments. Project staff promoted the profile of preventative child health and the uptake of the EACHS policy across the state by agencies operating in the sector. Setting Western Australia. Key measurements for improvement Reach of the implementation workshop was measured by the number of staff attending policy implementation and the total number for agencies represented. One measure of impact was the number of agencies requesting the EACHS policy who adapted or adopted it to deliver evidence based comprehensive child health programs. Strategies for change The Project offered policy implementation workshops to health staff delivering services to young Aboriginal children. In addition to the evidence-based policy, a suite of resources were made available to support service delivery. Effects of change The EACHS is a framework used by agencies to deliver consistent care and support governance when providing child health services to Aboriginal families across Western Australia. Lessons learnt Providing a policy that was consistent with identified service strengths allowed agencies to individually build their capacity to deliver child health checks, using existing resources, at their own pace. [ABSTRACT FROM AUTHOR]

Objective To undertake an evaluation of elements of the role of the child health nurse in the development of peer support for Aboriginal families with young children in a remote setting. Design The Halls Creek Community Families Program uses expertise of peer support workers to support parents of young families. In stage one, participatory action research was used. The program facilitator, who was a child health nurse, undertook action learning sets where issues were explored relating to home visiting strategies to families. Additionally, the facilitator maintained a reflective practice diary. Outcomes contributed to stage two, where an independent researcher evaluated program changes.This report relates to stage one, which used descriptive qualitative data from interviews with peer support workers and community support agencies, and the facilitator's reflective diary. Data were analysed by thematic analysis, focusing on elements of the role of the facilitator in program development. Setting A remote Aboriginal community in the Kimberley region of Western Australia. Participants Eight peer support workers and five health and welfare professionals from community support agencies. Main outcome measures This study measures changes in participants' understanding of the role and scope of practice of the child health nurse facilitator, thereby supporting improved support for Aboriginal families with young children. Results Thematic analysis identified three major changes in understanding the child health nurse facilitator role: working in partnership, communication strategies and education and organisational strategies. Conclusion Findings suggest empowering benefits for Aboriginal peer support workers from the facilitating role of the child health nurse. [ABSTRACT FROM AUTHOR]

Objectives To compare clinical outcomes and mortality rates between Kimberley Indigenous, other Indigenous and non- Indigenous Australian patients on peritoneal dialysis ( PD). Design and participants Patients commencing renal replacement therapy ( RRT) with PD for the first time from 1 January 2003 to 31 December 2009 were retrospectively identified. Secondary data from medical records and the Australian and New Zealand Dialysis and Transplant Registry from 1 January 2003 to 31 December 2010 were used to compare outcomes between patients. Main outcome measures Time to first peritonitis; failure and death rates per 100 patient-years, hazard ratios, unadjusted and adjusted (for age, sex, comorbid conditions, PD not the first RRT modality used). Comparison of the two PD systems used in the Kimberley. Results Kimberley patients had significantly shorter median time to first peritonitis (11.2 versus 21.5 months), higher technique failure (46.0 versus 25.2 per 100 patient-years) and shorter median survival on PD (17.5 versus 22.4 months) but similar adjusted mortality (hazard ratio 1.32; 95% CI, 0.76-2.29) as non- Indigenous patients. They also had a significantly higher technique failure rate than other Indigenous patients (46.0 versus 31.4 per 100 patient-years) and nearly double the average peritonitis episodes previously reported for Indigenous Australians (2.0 versus 1.15 per patient-year). Conclusions PD can bring patients closer to home; however, it is relatively short term and potentially hazardous. PD remains an important therapy for suitable remote patients to get closer to home, providing they are fully informed of the options. The current expansion of safer Kimberley haemodialysis options needs to continue. [ABSTRACT FROM AUTHOR]

Objective Reduce long waiting lists for ear, nose and throat ( ENT) specialist review and improve primary ear health care. Design A retrospective evaluation of ear health care after the implementation of an ear health program ( EHP). Setting and participants School children in Aboriginal communities in the Fitzroy Valley of Western Australia. Key measures for improvement Access number of children screened for ear disease, effectiveness-referral letter completeness (history, otoscopy, tympanometry, audiometry), patient management and waiting time until first ENT contact. Interventions EHP - an electronic referral template, ear health nurse, ear health educator and telehealth ENT specialist review. Main outcome measures Screening rates, timely ENT review and improved primary care management. Results Number of children screened increased from 148 per 18 months to 710. Nearly twofold increase in numbers of patients referred to ENT (32, 66). A reduction in median waiting time from 141 days to 22 days for ENT review using telehealth. Content of referral letters showed an increase in essential information - otoscopy, audiometry and tympanometry. Primary care management in accordance with guidelines improved. Conclusions The addition of an ear health team increased access to appropriate primary care management and the time to contact with ENT was reduced by using an electronic template and telehealth sessions. [ABSTRACT FROM AUTHOR]

Objective To explore perceptions of Noongar community members towards advance care planning (ACP), while developing culturally appropriate information resources for use in community and hospital settings. Design Qualitative research methods, combining active health promotion with interviews and group discussions for participant feedback. Setting Six rural communities across the Great Southern region of Western Australia. Participants Eighteen Noongar community members consented to participate in interviews or group discussions. Interventions Community members received information about ACP at community events or home visits, from an Aboriginal health worker and palliative care researcher. Main outcome measures Semi-structured interviews and group discussions were thematically analysed using a descriptive, exploratory approach. Research team reflections on community events also constituted data. Results Key themes impacting on perceptions of ACP included cultural approaches to dying, importance of family and kin, and appropriate communication. Participants were satisfied with the information resource and method of community engagement. Conclusions Culturally appropriate methods of engaging Aboriginal people in ACP discussions should include Aboriginal health workers and take a whole of community approach to awareness raising. [ABSTRACT FROM AUTHOR]

Objective To determine whether an outreach community-based training program on eating disorders enhances perceived capacity of rural health and education professionals to respond to and manage eating disorders. Design Survey conducted upon completion of outreach training. Setting Rural Western Australia. Participants Health and education professionals working in rural Western Australia. Main outcome measures Questionnaire responses analysed via descriptive statistics and inferential tests. Results There was a significant increase in perceived ability to identify, support and/or treat people with eating disorders among health and education professionals. Conclusions Outreach training up-skilled rural gatekeepers and introduced systemic health system benefits of increased consultation and liaison, a fine-tuning of referral processes, a reduction in hospital admissions and better uptake of local services by patients discharged from hospital. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of remoteness on Aboriginal and non- Aboriginal myocardial infarction incidence rates in men and women of different ages. Design Descriptive study. Setting Western Australia. Participants Incident cases of myocardial infarction in Western Australia from 2000-2004 identified from person-linked files of hospital and mortality records. Analysis was undertaken for Aboriginal and non- Aboriginal populations, separately and combined, by broad age group, sex and remoteness. Main outcome measure Incidence of myocardial infarction. Results In the combined analysis, age-standardised incidence was significantly higher for men in very remote areas (rate ratio 1.31: 95% confidence interval ( CI), 1.19-1.45) and in women in both regional (rate ratio 1.12: 95% CI, 1.01-1.20) and very remote (rate ratio 2.05: 95% CI, 1.75-2.41) areas. Aboriginal rates were substantially higher than non- Aboriginal rates in all substrata. Compared with metropolitan people, regional Aboriginal men and very remote non- Aboriginal men aged 25-54 years had significantly higher incidence rates. For the remaining rural strata, there was either no geographical disadvantage or inconclusive findings. Conclusions Non-metropolitan disadvantage in myocardial infarction rates is confirmed in regional areas and women in very remote areas. This disadvantage is partly explained by the high rates in Aboriginal people. Non-metropolitan dwellers are not uniformly disadvantaged, reflecting the interplay of the many factors contributing to the complex relationship between myocardial infarction incidence and sex, age, Aboriginality and residence. Aboriginal Western Australians in all regions and young non- Aboriginal men living in very remote areas need to be targeted to reduce disparities in myocardial infarction. [ABSTRACT FROM AUTHOR]

Objective This study examines the cost effectiveness of a model of remote area oral health service. Design Retrospective financial analysis. Setting Rural and remote primary health services. Participants Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Main Outcome Measured Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. Results and Conclusion The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. [ABSTRACT FROM AUTHOR]

Objective: To determine whether food scarcity or economic constraint is more strongly associated with purchasing patterns in a rural Aboriginal community. Design: Store receipts were collected to determine money spent in the community shop across a four-month period from January to April 2006. Variability in expenditures is then studied using measures of food scarcity (days since shop loading) and economic constraint (days since payday). Setting: Parnngurr Outstation in the Western Desert of Australia. Main outcome measures: Daily gross and per-household gross expenditures at the community shop. Results: There is a significant association between food scarcity and money spent in the shop (−42.89, confidence interval −62.62 to −23.18, P < 0.001). There is no association between economic constraint and money spent in the shop. Conclusion: In rural and remote communities, reliable access to food is critical to food security. Circumstantial constraints such as seasonal flooding and political insecurity can augment food access problems and put Aboriginal people at risk of malnutrition and other dietary harms. [ABSTRACT FROM AUTHOR]

Problem: Cancer-related mortality is higher in rural areas than in urban centres. One of the contributing factors is limited access to treatment options in rural areas. Design: An evaluation of the effectiveness of the Western Australian Cancer Network (CanNET WA) pilot project was undertaken using qualitative methods and document analysis. Setting: CanNET WA was established in the Great Southern region of Western Australia. Key measures for improvement: Three measures were assessed: impact of the CanNET WA on consumers, care providers and changes to systems and processes. Strategies for change: CanNET WA comprised a number of initiatives that together led to an improvement in cancer care. These included a multidisciplinary cancer team, improved access to visiting medical specialists, formal links with tertiary cancer centres, increased primary health involvement in cancer care and increased education regarding cancer care for local health care providers. Effects of change: Changes in the three key outcome measures were reported. Consumers had greater choice of treatment options and had more involvement in decision making. Health professionals reported improvements in care coordination and in peer support related to the new multidisciplinary cancer care team, and improved links with tertiary cancer centres in Perth. Systemic changes included mapping of referral pathways and tumour-specific care pathways. Lessons learnt: CanNET WA has demonstrated the need for coordinated cancer care for rural people that offers care locally whenever possible. The success of the project paved the way for the rollout of the CanNET WA concept into other regional areas of Western Australia. [ABSTRACT FROM AUTHOR]

Information about several papers discussed the annual General Practice and Primary Heath Care Research conference held in Perth, Western Australia in July 2006 is presented. The conference brought together primary health care researchers in Australia. The conference featured several medical professional including Martin Roland, director of National Primary Care Research and Development Center.

Objective: This study investigates if the pattern of diagnostic testing for suspected lung cancer, stage at diagnosis, patterns of specialist referral and treatment options offered to people in rural Western Australia are similar to those in the metropolitan area. It then explores the barriers to quality care in rural areas as perceived by GPs and patients. Methods: There was a review of GP records to obtain clinical and referral information and an in-depth interview with patients and GPs concerning their perspectives of the quality of care. Results/Discussion: We selected age and sex-matched samples of 22 rural and 21 metropolitan patients. Rural patients had more symptoms and took longer to consult their GPs, leading to later diagnosis and fewer treatment options. They experienced longer waits for specialist consultation and underwent less diagnostic testing. The GPs always referred lung cancer patients to a specialist, usually a respiratory physician. Teaching hospitals were preferred because of their comprehensive facilities and multidisciplinary teams. Rural GPs reported distance, time and availability of appointments as barriers; they also raised concerns about late confirmation of diagnosis. Rural and metropolitan patients were equally satisfied with their quality of care, but rural patients desired more information and better communication between hospital and GPs. Facilities for rural patients at some metropolitan hospitals were criticised. In conclusion, rural patients received a different care pattern from metropolitan patients and they and their GPs raised concerns about the equity and quality of lung cancer care. [ABSTRACT FROM AUTHOR]

Objective: To explore the social, health and economic impact of a farmers’ market on a small rural community in the north of Western Australia. Design: Qualitative and quantitative research using a random structured intercept survey, and focus group interviews around four domains of social capital: economic impact, governance and capacity building, healthy public places and social and civic participation. Setting: The Gascoyne Growers Markets in Carnarvon. Subjects: One hundred consumers and 28 market stallholders. Results: Consumers demonstrated community pride and an increase in fruit and vegetable consumption since they commenced shopping at the markets. The stallholders appear to have gained economically, professionally and socially from the market experience. Conclusions: The Gascoyne Growers Markets demonstrate a sustainable health promotion activity developed in partnership with the community. It has contributed to the local economy, providing local quality fruit and vegetables directly to the community while also increasing social capital and creating a healthy public space. [ABSTRACT FROM AUTHOR]

Objective: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. Design: A postal survey was undertaken among all registered oral health professionals in Western Australia. Setting: Rural and remote Western Australia. Participants: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. Results: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. Conclusions: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia. [ABSTRACT FROM AUTHOR]

It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months. A cross-sectional telephone survey was conducted. Urban, rural and remote locations in Western Australia. A total of 2100 participants, 60 years of age and older. The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely. The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas. Although the existing literature identifies needs of the aged and those in rural areas, there is a lack of data at a level in a state with sufficient sample size to fully investigate use of dental services by the aged. The present study contributes to our knowledge of the ways that rurality affects the demand for and utilisation of dental services by the aged in this sparsely populated state. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of a cardiac rehabilitation program (HeartSmart) in a rural area on the quality of life, dietary behaviour, weight loss and physical activity participation of patients with cardiovascular disease (CVD) or at high risk of CVD. The evaluation of the program consisted of a single group pre and post-test design with follow-up at 3, 6 and 12 months after program completion, complemented with a cross-sectional survey of non-participants as a pseudo comparison group. The HeartSmart program is a hospital-based cardiac rehabilitation program in Bunbury, a regional centre of Western Australia. A total of 203 participants and 159 non-participants. The program consisted of 7 weeks of education and exercise sessions. The program had a high rate of completion (92%). Evaluation results suggested that HeartSmart participants demonstrated significant improvements in quality of life, compliance with medication, dietary behaviour, weight loss and physical activity participation. The largest changes were mostly observed between pre and post-program stages, with sustained behaviour change at 6 months after the completion of the program. Further evidence of the HeartSmart benefits was provided through significantly better health-related behaviour, confidence to diet and exercise, dietary fat intake, cardiac knowledge and quality of life scores among HeartSmart participants compared with non-participants. While this program has achieved its objectives, there are a few issues that need to be considered by similar programs: the post-program stage of patient follow-up by general practitioners; the geographical disadvantage of those living outside regional centres to access the service; enhancing the primary prevention aspect of the program; adapting the program to the needs of Aboriginal clients; facilitating evaluations by resourcing and training program staff in computer skills. The viability of establishing cardiac rehabilitation programs in rural Australia has been questioned and few if any have been formally evaluated, particularly using a follow-up design and a control group. This study ascertains the benefits of secondary prevention programs in rural areas not only on the quality of life but also shows positive outcomes in lifestyle modification for program participants compared to non-participants. The lessons learnt can improve the effectiveness of similar prevention programs. [ABSTRACT FROM AUTHOR]

A regional success story in capacity building in terms of workforce development in rural Western Australia is described. A rural and remote distance education program in mental health was delivered in 1999 across 10 rural sites to 31 health professionals (26 general nurses, four allied health and one Aboriginal health worker) who are in contact with mentally ill patients at the primary level in country areas. Evaluation on completion of the program and at 4 months postprogram was extremely positive, with participants reporting that they have gained knowledge of mental health management regimens, developed mental health assessment skills and enhanced their clinical practice. Both participants and their line managers identified that the program had greatest impact on improving relationships with the mental health team. The program has also been an example of capacity building in terms of innovative resourcing to address a statewide need in mental health education for those at the forefront of rural practice. [ABSTRACT FROM AUTHOR]

ABSTRACT In 1998, the Department of General Practice (Faculty of Medicine and Dentistry, University of Western Australia) ran a pilot project to use computers in a sixth year rural general practice term. Students were provided with a laptop computer to take into rural and remote areas throughout Western Australia during their 4-week clinical attachment. An email mailing list was set up for course participants to share experiences and complete set learning activities specifically related to rural general practice. An evaluation of this pilot project found that students felt less isolated on rural attachments, course outcomes were improved and rural preceptors were more involved in the programme. The development of a teaching and learning programme that involves the use of computers in rural general practice for undergraduate students has the potential to improve the quality of their medical education. [ABSTRACT FROM AUTHOR]

Assesses the utilization of ear, nose and throat services by patients in rural and remote areas in Western Australia. Role played by telemedicine in overcoming poor access to specialist services; Investigation of the reason for the consultation or procedure; Costs involved in attending Perth hospital clinics.

The usual and common-sense definition of disability is based on a medical model that sees disability as a limitation or lack of competence on the part of the individual. This definition fails to acknowledge that in some cultures disability as a concept does not exist. This paper, based on research undertaken in 1994/1995, examines how the social construction of disability among the Anangu of the cross border region of Western Australia, South Australia and the Northern Territory, takes into consideration the important factors of history, culture and language. The theoretical underpinning of the research was symbolic interactionism, which led to collaborative ethnography becoming the methodology employed to collect and analyse the data. The findings of the research indicate that the social construction of disability among the Anangu occurs in three historical phases: the impairment, oppression and empowerment phases. The paper's purpose is to offer service providers to Aboriginal people with disabilities, information that will help them understand some of the attitudes, customs, mores and beliefs of their clientele.

Rural women face a variety of health-related problems, some of which they share with their city sisters. However, the multiple responsibilities of women on the land, and their geographical isolation and lack of support, can lead to physical decline and increased mental strain. It is these factors which are often overlooked in the planning and allocation of funding and services to rural areas. This paper examines the application of community competence and empowerment measures in developing and implementing health services for women in rural Australian communities. A study conducted in the south-west region of Western Australia illustrates the ability of women within rural communities to identify and respond constructively to health issues of concern.