Regional Western Australia Research Articles

Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia.

To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. Nine general practitioner obstetrician practices located in regional Western Australia. 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.

Geoparks – learnings from Australia

PurposeThis study aims to provide an overview of the current socio-political geopark situation in Australia and set this into a global context. In addition, the authors consider this information to be useful for all stakeholders involved in geopark research and development. An analysis of constraints is set alongside stakeholder views collected from remote rural Western Australia. The authors also place Australia in a global context in regard to the future of geoparks.Design/methodology/approachVital contextual information regarding the tourism significance of geoparks is sourced from key literature. The authors analyse and report on the situation surrounding the current lack of enthusiasm for the geopark concept by the federal government and states in Australia. The authors also report positive rural community stakeholder views on geopark development from regional Western Australia.FindingsWhile Australian federal, as well as state governments have yet to accept geoparks, stakeholder research in Western Australia supports the idea of geopark development. Learnings articulated in this viewpoint are relevant to any country pursuing and initiating the geopark concept. The authors posit that global geopark development can become a vital strategy in post-COVID-19 tourism recovery planning.Originality/valueAustralia currently does not have a United Nations Educational, Scientific and Cultural Organisation (UNESCO)-recognised geopark. Accordingly, the authors present a case for geopark development, while at the same time exploring the socio-political reasons behind the lack of geopark implementation in Australia. The authors consider the future of geoparks in the global context and reiterate the point that geoparks are important for COVID-19 recovery of tourism and in regard to UNESCO's Sustainable Development Goals for 2030.

Development, deployment and in-field demonstration of mobile coronavirus SARS-CoV-2 Nucleic acid amplification test.

IntroductionThe evolving SARS-CoV-2 coronavirus pandemic presents a series of challenges to clinical diagnostic services. Many proprietary PCR platforms deployed outside centralised laboratories have limited capacity to upscale when public health demands increase. We set out to develop and validate an open-platform mobile laboratory for remote area COVID-19 diagnosis, with a subsequent field trial.Gap StatementIn regional Western Australia, molecular diagnostic support is limited to near point-of-care devices. We therefore aimed to demonstrate open-platform capability in a rapidly deployable format within the context of the COVID-19 pandemic.MethodologyWe compared, selected and validated components of a SARS-CoV-2 RT-PCR assay in order to establish a portable molecular diagnostics laboratory. The optimal combination of PCR assay equipment, reagents and consumables required for operation to national standards in regional laboratories was identified. This comprised RNA extraction and purification (QuickGene-480, Kurabo, Japan), a duplex RT-PCR assay (Logix Smart COVID-19, Co-Diagnostics, USA), a Myra liquid handling robot (Biomolecular Systems, Australia) and a magnetic induction thermal cycler (MIC, Biomolecular Systems).ResultsThe 95 and 99% limits of detection were 1.01 copies μl−1 (5.05 copies per reaction) and 2.80 copies μl−1 (14.00 copies per reaction) respectively. The Co-Diagnostics assay amplified both SARS-CoV-1 and −2 RNA but showed no other cross reactivity. Qualitative results aligned with the reference laboratory SARS-CoV-2 assay (sensitivity 100% [95 % CI 96.48–100%], specificity 100% [95% CI 96.52–100%]). In field trials, the laboratory was operational within an hour of arrival on-site, can process up to 36 samples simultaneously, produces results in two and a half hours from specimen reception, and performed well during six consecutive runs during a 1 week deployment.ConclusionOur mobile laboratory enables an adaptive response to increased test demand, and unlike many proprietary point-of-care PCR systems, rapid substitution with an alternative assay if gene targets change or reagent supply chains fail. We envisage operation of this RT-PCR assay as a standby capability to meet varying regional test demands under public health emergency operations guidance.

Effectiveness and cost-effectiveness of TeleStroke consultations to support the care of patients who had a stroke presenting to regional emergency departments in Western Australia: an economic evaluation case study protocol

IntroductionThe Western Australia (WA) Acute TeleStroke Programme commenced incrementally across regional WA during 2016–2017. Since the introduction of the TeleStroke Programme, there has been monitoring of service outputs, including regional...

Differences in Clinical Presentation and Outcomes between Metropolitan and Rural Myeloma Patients

Introduction: Australia's largest state, Western Australia (WA), comprises a land area of more than 2.5 million square kilometres, an area than larger than that of Texas and Alaska in the United States combined, with a population of more than 2.6 million. Whilst a large proportion of Western Australians live in the capital city Perth, approximately 20% are dispersed across the state in regional and remote areas. The diagnosis and treatment of myeloma require specialist Haematologist management and frequent follow-up. Access to Haematology specialist services and treatment in WA is centred in metropolitan Perth, with outreach services visiting regional and remote areas limited in location and frequency. Some patients are required to travel long distances or relocate to access treatment. The aim of our study was to assess difference in clinical presentation, treatment and outcomes of myeloma patients living in regional or remote Western Australia compared to metropolitan Perth. Methods: A retrospective chart review of new cases of symptomatic multiple myeloma diagnosed between January 2008 and December 2019 and referred to Royal Perth Hospital and Fiona Stanley Hospital, two tertiary metropolitan hospitals was conducted. Data was obtained regarding patient demographics, disease characteristics, treatment, response and survival outcomes, through review of patient paper and electronic medical records. Patients were grouped into those living inside or outside the Perth metropolitan area (metro or non-metro) according to area codes obtained from the WA government data suite. Results: Two hundred and seventy-five cases were identified, 218 (79%) metro and 57 (21%) non-metro. Baseline characteristics for the two groups are listed in Table 1. The median age at diagnosis was 68.4 years (range 30-91.5 years) and 47% were female, with no significant difference between the groups. There were a higher number of patients with lytic bone disease at diagnosis in the non-metro cohort (75.4% non-metro vs 60.2% metro, p=0.03) as well as a higher proportion of patients with international staging system (ISS) stage II or III disease (77.8% non-metro vs 55.8% metro, p=0.005). Sixty three percent of patients overall received first line bortezomib based therapy and 27% first line imid based therapy, with no significant difference by location. Overall 41% of patients underwent autologous stem cell transplantation, 70% of those ≤70 years of age, with no significant difference between the groups (33.3% non-metro vs 42.5% metro, p=0.21). The median overall survival (OS) was 47 months for the entire cohort. Survival was lower in the non-metro cohort, although this did not reach statistical significance (median OS 52 months for metro vs 40 months for non-metro, p=0.05) Figure 1. Progression free survival (PFS) was similar between the two groups (median PFS 23 months metro vs 12 months non-metro, p=0.12) Figure 2. Early mortality at 6 and 12 months was higher in the non-metro cohort (Six-month mortality was 21.1% non-metro vs 8.3% metro, p=0.01. Twelve-month mortality was 28.1% non-metro vs 13.4% metro, p=0.01) Figure 3. There was a trend in cause of early mortality due to infection being higher in the metro cohort, and cause of early mortality due to renal failure being higher in the non-metro cohort, Table 1. Conclusions: In our cohort, patients living in non-metropolitan locations were more likely to present with higher ISS stage and lytic lesions at diagnosis. Rates of early mortality were significantly higher in the non-metropolitan cohort. There was a trend towards shorter overall survival although this did not meet statistical significance. These differences may represent delays in clinical presentation and diagnostic workup and highlight the need for optimisation of follow up of patients in non-metropolitan areas particularly during the early time period post diagnosis. Periods of resource constraint and travel restrictions as is faced currently may accentuate these disparities. In addition, the nature of myeloma therapy is evolving with addition of treatments requiring expertise to deliver, such as monoclonal antibodies and chimeric antigen receptor T cells. As these therapies become commercial further studies are needed to assess adequacy of access for patients from non-metropolitan centres. Disclosures Leahy: Pfizer: Membership on an entity's Board of Directors or advisory committees. Sidiqi:Celgene: Honoraria, Other: Travel grant; Amgen: Honoraria; Janssen: Honoraria.

Patients with multiple myeloma over a large catchment of 2.5 million square kilometres: a Western Australia retrospective survival review.

Multiple myeloma is an incurable malignancy of plasma cells. We retrospectively reviewed the survival outcomes of patients with multiple myeloma in Western Australia (WA) public hospitals over a 10-year period. We did not detect a difference in survival between patients residing the metropolitan Perth and regional areas, despite a paucity of haematology services in regional WA due to low population density in a large geographic area. Patients with R-ISS Stage 3 had the poorest survival in our cohort with median survival of 24 months.

On‐call telehealth for visiting optometry in regional Western Australia improves patient access to eye care

Telehealth has come a long way since our forebears used two‐way radios powered by a bicycle pedal to communicate with the Royal Flying Doctor Service. Yet we still have recurring barriers to patien...

Exploring Readiness for Change: Knowledge and Attitudes towards Family Violence among Community Members and Service Providers Engaged in Primary Prevention in Regional Australia.

Community efforts at the primary prevention of family violence (FV) involve changing values, structures and norms that support gender inequality. This study examines the attitudes of a group of highly engaged community leaders and service providers involved in FV primary prevention in Geraldton, a small city in regional Western Australia. The outcomes of focus group discussions were mapped against a readiness for change model. Despite considerable involvement in discussions of FV prevention over time, the readiness level of these engaged community members for taking leadership roles in the prevention strategy were between pre-planning and preparation stages, although some individuals’ understanding of the drivers of FV and readiness for implementing change was higher. Key areas for further education are the role of gender inequality as the primary driver of FV, particularly rigid gender roles and men’s control of decision making, and the role of alcohol and drugs as reinforcers but not primary drivers of FV.

Increasing patient activation through diabetes self-management education: Outcomes of DESMOND in regional Western Australia

ObjectiveTo evaluate the effects of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) program on patient activation in adults living with type 2 diabetes (T2D). Methods233 individuals attended a DESMOND program in 26 locations across regional Western Australia. Individuals completed the Patient Activation Measure (PAM) prior to and immediately after DESMOND participation. ResultsPatient Activation significantly increased by 9.7 points from pre to post DESMOND intervention (p < 0.001, z = −7.94). Of all participants who exhibited an increase in patient activation, 87% (n = 142) experienced a clinically significant (>5 point) increase. Post-DESMOND participation, an 86% reduction (from 6% −0.9%) in the proportion of participants scoring in the lowest PAM level (Level 1) was observed (p < 0.01). ConclusionDESMOND, a structured diabetes self-management education (DSME) program aimed at strengthening the role of people living with type 2 diabetes in self-managing their healthcare, significantly increased patient activation in a real-world setting. Practice implicationsIn line with international diabetes guidelines it is recommended that people living with T2D, particularly those with lower levels of activation, attend an evidence based DSME such as DESMOND to increase their capacity to effectively self-manage their condition.

Do air passengers behave differently to other regional travellers?: A travel mode choice model investigation

This research aims to investigate travel mode choices and behaviours of air passengers and community respondents in regional Western Australia. Multinomial logit and Nested logit models were used for the mode choice analysis based on Stated-Preference survey data. The results indicate that travel cost, journey time, service frequency and seat comfort played important roles in affecting travellers' mode choices. For business trips, air passengers are willing to pay more to reduce journey time and increase seat comfort and service frequency compared to community respondents. While for non-business trips, these differences were much smaller. The findings will provide some insights in understanding people's mode choice behaviours and therefore guide policy makers and airlines in developing policies and practice.

Study protocol of a multicentre cohort pilot study implementing an expanded preconception carrier-screening programme in metropolitan and regional Western Australia

IntroductionPreconception carrier screening (PCS) identifies couples at risk of having children with recessive genetic conditions. New technologies have enabled affordable sequencing for multiple disorders simultaneously, including identifying carrier status for...

Promoting physical activity in regional and remote cancer survivors (PPARCS) using wearables and health coaching: randomised controlled trial protocol

IntroductionPhysically active cancer survivors have substantially less cancer recurrence and improved survival compared with those who are inactive. However, the majority of survivors (70%–90%) are not meeting the physical activity...

Can community pharmacists overcome barriers to partner treatment for chlamydia in regional and remote Western Australia?

Can community pharmacists overcome barriers to partner treatment for chlamydia in regional and remote Western Australia?

Participation in planning and governance: closing the gap between satisfaction and expectation

BackgroundMaking and implementing decisions to improve long term sustainability, particularly in democratic countries, is a significant challenge. This is exacerbated when citizens’ expectations of their relationship with government is significantly at odds with what they experience, since this is likely to further reduce their already low trust in government and its decision-making. Research in the USA has demonstrated a clear gap between citizens’ expectations of their participation in government and their satisfaction with that participation. This finding inspired a research project in regional Western Australia to determine if a similar gap existed between citizens’ expectations and experience of their relationship with government. Additionally, a public participation intervention was devised to determine whether the gap between citizens’ expectations of, and experience with, governance could be reduced and whether the decisions made from such an intervention would be more implementable. To better reflect the partnership relationship citizens expected from government, ‘deliberative democracy’ initiatives were implemented to resolve the local government’s budgeting challenges.ResultsThe results demonstrated that a similar gap to that in the USA was present in Western Australia community and the sample populations used in the partnership interventions. Further, the citizens’ experience of deliberative democracy substantially reduced the gap between their expectations and experience of government participation. These case studies also revealed the existence and details of the nature of this partnership relationship between citizens and government as well as between the citizens themselves. Moreover, the tough budgetary decisions they made were implemented without public outcry.ConclusionsThese case studies show a promising route to close the gap between citizen expectations and satisfaction with participation in government, as well as having the potential to increase the trust in government so necessary for advances in sustainability. Future research directions have been outlined to improve understanding of how these results could impact on sustainability efforts.

The role of trust and transparency in accountable outsourced prisoner transport

AbstractExplores the privatisation of prisoner transport in regional Western Australia. Focuses on the role collaboration plays in the development of transparency, trust and accountability in service delivery. Latent racism, the challenging physical environment, risks associated with unsuitable vehicles, uncaring contractors and ineffective departmental oversight contributed to transport failures. The complexity and scope of responsibilities, underfunding, poor departmental management, unresponsive contractors and the physical environment undermined the development of trust, transparency and accountability essential for building effective working relationships between government and contractors.

The Rise of Shared Work Spaces: A Disruption to Urban Planning Policy?

ABSTRACTNew models of shared work spaces have the potential to disrupt planning for traditional employment spaces. Drawing on a pilot study of Greater Perth and regional Western Australia, relevant planning policies and interviews with a sample of managers and users of shared work spaces are reported. Shared work spaces are emerging in regulatory voids left by outdated policy frameworks, instead relying on the forward thinking of local innovators seeking to revitalise urban centres. The success of innovative repurposing of space brings into question the efficacy and purpose of more prescriptive land use regulations and policies.

Investigating the impact of catchment areas of airports on estimating air travel demand: A case study of regional Western Australia

The aviation industry in Western Australia (WA) plays a vital role in the economic and social development of the state. However, accurate forecasts for passenger movements are not available to policy makers due to lack of relevant air travel demand information. The objective of this study is to estimate the domestic air passenger seat numbers between airport-pairs based on online flight information in regional WA based on a gravity model using Poisson pseudo-maximum likelihood estimation (PPML). Particularly, we aim to investigate the impact of distance, airfare, catchment areas, population, tourism and mining sector on forecasting air passenger seat numbers in order to inform and guide policy making.This research collected appropriate data and produced valid models that represent air passenger seat numbers offered on regular public transport (RPT) air services in regional WA. The models consider both geographic and service-related variables, such as the catchment area of airports, population and number of tourists in the airport's catchment area. Two kinds of airport catchment areas are generated in this study, based on Thiessen polygon and two and half hours' driving distance. The Thiessen polygon catchment areas cover the whole WA regions, while the 2.5 h's driving catchment area covers only 32 percent of the WA region. The size of the catchment area can affect the magnitude of factors, and therefore influence the modelling results. When deciding the catchment area for the study, it is important to take the spatial distribution of factors into considerations. For both Thiessen polygon and two and half hours' driving distance catchment area, the model results illustrate that distance between airports, airfare of the flight, population of the origin airport's catchment area and the number of operating mine sites of the destination airport's catchment area are significantly correlated with domestic air travel seat capacity provided. Given the guidance from policy documents and policy makers, the results will improve the understanding of the key parameters of regional passenger aviation services and help to guide policy makers considering regional passenger aviation issues. The outcome of this study would be useful for and guide policy development.

"You either need help…you feel you don't need help…or you don't feel worthy of asking for it:" Receptivity to bereavement support.

Although the needs of the bereaved have been identified widely in the literature, how these needs translate into meaningful, appropriate, and client-centered programs needs further exploration. The application of receptivity to support is a critical factor in participation by the bereaved in palliative care bereavement programs. Receptivity is a complex multifactorial phenomenon influenced by internal and external factors that ultimately influences engagement in psychosocial support in bereavement. This study explored factors that influence receptivity to bereavement support from palliative care services in rural, regional, and remote Western Australia. The study comprised a qualitative descriptive research design using semistructured interviews with 24 bereaved individuals, nine palliative care health professionals, and four Aboriginal Health Professionals. Participants were recruited via palliative care services in country Western Australia. Interviews were transcribed verbatim and thematically analyzed. Findings revealed that a range of individual, social, and geographical factors influence receptivity to bereavement support and can impact on utilization of bereavement support services. Receptivity provides a frame of reference to enhance understanding of factors influencing engagement in psychosocial support in bereavement. Receptivity promotes a shift of service provider perspectives of effective supportive care to consumer-centric reasons for engagement.

Participation profiles and the barriers and facilitators that impact on participation of children with Autism Spectrum Disorders living in regional and remote Western Australia.

Background:Autism Spectrum Disorder (ASD) is a heterogeneous condition, influencing participation in activity and occupation. Approximately, 1% of Australian children have an ASD diagnosis, with many of these families living in remote and regional areas. Given the environments role in facilitating or hindering participation, there is a need to understand how geographical location impacts the participation profiles of children with ASD.Objective:This study aims to describe the participation profiles, and environmental barriers and facilitators to participation for children with ASD living in regional or remote Western Australia.Methods:A total of 32 families completed a questionnaire pack including a socio-demographic questionnaire and the Participation and Environment Measure – Children and Youth.Results:Children with ASD had reduced participation in community activities. Within the home, children most commonly participated in computer and video games, and in school settings, children participated rarely in non-classroom and extracurricular activities. Parents reported a desire for their children to decrease time spent engaging in video games and increase time spent in the community, socializing, engaging in extracurricular activities, and completing chores. Parents reported a number of barriers to participation across community, home, and school settings.Conclusion:Children with ASD living in regional areas had restricted participation profiles and a number of barriers to participation as reported by their parents. There is a need for additional support and services in non-metropolitan areas for families of children with ASD to increase participation. This study also highlights the need to expand the definition of participation in the International Classification of Functioning, Disability and Health to include aspects of involvement.

Breastfeeding beyond the big smoke: Who provides support for mothers in rural Western Australia?

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. 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. 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. 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.