Remote Western Australia Research Articles

The Relationship Between Remoteness and Trauma Deaths in Western Australia

Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA). We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census. There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years +/- 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93-4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA. We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.

Population dynamics of methicillin-susceptible and -resistant Staphylococcus aureus in remote communities

ObjectivesCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was first reported in remote regions of Western Australia (WA) in 1992 and is now the predominant MRSA isolated in the State. To gain insights into the emergence of CA-MRSA, 2146 people living in 11 remote WA communities were screened for colonization with S. aureus.MethodsAntibiogram analysis, contour-clamped homogeneous electric field electrophoresis, multilocus sequence typing, Panton–Valentine leucocidin determinant detection and accessory genetic regulator typing were performed to characterize the isolates. MRSA was further characterized by staphylococcal cassette chromosome mec typing.ResultsThe S. aureus population consisted of 13 clonal complexes and two Singleton lineages together with 56 sporadic isolates. Five lineages contained MRSA; however, these were not the predominant methicillin-susceptible S. aureus (MSSA) lineages. There was greater diversity amongst the MSSA while the MRSA appeared to have emerged clonally following acquisition of the staphylococcal cassette chromosome mec. Three MRSA lineages were considered to have been endemic in the communities and have subsequently become predominant lineages of CA-MRSA in the wider WA community. People colonized with MSSA tended to harbour clones of a different genetic lineage at each anatomical site while people colonized with MRSA tended to harbour clones of the same lineage at each site. Overall, the isolates were resistant to few antimicrobials.ConclusionsAlthough the evidence suggests that in WA CA-MRSA strains arose in remote communities and have now disseminated into the wider community, there is no evidence that they arose from the predominant MSSA clones in these communities.

Youth empowerment and information and communication technologies: a case study of a remote Australian Aboriginal community

In spite of a ‘digital divide’, Aboriginal groups in Australia, as internationally, are increasingly using information and communication technologies (ICTs) to maintain their cultures, communicate, archive knowledge, empower their communities, develop skills and generate income. Each community uses the technologies differently in accordance with their particular needs and the opportunities available. The use of ICTs in Aboriginal youth empowerment is illustrated through a case study of an initiative undertaken by the Walkatjurra Cultural Centre in Leonora, remote Western Australia. A participatory process was used to engage the Centre’s young people and they were given individual assistance to develop their ICT related capacity. The community conceives this youth empowerment to be part of a broader youth participation process that will contribute to the Centre’s overall objectives.

Education in cognitive-behavioural therapy for mental health professionals

Since 1998, videoconferencing has been used to provide training in cognitive-behavioural therapy (CBT) for mental health practitioners in rural and remote Western Australia. A preliminary study of the outcomes found significant improvements in knowledge of the therapy among participants. In this study, data from 48 participants were collected over a seven-year period. Each participant completed the Cognitive-Behavioural Therapy Knowledge Questionnaire before and after training, as well as a questionnaire about satisfaction. The sample included different training groups, made up of different mental health practitioners with varying levels of motivation and experience in mental health. There was a significant improvement in the participants' knowledge of CBT from pre- to post-training (P < 0.001) as well as high levels of satisfaction with the content and delivery of the programme. The majority of participants had used CBT principles learned in the course during their clinical practice. A range of patients had been treated, from those with anxiety disorders to those with bipolar disorder, i.e. the training was applicable to professionals working at the more severe end of the disease spectrum.

‘It's really, really good, but it could be a lot better’: Qualitative evaluation of a Rural Clinical School, four years on

Introduction: In their first clinical year 25% of Western Australia's medical students undertake a clinical longitudinal integrated clerkship in rural and remote Western Australia. Annual evaluations are undertaken.Method: All students, academic and administrative staff employed by the university were interviewed. Qualitative analysis of interview data was taken, fed back to the coordinators and modifications for the next annual cycle were then discussed and decided upon.Results: The predominant themes were elation at the excellence of much of their rural experience and frustration at some individual sites because of issues which were not being resolved. Students were overwhelmingly positive in their interpretation of problems seeing them as systems issue to be improved. Staff at some sites, however, had a strong tendency to blame the student and not respond to the actual problem. All students passed their end of year examinations.Discussion: Most academic evaluation of courses has focussed on comparative academic results with less, if any, attention paid to the qualitative experience of students. Not all clinical clerkship experiences are positive and it is useful to identify what works and what does not work in any medical school. Staff defensiveness is a well-recognised response to challenges and an evaluation system which encourages staff development is an essential component to any School's ongoing improvement.

Supporting an emerging workforce: Characteristics of rural and remote therapy assistants in Western Australia

Multidisciplinary therapy assistants (TAs) are an emerging but poorly understood rural and remote allied health workforce. As an aid to planning and support of TA programs in rural and remote Western Australia (WA), the number, locality and a range of practice variables of rural and remote TAs in WA were determined. Survey questionnaire. Rural and remote regions of WA. Allied health professionals, TAs, TA coordinators and managers of allied health in country regions of WA. Information was gathered on TA location, qualifications, employing organisation, allied health disciplines TAs work with, supervision practices, role and work scenarios. Ninety-eight TAs were identified in rural and remote WA with a further 23 vacant TA positions. Most TAs work across multiple allied health disciplines, half are located at a distance to their supervisors, and very few have a recognised qualification for their TA work. A substantial rural and remote TA workforce was found. A range of TA characteristics were identified that have considerable relevance to the future planning of TA initiatives in rural and remote WA.

Providing library resources to 37 medical students at eight remote sites across 2600 km

The University of Western Australia’s Rural Clinical School was set up to train a quarter of the medical students for a full year in rural and remote Western Australia. These students need full access to the resources of the medical library so that they are not disadvantaged in comparison to metropolitan students. Setting up library access for small numbers of students across eight sites separated by thousands of kilometres comes with its own set of difficulties. Broadband internet allows access to journals and online books and selected books are provided for each site. Government, Faculty and School policy has facilitated this by ensuring financial resources are available to follow the students.

Small‐area estimates of general practice workforce shortage in rural and remote Western Australia

To trial a measure of rural and remote GP access for small areas. A cross-sectional study using geographical information systems software to calculate GP to population rates with a floating catchment of 100 km radius around census collection districts (CCDs). Non-metropolitan Western Australia. The locations and full-time equivalents of GPs and other primary-care doctors were identified through a GP workforce survey. GP to population ratios for each CCD were classified as being above or below a benchmark of adequate GP access. CCDs with no GP sessions reported within 100 km were identified separately. These categories were investigated by divisions of general practice and by indigenous status, age and employment characteristics of the population. Small-area estimates detected greater variation in access than depicted by conventional methods. Sixty-four per cent of the non-metropolitan population live in CCDs with adequate GP access. Forty-five per cent of indigenous people and 52% of people working in rural industries live in CCDs with access below the benchmark. The floating catchment method is a powerful tool to identify small areas of inadequate service. It can be applied to measure access to other professionals, medical equipment or facilities.

Oral health workforce in rural and remote Western Australia: Practice perceptions

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. A postal survey was undertaken among all registered oral health professionals in Western Australia. Rural and remote Western Australia. Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. 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. 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.

Scanning the Satellite Signal in Remote Western Australia

Scanning the Satellite Signal in Remote Western Australia

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A baseline study of the demographics of the oral health workforce in rural and remote Western Australia

A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce. A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia. Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums. The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.

Towards a health career for rural and remote students: cultural and structural barriers influencing choices

To promote tertiary health careers to rural and remote young people. Qualitative research using large and small group discussions and semistructured interviews. Fifteen secondary schools in rural and remote Western Australia including five senior secondary schools and 10 district high schools. 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). 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. 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.

Internet use in rural and remote Western Australia

Australian telecommunications universal service policy has recently been extended to include the provision of basic data services within a contestable universal service framework. In view of this fundamental policy change, information about the demand for telecommunication services is critical if competition is to deliver intended outcomes. This analysis examines the demand for Internet in rural and remote communities in Western Australia. Toward this end econometric Internet subscription and use models are estimated on survey data collected for this purpose. Estimation results indicate price reduction will have a positive influence among existing Internet subscribers. A model of Internet subscription itself, however, suggests that demand for access is derivative of education and work requirements.

Edentulism and associated factors in people 60 years and over from urban, rural and remote Western Australia.

Edentulism is declining in the aged, in turn increasing demand on dental services. The aim of this study was to describe the pattern of edentulism and associated factors for people 60 years or over in urban, rural and remote Western Australia. A cross-sectional telephone interview survey was conducted of 2100 people aged 60 years or over (urban n=800, rural n=800, remote n=500), identified through the State Electoral Roll, who were living in non-institutionalized accommodation in Western Australia and who were able to speak English sufficiently well to be interviewed in English. The main outcome measure was edentulism. The prevalence of edentulism was 25 per cent for people in urban areas, 34 per cent for people in rural areas and 32 per cent for people in remote areas. Respondents aged 60-69 years had less than half the edentulism than respondents aged 80 years or over. Multivariable logistic regression models showed geographic location, age, gender, education and occupation were significantly associated with edentulism. The percentage of edentulism was highest in rural areas with some clear demographic trends. These future aged cohorts are likely to follow the same patterns of social and geographic disadvantage as found for the current edentate cohort. The results were consistent with other studies while providing state level multivariate results to assist service planning.

Tele-otology: planning, design, development and implementation.

The view of the tympanic membrane of the ear provides the specialist with important information for the assessment of ear disease and for treatment planning. In rural and remote areas, the incidence of ear disease is high but access to ear specialists is limited. As part of a project to deliver tele-otoscopy services to remote Western Australia, we have investigated various aspects of a tele-otoscopy system. We found that the MedRX video-otoscope is relatively safe to use and produces images of very good quality. A confident diagnosis could be made from still images compressed to 20 kByte. Video sequences could be compressed to a ratio of 1:300. Furthermore, a software package has been developed, and we are developing a training course for health-care workers in remote areas.

Open access endoscopy in rural and remote Western Australia: does it work?

Access to diagnostic endoscopy is limited in rural and remote Western Australia. Published reports suggest open access referrals may result in over-servicing, this is reduced by adherence to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. The aim was to assess whether an outreach surgical service offering open access endoscopy to rural areas was being over utilized. Prospective data collection from all patients undergoing upper and lower endoscopy procedures between January 1996 and June 2000 were included in the present study. Indications for referral between the general practitioners and the visiting surgeons were reviewed in patient records and assessed for compliance with the ASGE guidelines. The groups were analysed for appropriateness of referrals and frequency of positive pathology investigations. Records for all patients undergoing colonoscopy were reviewed to determine the reason and number of cancelled procedures. A total of 772 endoscopies were performed and 75% were booked as open access services. The referral rate for procedures was greater for general practitioners (583) compared to the visiting surgeons (189), the overall compliance rate for approved indications using the ASGE guidelines for both groups was 92%. There was no significant difference in pathology found between groups. The present study shows that an outreach rural surgical service programme in Western Australia offering open access endoscopy conforms to international guidelines and does not induce unnecessary procedures. Rural patients benefit from a personal cost savings and convenience. There is an associated reduction in government-assisted travel costs to larger centres as well as decreased waiting lists.

Experiencing "change" from within: situating the transition to primary health care in a remote Australian context.

The transition to primary health care (PHC) is often described in an idealized manner, which either ignores or obscures the experiences associated with its implementation at the local level. By adopting an anthropological perspective, this article highlights some of these experiences and the context within which they occur for one health care organisation in remote Western Australia. It specifically focuses on problems associated with economic rationalism, managerialism, and the inherently fragmented character of health service organisations. Such issues must be allowed to inform idealized PHC models in order to make them more applicable and attuned to local needs and realities.

Training in cognitive-behavioural therapy for mental health professionals: a pilot study of videoconferencing.

A foundation course in cognitive-behavioural therapy (CBT) was developed specifically for delivery via videoconferencing at 256 kbit/s. A two-part, 20-week programme was evaluated at seven sites, with a total of 12 participants, in rural and remote Western Australia. Eleven of the participants completed a pre- and post-training knowledge test. There was a significant improvement in their knowledge of CBT after training. Ten participants also completed a satisfaction questionnaire. The majority were satisfied with the training they received and stated that the training had given them greater confidence in their ability to use CBT with their patients. This study lends support to the use of videoconferencing in the training of rural and remote mental health practitioners.

(Not) Using the Remote Commercial Television Service to Dispel Distance in Rural and Remote Western Australia

This paper addresses issues of ‘distance’ between remote and metropolitan audiences, and the use of communications technologies as tools to dispel such distance. Using the satellite-delivered RCTS broadcasting as a case study — given that this was part of the thrust to ‘dispel’ this distance — the research reported here interrogates notions of difference and inclusion as perceived, experienced and expressed by people resident in remote and regional Western Australia. The argument advanced is that new communications technologies do not dispel distance; rather, they act as catalysts through which distance is re-experienced and redefined. These distinctions are of continuing and growing importance in a climate within which Networking the Nation and digital TV again promise more equalisation of differences and services, and more dispelling of distance.