Preparing doctors for working in remote health teams

1. Preparing doctors for working in remote health teams

5. Australian Standard Government Classification

6. Population distribution

7. Socioeconomic status

8. Food prices

9. Percentage of young people entering university

10. Social determinants • Decreasing SES with remoteness • Increasing cost of living with remoteness • Decreasing educational opportunity & outcomes with remoteness • Decreased educational opportunity & attainment for Indigenous vs non-Indigenous • Higher levels of unemployment for Indigenous people

11. Mortality

12. Outcomes: Mortality rates 1992 - 2003

13. NT life expectancy gap by GBD 1981-2000Zhao & Dempsey 2006

14. Health outcomes • Overall mortality rates increase with increasing remoteness • Significant geographical variation in rates • Mortality rates declining over time, especially in remote areas • NT Indigenous mortality improving, but not declining at a comparable rate to non-Indigenous Australians except in 0-4 year old group • This observation may result from health service development targeting this age group • The biggest ‘gap’ in 35-64 year old group • Increasing prevalence of chronic diseases • Little information regarding social & emotional health

15. Practitioner to population ratios

16. Doctors – FTE/100,000 by ASGC

17. Access to treatment for IHD

21. Remote medical practice Eight key features: • salaried employment, not private practice • isolation • telehealth • increased clinical acumen • extended practice • cross-cultural setting • multidisciplinary practice • emphasis on public health & personal security (Smith et al 2008)

22. Remote Health Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by: • Geographical, professional and, often, social isolation of practitioners; • A strong multidisciplinary approach; • Overlapping and changing roles of team members; • A relatively high degree of GP substitution; • Practitioners requiring public health, emergency and extended clinical skills.

23. Remote Health (cont.) These skills and health systems need to be suited to: • Working in a cross-cultural context; • Serving small, dispersed and often highly mobile populations; • Physical environment of climatic extremes; • Rapid technological change. (Wakerman 2004)

24. Integrated Training in Remote Medicine • ACRRM Primary Curriculum • ACRRM Advanced Remote Curriculum • Endpoints: • FACRRM • Graduate Certificate in Health (Remote Health Practice) – Flinders University • Graduate Diploma in Health (Remote Health Practice) – Flinders University

25. Integrated Training in Remote Medicine- curriculum • Grad Cert (Core Year 1): • Context of Remote Health • Remote PHC • RMP 1 • RMP 2 • Grad Dip: • PH Principles & Practice • Ethics Power & Practice • Introduction to Research & EBDM

26. Graduate Certificate in Remote Health Practice (Year 1) • Remote Medical Practice 1 • Remote medical practice & teamwork • Emergency skills in remote areas • Consultation & communication skills • Chronic disease in remote areas

27. Graduate Certificate in Remote Health Practice Remote Medical Practice 2 • Mental health • Management of STIs in remote areas • Women’s health • Child & adolescent health

29. Graduate Diploma in Remote Health Practice • Grad Cert (18 U) plus • Public health principles & practice • Ethics power & practice • Introduction to research & EBDM

31. Remote medicine advanced training • Core clinical knowledge & skills • Extended clinical practice • Emergency care • Population health • Indigenous health • Professional, legal & ethical practice • Rural & remote context