1. Preparing doctors for working in remote health teams

4. About 3% in remote, compared to 25-30% in rural (depending on classification system used)
In Australia, there is a population density gradient from metropolitan to remote areas. Large rural centres have an average of 59.4 persons/sq. km, whilst ‘remote other’ averages 0.1 person/ sq. km (AIHW 1998 p6). Population dispersion is a very salient factor for health care planning and delivery.

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 1981-2000 Zhao & 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 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

18. There is a common perception that mortality increases with increasing remoteness. Recent analysis of mortality data across different geographical areas indicates that total population death rates are about 10% (1.1 times) higher in Inner and Outer Regional areas and Remote areas than in Major Cities, but 50% (1.5 times) higher in Very Remote areas (AIHW 2003 p 33)[i]. It is likely that the high Indigenous proportion of the population in remote areas makes a substantial contribution to the higher overall death rate.
[i] This five-tired geographical classificatory system, known as the Australian standard Geographical Classification (ASGC), was developed by the Australian Bureau of Statistics, derived from the ARIA.

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
Context: ENSURING SAFE PRACTICE. Concerned with the cultural, social and economic context of remote health care in Australia and will facilitate the development of the student's understanding of the people in remote areas and the major issues they face. The topic explores the definition of remote and examines significant issues remote communities face, as well as the concept of culture and racism within Australian society. There is an emphasis on indigenous health and how present health status is related to history. The topic also explores the adaptation process to living and working in remote areas, examines sources of stress associated with remote practice and suggests strategies to manage stress.
The topic provides an opportunity for reflection on how services are delivered in remote areas; it proceeds from an examination of models of health, epidemiology and public health to an analysis of primary health care and introduction to HP.
All topics have an emphasis on Aboriginal health

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

28. Aboriginal Health
RMP 1 + Context + PHC
Adult Internal Medicine
RMP 1: mgt of chronic disease
Aged Care
Anaesthetics
Child and Adolescent Health
RMP 2
Dermatology
Emergency Medicine
RMP 1 (EMST)
IT/ IM
Management
Musculoskeletal medicine
O & G /women’s health
Ophthalmology
Palliative care
Research and evidence based practice
Population health
Principles of r & r general practice
RMP 1
Psychiatry/mental health
Radiology
Renal medicine
Strategic skills in rural medical practice
Surgery

29. Graduate Diploma in Remote Health Practice
Grad Cert (18 U) plus
Public health principles & practice
Ethics power & practice
Introduction to research & EBDM
This topic aims to develop the reflective practice of students in relation to their role within a multidisciplinary team and with the community where they work. The topic examines ethics, reflective practice, working in teams, power relationships, and indigenous health issues in a remote context.

30. Aboriginal Health
RMP 1 + Context + PHC
Adult Internal Medicine
RMP 1: mgt of chronic disease
Aged Care -
Anaesthetics
Child and Adolescent Health
RMP 2
Dermatology
Emergency Medicine
RMP 1 (EMST)
IT/ IM
Management
Musculoskeletal medicine
O & G /women’s health
Ophthalmology
Palliative care
Research and evidence based practice
Intro research & EBDM
Population health
PH principles & practice
Principles of r & r general practice
RMP 1
Psychiatry/mental health
Radiology
Renal medicine
Strategic skills in rural medical practice
Surgery
Ethics,power,practice;Context

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