Centre for Remote HealthA joint centre of• Flinders University and• Charles Darwin University

Preparing doctors for working in remote health

teams

Australian Standard Government Classification

Population distribution

Socioeconomic status

0

10

20

30

40

50

60

70

80

90

100

MC IR OR R VR

4th quartile

3rd quartile

2nd quartile

1st quartile

Per cent

Food prices

Percentage of young people entering university

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

Mortality

Outcomes: Mortality rates 1992 - 2003

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

Health outcomes

1. Overall mortality rates increase with increasing remoteness

2. Significant geographical variation in rates

3. Mortality rates declining over time, especially in remote areas

4. NT Indigenous mortality improving, but not declining at a comparable rate to non-Indigenous Australians except in 0-4 year old group

5. This observation may result from health service development targeting this age group

6. The biggest ‘gap’ in 35-64 year old group

7. Increasing prevalence of chronic diseases

8. Little information regarding social & emotional health

Practitioner to population ratios

Doctors – FTE/100,000 by ASGC

Access to treatment for IHD

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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)

Remote HealthRemote 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.

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)

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

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

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

Graduate Certificate in Remote Health Practice

Remote Medical Practice 2

• Mental health

• Management of STIs in remote areas

• Women’s health

• Child & adolescent health

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 RMP 2

Ophthalmology

Palliative care

Research and evidence based practice

Population health

Principles of r & r general practice RMP 1

Psychiatry/mental health RMP 2

Radiology

Renal medicine

Strategic skills in rural medical practice

Surgery

Graduate Diploma in Remote Health Practice

• Grad Cert (18 U) plus

Public health principles & practice Ethics power & practice Introduction to research & EBDM

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 RMP 2

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 RMP 2

Radiology -

Renal medicine -

Strategic skills in rural medical practice -

Surgery Ethics,power,practice;Context

Remote medicine advanced training

• Core clinical knowledge & skills

• Extended clinical practice

• Emergency care

• Population health

• Indigenous health

• Professional, legal & ethical practice

• Rural & remote context