This is a panel discussion about introducing Shared Medical Appointments in the Northern Territory (NT).
The Northern Territory Primary Health Network has funded 3 Aboriginal Community Controlled Health Organizations (Miwatj Health Aboriginal Corporation, Danila Dilba, Central Australian Aboriginal Congress) for 2 years as a Pilot to develop Shared Medical Appointments in the more remote Aboriginal Health Service context. Consultants from Aboriginal Medical Services Alliance of NT (AMSANT) and Australasian Society for Lifestyle Medicine (ASLM) have helped services to work with local communities to develop the concept of Shared Medical Appointments and co design a model that works for their community.
The Shared Medical Appointment is series of individual consultations in a group setting, where the focus may be a particular condition like diabetes or COPD. It can provide opportunities for the group to learn from each other's discussions with a health professional and have the support of peers in what may be an intimidating environment.
Speakers from the health services will discuss lessons learned in this multilingual and multicultural context. The model emphasizes the value of "both ways" learning in health care and how this improves trust and relationships with health care providers and ultimately may improve health outcomes.

This is a workshop to explore and learn about Medical Dhäwu Dhäwu (Shared Medical Appointments) in a Yolŋu context in Northeast Arnhem land.

The Northern Territory Primary Health Network has funded Miwatj Health Aboriginal Corporation for 2 years as a Pilot to develop Shared Medical Appointments in the remote Aboriginal Health Service context. Consultants from Aboriginal Medical Services Alliance of NT (AMSANT) and Australasian Society for Lifestyle Medicine (ASLM) have helped services to work with local communities to develop the concept of Shared Medical Appointments and co design a model that works for their community.
The Shared Medical Appointment is series of consultations in a group setting, where the focus may be a particular condition eg diabetes. It can provide opportunities for the group to learn from each other's discussions with a health professional and have the support of peers in what may be an intimidating environment.
The workshop will enable discussion of the learnings from this pilot project particularly in relation to developing an Aboriginal led program with emphasis on the importance of cultural and language considerations. An opportunity for groups to role play a Shared Medical Appointment will be facilitated to enable experiential learning.

Gestational diabetes mellitus (GDM) affects one in six pregnancies per year in Australia and is a well-established risk factor for subsequent development of Type 2 Diabetes Mellitus (T2DM). The prevalence of T2DM in women previously diagnosed with GDM has been reported between 10-25% in Australia and between 2.6-70% worldwide. Our study aimed to establish the prevalence of T2DM in women within the Illawarra Shoalhaven Local Health District who were diagnosed with GDM between 1991-2010. We used a pre-existing database of consenting women. Participants were asked to complete an HbA1c test to determine if they have T2DM, and if they already had T2DM what year they were diagnosed. Data was linked to existing obstetric information in the database. The prevalence of T2DM in this cohort was 31.2%, higher than some other Australian studies. Regular testing amongst this group was low (30.8% in the last year). Pre-diabetic or diabetic levels were found in 13.1% of participants without confirmed T2DM. Women with prior GDM were continuing to develop T2DM decades later, sometimes in the absence of usual diabetes risk factors. This study illustrates the importance of understanding long-term T2DM prevalence, including risk factors and barriers to follow up, particularly within local Australian contexts.

Rural and remote populations have a high burden of depression and poorer access to mental healthcare services than their urban counterparts. Systematic reviews have examined the effectiveness of treatments for depression among the general population, however there is little evidence amongst rural and remote populations, despite unique social and geographical challenges.

This systematic review and meta analysis, conducted as per the Cochrane guidelines, aimed to assess the effectiveness of any type of psychological and pharmacological treatments on reducing depression specifically in rural and remote residents.

Our systematic review suggests behavioural activation and group therapy appear beneficial in the management of depression among rural populations. Additionally, group therapy may generally be more cost-effective than individualised CBT and may be a more appropriate option for depression management in areas with limited resources. Whilst the certainty of evidence was rated as low, group therapy and behavioural activation should be considered by health care providers who service rural populations, in conjunction with emerging evidence.

A maximum of only three studies could be pooled per meta-analysis due to the limited evidence examining the effectiveness of each intervention, and the pooled studies had limited sample sizes, indicating more research into all interventions is required.

Objective: This study aims to investigate the impact of remoteness on the timeliness of operative fixation and mortality for neck of femur fractures (NOFs) comparing patients presenting directly to the operating centre with those transferred from peripheral centres.

Design: Retrospective cohort study
Participants: The study includes 350 patients over 65, presenting with closed, unilateral neck of femur or intertrochanteric fractures who underwent operative management at Dubbo Base Hospital, NSW Main Outcome

Measures: Primary outcomes include time to surgery and adherence
to recommended timeframes for neck of femur fixation. Secondary outcomes
include complication rate, hospital length of stay, and a subgroup analysis to identify causes of surgical delay.

Results: Patients transferred from peripheral hospitals experienced a statistically significant delay in time from presentation to surgery compared to those presenting directly to the operating centre (42hrs vs. 24hrs, p < 0.001*) and were more likely to be outside of current guidelines for NOF fixation of within 36 hours of presentation (OR 5.1, p < 0.001*). There were no differences in mortality at 1 year between the two groups (15% vs 18%, p=0.5). On subgroup analysis, distance from the operating centre, time to x-ray and after-hours presentation were associated with increased likelihood of surgery outside of 36 hours in the peripheral hospital group.

Conclusion: This study underscores an inequity in service delivery for rural patients with NOF fractures, particularly those requiring transfer. Pre-arrival delays necessitate targeted interventions to address diagnostic service delays, logistical challenges, and transport issues in rural healthcare.

Keywords: Rural, Neck of femur fracture, interhospital transport, Distance

Rural generalists have a passport to an exciting world of career opportunities. But… how to find a niche, and keep that commitment alive over twenty years? Achieving early success may not last the duration of a training program. Life events can shift goals, perspective, location and specialty. Some suffer profound dissatisfaction or burn out entirely.

Rural doctors understand more than most how important it is to be flexible and resilient, given the unique challenges working in our world. We have a critical role in driving reform, improving community solidarity and health and can achieve this in unique ways by the roles we choose.

Be inspired by our diverse panel who between them have been there and done just that. Learn from rural doctors who changed pathways, or changed back much later. Hear from those who have acquired multiple advanced skills, or left clinical medicine to become passionate educational directors, CEOs and prominent public health leaders. Discover how to find your fit in established rural practice and for those with itchy feet – why expedition or humanitarian medicine is the perfect work life balance. We invite you to peek into the future…but be warned, it’s unlikely to be what you imagined!

Arboviruses pose significant public health threats in Australia due to their potential to cause human diseases, while also disproportionately impacting socioeconomically vulnerable areas. Over 75 arboviruses have been detected in Australia, with Ross River virus and Barmah Forest virus being major contributors to disease notifications. Traditional surveillance methods involve sentinel animals and mosquito-based trapping, but these have limitations. The emergence of exotic arboviruses highlights the need for proactive surveillance strategies, especially in remote territories. This study evaluates a modern-traditional surveillance approach in the Indian Ocean Territories (Christmas Island and Cocos (Keeling) Islands) to monitor arboviral activity. Our methods used sentinel chicken sampling, mosquito trapping, and environmental sampling, with subsequent ELISA and metagenomic sequencing analyses. With unusually low rainfall during the study period, viral abundance assessment revealed no significant findings, with only one weak positive seroconversion observed. The metagenomic next-generation sequencing (NGS) approach has allowed obtaining unbiased sequence information of millions of DNAand RNA molecules from clinical and environmental samples. Through the mNGS approach, it is now possible to obtain millions of sequence reads from RNA or DNA molecules present in a sample, which constitutes an unprecedented amount of information for a full characterisation of the presence of biological entities.

It is well known that rural physicians face unique barriers in their daily practice that impede their ability to engage in research. A lack of time, skills, and professional and geographical isolation prevent the most knowledgeable and experienced players in rural medicine from conducting rurally relevant research. 6for6 is a research skills training program developed by Memorial University of Newfoundland, Canada that provides rural physicians with the support and tools they need to conduct research. By providing this training, support, and mentorship, 6for6 has helped 38 rural doctors conceive and conduct research important to their rural communities.

Since the program was established in 2014, there have been many obstacles that required the program to pivot unexpectedly, such as the COVID-19 pandemic. By employing various problem-solving strategies, we have successfully adapted the program as new challenges arise. This workshop will demonstrate the use of one strategy, the TRIZ method, which encourages creative thinking. This method helps participants identify counterintuitive practices that they may not realize they engage in while developing new ideas to tackle their research problem.