Current Research Activity
The Broken Hill Centre for Remote Health Research is involved in a number of research projects relevant to population health and the delivery of health services in rural and remote settings.
Currently core research topics include:
- The impacts of chronic disease on rural communities
- Development and evaluation of the Broken Hill Environmental Lead Management Program
- The development and evaluation of effective models of primary health care delivery in remote communities, with a focus on the interplay between the concepts of primary health care and systems
- Primary Mental Health Service delivery in rural settings
- Workforce development
Reducing community exposure to environmental lead.
Lead has been recognised as poisonous since at least Roman times, and in recent years evidence has been growing that there are no levels below which health effects are not detectable. Young children are particularly at risk because their brains and nervous systems are still developing, and they are better able to absorb lead than adults and less able to excrete it.
The main ways in which people are exposed to lead are through living close to current or former industrial sites involving lead, for example lead mines and smelters, battery manufacturing or recycling plants, soldering plants; living in areas with high traffic density where lead is currently or was previously used in fuel; living in homes with unstable lead-based paint or renovating homes containing lead paint.
Internationally there are several long-running programs which aim to reduce community exposure to lead; these have all shown large reductions of children’s blood lead levels over time but have had difficulty reducing average blood lead levels below 4 – 7 µg/dL.
Key informants from these management programs are currently being interviewed to determine what has been successful in communities with different sources of lead exposure (industrial sites, paint, etc); what the perceived barriers are to further reduction in lead exposure and whether and how these are being overcome.
The learnings from this study will be used to inform the lead management program in Broken HIll, NSW, and lead management internationally.
The research is being led by Frances Boreland. Final results will be available from April 2014. For further information about the study contact Frances Boreland on +61 8 8080 1279.
Evaluation of the Mental Health Emergency Care - Rural Access Project
The Mental Health Emergency Care - Rural Access Project (MHEC - RAP) is designed to improve the quality and responsiveness of metal health emergency services in the Western NSW LHD and Far West LHD. It is intended to improve access to services and safety in the assessment and treatment of clients and to improve coordination of services provided by health, police and ambulance.
Specifically, the evaluation will address the following questions:
1. What is the MHEC-RAP model and how does it meet mental health emergency care needs, in the context of improving access, safety, and service coordination in rural and remote locations?
2. Do the activities of the MHEC-RAP team lead to changes in (either or both) the patient journey and provider decisions about care? The patient journey describes the identification, assessment, transport and care for particular/ typical mental health patients.
3. What impact have the activities of the MHEC-RAP team had on the agencies and patients associated with mental health emergency care in rural and remote health?
Research is being led by Emily Saurman. For further information about the study, contact Emily Saurman on +61 8 8080 1203.
Evaluation of Nurse-Led Cycle of Diabetes Care in Remote Communities
Does Nurse-led Diabetes Care Work in the Remote Locations?
Less than one third of people with diabetes manage their blood glucose levels effectively. This study evaluated a nurse-led cycle of care diabetes management program in remote western NSW.
We interviewed 14 patients from 17 recruited to the nurse-led cycle of care from three locations, a major town and two small remote townships, to gauge their perceptions of the program. Five outreach general practitioners and a remote registered nurse involved in patient care were also interviewed. Clinical outcomes for 17 patients were compared before and after the one year cycle of care.
All patients reported that they: trusted the nurse; thought nurse advice was “at my level” and useful to change lifestyle and manage medications and they appreciated being supported to change rather than being “bossed around”. Clinicians reported that: inter-professional relationships worked well; patient care was of a high standard and the nurse-developed management plan worked well. Patient clinical outcomes were: saturated haemoglobin levels reduced in 60% of patients; 65% of patients lost weight and glomerular filtration rate was kept in normal range in 35% of patients.
Remote location nurse-led diabetes care can enable good diabetes management and is acceptable to patients and clinicians.
Sue Kirby1, Trish McCarron2, Malcolm Moore1, 2, Patricia Johnson3and David Lyle1.
1. Broken Hill University Department of Rural Health, Broken Hill NSW 2880 Australia
Email or phone: 08 8080 1287.
2. Royal Flying Doctor Service South Eastern Sector Broken Hill NSW 2880 Australia
3. Far West Local Health District, Tibooburra NSW 2880 Australia