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 1200.

Evaluation of the Mental Health Emergency Care - Rural Access Project

The Mental Health Emergency Care-Rural Access Project (MHEC-RAP) was developed to increase community access to emergency mental health care and improve patient outcomes across western NSW. MHEC-RAP provides 24 hour access to mental health specialists via the state-wide freecall metal health number (1800 011 511). The MHEC-RAP team offer contextually relevant information, support and advice for patients and providers alike. They also provide emergency clinical services such as telephone triage and video assessment.

An initial evaluation concluded that MHEC-RAP was helpful for both patients and providers1,2. A further evaluation is being conducted and has demonstrated that MHEC-RAP is well established and is used as it was intended3. Additional research will report upon the particular use of MHEC-RAP by hospital emergency departments, the capacity of the program using a time and motion study, and the impact of the program upon variables of access as determined through interviews with providers.

The MHEC-RAP evaluation is being led by Emily Saurman. For further information about the evaluation, contact Emily Saurman on +61 8 8080 1206.

1 Saurman, E., D. Perkins, R. Roberts, A. Roberts, M. Patfield and D. Lyle (2011). "Responding to mental health emergencies: Implementation of an innovative telehealth service in rural and remote NSW, Australia." The Journal of Emergency Nursing 37(5): 453-459

2 Saurman, E., D. Perkins, D. Lyle, M. Patfield and R. Russell (2011). Mental Health Emergency Care - Rural Access Project: Assessing Rural and Remote Emergency Mental Health in Western New South Wales Australia by Videoconference Technology. Evidence-Based Practice in Nursing Informatics: Concepts and Applications. A. Cashin and R. Cook, IGI Global: 191-203.

3 Saurman, E., D. Lyle, D. Perkins and R. Roberts "The successful provision of emergency mental health care to rural and remote NSW - an evaluation of the Mental Health Emergency Care-Rural Access Program." Australian Health Review accepted for publication 16 October 2013.

Evaluation of Nurse-Led Cycle of Diabetes Care in Remote Communities

Research Question
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 Johnson3 and David Lyle1.

1. Broken Hill University Department of Rural Health, Broken Hill NSW 2880 Australia
Phone: 08 8080 1200.

2. Royal Flying Doctor Service South Eastern Sector Broken Hill NSW 2880 Australia

3. Far West Local Health District, Tibooburra NSW 2880 Australia

Review of Service-Learning Models for Primary Health Care Professionals in Rural and Remote Settings

Recruitment and retention of primary health care professionals to rural and remote settings remains a serious problem in Australia, as it is worldwide, in spite of financial incentives and educational strategies aimed at encouraging graduates to take up rural and remote practice. This review examined the evidence for service-learning models to reduce primary health care workforce shortages in rural and remote locations.

The history of service-learning and the theoretical framework which underpins it is described in the context of the development of the research question:

  • How and what do students learn in service-learning programs?
  • What are the educational outcomes for students in service-learning placements compared to those for students in traditional placements?
  • Do service-learning programs improve the uptake of rural practice?

Databases and grey literature sources were searched to enable the assessment of evidence for the effectiveness of medical education, training and supervision models in rural and remote locations.

Preliminary results show that long rural and remote undergraduate placements improve clinical and non-clinical knowledge and skills and are likely to promote rural practice in medical and allied health students.

Sue Kirby
Broken Hill University Department of Rural Health
Phone: 08 8080 1200

Professor David Lyle
Broken Hill University Department of Rural Health