After gathering women’s lived experiences around pain and pain management in the Loddon Mallee region, Women’s Health Loddon Mallee is pleased to share our regional submission to the Victorian Government’s Inquiry into Women’s Pain. This submission highlights critical issues and provides a comprehensive set of recommendations aimed at improving the health outcomes and care experiences of women and gender-diverse people in the Loddon Mallee.
Summary of Recommendations
WHLM makes the following evidence-based recommendations, under 7 key themes:
Theme 1: Women’s Experiences of Pain
- WHLM recommends that stage 2 of the pain inquiry takes an intersectional approach to consider whose voices might be missing as a result of digital exclusion and look at implementing other methods for women to share their experiences of pain.
Theme 2: Availability and Accommodation of Healthcare
- Invest in improving internet infrastructure across the region to support telehealth services and ensure reliable access for all residents.
- Advocate for increased funding and incentives to expand telehealth services and encourage provider participation.
- Increase the availability of government-subsidised early learning and childcare centres in the LMR.
- Invest in expanding the public transport network in rural and regional Victoria.
- Develop regionally informed incentives to attract and retain primary, specialist and allied health professionals in rural and regional areas to enable women’s access to multidisciplinary pain management and alleviate the pressure on GPs.
- Consult healthcare workforce in the LMR to identify local drivers of high workforce turnover and use this evidence to develop holistic, place-based strategies and incentives to strengthen the rural and regional workforce. To recommendations on addressing the shortage of female practitioners and gender bias in the healthcare profession, please refer to the Women’s Health Service Network submission into women’s pain.
- Develop nurse-led models of care for pain management in rural and regional Victoria. This includes:
- Incentivising and supporting nurses to develop the appropriate skills, qualifications, and expertise to support pain management in primary care settings.
- Advocating to the Federal Government to increase to availability of Medicare Benefits Schedule (MBS) item numbers for nurse practitioners and general-practice nurses.
Theme 3: Appropriateness of Care
- Partner with the Victorian Women’s Health Services and community stakeholders to support the implementation of women’s forums, support groups, and/or peer networks in various community settings, such as workplaces and community centres. These spaces should allow women to share experiences, gain emotional support, access informational resources and develop self-management and self-advocacy skills.
- Invest in existing health promotion and women’s health infrastructure, such as the Victorian Women’s Health Services to deliver coordinated, evidence-based intersectional and effective prevention and health promotion activities within communities, focused on women’s SRH.
- Implement policies that require the inclusion of sex and gender dimensions in government-funded research.
- Advocate for the inclusion of preventative care and health promotion education into medical training and professional development for GPs and other healthcare providers. This is to support the delivery of holistic, patient-centred care that is sensitive to the diverse needs of individuals and considers the complex interplay of social determinants of health (SDOH) influencing their experience of pain.
- Advocate for the integration of SRH and women’s health as a core component in tertiary medical education and ongoing training opportunities for healthcare providers.
- Utilise the existing and planned SRH hubs, women’s clinics and endometriosis and pelvic pain clinics to increase access to train the trainer opportunities in rural and regional Victoria. Focus these programs on enhancing knowledge of women’s pain experiences and SRH, including IUD insertion.
- Invest in the expansion of endometriosis and pelvic pain clinics, and SRH hubs in rural and regional Victoria.
- Prioritise areas with the greatest services gaps, such as Loddon Shire, when establishing future SRH hubs across rural and regional Victoria.
- Advocate for the implementation of comprehensive communication training for all healthcare professionals and practice staff to support the delivery of clear, empathetic, tailored to individual patient needs and circumstances.
- Advocate for healthcare practices to implement patient feedback mechanisms so areas for improvement can be identified and strategies to improve patient-centred care can be implemented.
- Advocate for health system funding and incentives to support coordinated, multidisciplinary team-based care, rather than episodic care. This includes the development of dedicated pain care plans with Medicare-funded allied health support and a reformed primary care funding model. Such reforms should enable longer appointment times for complex conditions like pain, allowing women and healthcare providers to engage in thorough discussions, receive comprehensive explanations, and make informed decisions about treatment.
- Advocate to the Federal Government to remove regulatory barriers to providing team-based primary care.
- Advocate for funding to establish co-located multidisciplinary healthcare centres in rural and regional areas.
- Support Primary Health Networks to develop onboarding programs that assist new practitioners to familiarise themselves with local referral pathways, available treatments and existing care networks.
- Advocate for funding research initiatives to develop best-practice guidelines on pain management that considers the experiences and needs of women and gender-diverse people. These guidelines should provide guidance for healthcare providers and be integrated into medical curricula.
- Conduct regular training sessions for practitioners on local resources, referral pathways and treatment options.
Theme 4: Approachability of Healthcare
- Incorporate pelvic and menstrual pain into the sexual health and education curriculum within schools.
- Provide funding specifically for multilingual staff and interpreter services within healthcare settings to ensure that all patients, regardless of language, have equitable access to culturally competent pain management.
- Provide funding to rural and regional health services to promote and deliver outreach programs within communities.
- Increasing funding for the Victorian Women’s Health Services and culturally competent care providers and community services. This will enable targeted health education to be delivered directly within communities, equipping women with the knowledge and tools necessary to navigate the health system and access effective pain management. Please see Multicultural Centre for Women’s Health submission for specific recommendations related to migrant and refugee women.
- Centralise information about local services by collaborating with community and local government stakeholders to develop and disseminate comprehensive directories of local healthcare providers, social and community services and health education resources. Ensure these directories are accessible online, including on government websites such as myGov, and widely disseminated in community settings.
Theme 5: Acceptability
- Partner with the Victorian Women’s Health Services, education and community-facing organisations to develop strategies to address the implicit and explicit gender bias in medical care. This should include embedding gender-responsive practice training into healthcare professional curricula and ongoing professional development. Further recommendations are detailed in the Women’s Health Service Network submission into women’s pain.
- Increase funding support for organisations dedicated to promoting gender equality and combatting violence against women to dismantle systemic gender bias.
- Develop standardised protocols for managing persistent pain that prioritise validating patients’ experiences. These protocols should ensure that women receive thorough and empathetic pain assessments and appropriate treatments, fostering a consistent and supportive approach to pain management across healthcare settings.
- Develop policies and training for healthcare providers that emphasise shared decision making and the importance of patient autonomy.
- Establish patient advocacy programs within healthcare settings.
Theme 6: Affordability
- Advocate to the Federal Government to reform primary care funding arrangements to favour a new model which supports team-based care, incentivises providers to dedicate more time to complex cases and bulk-bill appointments.
- Advocate to the Federal Government to implement dedicated pain care plans in general practice and remove caps on MBS-funded allied-health services to enable comprehensive management.
- Advocate to the Federal Government to address Medicare gaps for non-citizens and ensure equitable access to pain management for all community members.
- Allocate resources to improve public transport options, childcare and other infrastructure to reduce the indirect cost of accessing healthcare incurred by rural and regional women, such as travel expenses, childcare and lost income.
Theme 7: Translate Research and Evidence-based Interventions
- Research into pain needs to include both quantitative and qualitative approaches in which sex and gender considerations are included in research design including the collection and dissemination of sex and gender disaggregated data to continue building the evidence to inform policy and practices.
- Diverse women’s voices and experiences need to be included in knowledge generation and translation.
- Collection and dissemination of sex disaggregated data in pain research.
- Future research should consider more complex gender constructs instead of relying solely on binary comparisons between males/men and females/women. This is particularly crucial for gender-diverse individuals, where sex and gender identity may differ.
- Future research should shift focus from individual characteristics to investigate the direct and indirect effects of social policies and cultural norms on sex differences in pain.
The evidence supporting these recommendations is detailed below.