Professor Adam Scott

Heart and soul

When UNE alumnus Adam Scott first learned of the "ridiculously long" wait times for cardiac diagnostic tests in the outback town of Longreach in 2016 he immediately thought of his parents. It often took patients months to access routine investigations or they were forced to travel thousands of kilometres to tertiary hospitals to have them performed. Many were either delaying or forgoing treatment altogether.

"Cardiovascular disease is the leading cause of death for Queenslanders, and rural Queenslanders have a 25% higher morbidity and mortality rate compared to metropolitan residents," Adam says. "People in rural locations also have, on average, a seven-year lower life span, largely due to the reduced access to specialist investigations compared to major cities. I thought that if my parents lived in Longreach I would be appalled that the health system had not created solutions to this problem. My parents don’t, but someone else’s parents do."

So Adam promptly set about creating a solution.

After graduating from UNE he'd spent time completing his PhD and working in cardiac sciences at Imperial College, University of London in England, where he became a passionate advocate for value-based healthcare. Returning home to become the Director of Cardiac Sciences at the Royal Brisbane Women's Hospital (RBWH) provided just the opportunity to flip the standard health care model on its head.

"In health care we have a tendency to keep doing what we've always done, and the trouble with that is that we keep getting the same results," Adam says. "Value-based health care focuses first and foremost on the patient and asks 'how do we do best by the patient?'. Ultimately, it enables greater patient reach, timely access to testing and reporting, and further health support for those who have long been denied it."

Such thinking was the genesis for the world-first telemedicine program that Adam developed with his colleagues at the RBWH. This program enables cardiac specialists based in Brisbane to remote control operate cardiology equipment that is located in 22 rural health facilities across Queensland. "We have the cardiac specialists working in collaboration with the local rural treating team to ensure that the patient receives the same level of access and care that they would in a metropolitan location, thus resulting in early access to treatment when they need it, in their rural location," he says.

The program was recently published in the New England Journal of Medicine and earned international acclaim at the European Society of Cardiology conference, where delegates from countries with similar geographical challenges, such as Sweden, Canada, Nepal and China, inquired how they could rapidly adopt it. But Adam is far more interested in the hundreds of thousands of kilometres (187,073 km, to be precise) of travel that Queensland patients have been spared, the doubling of testing rates for Aboriginal and Torres Strait Islander people, and how the dramatic reduction in waiting times is impacting health outcomes.

"You can now get access to cardiovascular investigations in Camooweal faster than you can in Brisbane," he says. "The urban-rural disparity no longer exists for these locations for cardiac investigations. It demonstrates how creating teams of likeminded people, who are committed to devising solutions around a patient's needs, can be surprisingly simple and start moving things rapidly forward. Value-based health care can be implemented and solutions created in locations where in the past they said it couldn’t be done."

Not content to confine the applications of telehealth to cardiology, Adam was soon exploring ways to replicate the program across other health disciplines. And he didn't have to look far.

In 2011 Adam had taken 12 months' leave without pay to investigate better ways of supporting people struggling with their mental health, particularly depression, which is the number one global health burden. It was a goal Adam traces back to challenging experiences during his days studying for a Bachelor of Science at UNE in the mid 1990s.

"One of my best friends in college suffered from severe depression and had suicidal tendencies," Adam recalls. "It was really hard as a 17 and 18-year-old, being a confidante, without the knowledge or skills to know how best to support my friend. He'd knock on my door at 11pm with two long-neck beers, a jar of kalamata olives and some old VHS tapes of the Tour de France. It was his way of reaching out for help. I'd take him cycling and surfing and running; I essentially medicated him with exercise to keep him functional. Fortunately, we got him through these difficult times."

After a year of wide consultation and development, Adam established the mental health not-for-profit White Cloud Foundation (WCF) - an early intervention service for adults and their families who are living with or at risk of developing depression. "We try to get in earlier to provide access to multi-disciplinary allied health staff who work as an integrated practice unit to deliver individual treatment plans," he says. "People can self-refer and receive treatment utilising telehealth from a team of psychologists, exercise physiologists, dieticians and social workers.

"Our focus is on providing practical and evidence-based support to people when and where ever they need it, regardless of their geographic location, age, gender or socio-economic situation. In Queensland and Tasmania, for example, we offer a Meals for Mums program that provides women at risk of perinatal depression with nutritious, home-delivered meals. We know that mothers are the backbone of our families and communities, and when they break, the whole family breaks.

"We are all volunteers and it's all pro bono work, but as soon as you start seeing the impact you can have when you have no personal agenda other than to help people, the internal satisfaction and pride that you feel in return is incredible. Talk about chicken soup for the soul."

Even as the Executive Director of Clinical Support Services for Queensland Health's Metro North Hospital and Health Service and a teaching adjunct professor at Queensland University of Technology, Adam still manages to develop new clinical and fundraising programs for the White Cloud Foundation. These range from an 80km running relay known as the Mummy Run and leap of faith abseil off Kangaroo Point cliffs for depression, to The Paddle to Battle Depression, now in its eleventh year.

Of all the things I do, outside my family life, my charity work remains my highest priority," Adam says. "I had a stroke in 2012 and it was a real turning point. I realised that you only have one life and it's really short, and that life isn't about what I can do for me; it's about how I can help others. It's about practising and encouraging generosity and kindness every day.