The effect of oxytocin nasal spray on social interaction in young children with autism: a randomized clinical trial.

Early supports to enhance social development in children with autism are widely promoted. While oxytocin has a crucial role in mammalian social development, its potential role as a medication to enhance social development in humans remains unclear. We investigated the efficacy, tolerability, and safety of intranasal oxytocin in young children with autism using a double-blind, randomized, placebo-controlled, clinical trial, following a placebo lead-in phase. A total of 87 children (aged between 3 and 12 years) with autism received 16 International Units (IU) of oxytocin (n = 45) or placebo (n = 42) nasal spray, morning and night (32 IU per day) for twelve weeks, following a 3-week placebo lead-in phase. Overall, there was no effect of oxytocin treatment over time on the caregiver-rated Social Responsiveness Scale (SRS-2) (p = 0.686). However, a significant interaction with age (p = 0.028) showed that for younger children, aged 3-5 years, there was some indication of a treatment effect. Younger children who received oxytocin showed improvement on caregiver-rated social responsiveness ( SRS-2). There was no other evidence of benefit in the sample as a whole, or in the younger age group, on the clinician-rated Clinical Global Improvement Scale (CGI-S), or any secondary measure. Importantly, placebo effects in the lead-in phase were evident and there was support for washout of the placebo response in the randomised phase. Oxytocin was well tolerated, with more adverse side effects reported in the placebo group. This study suggests the need for further clinical trials to test the benefits of oxytocin treatment in younger populations with autism.Trial registration www.anzctr.org.au (ACTRN12617000441314).

Social and joint attention during shared book reading in young autistic children: a potential marker for social development.

BACKGROUND: Atypical patterns of social engagement and joint attention behaviors are diagnostic criteria for people with autism spectrum disorder. Experimental tasks using eye-tracking methodologies have, however, shown inconsistent results. The development of tasks with greater ecological validity and relevance for developmentally appropriate social milestones has been identified as important for the field. METHODS: We developed a novel, dynamic eye-tracking task emulating a shared book reading (SBR) scenario. Four SBR videos of an adult reader engaging with the viewer while reading a children's picture book and including sequenced bids for joint attention were developed. Participants included 90 children (N = 56 autistic children, N = 34 neurotypical children; aged 3-12). Social attention was also measured in a live free play task between participants and an experimenter. RESULTS: Compared to neurotypical children, autistic children displayed reduced attention to socially salient stimuli including the reader's face and picture book across SBR videos and during joint attention bids specifically. In contrast, they showed increased attention to nonsalient background stimuli compared to their neurotypical peers. These attention patterns in autistic children were associated with reduced verbal and nonverbal cognitive skills and increased symptoms associated with autism. Interestingly, positive correlations in the frequency of eye gaze between SBR and free play suggested a potential predictive value for social attention in live social interactions. CONCLUSIONS: Findings highlight the utility of SBR eye-tracking tasks in understanding underlying divergences in social engagement and joint attention between autistic and neurotypical children. This commonly practiced early childhood activity may provide insights into the relationship between social engagement and learning to reveal how such attentional patterns might influence broader developmental and educational outcomes.

Systematic review and meta-analysis of text messaging interventions to support tobacco cessation.

OBJECTIVE: To review randomised controlled trials (RCTs) investigating the effectiveness of text message-based interventions for smoking cessation, including the effects of dose (number of text messages) and concomitant use of behavioural or pharmacological interventions. DATA SOURCES: We searched seven databases (PubMed, CINAHL, PsycINFO, Scopus, EMBASE, Cochrane Library and Web of Science), Google Scholar and the reference lists of relevant publications for RCTs. Eligible studies included participants aged ≥15 years who smoked tobacco at enrolment. STUDY SELECTION: One reviewer screened titles and abstracts and two reviewers independently screened full texts of articles. DATA EXTRACTION: One of three reviewers independently extracted data on study and intervention characteristics and smoking abstinence rates using Qualtrics software. DATA SYNTHESIS: 30 of the 40 included studies reported higher rates of smoking cessation among those receiving text messaging interventions compared with comparators, but only 10 were statistically significant. A meta-analysis of seven RCTs found that participants receiving text messages were significantly more likely to quit smoking compared with participants in no/minimal intervention or 'usual care' conditions (risk ratio 1.87, 95% CI 1.52 to 2.29, p <0.001). Three trials found no benefit from a higher dose of text messages on smoking cessation. Two trials that tested the added benefit of text messaging to pharmacotherapy reported outcomes in favour of adding text messaging. CONCLUSIONS: Findings suggest that text messaging-based interventions are effective at promoting smoking cessation. Further research is required to establish if any additional benefit is gained from an increased number of text messages or concurrent pharmacotherapy or behavioural counselling.

Impact of Early COVID-19 Waves on Cardiac Rehabilitation Delivery in Australia: A National Survey.

BACKGROUND: The novel coronavirus disease of 2019 (COVID-19) pandemic significantly disrupted health care, especially outpatient services such as cardiac rehabilitation (CR). We investigated the impact of early COVID-19 waves on the delivery of Australian CR programs, comparing this time period with usual practice prior to the pandemic (2019) and current practice (2021) once the early waves had subsided. Specifically, we aimed to understand how the delivery of programs during COVID-19 compared to usual practice. METHODS: An anonymous online cross-sectional survey of Australian CR program staff was conducted, comprising three sections: program and respondent characteristics, COVID-19 impact on program delivery, and barriers to, and enablers of, program delivery. Respondents were asked to consider three key timepoints: 1) Pre-COVID-19 (i.e. usual practice in 2019), 2) Early COVID-19 waves (March-December 2020), and 3) Currently, at time of survey completion post early COVID-19 waves (May-July 2021). RESULTS: Of the 314 Australian CR programs, 115 responses were received, of which 105 had complete data, representing a 33% response rate. All states and territories were represented. During early COVID-19 waves programs had periods of closure (40%) or reduced delivery (70%). The majority of programs reported decreased CR referrals (51.5%) and decreased participation (77.5%). The two core components of CR-exercise and education-were significantly impacted during early COVID-19 waves, affecting both the number and duration of sessions provided. Exercise session duration did not return to pre-pandemic levels (53.5 min compared to 57.7 min, p=0.02). The majority of respondents (77%) reported their CR program was inferior in quality to pre-pandemic and more organisational support was required across information technology, staffing, administration and staff emotional and social support. CONCLUSION: Australian CR programs underwent significant change during the early COVID-19 waves, consistent with international CR reports. Fewer patients were referred and attended CR and those who did attend received a lower dose of exercise and education. It will be important to continue to monitor the long-term impacts of the COVID-19 pandemic to ensure CR programs return to pre-pandemic functioning and continue to deliver services in line with best practice and evidence-based recommendations.

Considerations for the Implementation of a Telestroke Network: A Systematic Review.

The application of telestroke has matured considerably since its inception in 1999. The use of telestroke is now recommended in several published guidelines. Consequently, jurisdictions without a telestroke service are seeking practical information on the best approach to implement telestroke. French et al. (2013) reviewed the challenges of implementing a telestroke network including studies between 2000 and 2010. At the time, telestroke networks were largely limited to the UK, USA, Canada and Europe and only one process evaluation had been conducted. Given the prolific expansion of telestroke services since 2010, we conducted a systematic review to determine factors associated with successful establishment, management, and sustainability of a contemporary telestroke services. A comprehensive search of telestroke studies was conducted in July 2021. Empirical studies published between 2010 and 2021 were included if they contained descriptive, evaluation or operational data on the implementation of a telestroke network. Studies were subsequently evaluated using the Consolidated Framework for Implementation Research (CFIR). The initial literature search revealed a total of 7415 potential studies; 38 of which met the inclusion criteria. The past decade of process evaluation studies has enabled a more nuanced investigations into how to implement and sustain a telestroke network. Pre-implementation planning is crucial to ensure clear telestroke processes, governance structures and stakeholder engagement. Sustainability of networks relies on securing long-term investment, providing adequate resources, and maintaining staff motivation and willingness. Recommendations are provided to overcome commonly identified barriers related to technology, staffing, planning and standardisation of processes, evaluation, and sustainability and scale-up. Further research needs to explore how new advancements in stroke care such as endovascular clot retrieval (EVT) and advanced brain imaging can be considered and planned for during the implementation of a new telestroke service.

Resting Heart Rate and Heart Rate Variability in the Year Following Acute Coronary Syndrome: How Do Women Fare?

BACKGROUND: Women experience poorer health outcomes following acute coronary syndrome (ACS). Heart rate (HR) and heart rate variability (HRV) have emerged as sensitive and cost-effective markers of autonomic function and prognostic risk factors of poor cardiac outcomes. The aim of the current study was to investigate whether sex-specific differences existed across HR and five parameters of HRV, at 1 and 12 months following ACS diagnosis. METHODS: Between January 2013 and June 2014, a sample of 416 ACS patients was enrolled in the Anxiety Depression & Heart Rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) longitudinal cohort study. At 1 and 12 months following discharge, patient HR and HRV (root mean square of successive differences [RMSDD], standard deviation of RR intervals [SDRR], high frequency power [HF], low frequency power [LF], very low frequency power [VLF]) was measured via three-lead electrocardiogram. RESULTS: At 1 month post-ACS, sex was a significant predictor of HR and VLF power in fully- adjusted models. At 12 months post-ACS, sex was a predictor of HR, SDRR and VLF power in fully-adjusted models. CONCLUSION: Sex-specific differences in resting HR and HRV were observed in the year following ACS, whereby women had higher HR and lower HRV, suggestive of poorer autonomic function. Further large-scale cohort studies examining autonomic function as a driver of sex-specific outcomes following ACS are required.

Exercise prior to influenza vaccination for limiting influenza incidence and its related complications in adults.

BACKGROUND: Influenza is an infectious virus affecting both humans and animals. In humans, symptoms present as fever, cough, sore throat, runny nose, headache, muscle and joint pain, and malaise. The epidemiological profile of influenza is influenced by multiple factors, including transmissibility of the virus and the susceptibility of the population. Annually, influenza is estimated to infect 5% to 10% of adults, with higher rates in winter seasons in countries with seasonal variation. Exercise could be an intervention to enhance immune response and limit influenza incidence and its related complications. OBJECTIVES: To assess the efficacy and safety of short and long-term exercise prior to influenza vaccination in enhancing influenza prevention in adults. SEARCH METHODS: We searched CENTRAL (2015, Issue 11), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to 3 November 2015), Embase (1974 to 3 November 2015), CINAHL (1981 to 3 November 2015), LILACS (Latin American and Caribbean Health Sciences, 1982 to 3 November 2015), PEDro (1980 to 3 November 2015), SPORTDiscus (1985 to 3 November 2015), the WHO International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (November 2015). SELECTION CRITERIA: Randomised controlled trials (RCTs) of short- and long-term exercise prior to influenza vaccination for the general adult population were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted and checked data from the included trials using a standard form. We used the random-effects model due to differences in the type, duration, intensity and frequency of exercise in the analysis. MAIN RESULTS: We included six trials published between 2007 and 2014 that randomised 599 adult participants. Study size ranged from 46 to 158 participants. Participants were aged between 18 years and 80 years; we could not derive gender proportions, as participants' sex was not reported in all studies. One study was available in abstract form only.We did not find a significant difference in outcomes between people who exercised and those who did not exercise before receiving influenza vaccination.Pre-vaccination exercises included endurance activities such as walking or using a treadmill, and resistance activities included biceps curls and lateral raises. Five of the studies provided one session of exercise between 25 and 50 minutes. In five studies, exercise was undertaken on the same day as the vaccination. One study provided exercise over a period of eight weeks before vaccination, with one 2½ hour supervised session, plus daily home exercise practice of 45 minutes. Exercise intensity ranged from 55% to 85% of maximal heart rate. Control group participants undertook a range of activities, including quiet rest, sitting, reading, meditation or unspecified activity.One study reported numbers of people who contracted influenza; no significant difference was reported between exercise and no-exercise participants. None of the included studies reported complications related to influenza illness. Only one study, which we assessed as providing low-quality evidence, reported numbers of people who experienced adverse events. This study reported no significant difference in outcomes between people who exercised and those who did not. No studies reported numbers of working days or days lost related to influenza illness. Only two studies reported participant-centred outcomes.Overall, study quality was unclear; we assessed five of the six included studies to have at least four unclear 'Risk of bias' domains (allocation concealment, blinding of outcome assessment, selective reporting and other bias). Insufficient reporting in four studies about selective reporting did not provide enough information to enable judgement; only two studies were included in trials registers. AUTHORS' CONCLUSIONS: From the available evidence, we found that exercising before influenza vaccination is neither beneficial nor harmful. However, study data were limited and of low quality. Small sample sizes, study design limitations, exercise types, and focus on biochemical rather than participant-centred outcomes strongly influenced our findings.

Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake.

Aims: Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia. Methods and results: We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access. Conclusion: Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care.

Key features in telehealth-delivered cardiac rehabilitation required to optimize cardiovascular health in coronary heart disease: a systematic review and realist synthesis.

Telehealth-delivered cardiac rehabilitation (CR) programmes can potentially increase participation rates while delivering equivalent outcomes to facility-based programmes. However, key components of these interventions that reduce cardiovascular risk factors are not yet distinguished. This study aims to identify features of telehealth-delivered CR that improve secondary prevention outcomes, exercise capacity, participation, and participant satisfaction and develop recommendations for future telehealth-delivered CR. The protocol for our review was registered with the Prospective Register of Systematic Reviews (#CRD42021236471). We systematically searched four databases (PubMed, Scopus, EMBASE, and Cochrane Database) for randomized controlled trials comparing telehealth-delivered CR programmes to facility-based interventions or usual care. Two independent reviewers screened the abstracts and then full texts. Using a qualitative review methodology (realist synthesis), included articles were evaluated to determine contextual factors and potential mechanisms that impacted cardiovascular risk factors, exercise capacity, participation in the intervention, and increased satisfaction. We included 37 reports describing 26 randomized controlled trials published from 2010 to 2022. Studies were primarily conducted in Europe and Australia/Asia. Identified contextual factors and mechanisms were synthesized into four theories required to enhance participant outcomes and participation. These theories are as follows: (i) early and regular engagement; (ii) personalized interventions and shared goals; (iii) usable, accessible, and supported interventions; and (iv) exercise that is measured and monitored. Providing a personalized approach with frequent opportunities for bi-directional interaction was a critical feature for success across telehealth-delivered CR trials. Real-world effectiveness studies are now needed to complement our findings.

Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study.

AIMS: As we move into a new phase of the COVID-19 pandemic, cardiac and pulmonary services are considering how to sustain telehealth modalities long-term. It is important to learn from services that had greater telehealth adoption and determine factors that support sustained use. We aimed to describe how telehealth has been used to deliver cardiac and pulmonary rehabilitation services across Queensland, Australia. METHODS AND RESULTS: Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June and August 2021. Interview questions were guided by Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: (i) Variable levels of readiness; (ii) Greater telehealth uptake in pulmonary vs. cardiac rehabilitation; (iii) Safety and risk management; (iv) Client willingness-targeted support required; (v) Equity and access; and (vi) New models of care. We found that sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g. co-design), clinicians (e.g. shared learning), health services (e.g. increasing platform functionality), and the profession (e.g. sharing resources). CONCLUSION: There are opportunities for telehealth programmes servicing large geographic areas and opportunities to increase programme participation rates more broadly. Centralized models of care serving large geographic areas could maximize sustainability with current resource limitations; however, realizing the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organizations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth.

Since the COVID-19 pandemic onset, there has been exponential growth in the uptake of telehealth, globally. However, evidence suggests that people living in lower socioeconomic areas, cultural and linguistically diverse communities, people with disabilities, and with low health literacy are less likely to receive telehealth services. These population groups have disproportionately higher health needs and face additional barriers to healthcare access. Barriers that reduce access to telehealth further exacerbate existing gaps in care delivery. To improve equity of access to telehealth, we need to reduce the digital divide through a multi-stakeholder approach. This article proposes practical steps to reduce the digital divide and encourage equitable access to telehealth. Enabling more equitable access to telehealth requires improvements in digital health literacy, workforce training in clinical telehealth, co-design of new telehealth-enabled models of care, change management, advocacy for culturally appropriate services, and sustainable funding models.

The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019.

INTRODUCTION: To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS: A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS: We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION: This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.

How do consumers prefer their care delivered: In-person, telephone or videoconference?

AIM: To gain a better understanding of consumer experiences with and preferences for telephone and videoconference consultations (telehealth), and how these compare to traditional in-person consultations. METHODS: A national cross-sectional survey was administered to a representative sample of Australian adults who have received a telehealth service within the last year. Consumers were recruited by Qualtrics® through their online sampling service. The sample was representative of the broader Australian population according to gender, age, location (state/territory), and place of residence (urban or remote). Information on demographics (e.g., age, gender, employment status), recent telehealth experience, and preferences for consultation modality was collected. To measure preferences consumers were asked to indicate which modality they would prefer (in-person, telephone, or videoconference) for different scenarios. These included consultations of various time lengths, and for the top ten conditions for which individuals sought a general practitioner. RESULTS: A total of 1069 consumers completed the survey. When consumers were asked to describe their most recent telehealth appointment, most were for follow-up appointments (67%) and completed by telephone (77%) rather than by videoconference, and with a general practitioner (75%). In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, a telephone consultation was the preferred modality. Inexperience with videoconference and duration of consultation influenced preference for consultation mode. Consumers preferred to have short consultations of around five minutes done by telehealth (telephone or videoconference), while they preferred in-person for longer consultations (up to 60 minutes). CONCLUSIONS: Many Australians have used telehealth in the past year to access healthcare, with telephone being the most common form of communication. Given the option and the experience to date, consumers prefer telephone when consultations related to either prescriptions or test results. Experience with videoconference for consultations increased consumer preferences for using it for future consultations.

A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service.

Objectives The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31-0.36, P P Conclusion There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this.

Digital divide or digital exclusion? Do allied health professionals' assumptions drive use of telehealth?

INTRODUCTION: Telehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth. METHODS: This study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach. RESULTS: Six themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes. DISCUSSION: Clinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.

Telehealth adoption in cancer clinical trials: An Australian perspective.

INTRODUCTION: Cancer clinical trials have traditionally occurred in-person. However, the COVID-19 pandemic has forced adaptions of all aspects of cancer care (including clinical trials) so they can be delivered remotely. We aimed to quantify and qualify current use of telehealth and how it can be further improved and routinely integrated into cancer clinical trials in Australia. METHODS: We used a mixed-method study design, involving surveys of 14 multi-site Collaborative Cancer Clinical Trial Groups members across Australia (n = 98) and qualitative interviews with trial administrators and clinicians (n = 21). RESULTS: The results of our study indicated a strong willingness to use telehealth for certain transactions of clinical trials because it was perceived as a way of increasing efficiency and reach of services. Hybrid models (including telehealth and in-person methods), which considered transaction, cancer type, and patient preferences were most favorable. Additionally, telehealth allowed for greater equity to access and reduced trial burden but interestingly had little effect on increased diversity and recruitment. Factors influencing telehealth service implementation and uptake included communication among trial stakeholders, training, and learning from the experience of others in the clinical trials community. CONCLUSION: Many but not all aspects of clinical trial care are appropriate to be delivered via telehealth. A hybrid approach provides flexibility to trial delivery and may support greater equity of access to trials in the future. Our findings and actionable recommendations support the need for greater planning, training, and guidelines to enable telehealth to be better integrated into clinical trials. Opportunities exist to expand the use of remote patient monitoring to enable more objective data collection from trial participants in the future.

Does the requirement for an interpreter impact experience with telehealth modalities, acceptability and trust in telehealth? Results from a national survey including people requiring interpreter services.

We aimed to assess if experience with telehealth modalities, acceptability and levels of trust in telehealth vary with the need for an interpreter using a cross-sectional survey of telehealth consumers in Australia. Non-parametric tests were used to compare the means and percentages between those who required an interpreter and those who did not. A total of N = 1,116 completed the survey; 5% (n = 56) represented people needing an interpreter for telehealth services. Of those needing interpreters, 14.29% had experienced only phone consultations whereas 63.21% of those who did not need interpreters had experienced only phone consultations. Trust in telehealth with allied health professionals was significantly higher among people needing interpreters (mean 4.12 ± 1.02) than those with no interpreter required (mean 3.70 ± 1.30), p = 0.03. People requiring interpreters had non-significantly higher acceptability towards video consultation than those who did not (mean 3.60 ± 0.61 vs mean 3.51 ± 0.80, p = 0.42), similar to telephone consultations (mean 3.71 ± 0.95 vs mean 3.48 ± 0.79, p = 0.38). The need for interpreters does not appear to impact acceptability or trust in telehealth with doctors. However, experience with telehealth modalities and trust in telehealth with allied health varied significantly among groups. Increasing exposure to telehealth modalities, trust and acceptability is crucial to promote equitable access to telehealth.

Development and validation of the Digital Health Acceptability Questionnaire.

Acceptability (of healthcare services) is an important construct that lacks a consistent definition within research. Addressing this issue, a systematic review led to the Theoretical Framework of Acceptability. In this study, we describe the development (based on the Theoretical Framework of Acceptability) and validation of the Digital Health Acceptability Questionnaire. Nineteen items aligning with the Theoretical Framework of Acceptability were developed. Two versions of the questionnaire measuring telehealth acceptability by telephone (N = 644) and videoconference appointment (N = 425), were administered to a nationally representative survey of consumers in Australia. Two exploratory factor analyses (Oblimin rotation) were conducted for each scale (telephone/videoconference). Two-factor solutions (5 items each) were found for both (telephone/videoconference) acceptability questionnaires: (a) attitude toward the service as a means to address healthcare needs and affective attitude and (b) individual capacity and effort to use telehealth. Before rotation, Factor 1 of the telephone scale (α = 0.92) measured 56.18% of the variance and Factor 2 (α = 0.86) measured 14.17%. Factor 1 of the videoconference scale (α = 0.90) measured 56.68% of the variance and Factor 2 (α = 0.85) measured 10.63%. The full10-item acceptability questionnaire showed excellent internal consistency (telephone: α = 0.91 and videoconference: α = 0.92). The 2-dimensional Digital Health Acceptability Questionnaire is a brief survey based on research evidence and validated in a large Australian sample.

Exploring factors of uneven use of telehealth among outpatient pharmacy clinics during COVID-19: A multi-method study.

BACKGROUND: To enable services to be provided at a distance during the COVID-19 pandemic, outpatient pharmacy services in Australia underwent near-immediate reform by moving to telehealth, including telephone and video consults. OBJECTIVE: To investigate how telehealth was used in a metropolitan outpatient pharmacy setting before and after the start of the COVID-19 restrictions and the various influences on the uptake of phone and video modalities. METHODS: A multi-methods approach was used including: (1) quantifying administrative activity data between July 2019 to December 2020 and, (2) semi-structured interviews with key stakeholders (n = 34). RESULTS: Activity data: Between July 2019 to December 2020 16,377 outpatient pharmacy consults were provided. Of these, 13,543 (83%) were provided in-person, 2,608 (16%) by telephone and 226 (1.4%) by video consult. COVID-19 impacted how these services were provided with telephone activity more than four-times higher in April 2020 than March 2020 and slight increases in video consults. Pharmacists have heavily favoured using the telephone despite the recommendation that video consults be used as the primary mode of contact and that telephone only be used when a video consult was not possible. As soon as COVID-19 restrictions eased, clinicians gradually returned to in-person appointments, maintaining some use of telephone and very limited use of video consult. Semi-structured interviews: Whilst clinicians recognised the potential benefits of video consults, challenges to routine use included the additional administrative and planning work required pre-consult, perceptions that patients were unable to use the technology, and the belief that in-person care was 'better' and that the telephone was easier. CONCLUSION: Organisational strategies that encouraged the use of video over telephone (e.g. through financial incentives) did not appear to influence clinicians' choice of care modality. Implementation studies are required to co-develop solutions to embed telehealth options into outpatient pharmacy settings that provide the best experience for both patients and clinicians.