Tailoring communication practices to support effective delivery of telehealth in general practice.

BACKGROUND: The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. METHODS: This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. RESULTS: Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. CONCLUSIONS: Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice.

Pattern of mental health attendances at a metropolitan university general practice clinic in Sydney before and during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The aim of this study was to describe the pattern of mental health attendances in a university-based general practice clinic during phases of the COVID-19 pandemic. The COVID-19 pandemic has created social and medical disruptions to the Australian community. There is a literature gap pertaining to the ongoing trends that extend beyond the initial 'first wave' of the pandemic in the context of the Australian landscape. METHOD: Retrospective data were obtained from 435 adults attending a community university-based general practice in Sydney, Australia, during four time periods: T1, before the COVID-19 pandemic (1 February - 7 March 2019); T2, during the first COVID-19 lockdown (31 March - 4 May 2020); T3, during the second COVID-19 lockdown (20 August - 23 September 2021); and T4, after the end of the COVID-19 lockdowns (1 February - 7 March 2022). Attendances were identified as mental health Medicare Benefits Schedule codes for face-to-face, televideo and telephone consultations. Patterns of attendances were evaluated using frequency analysis. RESULTS: There was a decline in mental health attendances compared to all attendances at the general practice from T1 (7.5%) to T2 (4.8%). During T4, mental health attendances returned to 7.1% of all consultations at the general practice. Face-to-face attendances decreased by 50% in T2 relative to T1, and this trend was maintained in T3 and T4, whereas the utilisation of telehealth approached that of face-to-face by T4. DISCUSSION: Post-pandemic policies that support the use of telehealth in general practice may help improve mental healthcare delivery and outcomes.

Experiences of telehealth in general practice in Australia: research protocol for a mixed-methods study.

BACKGROUND: Owing to the COVID-19 pandemic, the use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood. AIM: This study will explore interactional practices of GPs and patients in telehealth consultations to develop evidence-based resources to improve communication. DESIGN & SETTING: The study will be conducted within the Australian general practice setting. METHOD: Conversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews, and collaborative workshops with telehealth users including both GPs and patients. CONCLUSION: Effective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. Evidence-based guidelines encompassing effective telehealth communication strategies will be co-developed with end-users in this study.

Assessing Long-Term Trend of Particulate Matter Pollution in the Pearl River Delta Region Using Satellite Remote Sensing.

Serious particulate matter (PM) pollution problems in many polluted regions of China have been frequently reported in recent years. Long-term exposure to ambient PM pollution is significantly associated with adverse health effects. Characterizing the long-term trends and variation in PM pollution is a basic requirement for evaluating long-term exposure and for guiding future policies to reduce the effects of air pollution on health. However, long-term, ground-based PM measurements are only available at a few fixed stations. In this study, an algorithm is developed and validated to estimate PM concentrations based on the satellite atmospheric optical depth with 1 km spatial resolution. The long-term trends of PM10 concentrations in the entire Pearl River Delta (PRD) region and different cities are quantified and discussed. From 2001 to 2013, the PM10 pollution of the entire PRD region was dominated by a decreasing trend of -0.15 ± 0.23 µg/m(3)·yr. This decreasing PM10 trend was apparent over 75% of the PRD area, with the most significant decreases observed in the center of the region. However, the remaining 25%, mostly located in the outskirts of the region, showed an increasing PM10 trend. This overall decreasing trend indicates the effectiveness of the control measures applied in the past decade for the primary pollutants.

Differential regulation of chemotaxis: role of Gßγ in chemokine receptor-induced cell migration.

CC and CXC chemokine receptor signalling networks are regulated in different ways. Here we show that intracellular calcium release and cell migration occur independent of Gßγ activation in response to CCL3, whereas CXCL11 induced migration of activated T-lymphocytes depends on Gßγ activation. Treatment of a range of cell types with gallein, a pharmacological inhibitor of Gßγ signalling, did not result in a reduction in CCL3 induced cellular migration, but resulted in enhanced calcium mobilisation following chemokine stimulation. Inhibition of PI3 kinase (PI3K) and AKT, which are activated downstream of Gßγ, equally had no effect on calcium release and a minor effect on cell migration. Similarly, inhibition of ERK1/2 did not prevent CCL3 induced migration. Interestingly, Gßγ as well as PI3K activation is necessary for CXCL11 induced migration of activated T-cells. These data not only confirm a role for Gßγ signalling in CXCL11 induced migration, but also demonstrate that targeting Gßγ as a therapeutic target to prevent migration in inflammatory disease may not be beneficial, at least not for CCL3 induced migration. This highlights the distinct differences in the mechanisms on how CC- and CXC-receptors activate cellular migration.