Health and Wellbeing of Regional and Rural Australian Healthcare Workers during the COVID-19 Pandemic: Baseline Cross-Sectional Findings from the Loddon Mallee Healthcare Worker COVID-19 Study-A Prospective Cohort Study.

BACKGROUND: Coronavirus 19 (COVID-19) has created complex pressures and challenges for healthcare systems worldwide; however, little is known about the impacts COVID-19 has had on regional/rural healthcare workers. The Loddon Mallee Healthcare Worker COVID-19 Study (LMHCWCS) cohort was established to explore and describe the immediate and long-term impacts of the COVID-19 pandemic on regional and rural healthcare workers. METHODS: Eligible healthcare workers employed within 23 different healthcare organisations located in the Loddon Mallee region of Victoria, Australia, were included. In this cohort study, a total of 1313 participants were recruited from November 2020-May 2021. Symptoms of depression, anxiety, post-traumatic stress, and burnout were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7), Impact of Events Scale-6 (IES-6), and Copenhagen Burnout Inventory (CBI), respectively. Resilience and optimism were measured using the Brief Resilience Scale and Life Orientation Test-Revised (LOT-R), respectively. Subjective fear of COVID-19 was measured using the Fear of COVID-19 Scale. RESULTS: These cross-sectional baseline findings demonstrate that regional/rural healthcare workers were experiencing moderate/severe depressive symptoms (n = 211, 16.1%), moderate to severe anxiety symptoms (n = 193, 14.7%), and high personal or patient/client burnout with median total scores of 46.4 (IQR = 28.6) and 25.0 (IQR = 29.2), respectively. There was a moderate degree of COVID-19-related fear. However, most participants demonstrated a normal/high degree of resilience (n = 854, 65.0%). Based on self-reporting, 15.4% had a BMI from 18.5 to 24.9 kgm2 and 37.0% have a BMI of 25 kgm2 or over. Overall, 7.3% of participants reported they were current smokers and 20.6% reported alcohol consumption that is considered moderate/high-risk drinking. Only 21.2% of the sample reported consuming four or more serves of vegetables daily and 37.8% reported consuming two or more serves of fruit daily. There were 48.0% the sample who reported having poor sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI). CONCLUSION: Regional/rural healthcare workers in Victoria, Australia, were experiencing a moderate to high degree of psychological distress during the early stages of the pandemic. However, most participants demonstrated a normal/high degree of resilience. Findings will be used to inform policy options to support healthcare workers in responding to future pandemics.

The moderating role of psychological resilience in the relationship between fear of COVID-19 and psychological distress, in a cohort of rural and regional healthcare workers. During major lockdowns in Victoria, Australia 2020-2021.

The emergence of the COVID-19 pandemic resulted in substantial pressures for healthcare workers across the world. The association between fear of COVID-19 and psychological distress, and the role of psychological resilience have gained research interest. The current study aimed to investigate the cross-sectional association between fear of COVID-19 and psychological distress, in Australian rural/regional healthcare workers and determine whether resilience modifies this association. Most participants were nurses (38.0%), mean age was 44.9 years, and 80.5% were female (N = 1313). An adjusted logistic regression analysis showed that the highest tertile of the Fear of COVID-19 scale was associated with higher odds of moderate to severe symptoms of anxiety (OR = 3.72, 95% CI = 2.27, 6.11; p < 0.001) and depression (OR = 3.48, 95% CI = 2.30, 5.28; p < 0.001). Healthcare workers with high level of fear of COVID-19 and low level of resilience were much more likely to report moderate to severe symptoms of anxiety (OR = 12.27, 95% CI = 6.65-22.65, p < 0.001) and depression (OR = 12.21, 95% CI = 6.93-21.50, p < 0.001) when compared to healthcare workers with low level of fear of COVID-19 and high level of resilience. A cross-sectional design was used and therefore cause and effect between fear of COVID-19 and psychological distress cannot be inferred. Longitudinal research is needed to investigate the possible causal relationship. These findings highlight the potential mental health effects of fear of COVID-19 on HCWs and demonstrate the importance of resilience as a possible moderator of these effects.

Understanding the research capacity and culture of a regional allied health workforce.

The aim of this study was to understand the research capacity and culture of a regional allied health workforce over time. A cross-sectional study design was used, with data collected using the validated Research Capacity and Culture (RCC) tool. The results were compared with an earlier administration of the RCC survey. The findings demonstrate that allied health professionals (AHPs) perceive that the organisation's capability of conducting research is at a higher level than that of teams and individuals. Over a 4-year period the profile of the research culture of an allied health workforce in a regional health service was described similarly. The highest rated motivator for conducting research (to develop skills) and barrier to conducting research (other work roles take priority) were unchanged between 2018 and 2014. AHPs have maintained the previous viewpoint that there is research capacity at the health service and opportunities to develop the research culture. The findings of the 2018 data compared with the 2014 data highlight that specific and targeted research capacity-building strategies need to be used in order to create an active and vibrant research culture.

Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program.

Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P=0.037) and complex needs (P<0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P<0.001), heart disease (P=0.015) and complex needs (P=0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0-65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

Mapping patient flow in a regional Australian emergency department: a model driven approach.

Unified Modelling Language (UML) models of the patient journey in a regional Australian emergency department (ED) were used to develop an accurate, complete representation of ED processes and drive the collection of comprehensive quantitative and qualitative service delivery and patient treatment data as an evidence base for hospital service planning. The focus was to identify bottle-necks that contribute to over-crowding. Data was collected entirely independently of the routine hospital data collection system. The greatest source of delay in patient flow was the waiting time from a bed request to exit from the ED for hospital admission. It represented 61% of the time that these patients occupied ED cubicles. The physical layout of the triage area was identified as counterproductive to efficient triaging, and the results of investigations were often observed to be available for some time before clinical staff became aware. The use of independent primary data to construct UML models of the patient journey was effective in identifying sources of delay in patient flow, and aspects of ED activity that could be improved. The findings contributed to recent department re-design and informed an initiative to develop a business intelligence system for predicting impending occurrence of access block.

Correlation of MAPT scores with clinical and radiographic assessment of patients awaiting THR/TKR.

BACKGROUND: The Multi-attribute Arthritis Prioritisation Tool (MAPT) score is used as a tool to prioritize referrals to specialist clinics and care given to patients with hip and knee problems. Our pilot study aimed to determine the extent of any relationship between the MAPT scores and the clinician's assessment of severity of disease in terms of surgical waiting list (SWL) categories and radiological assessment. METHODS: This is a retrospective study of patients with symptomatic hip or knee osteoarthritis (OA) that were referred via the orthopaedic waiting list project between January and July 2009 to the Bendigo Health's orthopaedic outpatients clinic and were waitlisted for a total hip replacement (THR)/total knee replacement (TKR). The MAPT score was calculated and the Surgical waitlist Category was obtained from the surgical booking office. The radiographs of all these patients were reviewed and graded independently according to the Kellgren and Lawrence radiographic grading for severity of arthritis. The relationships between MAPT score, SWL category and the Kellgren and Lawrence radiographic grades were examined using graphical methods and Kendall's tau correlation coefficients. RESULTS: There were 62 patients in the study. The Kendall-tau sample correlation coefficient between MAPT score and the radiographic grade is τ(b) = -0.091 (P = 0.330) and between MAPT score and SWL category is τ(b) = 0.007 (P = 0.951). CONCLUSIONS: The sample data suggests that there is no significant relationship between the MAPT score and radiographic severity of OA, or between MAPT score and surgical waitlist category of patients with OA waitlisted for a THR/TKR.

Planning for transition care.

The Australian Government introduced the National Transition Care Program in the 2004-2005 Federal Budget. This program is designed to assist elderly patients who have completed a stay in hospital to move from the hospital to their homes or other suitable accommodation. In planning for transition care services, managers are faced with the question, "How many places should be allocated to transition care in our facility?" This case study offers an approach to this question based on queueing theory.

Assessing the impact of streaming in a regional emergency department.

OBJECTIVE: To evaluate the impact of a streaming model, previously validated in metropolitan EDs, on selected performance indicators in a regional ED. METHOD: Multiple linear regression models were applied to monthly time series data from 43 months prior to the intervention and 15 months following the intervention to measure the impact of the streaming model on the following performance indicators: (i) percentage of emergency patients admitted to an inpatient bed within 8 h; (ii) percentage of non-admitted emergency patients with a length of stay of less than 4 h; and (iii) percentage of emergency patients who left without being seen by a doctor or nurse practitioner. SETTING: Bendigo Health ED in regional Victoria. RESULTS: Prior to the introduction of streaming, there was a downward trend in both the percentage of emergency patients admitted to an inpatient bed within 8 h, and the percentage of non-admitted emergency patients with a length of stay of less than 4 h. After the introduction of streaming, these trends were reversed (P = 0.008 and P = 0.004, respectively). There was no statistically significant change in the trend associated with the percentage of emergency patients who left without being seen (P = 0.904). CONCLUSIONS: The implementation of the streaming model had an impact on the two performance indicators associated with length of stay in this regional ED, but did not have a significant impact (positive or negative) on the percentage of patients who did not wait to be seen. These results might interest other EDs in regional hospitals.

Forecasting emergency department presentations.

OBJECTIVE: To forecast the number of patients who will present each month at the emergency department of a hospital in regional Victoria. METHODS: The data on which the forecasts are based are the number of presentations in the emergency department for each month from 2000 to 2005. The statistical forecasting methods used are exponential smoothing and Box-Jenkins methods as implemented in the software package SPSS version 14.0 (SPSS Inc, Chicago, Ill, USA). RESULTS: For the particular time series, of the available models, a simple seasonal exponential smoothing model provides optimal forecasting performance. Forecasts for the first five months in 2006 compare well with the observed attendance data. CONCLUSIONS: Time series analysis is shown to provide a useful, readily available tool for predicting emergency department demand. The approach and lessons from this experience may assist other hospitals and emergency departments to conduct their own analysis to aid planning.