Evolving Adult ADHD Care: Preparatory Evaluation of a Prototype Digital Service Model Innovation for ADHD Care.

BACKGROUND: Given the prevalence of ADHD and the gaps in ADHD care in Australia, this study investigates the critical barriers and driving forces for innovation. It does so by conducting a preparatory evaluation of an ADHD prototype digital service innovation designed to help streamline ADHD care and empower individual self-management. METHODS: Semi-structured interviews with ADHD care consumers/participants and practitioners explored their experiences and provided feedback on a mobile self-monitoring app and related service innovations. Interview transcripts were double coded to explore thematic barriers and the enablers for better ADHD care. RESULTS: Fifteen interviews (9 consumers, 6 practitioners) revealed barriers to better ADHD care for consumers (ignorance and prejudice, trust, impatience) and for practitioners (complexity, sustainability). Enablers for consumers included validation/empowerment, privacy, and security frameworks, tailoring, and access. Practitioners highlighted the value of transparency, privacy and security frameworks, streamlined content, connected care between services, and the tailoring of broader metrics. CONCLUSIONS: A consumer-centred approach to digital health service innovation, featuring streamlined, private, and secure solutions with enhanced mobile tools proves instrumental in bridging gaps in ADHD care in Australia. These innovations should help to address the gaps in ADHD care in Australia. These innovations should encompass integrated care, targeted treatment outcome data, and additional lifestyle support, whilst recognising the tensions between customised functionalities and streamlined displays.

Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study.

BACKGROUND: In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests-focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information. OBJECTIVE: This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications. METHODS: We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis. RESULTS: Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology's utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages. CONCLUSIONS: We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users.

High-Quality eHealth Websites for Information on Endometriosis: Systematic Search.

BACKGROUND: eHealth websites are increasingly being used by community members to obtain information about endometriosis. Additionally, clinicians can use these websites to enhance their understanding of the condition and refer patients to these websites. However, poor-quality information can adversely impact users. Therefore, a critical evaluation is needed to assess and recommend high-quality endometriosis websites. OBJECTIVE: This study aimed to evaluate the quality and provide recommendations for high-quality endometriosis eHealth websites for the community and clinicians. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed 2 Google searches of international and Australian eHealth websites. The first search string used the terms "endometriosis," "adenomyosis," or "pelvic pain," whereas "Australia" was added to the second search string. Only free eHealth websites in English were included. ENLIGHT, a validated tool, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. Websites with a total score of 3.5 or more were classified as "good" according to the ENLIGHT scoring system and are recommended as high-quality eHealth websites for information on endometriosis. RESULTS: In total, 117 eHealth websites were screened, and 80 were included in the quality assessment. Four high-quality eHealth websites (ie, those that scored 3.5 or more) were identified (Endometriosis Australia Facebook Page, Endometriosis UK, National Action Plan for Endometriosis on EndoActive, and Adenomyosis by the Medical Republic). These websites provided easily understood, engaging, and accurate information. Adenomyosis by the Medical Republic can be used as a resource in clinical practice. Most eHealth websites scored well, 3.5 or more in the domains of usability (n=76, 95%), visual design (n=64, 80%), and content (n=63, 79%). However, of the 63 websites, only 25 provided references and 26 provided authorship details. Few eHealth websites scored well on user engagement (n=18, 23%), therapeutic persuasiveness (n=2, 3%), and therapeutic alliance (n=22, 28%). In total, 30 (38%) eHealth websites scored well on general subjective evaluation. CONCLUSIONS: Although geographical location can influence the search results, we identified 4 high-quality endometriosis eHealth websites that can be recommended to the endometriosis community and clinicians. To improve quality, eHealth websites must provide evidence-based information with appropriate referencing and authorship. Factors that enhance usability, visual design, user engagement, therapeutic persuasiveness, and therapeutic alliance can lead to the successful and long-term uptake of eHealth websites. User engagement, therapeutic persuasiveness, and therapeutic alliance can be strengthened by sharing lived experiences and personal stories and by cocreating meaningful content for both the community and clinicians. Reach and discoverability can be improved by leveraging search engine optimization tools. TRIAL REGISTRATION: PROSPERO CRD42020185475; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185475&VersionID=2124365.

A micro-randomized pilot study to examine the impact of just-in-time nudging on after-dinner snacking in adults with type 2 diabetes: A study protocol.

AIM: To determine whether a digital nudge soon after dinner reduces after-dinner snacking events as measured objectively by continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D). METHODS: This is a single-site micro-randomized trial (MRT). People with T2D, aged 18-75 years, managed with diet or a stable dose of oral antidiabetic medications for at least 3 months, and who habitual snack after dinner at least 3 nights per week, will be recruited. Picto-graphic nudges were designed by mixed research methods. After a 2-week lead-in phase to determine eligibility and snacking behaviours by a CGM detection algorithm developed by the investigators, participants will be micro-randomized daily (1:1) to a second 2-week period to either a picto-graphic nudge delivered-in-time (Intui Research) or no nudge. During lead-in and MRT phases, 24-hour glucose will be measured by CGM, sleep will be tracked by an under-mattress sleep sensor, and dinner timing will be captured daily by photographing the evening meal. RESULTS: The primary outcome is the difference in the incremental area under the CGM curve between nudging and non-nudging days during the period from 90 minutes after dinner until 04:00 AM. Secondary outcomes include the effect of baseline characteristics on treatment, and comparisons of glucose peaks and time-in-range between nudging and non-nudging days. The feasibility of 'just-in-time' messaging and nudge acceptability will be evaluated, along with the analysis of sleep quality measures and their night-to-night variability. CONCLUSIONS: This study will provide preliminary evidence of the impact of appropriately timed digital nudges on 24 -hour intertitial glucose levels resulting from altered after-dinner snacking in people with T2D. An exploratory sleep substudy will provide evidence of a bidirectional relationship between after-dinner snacking behaviour, glycaemia and sleep. Ultimately, this study will allow for the design of a future confirmatory study of the potential for digital nudging to improve health related behaviours and health outcomes.

Heart Rate Variability for Evaluating Psychological Stress Changes in Healthy Adults: A Scoping Review.

The utility of heart rate variability (HRV) for characterizing psychological stress is primarily impacted by methodological considerations such as study populations, experienced versus induced stress, and method of stress assessment. Here, we review studies on the associations between HRV and psychological stress, examining the nature of stress, ways stress was assessed, and HRV metrics used. The review was performed according to the PRISMA guidelines on select databases. Studies that examined the HRV-stress relationship via repeated measurements and validated psychometric instruments were included (n = 15). Participant numbers and ages ranged between 10 and 403 subjects and 18 and 60 years, respectively. Both experimental (n = 9) and real-life stress (n = 6) have been explored. While RMSSD was the most reported HRV metric (n = 10) significantly associated with stress, other metrics, including LF/HF (n = 7) and HF power (n = 6) were also reported. Various linear and nonlinear HRV metrics have been utilized, with nonlinear metrics used less often. The most frequently used psychometric instrument was the State-Trait Anxiety Inventory (n = 10), though various other instruments have been reported. In conclusion, HRV is a valid measure of the psychological stress response. Standard stress induction and assessment protocols combined with validated HRV measures in different domains will improve the validity of findings.

Hearing Health Care Stakeholders' Perspectives on Teleaudiology Implementation: Lessons Learned During the COVID-19 Pandemic and Pathways Forward.

PURPOSE: The purpose of this study was to explore how teleaudiology is perceived by Australian-based hearing health care stakeholders (clients, clinicians, students, academics, and industry partners) to inform future teleaudiology implementation. METHOD: Five cross-sectional online surveys were adopted, and a total of 366 stakeholders responded (173 clients, 110 clinicians, 58 students, 19 academics, and six industry partners). RESULTS: Results show that 55% of clients and over 90% of clinicians, students, academics, and industry partners knew what teleaudiology was. Experience in teleaudiology appointments was shared by 85% of clinicians and 7% of clients. Moreover, 98% of clients were not offered any teleaudiology appointments. Teleaudiology apps were used by 66% of clinicians and 26% of clients. Both clients and clinicians acknowledged the benefits of teleaudiology including convenience and accessibility and identified drawbacks, such as loss of personal interaction and communication difficulty. About 80% of students and academics reported inclusion of teleaudiology within their universities' curriculum but only to a limited extent. Low teleaudiology uptake rates in placement clinics, as well as insufficient funding and staffing, were suggested as barriers to learning and teaching teleaudiology. Industry partners were generally confident in training clinicians to use teleaudiology products and teaching students on teleaudiology, but only one industry partner had been invited by universities for teaching purposes. CONCLUSIONS: Low teleaudiology use and reserved attitudes toward widespread teleaudiology implementation were observed among clients. Clinicians, students, academics, and industry partners generally displayed positive attitudes toward teleaudiology use. Increasing awareness of teleaudiology services and collaboration between stakeholders are crucial in promoting teleaudiology uptake. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23519292.

An Umbrella Systematic Review of Seasonality in Mood Disorders and Suicide Risk: The Impact on Demand for Primary Behavioral Health Care and Acute Psychiatric Services.

Objective: To review the current literature focusing on the most recent systematic reviews relating to mood, suicide, and psychiatric service utilization.Study Selection and Data Extraction: A systematic literature search of PubMed, CINAHL, and PsycINFO databases using the search terms "Systematic review" AND "season*" AND mood OR depression OR bipolar OR psychosis OR suicid* OR psychiatr* initially yielded 209 results. After screening by title and abstract for relevance, 6 records remained, while a further 3 were identified after screening of reference lists. A qualitative synthesis of these results was then performed due to data heterogeneity between studies.Results: We found evidence of winter peaks for depressive symptoms and suggestions of summer peaks for suicidal activity, emergency department (ED) self-harm presentations, and manic-related hospital admissions. Suicide is 11%-23% more frequent in spring and summer. ED suicide attempts are also 1.2-1.7 times higher in spring and summer compared to winter. Admissions for mania are 7.4%-16% higher in spring and summer, while there are 1.5 times more admissions for bipolar depression in winter months.Conclusions: There is a summer peak for many aspects of mental health activity, particularly in terms of acute hospital utilization and suicidality. This is contrary to the winter-related peak of depressive symptoms. Further research is needed to affirm these findings.

Examining clinician choice to follow-up (or not) on automated notifications of medication non-adherence by clinical decision support systems.

BACKGROUND: Maintaining medication adherence can be challenging for people living with mental ill-health. Clinical decision support systems (CDSS) based on automated detection of problematic patterns in Electronic Health Records (EHRs) have the potential to enable early intervention into non-adherence events ("flags") through suggesting evidence-based courses of action. However, extant literature shows multiple barriers-perceived lack of benefit in following up low-risk cases, veracity of data, human-centric design concerns, etc.-to clinician follow-up in real-world settings. This study examined patterns in clinician decision making behaviour related to follow-up of non-adherence prompts within a community mental health clinic. METHODS: The prompts for follow-up, and the recording of clinician responses, were enabled by CDSS software (AI2). De-identified clinician notes recorded after reviewing a prompt were analysed using a thematic synthesis approach-starting with descriptions of clinician comments, then sorting into analytical themes related to design and, in parallel, a priori categories describing follow-up behaviours. Hypotheses derived from the literature about the follow-up categories' relationships with client and medication-subtype characteristics were tested. RESULTS: The majority of clients were Not Followed-up (n = 260; 78%; Followed-up: n = 71; 22%). The analytical themes emerging from the decision notes suggested contextual factors-the clients' environment, their clinical relationships, and medical needs-mediated how clinicians interacted with the CDSS flags. Significant differences were found between medication subtypes and follow-up, with Anti-depressants less likely to be followed up than Anti-Psychotics and Anxiolytics (χ2 = 35.196, 44.825; p < 0.001; v = 0.389, 0.499); and between the time taken to action Followed-up0 and Not-followed up1 flags (M0 = 31.78; M1 = 45.55; U = 12,119; p < 0.001; η2 = .05). CONCLUSION: These analyses encourage actively incorporating the input of consumers and carers, non-EHR data streams, and better incorporation of data from parallel health systems and other clinicians into CDSS designs to encourage follow-up.

COVID-19 and tinnitus: an initiative to improve tinnitus care.

OBJECTIVE: To investigate the effects of COVID-19 on individuals with tinnitus and their views to guide future tinnitus care. DESIGN: A mixed-methods cross-sectional research design. STUDY SAMPLE: An online survey was completed by 365 individuals with tinnitus from Australia and other countries. RESULTS: Tinnitus was reported to be more bothersome during the pandemic by 36% of respondents, whereas 59% reported no change and 5% reported less bothersome tinnitus. Nearly half of the respondents had received COVID-19 vaccination(s) and 12% of them reported more bothersome tinnitus while 2% developed tinnitus post-vaccination. Australian respondents spent less time in self-isolation or quarantine and saw fewer change in in-person social contact than respondents from other countries. More than 70% of respondents thought that tinnitus care services were insufficient both before and during the pandemic. Regarding their opinions on how to improve tinnitus care in the future, five themes including alleviation of condition, government policies, reduced barriers, self- and public-awareness, and hearing devices were identified. CONCLUSIONS: A majority of respondents did not perceive any change in tinnitus perception and one-third of respondents had worsened tinnitus during the pandemic. To improve tinnitus care, better awareness and more accessible resources and management are crucial.

Integrating smart phone applications in the management of cirrhotic patients: A scoping review.

Background and Aim: Chronic liver disease and cirrhosis is a significant cause of healthcare utilization and patient morbidity and mortality worldwide. Smartphone applications have high uptake in most communities and therefore have great potential to provide remote support solutions to this patient population. The aim of this scoping review was therefore to provide a comprehensive overview using narrative synthesis on the use of smartphone-application-based digital interventions in cirrhotic populations. Materials and Methods: PRISMA guidelines were followed, with two independent researchers identifying 10 relevant studies. Patients studied were predominantly those with decompensated cirrhosis, and hepatic encephalopathy was the most common complication studied. Results: Smartphones were the most common platform used, but training periods, prior to commencement of the study, were rarely offered. Patient engagement rates with the technology were reported only in three studies, but all reported high (>50%) rates of engagement. Only one study examined the clinical effects of their digital intervention, with a 38% reduction in readmission rate reported. Conclusion: Overall, the use of smartphone apps in cirrhosis is in an early phase of development and evaluation but preliminary studies suggest significant potential as an adjunct to routine medical care. Further high-quality studies of well-designed digital interventions are needed to advance this promising early experience.

Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis.

Background: Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16-24 years of age) engagement with wellbeing apps. Methods: A systematic review of the literature and narrative synthesis was conducted to investigate users' characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included. Results: Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others. Conclusion: This research reflects on the need to consider participants' individuality when designing app mediated wellbeing interventions.

Automated Decision Support For Community Mental Health Services Using National Electronic Health Records: Qualitative Implementation Case Study.

BACKGROUND: A high proportion of patients with severe mental illness relapse due to nonadherence to psychotropic medication. In this paper, we use the normalization process theory (NPT) to describe the implementation of a web-based clinical decision support system (CDSS) for Community Mental Health Services (CMHS) called Actionable Intime Insights or AI2. AI2 has two distinct functions: (1) it provides an overview of medication and treatment history to assist in reviewing patient adherence and (2) gives alerts indicating nonadherence to support early intervention. OBJECTIVE: Our objective is to evaluate the pilot implementation of the AI2 application to better understand the challenges of implementing a web-based CDSS to support medication adherence and early intervention in CMHS. METHODS: The NPT and participatory action framework were used to both explore and support implementation. Qualitative data were collected over the course of the 14-month implementation, in which researchers were active participants. Data were analyzed and coded using the NPT framework. Qualitative data included discussions, meetings, and work products, including emails and documents. RESULTS: This study explores the barriers and enablers of implementing a CDSS to support early intervention within CMHS using Medicare data from Australia's national electronic record system, My Health Record (MyHR). The implementation was a series of ongoing negotiations, which resulted in a staged implementation with compromises on both sides. Clinicians were initially hesitant about using a CDSS based on MyHR data and expressed concerns about the changes to their work practice required to support early intervention. Substantial workarounds were required to move the implementation forward. This pilot implementation allowed us to better understand the challenges of implementation and the resources and support required to implement and sustain a model of care based on automated alerts to support early intervention. CONCLUSIONS: The use of decision support based on electronic health records is growing, and while implementation is challenging, the potential benefits of early intervention to prevent relapse and hospitalization and ensure increased efficiency of the health care system are worth pursuing.

Point of view: Could social media use be contributing to rising rates of deliberate self-harm and suicide in Australian youth populations?

OBJECTIVE: A rapid clinical update on the potential interplay between social media use and rates of deliberate self-harm amongst young people in Australia. CONCLUSIONS: Rising social media use has been associated with increasing cyberbullying and deliberate self-harm, especially in young women. On the other hand, social media use also provides beneficial support. Examination of problematic social media use in assessments of young people presenting with self-harm may be useful, along with discussion of responses to negative social media. In this point of view, we discuss these matters and the UK Royal College of Psychiatrists' recommendations for reducing the negative impact of social media.

Cost and Effort Considerations for the Development of Intervention Studies Using Mobile Health Platforms: Pragmatic Case Study.

BACKGROUND: The research marketplace has seen a flood of open-source or commercial mobile health (mHealth) platforms that can collect and use user data in real time. However, there is a lack of practical literature on how these platforms are developed, integrated into study designs, and adopted, including important information around cost and effort considerations. OBJECTIVE: We intend to build critical literacy in the clinician-researcher readership into the cost, effort, and processes involved in developing and operationalizing an mHealth platform, focusing on Intui, an mHealth platform that we developed. METHODS: We describe the development of the Intui mHealth platform and general principles of its operationalization across sites. RESULTS: We provide a worked example in the form of a case study. Intui was operationalized in the design of a behavioral activation intervention in collaboration with a mental health service provider. We describe the design specifications of the study site, the developed software, and the cost and effort required to build the final product. CONCLUSIONS: Study designs, researcher needs, and technical considerations can impact effort and costs associated with the use of mHealth platforms. Greater transparency from platform developers about the impact of these factors on practical considerations relevant to end users such as clinician-researchers is crucial to increasing critical literacy around mHealth, thereby aiding in the widespread use of these potentially beneficial technologies and building clinician confidence in these tools.

Provider perspectives on telemental health implementation: Lessons learned during the COVID-19 pandemic and paths forward.

After years of slow and fragmented implementation of telemental health (TMH), the coronavirus disease (COVID-19) pandemic necessitated widespread adoption. With the initial state of public health emergency behind us, we are at a decision point on whether to continue with TMH or return to a largely in-person care model. In this qualitative study, we investigated clinicians' perspectives on advantages and disadvantages of TMH in outpatient mental healthcare as well as considerations for future implementation. We conducted 29 semistructured interviews with outpatient mental health providers. Data were analyzed using rapid qualitative analysis methodology. Advantages included increased utilization of services, improved therapeutic processes, and improved provider wellbeing. Providers, however, also noted that TMH has some disadvantages in terms of therapeutic processes and provider wellbeing, and they reported technology issues as an additional disadvantage. Overall providers reported they can provide high quality care via TMH, but indicated some patient populations and appointment types are a better fit for in-person services. Most providers preferred a hybrid model of care moving forward with reimbursement discrepancies and out-of-state licensure restrictions as barriers. They indicated that, as TMH becomes a mainstay in psychiatric care, training and professional guidelines will be important. Continued implementation of TMH alongside in-person care is likely to offer improved access and enhanced service quality when applied to the right patient populations and appointment types. Effective implementation may require policy and systems level support on equitable reimbursement rates, out-of-state licensure restrictions and professional guidelines for delivering TMH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do young men and women differ in well-being apps usage? Findings from a randomised trial.

Introduction: The potential of mobile applications (apps) as a resource to support well-being in young people is hampered by low usage. Suggested reasons for this vary from technical issues to users' psychological and personal characteristics like gender, mood and perceptions on well-being. Objectives: To identify and understand predictive variables related to the use of well-being apps by young people in the context of the 'Online Wellbeing Centre' (OWC) Randomised Controlled Trial (a study assessing changes in well-being of young people who use well-being apps). Methods: A cross-sectional analysis using binary logistic regression was conducted, taking into account previous app usage of participants at baseline versus demographic, ecological momentary assessments, and well-being variables, of data collected in the OWC-RCT. To explore predictors further, follow-up post-RCT surveys were coded to better understand user's predisposition towards apps. Results: Mood (p < 0.006) and gender (p < 0.03) are significantly associated with the use of well-being apps. Female participants with elevated mood were more likely to use well-being apps before signing up into the study. Two themes were identified from participants at follow-up that related to the design of the app and engagement of the app user. Females were more likely to focus on the purpose of app, whereas males were more likely to focus on specific goals and features (e.g. tracking) offered by the app. Females were able to mention the link between well-being and app usage. Conclusion: Personal characteristics explain engagement with well-being apps, with mood and gender significant in the current sample. Further qualitative research may help identify other individual characteristics that explain why and how young people use well-being apps and the impact of these on a user's health.

Rapid national increases in the hospitalisation of Australian youth due to intentional self-harm between 2008 and 2019.

OBJECTIVE: Australian youth mental health services have received significant funding over the past 15 years. We analysed data on hospitalisation due to intentional self-harm to determine whether increased youth services were associated with reduction in a key indicator of youth population mental health. METHOD: Trends in national self-harm hospitalisation data from 2008 to 2019 for youth (<25 years) and adults (>25 years) were analysed using joinpoint regression. RESULTS: Rates of hospitalisation due to intentional self-harm increased significantly in both male (1.1% per annum, 95% CI [0.2%, 1.9%]) and female (3.0% per annum, 95% CI [0.9%, 5.1%]) youth aged <25 years between 2008 and 2019. Female youth had higher rates of hospitalisation than males, and there were average annual increases of 9.1% (95% CI [2.4%, 16.3%]) and 4.0% (95% CI [0.1%, 7.9%]), and absolute increases of 120% and 47.9%, in the rate of hospitalisation of females aged 0-14 and 15-19, respectively. In contrast, there was no overall change in adults (>25 years). CONCLUSIONS: Rates of hospitalisation due to intentional self-harm in Australian youth have increased despite significant investment in youth mental health services. This result could be attributable to several sociocultural factors and suggests a critical need for more hospital-based emergency youth mental health services.

Rethinking heart failure care and health technologies from early COVID-19 experiences - A narrative review.

Heart Failure (HF), a common chronic disease, requires multidisciplinary care to optimise outcomes. The COVID-19 pandemic, its impact on people's movement and access to health services, introduced severe challenges to chronic disease management. The era that will evolve after this pandemic is likely to provide uncertainty and service model disruptions. HF treatment is based on guidelines derived from randomised clinical trial evidence. Translational shortfalls from trials into practice have been overcome with post-trial service improvement studies like OPTIMIZE-HF where a team using a process of care can translate evidence to the general population. However, gaps remain for vulnerable populations e.g. those with more severe HF, with multiple comorbid conditions, and certain demographic groups and/or residents in remote locations. Health technology has come with great promise, to fill some of these gaps. The COVID-19 pandemic provides an opportunity to observe, from Australian healthcare lens, HF management outside the traditional model of care. This narrative review describes relatively recent events with health technology as a solution to improve on service gaps.

Demonstration of automated non-adherence and service disengagement risk monitoring with active follow-up for severe mental illness.

AIMS: Medication cessation and service disengagement often precedes relapse in people with severe mental illnesses but currently specialist mental health services only become involved after a relapse. Early detection of non-adherence is needed to enable intervention to avert relapse. This paper aims to demonstrate how digitally automated non-adherence risk monitoring from Medicare data with active follow-up can work and perform in practice in a real-world mental health service setting. METHODS: AI2 software is an automated risk monitoring tool to detect non-adherence using Medicare data. It was implemented prospectively in a cohort of 354 registered patients of a community mental health clinic between July 2019 and February 2020. Patients flagged as at risk by the software were reviewed by two clinicians. We describe the risks automatically flagged for non-adherence and the clinical responses. We examine differences in clinical and demographic factors in patients flagged at increased risk of non-adherence. RESULTS: In total, 46.7% (142/304) were flagged by the software as at risk of non-adherence, and 22% (31/142) received an intervention following clinician review of their case notes. Patients flagged by the software were older in age and had more prior mental health treatment episodes. More alerts were associated with patients who had been transferred from the mental health service to the care of their general practitioners, and those with more alerts were more likely to receive a follow-up intervention. CONCLUSION: Digitally automated monitoring for non-adherence risk is feasible and can be integrated into clinical workflows in community psychiatric and primary care settings. The technology may assist clinicians and services to detect non-adherence behaviour early, thereby triggering interventions that have the potential to reduce rates of mental health deterioration and acute illness relapse.

Differences in Temporal Relapse Characteristics Between Affective and Non-affective Psychotic Disorders: Longitudinal Analysis.

Objective: Multiple relapses over time are common in both affective and non-affective psychotic disorders. Characterizing the temporal nature of these relapses may be crucial to understanding the underlying neurobiology of relapse. Materials and Methods: Anonymized records of patients with affective and non-affective psychotic disorders were collected from SA Mental Health Data Universe and retrospectively analyzed. To characterize the temporal characteristic of their relapses, a relapse trend score was computed using a symbolic series-based approach. A higher score suggests that relapse follows a trend and a lower score suggests relapses are random. Regression models were built to investigate if this score was significantly different between affective and non-affective psychotic disorders. Results: Logistic regression models showed a significant group difference in relapse trend score between the patient groups. For example, in patients who were hospitalized six or more times, relapse score in affective disorders were 2.6 times higher than non-affective psychotic disorders [OR 2.6, 95% CI (1.8-3.7), p < 0.001]. Discussion: The results imply that the odds of a patient with affective disorder exhibiting a predictable trend in time to relapse were much higher than a patient with recurrent non-affective psychotic disorder. In other words, within recurrent non-affective psychosis group, time to relapse is random. Conclusion: This study is an initial attempt to develop a longitudinal trajectory-based approach to investigate relapse trend differences in mental health patients. Further investigations using this approach may reflect differences in underlying biological processes between illnesses.