Virtual emergency care in Victoria: Stakeholder perspectives of strengths, weaknesses, and barriers and facilitators of service scale-up.

BACKGROUND: Virtual emergency services have been proposed as an alternative service model to conventional in-person emergency department attendance. METHODS: Twenty participants were interviewed: 10 emergency medicine physicians, 4 health care consumers, and 6 other health care professionals. Conventional content analysis was performed on the interview transcriptions to identify perceived strengths and weaknesses of the VED, and barriers and facilitators to scaling-up the VED. RESULTS: VEDs are perceived as a convenient approach to provide and receive emergency care while ensuring safety and quality of care, however some patients may still need to attend the ED in person for physical assessments. There is currently a lack of evidence, guidelines, and resources to support their implementation. Most of the potential and existing barriers and facilitators for scaling-up the VED were related to their effectiveness, reach and adoption. Broader public health contextual factors were viewed as barriers, while potential actions to address resources and costs could be facilitators. CONCLUSIONS: VEDs were viewed as a convenient service model to provide care, can not replace all in-person visits. Current policies and guidelines are insufficient for wider implementation. Most of the barriers and facilitators for its scaling-up were related to VED effectiveness and delivery.

Identifying Public Healthcare Priorities in Virtual Care for Older Adults: A Participatory Research Study.

There has been increasing adoption and implementation of virtual healthcare in recent years, especially with COVID-19 impacting the world. As a result, virtual care initiatives may not undergo stringent quality control processes to ensure that they are appropriate to their context and meet sector needs. The two objectives of this study were to identify virtual care initiatives for older adults currently in use in Victoria and virtual care challenges that could be prioritised for further investigation and scale-up and to understand why certain virtual care initiatives and challenges are prioritised over others for investigation and scale-up. METHODS: This project used an Emerging Design approach. A survey of public health services in the state of Victoria in Australia was first carried out, followed by the co-production of research and healthcare priorities with key stakeholders in the areas of primary care, hospital care, consumer representation, research, and government. The survey was used to gather existing virtual care initiatives for older adults and any associated challenges. Co-production processes consisted of individual ratings of initiatives and group-based discussions to identify priority virtual care initiatives and challenges to be addressed for future scale-up. Stakeholders nominated their top three virtual initiatives following discussions. RESULTS: Telehealth was nominated as the highest priority initiative type for scaling up, with virtual emergency department models of care nominated as the highest priority within this category. Remote monitoring was voted as a top priority for further investigations. The top virtual care challenge was data sharing across services and settings, and the user-friendliness of virtual care platforms was nominated as the top priority for further investigation. CONCLUSIONS: Stakeholders prioritised public health virtual care initiatives that are easy to adopt and address needs that are perceived to be more immediate (acute more so than chronic care). Virtual care initiatives that incorporate more technology and integrated elements are valued, but more information is needed to inform their potential scale-up.

Mental health at the COVID-19 frontline: An assessment of distress, fear, and coping among staff and attendees at screening clinics of rural/regional settings of Victoria, Australia.

PURPOSE: Research examining psychological well-being associated with COVID-19 in rural/regional Australia is limited. This study aimed to assess the extent of psychological distress, fear of COVID-19, and coping strategies among the attendees in COVID-19 screening clinics at 2 rural Victorian settings. METHODS: A cross-sectional study was conducted during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale, and Brief Resilient Coping Scale were used to assess psychological distress, fear of COVID-19, and coping, respectively. FINDINGS: Among 702 total participants, 69% were females and mean age (±SD) was 49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher distress (AOR 10.4, 95% CI: 6.25-17.2) and fear (2.56, 1.41-4.66). Higher distress was also associated with having comorbidities, increased smoking (5.71, 1.04-31.4), and alcohol drinking (2.03, 1.21-3.40). Higher fear was associated with negative financial impact, drinking alcohol (2.15, 1.06-4.37), and increased alcohol drinking. Medium to high resilient coping was associated with being ≥60 years old (1.84, 1.04-3.24) and completing Bachelor and above levels of education. CONCLUSION: People who had pre-existing mental health issues, comorbidities, smoked, and consumed alcohol were identified as high-risk groups for poorer psychological well-being in rural/regional Victoria. Specific interventions to support the mental well-being of these vulnerable populations, along with engaging health care providers, should be considered.

Evaluation of population health short courses: implications for developing and evaluating population health professional development initiatives.

Population health as an approach to planning is key to improving the health and well-being of whole populations and to reduce inequities within and between population groups. The Victorian Department of Health North and West Metropolitan Region, in collaboration with The University of Melbourne (School of Population Health), have delivered four annual population health short courses. The short courses were designed to equip participants with knowledge and skills to implement population health approaches upon their return to their workplaces. For three consecutive years, online surveys (n=41) and semi-structured interviews (n=35), underpinned by participatory and realist evaluation approaches, were conducted to obtain the perceptions and experiences of the population health short course participants. Evaluation findings indicate that participants' understanding of population health concepts increased; however, there were mixed outcomes in assisting participants' implementation of population health approaches upon their return to their workplaces. A core list of perceived requirements, enablers and barriers emerged at an individual, organisational and system level as influencing the capability of participants to implement population health approaches. Evaluation recommendations and actions taken to revise short course iterations are presented, providing evidence that the evaluation approaches were appropriate and increased the use of evaluation learnings. Implications of evaluation findings for professional development practice (i.e. shift from a 'Course' as a one-off event to a Population Health 'Program' of inter-dependent components) and evaluation (i.e. participatory realist evaluation approaches) are presented.

Medical students' perceptions of role models on clinical placements.

BACKGROUND: Clinical placements have been reported as being challenging, demanding and rewarding for health professional students. For medical students, clinical placements are often their first interaction with other health professionals, who are often graduates. This study was designed to explore medical students' experiences of a clinical placement, in which their perceptions about role models from the same or other disciplines emerged. METHODS: A total of three focus groups (n = 15) were conducted with medical students following the completion of their clinical placement rotation in palliative and rehabilitative settings. FINDINGS: Role models and influential figures were key themes to emerge from the focus group data, reflecting an underlying tension between the practitioners that the students wanted to learn from and the practitioners who were actually willing, and available, to teach and model certain clinical skills. DISCUSSION: The extent to which doctors, nurses and allied health professionals were seen as role models became a central focus in exploring how the professional identity of students is influenced on clinical placement.

Medical students' interprofessional experiences in a rehabilitation and palliative care placement.

The majority of interprofessional learning literature focuses on initiatives within pre-clinical or simulated learning environments, with a paucity of research exploring the variation in impact of exposure to nurses and other health professionals in different health care settings. This study aimed to explore the experiences and attitudes of medical students following scheduled placements in palliative and rehabilitative care units. Three focus groups were conducted by researchers independent of the clinical school, to explore the attitudes of first clinical year medical students towards, and experiences of, a clinical placement that provided the opportunity to develop interprofessional skills. Students responded differently to the expectation put upon them to initiate their own learning experiences. A number of students felt that being asked to focus on clinical skill development conflicted with the assessment demands of the medical curriculum. This, in turn, contributed to a missed opportunity for them to learn with, from and about nurses and other health professionals. The driver of assessment was seen to be more important to their training. This emphasises the importance of including an assessment of interprofessional skills if we want to ensure students achieve these skills. If medical students are not going to be assessed on interprofessional knowledge, skills and attitudes then a curriculum orientation to the value of interprofessional practice is required.

An evaluation of New Zealand's iterative Workforce Service Reviews: a new way of thinking about health workforce planning.

OBJECTIVE: To ensure New Zealand's health workforce was fit for purpose, Health Workforce New Zealand (HWNZ) funded Workforce Service Reviews (WSRs) to develop visions for service reconfiguration and workforce for 2020. This paper describes what makes the WSR processes work, for whom, and in what circumstances. METHOD: Semi-structured interviews informed by a realist evaluation approach were conducted to obtain perceptions and experiences of WSR participants from four WSRs: eye health, palliative care, anaesthesia and aged care. RESULTS: The WSR process was a successful means of bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. WSRs were constrained by: mixed signals about process and outcomes; being challenged not milestone focussed; lacking clarity about ownership of visions; and variable clarity about next steps. WSRs were optimised by having: a lead clinician with policy know-how, ability to inspire, bring people together, distil ideas into coherent frameworks; and a project manager with project enablement skill sets and expertise in complex systems, implementation, change management. CONCLUSIONS: Evidence now exists at a point in time about what makes the WSR processes work. Implications for HWNZ are presented using a capacity-building framework to inform future decision making regarding WSRs. WHAT IS KNOWN ABOUT THE TOPIC? More appropriate workforce planning is required to meet the challenges facing the health workforce, from both the demand and the workforce side. To ensure New Zealand's healthcare workforce was fit for purpose, HWNZ initiated an iterative WSR process in topic specific areas. The WSRs process was designed to develop a vision of the relevant health service and workforce for 2020, and models of care that were patient-centred and team-based. WHAT DOES THIS PAPER ADD? The paper provides evidence that the WSR process was a successful means for bringing together professionals from across the health disciplines and building sector capacity to develop new ways of thinking about service and workforce planning. The paper presents key enablers of, and barriers to, the WSR iterative process. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The evaluation revealed that a multitude of factors can influence the capacity of the WSR process at the individual (workforce skills and abilities), organisational (leadership and interactions) and systems (infrastructure) levels. Implications for HWNZ on ways to build the capacity of the WSRs according to three capacity-building dimensions are presented to inform future decision making.

A framework to support team-based models of primary care within the Australian health care system.

Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning; organisational and management policies and systems; and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.

Taking stock of interprofessional learning in Australia.

Changes in health service delivery and issues of quality of care and safety are driving interprofessional practice, and interprofessional learning (IPL) is now a requirement for medical school accreditation. There is international agreement that learning outcomes frameworks are required for the objectives of IPL to be fully realised, but there is debate about the most appropriate terminology. Interprofessional skills can be gained in several ways - from formal educational frameworks, at pre- and post-registration levels to work-based training. Research activity suggests that many consider that IPL delivers much-needed skills to health professionals, but some systematic reviews show that evidence of a link to patient outcomes is lacking. Australian efforts to develop an evidence base to support IPL have progressed, with new research drawing on recommendations of experts in the area. The focus has now shifted to curriculum development. The extent to which IPL is rolled out in Australian universities will depend on engagement and endorsement from curriculum managers and the broader faculty.

Telecommunications as a means to access health information: an exploratory study of migrants in australia.

BACKGROUND: Health policies increasingly promote e-health developments (e.g., consumers' access to online health information) to engage patients in their health care. In order to make these developments available for culturally and socially diverse communities, not only do Internet accessibility, literacy and e-health literacy need to be taken into account, but consumers' preferences and information seeking behaviours for accessing health information have also to be understood. These considerations are crucial when designing major new health policy directions, especially for migration destination countries with culturally diverse populations, such as Australia. The aim of this study was to examine how people from a culturally and linguistically diverse (CALD) community use telecommunications (phone, mobile, Internet) to access health information. DESIGN AND METHODS: A case study was conducted using a questionnaire exploring the use of telecommunications to access health information among CALD people. The study was carried out at a community health centre in a socially and economically disadvantaged area of Melbourne, a city of 4 million people with a large CALD and migrant population. Questionnaires were translated into three languages and interpreters were provided. Fifty-nine questionnaires were completed by users of the community health centre. RESULTS: Most of the CALD participants did not have access to the Internet at home and very few reported using telecommunications to access health information. CONCLUSIONS: The findings of the study suggest that telecommunications are not necessarily perceived to be an important channel for accessing health information by members of the CALD community.