Electronic consultations (eConsults): a proof of concept trial in Australia.

BACKGROUND: Electronic consultations (eConsults) allow general practitioners (GP) to seek the advice of a specialist via secure asynchronous digital communication. AIMS: To report the outcomes of a proof of concept (POC) trial of eConsults for patients with diabetes and endocrine disorders. METHODS: A prospective observational study conducted from November 2020 to May 2021. eConsults were provided by endocrinologists from the Princess Alexandra Hospital, Brisbane. The requests for advice were from GP in Brisbane South. An online questionnaire was completed by the GP and endocrinologist after each eConsult. RESULTS: Forty eConsults were performed over 7 months. The majority were in relation to type 2 diabetes (30%) or thyroid conditions (30%). All eConsult responses were performed within the target of 72 h with 92.5% responses provided within 24 h. The average time taken for the endocrinologist to perform the eConsult was 14.2 ± 4.4 min. The GP rated the value of eConsults as excellent 97% of the time. The eConsult resulted in a new or additional course of action 68% (19/28) of the time and confirmed a course of action 32% (9/28) of the time. The eConsult avoided the need for referral of the patient for a face-to-face specialist review in 55% of the eConsults. CONCLUSION: An eConsult service was able to be delivered by endocrinologists from a tertiary hospital to GP in Brisbane South. With an appropriate funding model, the broader implementation and adoption of eConsults has the potential to address specialist waiting lists and facilitate models of integrated care.

Navigating athlete mental health: Perspectives from performance directors within elite sport.

Performance directors lead high-performance programmes within elite sport and where they opt to invest resources has implications for athletes. This study explores performance directors' perspectives on mental health and illness and their experiences of managing these within elite sport. We conducted semi-structured interviews with 11 performance directors, resulting in 18 h of data. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We constructed three themes: 1) making sense of mental health: legitimacy vs. scepticism; 2) mental health as athlete responsibility; and 3) simplifying and sanitising mental health. Performance directors used physical health analogies to make sense of mental health, sometimes describing unrealistic expectations regarding mental health management. They also positioned athletes as responsible for finding solutions to their mental health concerns, at times overlooking the impact of the elite sport environment. Some performance directors shared over-simplified perceptions of mental health, often focusing on 'the positive' and neglecting to talk about the more challenging aspects of mental health and illness. Educating performance directors, as well as others in leadership positions, on the complexities of mental health and illness is recommended. This should include how mental illness differs from physical illness and injury, how to respond when athletes disclose mental health concerns, and how mental illness recovery is often nonlinear and subjectively defined.