Physician leadership during the current crisis in healthcare: A perspective drawn from anthropological and clinical leadership research.

OBJECTIVES: There are ongoing challenges in workforce sustainability and service delivery due to the COVID-19 pandemic. Recruiting credible clinical leaders can enhance outcomes through mentoring, leading by example, and creating positive work environments. We investigate the anthropology of, and related research on leadership. CONCLUSIONS: Clinical and anthropological research provides strong grounds for investing in clinical leadership. The stability of 'prestige-based' leadership can be contrasted with the outcomes of 'dominance-based' leadership that relies on force, control, and threats. Dominance-based leadership increases the risks of bullying in stressed healthcare organisations. In contrast, expert clinical leaders can exert culturally mediated effects on social learning, team cooperation and morale, and patient outcomes.

Risk perception research informing recommendations for COVID-19 preventative health measures and public messaging.

OBJECTIVE: To provide a commentary on evidence-based recommendations for COVID-19 pandemic risk communication for more effective public health measures. METHOD: We apply the principles of risk communication to address key issues in the COVID-19 pandemic. RESULTS: Risk perception and communication research usefully informs preventative health education and public messaging during disease outbreaks such as the current COVID-19 pandemic, especially for those with severe mental illness. CONCLUSIONS: Key recommendations for pandemic public health risk communication are: clear, timely and balanced information from a reputable source; accurate and non-sensationalised depiction of infection, morbidity and mortality rates; awareness of fear as a powerful motivator for adoption of protective measures against the causative virus; promotion of self-efficacy and sense of control in terms of mitigating the health threats associated with a pandemic; correction of mis- and disinformation regarding the pandemic and associated protective measures; and messaging may need to be modified for people with a mental illness to avoid exacerbations of depressive and anxiety symptoms.

Economic Considerations in COVID-19 Vaccine Hesitancy and Refusal: A Survey of the Literature.

The COVID-19 global pandemic has triggered one of the greatest economic shocks in a century. Effective COVID-19 vaccines have been developed, but a proportion of people either are hesitant or refuse to be vaccinated, facilitated by a global misinformation campaign. If 'herd immunity' cannot be achieved, there is potential not only for ongoing surges in infection, but also for development of new strains of the virus that could evade vaccines and precipitate further health and economic crises. We review the economics of vaccination and of vaccine hesitancy and refusal, and their potential effects on the recovery from the COVID-19 pandemic.

Better Access: substantial shift to telehealth for allied mental health services during COVID-19 in Australia.

Objective To quantify the introduction of new, temporary telehealth Medicare Benefits Schedule (MBS) items delivered by allied mental health professionals (AMHPs) through the Better Access initiative during the COVID-19 pandemic in Australia. Methods MBS-item service data for clinical psychologists, registered psychologists, social workers, and occupational therapists were extracted for existing face-to-face, remote videoconferencing and new, temporary telehealth items for the study period April-December 2020. The total number of services in Australia were compared with the baseline period of 2019. Given the second wave of increased COVID-19 infections and prolonged lockdowns in the state of Victoria, we compared the per capita rate of services for Victoria versus other states and territories. Results During the study period, there was an overall 11% increase in all allied mental health consultations. Telehealth use was substantial with 37% of all sessions conducted by videoconferencing or telephone consultations. The peak month was April 2020, during the first wave of increasing COVID-19 cases, when 53% of consultations were via telehealth. In terms of Victoria, there was an overall 15% increase in all consultations compared with the same period in 2019. Conclusions Allied mental health services via MBS-subsidised telehealth items greatly increased during 2020. Telehealth is an effective, flexible option for receiving psychological care which should be made available beyond the pandemic. What is known about the topic? Little is known about the transition to and delivery of new, temporary Better Access telehealth services by AMHPs during the COVID-19 pandemic. What does this paper add? This paper provides valuable data on the rapid transition to telehealth by AMHPs to provide levels of psychological care commensurate to 2019. Data extends from April to December 2020 and includes the overall number of services provided for each profession, and the proportion of services delivered via face-to-face and telehealth. We highlight the impact of the new, additional items which temporarily raised the cap on sessions. We also illustrate the substantial use of the scheme by those living in Victoria who experienced greater COVID-19-related hardships. What are the implications for practitioners? The continuation of Better Access telehealth services by AMHPs has the potential to extend the reach of mental health care beyond the pandemic.

Conduct and evaluation of final-year medical student summative assessments in Psychiatry and Addiction Medicine during COVID-19: an Australian University Medical School experience.

OBJECTIVE: To describe and share with the medical education community, the conduct and evaluation of summative graduate medical student assessments in Psychiatry and Addiction Medicine during COVID-19 at an Australian university. METHODS: Summative assessments were redesigned as follows: written assessments were administered via an online platform (WATTLE), while the Objective Structured Clinical Examinations (OSCE) were conducted via a secure video-conferencing software (Zoom). RESULTS: Our preliminary analysis of the summative assessments indicated that both examiners and students adapted to the format, with overall performance of the students showing no variation due to timing of the assessment (earlier versus later in the day) and performances similar to face-to-face assessments in previous years. Examiners also expressed positive feedback on the assessment process. CONCLUSIONS: Our graduate fourth-year medical student summative assessments were effectively conducted using online and video-conferencing software in accordance with existing COVID-19 pandemic public health measures for physical distancing and hygiene.

Greatly increased Victorian outpatient private psychiatric care during the COVID-19 pandemic: new MBS-telehealth-item and face-to-face psychiatrist office-based services from April-September 2020.

OBJECTIVE: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists' uptake of telehealth, and face-to-face consultations for April-September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. METHOD: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. RESULTS: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April-September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria's increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April-September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April-September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. CONCLUSIONS: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.