Digital health to support primary care provision during a global pandemic.

The urgency of the COVID-19 pandemic in Australia has seen the implementation of digital health technologies to support continuity of high-quality primary care provision. Digital health innovation has been used to operationalise the nation's pandemic preparedness principles by reducing risk of infection to both healthcare workers and at-risk patients, sustaining care for chronic and acute health conditions, and supporting the mental health of the population. In this perspective piece, we document the Australian Federal government's digital health response to ensure the ongoing delivery of high-quality primary care. This includes the implementation of telehealth, point-of-care testing, electronic records and e-prescriptions, national primary care data collection and analysis, and digital communication. Digital health has been a critical element of the pandemic response and paves the way for future primary care provision during disasters and emergencies. Further research is needed to capture the effectiveness, feasibility and acceptability of these innovations for both patients and primary care practitioners.

COVID-19 and access to sexual and reproductive healthcare for young people

[...]the incidence of COVID-19 is lower in children than adults,1 and the prevalence of severe disease is lower among children than adults.2-4 Furthermore, medium-term sequelae (four months) have proven rare among children who recover from COVID-19,5 and their case fatality rate is also lower than that of adults.4 The World Health Organization (WHO) defines adolescents as individuals aged between 10 and 19 years;however, research often focuses on young people, defined as people under the age of 25 years.6 SRH covers services that promote sexual wellbeing and reproductive health, and prevent and treat sexually transmissible infections (STIs) and blood-borne viruses (BBVs). Adolescence and young adulthood are risky times for the development of mental health problems, with most disorders commencing during this time;however, diagnosis may occur later if healthcare access is limited.12 Young people are often reluctant to seek help, particularly if services are not specifically designed for young people.13 Young people with poor mental health have higher rates of physical health problems, including those related to SRH.12 This makes access to appropriate, high-quality mental healthcare for young people critical for maintaining their SRH. Results Sexual and reproductive wellbeing of young people during the COVID-19 pandemic In an Australian survey during lockdown (66.3% respondents aged 18-29 years), the frequency of sex with a partner varied depending on cohabitation, with the survey suggesting fewer casual partners and less group sex, while use of sex toys and masturbation increased.15 Some women also reported delaying childbearing because of the pandemic.16 Surveys from China reported reduced frequency of sex,17 reduced number of partners,17 increased relationship dissatisfaction18 and increased use of pornography.18 This is likely due to lockdown conditions and the high number of young people who live with their parents.17'18 A US survey of sexual minority males aged 14-17 years mirrored this finding, with online sexting and messaging becoming more common.19 This contrasted with data from African nations, where pockets of increased sexual activity20 led to increases in teenage pregnancy.21 School closures have been implicated with less visibility of children and increased potential for abuse from family and neighbours.21 One article highlighted the potential longer-term reduction in sexual wellbeing, with young people having reduced 'normative experiences' due to lockdown and increased parental scrutiny.22 The authors suggested increasing focus on young people in post-lockdown periods to ensure their sexual wellbeing.22 Access to sexual and reproductive healthcare during COVID-19 In Australia and internationally, SRH - including access to contraception and abortion services, STI screening and treatment, and HIV care - is recognised as an essential service during the COVID-19 pandemic.23-25 Despite this recognition, a rapid survey of 64 nations found services were scaled back across all nations and 5633 SRH clinics closed;26 2 7 00 young people from Africa reported reductions in access to SRH services due to clinic closures and fear of contracting COVID-19.20 As a result, contraception, HIV care, abortion services and comprehensive sexuality education (including menstrual education)20 for youth have been affected.26 A semi-rural area in the UK saw no people aged under 18 years access emergency contraception for six weeks, and there was a fall in accessing other sexual health services, especially for those aged under 18 years.27 This may be appropriate (eg a result of reduced intimacy18'22'27) or inappropriate (eg a consequence of disruption to public transport).28 The review also highlighted that young people may feel judged if they have broken lockdown restrictions and then need SRH.27 Few articles were focused on SRH within a generalist setting, such as general practice, so issues such as opportunistic preventive healthcare, cervical screening and general healthcare were not discussed. In the setting of SRH, telehealth can be used for contraception,10'25'29-33 STI screening,27'34 syndromic management of STIs28'33 and medical abortion.17'23'24'27'30'32'35 However, challenges to providing SRH via telehealth included: * maintaining confidentiality and privacy;especially for young people in crowded housing during lockdown conditions22,27 * providing culturally appropriate care22 * examining sensitive body parts33 * institutional support to implement telehealth, including appropriate funding and access to technology.33 Telehealth is also more difficult for those without access to a device and for individuals with poor internet access.22'31'33 Suggestions for overcoming these barriers are outlined in Table 1.

COVID-19 and access to sexual and reproductive healthcare for young people: An overview of the international literature and policy.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has reduced the ability of young people to access appropriate and timely sexual and reproductive healthcare (SRH). The aim of this study was to summarise international innovations aimed at ensuring ongoing access. METHOD: This study was an overview of peer­reviewed literature and policy statements from international and national organisations related to SRH for young people during COVID-19. RESULTS: Innovations have focused on improving access to appropriate and timely SRH for young people, mostly through telehealth; increasing community and healthcare worker awareness of the heightened risk of gender-based violence and its consequences; and removing restrictions on contraception and abortion access. Despite this, a substantial decline in sexual wellbeing and SRH access has been reported from many parts of the world, although Australian data are lacking. DISCUSSION: Support for young people to access timely and appropriate SRH during the COVID-19 pandemic should be a priority for policymakers around the world.

Ensuring the continuation of routine primary care during the COVID-19 pandemic: a review of the international literature.

BACKGROUND: The COVID-19 pandemic has resulted in the diversion of health resources away from routine primary care delivery. This disruption of health services has necessitated new approaches to providing care to ensure continuity. OBJECTIVES: To summarize changes to the provision of routine primary care services during the pandemic. METHODS: Rapid literature review using PubMed/MEDLINE, SCOPUS, and Cochrane. Eligible studies were based in primary care and described practice-level changes in the provision of routine care in response to COVID-19. Relevant data addressing changes to routine primary care delivery, impact on primary care functions and challenges experienced in adjusting to new approaches to providing care, were obtained from included studies. A narrative summary was guided by Burns et al.'s framework for primary care provision in disasters. RESULTS: Seventeen of 1,699 identified papers were included. Studies reported on telehealth use and public health measures to maintain safe access to routine primary care, including providing COVID-19 screening, and establishing dedicated care pathways for non-COVID and COVID-related issues. Acute and urgent care were prioritized, causing disruptions to chronic disease management and preventive care. Challenges included telehealth use including disparities in access and practical difficulties in assessing patients, personal protective equipment shortages, and financial solvency of medical practices. CONCLUSIONS: Substantial disruptions to routine primary care occurred due to the COVID-19 pandemic. Primary care practices' rapid adaptation, often with limited resources and support, demonstrates agility and innovative capacity. Findings underscore the need for timely guidance and support from authorities to optimize the provision of comprehensive routine care during pandemics.

The COVID-19 pandemic has resulted in considerable disruption to health services including regular primary care. As a consequence, primary care practices have had to adopt new ways of providing care to ensure ongoing availability of services. However, little is known about the type of measures taken by care providers and challenges encountered in reorganizing services. The aim of this research was to provide a detailed understanding of changes in the way primary care was delivered and to identify difficulties experienced by patients and providers in adjusting to new approaches. The 17 studies included in the review indicate that primary care providers quickly put in place strategies including telehealth (e.g. telephone and video consultations) and infection control measures to ensure safe access to care. Furthermore, urgent and short-term care were prioritized resulting in interruptions to other services, including management of preexisting or long-term illnesses. Challenges included barriers to accessing telehealth such as inadequate internet connection and practical difficulties in examining patients, personal protective equipment shortages, and financial losses by practices. Adequate support from authorities is needed to enhance the provision of comprehensive primary care during pandemics.

Protecting Nursing Homes and Long-Term Care Facilities From COVID-19: A Rapid Review of International Evidence.

OBJECTIVES: The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long-term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision making. DESIGN: Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long-term care. SETTING AND PARTICIPANTS: Residents and staff in care settings such as nursing homes and long-term care facilities. METHODS: PubMed/Medline, Cochrane Library, and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (eg, commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesized narratively using tabulated data extracts and summary tables. RESULTS: Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational, with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control measures. Symptom- or temperature-based screening and single point-prevalence testing were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications, and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher-performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, intersectoral collaboration, and policy that facilitated access to critical resources were all significant enablers of success. CONCLUSIONS AND IMPLICATIONS: High-quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though it continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long-term care residents from COVID-19 and other infectious diseases. This rapid review summarizes current evidence regarding strategies that may be effective.