ABSTRACT
Background: While the UK's Royal College of General Practitioners developed guidance concerning the delivery of essential services during the COVID pandemic, no such guidance was available in Australia and little is known about the experiences or approaches taken by general practitioners (GPs) for the delivery of care in Australia. Aims/Objectives: To describe GPs' experiences and approaches to delivering essential clinical services (ECS) during COVID lockdowns. Method(s): A survey of GPs who had practiced during lockdowns in Melbourne and Sydney. Questions focused on changes made to care delivery including what services were continued: (1) regardless of outbreak scale, (2) if capacity allowed, or (3) postponed. Finding(s): Of 274 completed surveys, 95% of participants reported increased use of telehealth for diagnosis, investigation, and management of clinical conditions, and 97% for follow-up. Time-sensitive services such as provision of care for symptoms consistent with cancer or those with immediate health impact (e.g., immunisations, prolia injections) were generally continued even if requiring face-to face delivery. Consultations involving screening or health assessments or those necessitating face-to-face care but not clinically urgent (e.g., low risk cervical cancer screening and IUD insertions), were more likely to be postponed, as were visits to homebound and nursing home patients. Implications: The almost universal uptake of telehealth by GPs supported continuity of service provision during lockdown. Australian GPs acted autonomously to triage and provide ECS face to face through the lockdowns. To optimise future preparedness, local guidance for safe delivery of ECS must be developed considering contextual factors relevant to the Australian primary healthcare system.
ABSTRACT
Background: Integrated health care, particularly between the broader health care system and primary care can ease the patient journey, improve outcomes and reduce healthcare costs. The rise of both Primary Health Networks and Advanced Health Research and Translation Centres in Australia expands the requirement for Australia's Practice Based Research Networks (PBRNs) to incorporate a focus on integration. However little is known about the ways in which PBRNs can help align and coordinate different parts of the health care system. Aim/Objectives: To conduct a scoping review to examine how PBRNs have been used to foster integrated care across the healthcare system. Method(s): Our scoping review used the PRISMA-ScR framework and was based on Valentijn's conceptual framework for integrated care. Two independent reviewers used CovidenceTM to search titles, s, and full texts in Ovid Medline, EMBASE, CINAHL and Scopus. We sought to identify peer-reviewed empirical studies conducted since 2000 that examined collaboration between PBRNs and the broader healthcare system. We excluded studies that solely used PBRNs for recruitment and those restricted to a single practice. Finding(s): We identified 3022 articles, of which 74 studied primary care PBRNs. Of these, 13 focussed on 'integrated care.' The studies documented collaboration between primary care and a wide range of professions and organisations. Only one explored integration at a clinical, organisational and system level, and few showed how collaborations could be established or maintained. Most prioritised population health rather than clincial care. Implications: While system integration is beginning to be explored as PBRNs evolve, there is a paucity of information on how PBRNs form and foster integration between primary care and the broader healthcare system. An improved understanding of the role of PBRNs in integration is important given the focus on system integration and sustainability within Australia's new 10 Year Plan for primary health care.
ABSTRACT
Background: Improving access to abortion services is a priority of the National Women's Health Strategy 2020-2030. However, access remains highly inequitable in Australia, with limited availability and inconsistent access to both medical and surgical abortion services and few publicly-funded options available in most states, particularly in regional, rural and remote areas. Rates of unintended pregnancy are disproportionately higher in non-urban areas, and access to abortion services similarly differs by geographical location. Aim(s): The SPHERE Women's Sexual and Reproductive Health COVID-19 Coalition aimed to develop a consensus statement to highlight current challenges and call for increased access to abortion care. Method(s): The statement was drafted and ratified by members of the Coalition (clinician experts and consumers, representatives from peak bodies and key stakeholder organisations and eminent Australian and international researchers) and disseminated in November 2021. Finding(s): Key recommendations outlined in the consensus statement included: (1) development of an abortion care standard that includes key performance indicators (KPIs);(2) annual public reporting against KPIs to monitor progress;(3) a National Federation Reform Council process that mandates that major regional or tertiary hospital services provide comprehensive abortion care with appropriate referral, as well as abortion training for hospital-based health professionals and students;and (4) that Primary Health Networks develop an integrated regional approach to abortion care that involves identifying gaps in local service provision, commissioning services to fill those gaps, and maintaining strong collaborative links and referral pathways. Implications: Increasing access to abortion care for women in rural and remote areas will contribute to meeting the goals of the National Women's Health Strategy and improving health outcomes. Government and stakeholder commitment to implementation of these recommendations is critical to ensure equitable access to abortion care for all women.
ABSTRACT
Background: Primary health care nurses (PHCNs) deliver women's sexual and reproductive health (SRH) services, and telehealth services are within their scope of practice. Despite the WHO resolution about eHealth in 2005 and increased use of telehealth during COVID-19, the extent to which PHC nurses have used telehealth technology to deliver SRH care in the international literature is not clear. Aim/Objectives: To explore how telehealth is used by PHCNs in the delivery of women's SRH care. Method(s): A scoping review of peer-reviewed primary research papers was undertaken following a Joanna Briggs Institute approach. Seven databases were searched including papers from 2005-December 2021 and published in English language. A grey literature search was used to identify current national or international policy or strategy documents about nurse roles in telehealth. Extracted data were then entered in NVivo and conceptual categories were mapped from descriptive summaries. Finding(s): Our database search yielded 745 papers and of these, eight papers met our inclusion criteria and were included in the review. The search of grey literature yielded 21 documents that met our inclusion criteria. Papers were largely from the United Kingdom (n=5), part of interventional trials (n=5) or used synchronous telehealth methods (n=5). Papers about patient perspectives described acceptability of SRH telehealth services (n=4). Grey literature revealed policy support for telehealth implementation as an approach to improving patient-centred care, were largely from the northern hemisphere (n=15) or outlined case studies of nurse use of telehealth (n=11). From all included documents, SRH care most commonly addressed pregnancy (n=6), cervical cancer screening (n=4), sexual health (n=3), and abortion (n=2). Implications: Evidence about the use of telehealth by PHCNs for SRH care is lacking. Opportunities exist to address women's health policy and service gaps, and better describe and optimise PHCN involvement in telehealth care.
ABSTRACT
During the emergency for SARS-COV-2 the high number of samples from different applicants related to the internal analytical capacity, initially limited and dedicated to inpatients, the emergency room and triage tents, has lead for the analysis of a large number of swabs to be entrusted to IZSLER, a structure with high skills and adequate technology for massive virological analyses. The need to trace these samples was immediately clear, given by the multiple applicants to the laboratory Service, for which complete traceability had to be guaranteed from check-in until delivery of the result to the correct subject. The initial table in Excel (Microsoft) used in the early days has been replaced by an application (TraceCOVID) conceived and developed by our laboratory. TraceCOVID was written in Visual Basic .NET (Microsoft) initially using a relational SQLlite database and, subsequently, SQL Oracle as the amount of data and the number of accesses to the application by different users required a more performing database. The application has an integration with the LIS (Dedalus) to receive samples' information. Actually it manages the sample check-in in the laboratory and the check-out in the preparation of shipment's list and the accompanying sheet (with barcode, name, surname and origin) plus a second excel file sent via SFTP allowing IZSLER to manage the samples with their systems. The results from the IZSLER are returned via SFTP in an excel file which TraceCOVID automatically import, associate the report with the patient and send an email for each patient containing the outcome. The application offers the possibility to print the report if necessary as well as the possibility of entering all the information (patient data and outcome) manually. There is also a statistics section that monitors the number of samples and outcomes generating different types of outputs. At the request of the Administrative Offices, a data export function consistent with the format requested by the Lombardy Region was also included. The emergency for COVID19 has highlighted how the presence of computer skills in the laboratory has made it possible to cope with a critical aspect regarding the swabs' management and allows efficient information flows to the competent health authorities.