Towards Zero Suicide for older adults: implications of healthcare service use for implementation.

OBJECTIVE: Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation. CONCLUSION: The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.

Development of a COVID-19 virtual community of practice in New South Wales

ON 30 JANUARY 2020, the Director-General of the World Health Organization announced that the outbreak of a novel coronavirus in China had been declared a Public Health Emergency of International Concern.1 At the time of that announcement, there were 7834 confirmed cases, 98 of those outside China.1 By April 5 2020, there were 1,133,758 cases of COVID-19 globally, with 62,784 deaths.2 At that time, Australia had 5805 COVID-19 notifications and 33 associated deaths.2 In the absence of an available vaccine or effective pharmacotherapy for COVID-19 in Australia during 2020, the mainstay of individual case management was prevention of transmission through identification and isolation of cases and, in severe cases, supportive care, including ventilation.3 Community management was recommended for the approximately 80% of patients with mild disease, provided there was capacity for counselling, isolation, support, monitoring and escalation to hospital-based care in the event of deterioration.3 As the principal providers of continuing healthcare for people living in the community, general practice shared community management and monitoring of Australians with COVID-19, in collaboration with public health units, virtual care clinics and hospital-in-the home teams. Implementation of new evidence, guidelines or procedures into clinical practice is a challenge, especially where the change is complex with limited external support (such as facilitation) or previous applicable experience.6 All of these applied to the early stages of the COVID-19 pandemic. [...]as a contribution to addressing the COVID-19 crisis in Australia, in early April 2020 a group of general practitioner (GP) leaders in NSW established a COVID-19 GP virtual community of practice (VCoP). Communities of practice (CoPs) and VCoPs have been demonstrated to be effective in improving processes and outcomes in education, industry and healthcare.7 CoPs are defined as 'groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly'.8 When a CoP is constructed primarily (although not exclusively) through internetbased interaction, it is termed a VCoP.7 The goal of the COVID-19 GP VCoP was to facilitate rapid implementation of the necessary changes in general practices through widespread sharing of knowledge (know-what) and experience of the application of that knowledge in practice (know-how). Analysis Framework analysis was used to analyse the data, using the VCoP framework developed by Barnett et al. to code the data under the following headings: objectives and goals, champion and support, facilitation, a broad church, supportive environment, technology and community, measurement benchmarking and feedback.7'10 Five members of the research team individually coded two FGD transcripts.

Development of a COVID-19 virtual community of practice in New South Wales: A qualitative study.

BACKGROUND AND OBJECTIVES: In April 2020, a group of general practice leaders in NSW, Australia, established a COVID-19 virtual community of practice (VCoP) to facilitate rapid transfer and implementation of clinical guidance into practice. This research aimed to gain an understanding of the experience and effectiveness of the VCoP from leaders and members. METHOD: The study used a qualitative participatory action research methodology. A framework analysis was applied to focus group discussion, semi-structured interview and open-text written response data. RESULTS: Thirty-six participants contributed data. In addition to a positive evaluation of the effectiveness of information transfer and support, a key finding was the importance of the role of the VCoP in professional advocacy. Areas for improvement included defining measures of success. DISCUSSION: This study has reinforced the potential for VCoPs to aid health crisis responses. In future crisis applications, we recommend purposefully structuring advocacy and success measures at VCoP establishment.

What is the role of the practice nurse in the care of people living with dementia, or cognitive impairment, and their support person(s)?: a systematic review.

BACKGROUND: The potential value of expanding the Practice Nurse role to include the recognition and management of dementia has been acknowledged. Practice Nurses are well-positioned to provide comprehensive dementia information and support so that people living with dementia are better equipped to self-manage their health and live well with dementia. The purpose of this review was to systematically examine published literature to identify existing and potential roles of Practice Nurse's in the delivery of care to people affected by dementia and to describe the characteristics and effectiveness of nurse interventions in dementia models of care. METHODS: The PRISMA statement guided the systematic review of the quantitative and qualitative evidence for roles and characteristics of the Practice Nurse in the delivery of dementia care. A comprehensive literature search of seven electronic databases and Google scholar identified relevant original research published in English between January 2000 and January 2019. Thirteen articles met the inclusion criteria and were extracted into the Covidence software for analysis. RESULTS: The heterogeneity of the included studies purpose, design and outcomes measures and the diversity in health systems and primary care nurses scope of practice made it difficult to synthesise the findings and draw conclusions. The heterogeneity did, however, provide important insights into the characteristics of roles undertaken by nurses working in the general practice setting, which were potentially beneficial to people living with dementia and their support person. These included patient accessibility to the Practice Nurse, early recognition and management of cognitive changes, care management and collaboration with the General Practitioner. Limitations of the provision of dementia care by Practice Nurses included a lack of definition of the role, inadequate dementia specific training, time constraints and poor communication with General Practitioners. CONCLUSIONS: Embedding an evidence-based model that describes the role of the Practice Nurse in dementia care provision has the potential to increase early recognition of cognitive impairment and more appropriate primary care management of dementia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2018 CRD42018088191.