COVID-19 medicare benefits schedule telehealth for private psychiatric outpatient care in Victoria, Australia.

OBJECTIVE: We explore telehealth use by private psychiatrists in Victoria during the first 12 months of COVID-19, in the context of: COVID-19 case numbers and restrictions; telehealth use in Victoria compared to national use; telehealth and face-to-face consultations during the first 12 months of COVID-19 compared to face-to-face consultations in the 12 months pre-COVID-19. METHOD: Outpatient psychiatric face-to-face and telehealth consultations, from March 2020 to February 2021 in Victoria, were analysed using face-to-face consultations from March 2019 to February 2020 as a comparison group, and compared to national telehealth use and trends in COVID-19 case rates. RESULTS: Total psychiatric consultations increased by 16% from March 2020 to February 2021. Telehealth compromised 56% of total, peaking at 70% of consultations in August during the height of COVID-19 cases. Thirty-three percent of total consultations and 59% of telehealth consultations were via telephone. Telehealth consultations per capita in Victoria were consistently lower than the overall Australian level. CONCLUSION: Telehealth usage during the first 12 months of COVID-19 in Victoria suggests it is a feasible alternative to face-to-face treatment. Telehealth-mediated increases in psychiatric consultations likely indicates an increased psychosocial need for support.

Lessons from billed telepsychiatry in Australia during the COVID-19 pandemic: rapid adaptation to increase specialist psychiatric care.

OBJECTIVE: To summarise and comment upon research regarding the service delivery impact of the introduction of COVID-19 pandemic Medicare Benefits Schedule (MBS) psychiatrist telehealth services in Australia in 2020-2021. Type of program or service: Privately-billed, MBS-reimbursed, face-to-face and telehealth consultations with a specialist psychiatrist during the first year of the COVID-19 pandemic. METHODS: This paper draws on analyses of previously published papers. MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 in Victoria, and compared to face-to-face consultations in the same period of 2019 and for all of Australia. We also extracted MBS-item-consultation data for all of Australia from April 2020-April 2021, and compared this to face-to-face consultations for April 2018-April 2019. RESULTS: Although face-to-face consultations with psychiatrists waned following nationwide lockdowns, the introduction of MBS billing items for video and telephone telehealth meant that overall consultations were 13% higher in April 2020-April 2021, compared to the pre-pandemic year prior. A lockdown restricted to Victoria was associated with a 19% increase in consultations from April-September 2020, compared to the corresponding period in 2019. LESSONS LEARNT: Telehealth has been an integral component of Australia's relatively successful mental health response to COVID-19. The public availability of MBS data makes it possible to accurately assess change in psychiatric practice. The Australian Federal Government subsidises MBS telepsychiatry care by a patient rebate per consultation, illustrating that government-subsidised services can rapidly provide additional care. Rapid and substantial provision of telepsychiatry in Australia indicates that it may be a useful substitute or adjunct to face-to-face care during future pandemics and natural disasters.

Final-year medical student Psychiatry and Addiction Medicine synchronous summative tele-assessments during a COVID-19 Delta-variant stay-at-home lockdown.

OBJECTIVE: We describe the planning, process and evaluation of final-year Psychiatry and Addiction Medicine summative assessments in a four-year graduate medical degree program, during a COVID-19 Delta-variant public health stay-at-home lockdown. CONCLUSIONS: We conducted separate written and clinical synchronous (real-time simultaneous) tele-assessments. We used online assessment technology with students, examiners and simulated patients, all in different physical locations. Medical students' examination performance showed a good range. This was comparable to other discipline stations, and performance in previous years. There was no differential performance of students through the day of the assessments.

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.

Pivot to Telehealth: Narrative Reflections on Circle of Security Parenting Groups during COVID-19.

In response to COVID-19 hygiene and physical distancing restrictions, our service rapidly shifted to delivering Circle of Security-Parenting™ (COS-P) groups via telehealth. In this article we report the perspectives and experiences of the group facilitator and the parents who received the intervention during the COVID-19 pandemic. We use semi-structured, qualitative interviews to explore the advantages, challenges, and positive impacts of the online parenting group from the perspectives of the group leader and the five group participants. Participants' narrative reflections show that they were satisfied with the convenient and engaging online delivery of the program and would recommend it to other parents. Parents reported significant improvements in their parenting and greater awareness of their strengths and struggles. The online delivery of COS-P resulted in more efficient service delivery, greater attendance rates, and adherence to the model. The stressors on the experienced facilitator, due to the abrupt transition and multiple technical and communication challenges, may have been mitigated by supervisor and collegial support, as well as careful preparation for herself and the participants. Future research should investigate the effectiveness of online versus face-to-face delivery of the intervention, including what works for whom.

Telehealth mental health services during COVID-19: summary of evidence and clinical practice.

OBJECTIVE: To provide a rapid clinical update on the evidence for telehealth in mental healthcare in the context of the COVID-19 pandemic public health measures. CONCLUSIONS: Telehealth has been rapidly implemented in metropolitan and rural settings and the existing evidence base demonstrates that it represents an effective mode of service delivery.

Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America.

In response to the COVID-19 pandemic, US federal and state governments have implemented wide-ranging stay-at-home recommendations as a means to reduce spread of infection. As a consequence, many US healthcare systems and practices have curtailed ambulatory clinic visits-pillars of care for patients with heart failure (HF). In this context, synchronous audio/video interactions, also known as virtual visits (VVs), have emerged as an innovative and necessary alternative. This scientific statement outlines the benefits and challenges of VVs, enumerates changes in policy and reimbursement that have increased the feasibility of VVs during the COVID-19 era, describes platforms and models of care for VVs, and provides a vision for the future of VVs.