Community-based access to oral antiviral treatments for COVID-19 in Australia.

BACKGROUND: The availability of oral antivirals for SARS-CoV-2 infection reduces the risk of severe, acute illness in people at higher risk for death and hospitalisation. OBJECTIVE: The process for antiviral prescription and dispensing in Australia is outlined using nationwide data. DISCUSSION: Australia has focused on providing rapid access to antivirals to high-risk people in the community via general practices and community pharmacies. Although the introduction of oral antiviral treatments is an important part of the response to the COVID-19 pandemic, vaccination remains the most effective way of mitigating the risk of developing severe complications of COVID-19, including hospitalisation and death.

At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19.

OBJECTIVES: The rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia modified clinical and organisational routines in response to the pandemic in 2020-2021 and identify factors that influenced these changes. DESIGN: Prospective, qualitative, participatory case study design using constant comparative data analysis, conducted between April 2020 and February 2021. Participant general practitioner (GP) investigators were involved in study design, recruitment of other participants, data collection and analysis. Data analysis included investigator diaries, structured practice observation, documents and interviews. SETTING: The cases were six Melbourne practices of varying size and organisational model. PARTICIPANTS: GP investigators approached potential participants. Practice healthcare workers were interviewed by social scientists on three occasions, and provided feedback on presentations of preliminary findings. RESULTS: We conducted 58 interviews with 26 practice healthcare workers including practice owners, practice managers, GPs, receptionists and nurses; and six interviews with GP investigators. Data saturation was achieved within each practice and across the sample. The pandemic generated changes to triage, clinical care, infection control and organisational routines, particularly around telehealth. While collaboration and trust increased within several practices, others fragmented, leaving staff isolated and demoralised. Financial and organisational stability, collaborative problem solving, creative leadership and communication (internally and within the broader healthcare sector) were major influences on practice ability to negotiate the pandemic. CONCLUSIONS: This study demonstrates the complex influences on primary care practices, and reinforces the strengths of clinician participation in research design, conduct and analysis. Two implications are: telehealth, triage and infection management innovations are likely to continue; the existing payment system provides inadequate support to primary care in a global pandemic.

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.

What strategies have been effective in optimising COVID-19 vaccine uptake in Australia and internationally?

BACKGROUND: A key public health measure protecting the population from COVID-19 is vaccination. Unvaccinated people have higher COVID-19 case rates and death rates than those who are fully or partially vaccinated. It has, and continues to be, critical to optimise COVID-19 vaccination uptake in the community. OBJECTIVE: The aim of this study was to identify population groups who were less likely to be fully vaccinated against COVID-19 and strategies that were successful in increasing uptake in these often hard-to-reach groups. DISCUSSION: Strategies that have successfully increased COVID-19 vaccine uptake may also be effective in enhancing uptake across a range of vaccine-preventable diseases. These strategies include collaboration and building trust with local communities, targeted communication and education, optimising access to vaccines and the use of targeted incentives. Primary care providers are often central to these strategies and are well placed to take the time that people need to shift from uncertain to becoming vaccinated.

Older people, the digital divide and use of telehealth during the COVID-19 pandemic.

BACKGROUND: Telehealth and other digital modes of care have been widely introduced in response to the COVID-19 pandemic and have enabled access to healthcare while reducing community transmission and keeping patients and practitioners safe. However, the benefits of telehealth are not evenly distributed, and may perpetuate some forms of disadvantage. OBJECTIVE: While the 'digital divide' is often understood in socioeconomic terms or geographic terms, the reasons for digital exclusion among older people may vary. The aim of this article is to explore what is known about this issue. DISCUSSION: Emerging insights from the pandemic suggest that there may be multiple reasons why older people are not able to effectively access or engage with health technologies despite their availability. These barriers should inform ongoing efforts to develop telehealth services that meet population needs and sustain their use beyond the pandemic.

How do general practices respond to a pandemic? Protocol for a prospective qualitative study of six Australian practices

IntroductionThe COVID-19 pandemic has transformed healthcare systems worldwide. Primary care providers have been at the forefront of the pandemic response and have needed to rapidly adjust processes and routines around service delivery. The pandemic provides a unique opportunity to understand how general practices prepare for and respond to public health emergencies. We will follow a range of general practices to characterise the changes to, and factors influencing, modifications to clinical and organisational routines within Australian general practices amidst the COVID-19 pandemic.Methods and analysisThis is a prospective case study of multiple general practices using a participatory approach for design, data collection and analysis. The study is informed by the sociological concept of routines and will be set in six general practices in Melbourne, Australia during the 2020–2021 COVID-19 pandemic. General practitioners associated with the Monash University Department of General Practice will act as investigators who will shape the project and contribute to the data collection and analysis. The data will include investigator diaries, an observation template and interviews with practice staff and investigators. Data will first be analysed by two external researchers using a constant comparative approach and then later refined at regular investigator meetings. Cross-case analysis will explain the implementation, uptake and sustainability of routine changes that followed the commencement of the pandemic.Ethics and disseminationEthics approval was granted by Monash University (23950) Human Research Ethics Committees. Practice reports will be made available to all participating practices both during the data analysis process and at the end of the study. Further dissemination will occur via publications and presentations to practice staff and medical 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.

What has the COVID-19 pandemic taught us about the use of virtual consultations in primary care?

BACKGROUND: Telehealth has been a very useful resource in primary care consultations during the COVID-19 pandemic. OBJECTIVE: The aim of this article is to examine primary care providers' (PCPs') and patients' experiences of using video and telephone modalities and their perceptions of the quality of telehealth. DISCUSSION: Video consultations offer the advantage of enabling visualisation of a patient's visual affect and physical appearance, and they are helpful in building therapeutic relationships. However, many PCPs and patients find telephone consultations of equal value, and this has been the preferred telehealth modality internationally. This may be due to challenges experienced by PCPs and patients with the set-up and use of video consultation technologies, and the quality of these experiences. Some members of a number of at-risk groups have experienced greater challenges with this. The future of telehealth in primary care requires its coherent integration into clinical infrastructure and substantial bolstering of community access and capacity to use both video and telephone modalities.

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.

Health equity and COVID-19: global perspectives.

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.

Trust within your team during a pandemic.

The concept of trust is essential for high-functioning general practice teams during a pandemic.