Specialist consultation activity and costs in Australia: Before and after the introduction of COVID-19 telehealth funding.

This study describes and analyses the Medicare Benefits Schedule (MBS) activity and cost data for specialist consultations in Australia, as a result of the coronavirus disease 2019 (COVID-19) pandemic. To achieve this, activity and cost data for MBS specialist consultations conducted from March 2019 to February 2021 were analysed month-to-month. MBS data for in-person, videoconference and telephone consultations were compared before and after the introduction of COVID-19 MBS telehealth funding in March 2020. The total number of MBS specialist consultations claimed per month did not differ significantly before and after the onset of COVID-19 (p = 0.717), demonstrating telehealth substitution of in-person care. After the introduction of COVID-19 telehealth funding, the average number of monthly telehealth consultations increased (p < 0.0001), representing an average of 19% of monthly consultations. A higher proportion of consultations were provided by telephone when compared to services delivered by video. Patient-end services did not increase after the onset of COVID-19, signifying a divergence from the historical service delivery model. Overall, MBS costs for specialist consultations did not vary significantly after introducing COVID-19 telehealth funding (p = 0.589). Telehealth consultations dramatically increased during COVID-19 and patients continued to receive specialist care. After the onset of COVID-19, the cost per telehealth specialist consultation was reduced, resulting in increased cost efficiency to the MBS.

A virtual multi-disciplinary meeting is a cost-effective method of triaging referrals to a regional musculoskeletal oncology service.

BACKGROUND AND AIMS: In 2010, a virtual sarcoma referral model was implemented, which aims to provide a centralised multidisciplinary team (MDT) to provide rapid advice, avoiding unnecessary appointments and providing a streamlined service. The aim of this study is to examine the feasibility of this screening tool in reducing the service burden and expediting patient journey. METHODS AND RESULTS: All referrals made to a single tertiary referral sarcoma unit from January 2010 to December 2018 were extracted from a prospective database. Only 26.0% events discussed required review directly. 30.3% were discharged back to referrer. 16.5% required further investigations. 22.5% required a biopsy prior to review. There was a reduction in the rate of patients reviewed at the sarcoma clinic, and a higher discharge rate from the MDT in 2018 versus 2010 (p < 0.001). This gives a potential cost saving of 670,700 GBP over the 9 year period. CONCLUSION: An MDT meeting which triages referrals is cost-effective at reducing unnecessary referrals. This can limit unnecessary exposure of patients who may have an underlying diagnosis of cancer to a high-risk environment, and reduces burden on services as it copes with increasing demands during the COVID-19 pandemic.

Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN' (REGAIN): a structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The primary objective is to determine which of two interventions: 1) an eight week, online, home-based, supervised, group rehabilitation programme (REGAIN); or 2) a single online session of advice (best-practice usual care); is the most clinically and cost-effective treatment for people with ongoing COVID-19 sequelae more than three months after hospital discharge. TRIAL DESIGN: Multi-centre, 2-arm (1:1 ratio) parallel group, randomised controlled trial with embedded process evaluation and health economic evaluation. PARTICIPANTS: Adults with ongoing COVID-19 sequelae more than three months after hospital discharge Inclusion criteria: 1) Adults ≥18 years; 2) ≥ 3 months after any hospital discharge related to COVID-19 infection, regardless of need for critical care or ventilatory support; 3) substantial (as defined by the participant) COVID-19 related physical and/or mental health problems; 4) access to, and able/supported to use email and internet audio/video; 4) able to provide informed consent; 5) able to understand spoken and written English, Bengali, Gujarati, Urdu, Punjabi or Mandarin, themselves or supported by family/friends. EXCLUSION CRITERIA: 1) exercise contraindicated; 2) severe mental health problems preventing engagement; 3) previous randomisation in the present study; 4) already engaged in, or planning to engage in an alternative NHS rehabilitation programme in the next 12 weeks; 5) a member of the same household previously randomised in the present study. INTERVENTION AND COMPARATOR: Intervention 1: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) programme: an eight week, online, home-based, supervised, group rehabilitation programme. Intervention 2: A thirty-minute, on-line, one-to-one consultation with a REGAIN practitioner (best-practice usual care). MAIN OUTCOMES: The primary outcome is health-related quality of life (HRQoL) - PROMIS® 29+2 Profile v2.1 (PROPr) - measured at three months post-randomisation. Secondary outcomes include dyspnoea, cognitive function, health utility, physical activity participation, post-traumatic stress disorder (PTSD) symptom severity, depressive and anxiety symptoms, work status, health and social care resource use, death - measured at three, six and 12 months post-randomisation. RANDOMISATION: Participants will be randomised to best practice usual care or the REGAIN programme on a 1:1.03 basis using a computer-generated randomisation sequence, performed by minimisation and stratified by age, level of hospital care, and case level mental health symptomatology. Once consent and baseline questionnaires have been completed by the participant online at home, randomisation will be performed automatically by a bespoke web-based system. BLINDING (MASKING): To ensure allocation concealment from both participant and REGAIN practitioner at baseline, randomisation will be performed only after the baseline questionnaires have been completed online at home by the participant. After randomisation has been performed, participants and REGAIN practitioners cannot be blind to group allocation. Follow-up outcome assessments will be completed by participants online at home. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 535 participants will be randomised: 263 to the best-practice usual care arm, and 272 participants to the REGAIN programme arm. TRIAL STATUS: Current protocol: Version 3.0 (27th October 2020) Recruitment will begin in December 2020 and is anticipated to complete by September 2021. TRIAL REGISTRATION: ISRCTN:11466448 , 23rd November 2020 FULL PROTOCOL: The full protocol Version 3.0 (27th October 2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interests of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

How can hospitals engage their current employees in the recruitment of qualified nurses? A referral bonus and self-determination perspective.

AIMS: To investigate the impact of promising a referral bonus and an autonomous referral request on nurses' referral likelihood and the quality of their referrals. DESIGN: We applied a 2 × 2 between-participants factorial design with referral bonus and autonomous referral request as experimental variables. METHODS: In May 2019, 110 nurses working in Belgian hospitals were shown a fictitious e-mail with a request from their employer to look for potential new-hires and filled out an online survey measuring referral likelihood and quality. RESULTS: Promising a referral bonus did not affect nurses' referral likelihood and quality. Instead supporting self-determination theory, nurses exposed to the autonomous request were more likely to refer and assure referral quality than those exposed to the controlling request. CONCLUSION: Hospitals can increase nurses' referral likelihood and quality by framing their referral request in an autonomy-supportive way. IMPACT: Recruiting nurses are more important than ever in the current Covid-19 crisis. Our findings offer practical insights on how hospitals can engage their employees in the recruitment of nurses (i.e. through framing referral requests in an autonomy-supportive way).