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.

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.

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.

Community-led vaccination programs: Getting the fundamentals right.

In September 2021, South Sudanese Australians in Canberra, ACT, piloted a community-led COVID-19 vaccination program.

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 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.