Perspectives on telehealth implementation in Australia: An exploratory qualitative study with practice managers and general practitioners.

BACKGROUND: There is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs). METHODS: Employing a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added. RESULTS: The innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform. CONCLUSION: Evolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth.

Type 2 Diabetes Stigma Assessment Scale (DSAS-2): Cultural and linguistic adaptation and psychometric assessment of the Arabic version.

AIMS: To culturally and linguistically adapt the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) into Arabic and assess its psychometric properties. METHODS: Following forward-backward translation of the DSAS-2, the Content Validity Index (CVI) was assessed. Cognitive debriefing and pilot testing were conducted with adults with T2DM. The Arabic DSAS-2 was included in a multi-center, cross-sectional study (N = 327) Arabic-speaking adults with type 2 diabetes. Psychometric analyses included exploratory and confirmatory factor analysis (EFA/CFA), internal consistency reliability, and convergent validity. RESULTS: The Arabic DSAS-2 was considered appropriate, with an excellent CVI (0.98). Unforced EFA revealed a satisfactory three-factor structure, indicating the same subscales as the original instrument ('Treated differently', 'Blame and judgment', 'Self-stigma'). EFA for three factors showed good indicators (KMO=0.924; Bartlett's test of sphericity χ2 = 4063.709, df=171, p < 0.001). Internal consistency was satisfactory for both the three-factor structure (α = 0.91, α = 0.88, and α = 0.88, respectively) and the single factor (α = 0.94). CFA results were inconclusive. Although fit indices improved for the single-factor model, compared to the three-factor, they remained inadequate. The total scale demonstrated satisfactory convergent validity with self-esteem. CONCLUSIONS: The Arabic DSAS-2 has excellent reliability and acceptable validity, supporting a three-factor structure as well as the use of a total score.

Participant perspectives of an online co-design process to develop a prevention-focused mental health and well-being platform for primary producers.

OBJECTIVE: To explore participant experiences of an online co-design process to develop a web-based preventative mental health and well-being intervention targeting primary producers in rural Australia. SETTING: Rural Victoria, Australia. PARTICIPANTS: Participants from a primary producer background, including horticulture, fisheries, animal cultivation and farm consultancy, were eligible for the study if they had participated in both the co-design and beta testing processes for a primary producer platform. DESIGN: A qualitative study using semi-structured phone-based interviews was undertaken. A reflexive inductive approach to data analysis was employed to develop themes. RESULTS: Eleven participants were interviewed, with an average age of 51 years, of which 7 were female. Five main themes were developed. These included: (1) participant diversity, (2) impact of online delivery on co-design participation, (3) experiences of the co-design process, (4) maintaining a shared vision and goals and (5) acting on the co-design recommendations. Use of online methods was a clear enabler to engage participants who were geographically dispersed and offers an alternative to more conventional approaches to co-design using face-to-face methods. Some aspects of participant engagement may need a greater focus when conducted online compared with face-to-face. CONCLUSIONS: Using an online co-design method to develop a preventative mental health and well-being web-based platform for primary producers was novel. Findings address a gap in the literature around the experience of participants engaging in a co-design process and identify opportunities to improve participant engagement and experience with the online format.

Development of a Complex Intervention for Effective Management of Type 2 Diabetes in a Developing Country.

There has been little focus on designing tailored diabetes management strategies in developing countries. The aim of this study is to develop a theory-driven, tailored and context-specific complex intervention for the effective management of type 2 diabetes at a tertiary care setting of a developing country. We conducted interviews and focus groups with patients, health professionals, and policymakers and undertook thematic analysis to identify gaps in diabetes management. The results of our previously completed systematic review informed data collection. We used the United Kingdom Medical Research Council framework to guide the development of the intervention. Results comprised 48 interviews, two focus groups with 11 participants and three co-design panels with 24 participants. We identified a lack of structured type 2 diabetes education, counselling, and collaborative care of type 2 diabetes. Through triangulation of the evidence obtained from data collection, we developed an intervention called VICKY (patient-centred collaborative care and structured diabetes education and counselling) for effective management of type 2 diabetes. VICKY comprised five components: (1) patient-centred collaborative care; (2) referral system for patients across transitions of care between different health professionals of the diabetes care team; (3) tools for the provision of collaborative care and documentation of care; (4) diabetes education and counselling by trained diabetes educators; and (5) contextualised diabetes education curriculum, educational materials, and documentation tools for diabetes education and counselling. Implementation of the intervention may help to promote evidence-based, patient-centred, and contextualised diabetes care for improved patient outcomes in a developing country.

Hospital pharmacists' experiences of participating in a partnered pharmacist medication charting credentialing program: a qualitative study.

BACKGROUND: Medication-related errors are one of the most frequently reported incidents in hospitals. With the aim of reducing the medication error rate, a Partnered Pharmacist Medication Charting (PPMC) model was trialled in seven Australian hospitals from 2016 to 2017. Participating pharmacists completed a credentialing program to equip them with skills to participate in the trial as a medication-charting pharmacist. Skills included obtaining a comprehensive medication history to chart pre-admission medications in collaboration with an admitting medical officer. The program involved both theoretical and practical components to assess the competency of pharmacists. METHODS: A qualitative evaluation of the multi-site PPMC implementation trial was undertaken. Pharmacists and key informants involved in the trial participated in an interview or focus group session to share their experiences and attitudes regarding the PPMC credentialing program. An interview schedule was used to guide sessions. Transcripts were analysed using a pragmatic inductive-deductive thematic approach. RESULTS: A total of 125 participants were involved in interviews or focus groups during early and late implementation data collection periods. Three themes pertaining to the PPMC credentialing program were identified: (1) credentialing as an upskilling opportunity, (2) identifying the essential components of credentialing, and (3) implementing and sustaining the PPMC credentialing program. CONCLUSIONS: The PPMC credentialing program provided pharmacists with an opportunity to expand their scope of practice and consolidate clinical knowledge. Local adaptations to the PPMC credentialing program enabled pharmacists to meet the varying needs and capacities of hospitals, including the policies and procedures of different clinical settings. These findings highlight key issues to consider when implementation a credentialing program for pharmacists in the hospital setting.

Pharmacists' experiences and views on providing screening services: An international comparison.

BACKGROUND: The PHARMASCREEN study, adapted from the Australian Cardiovascular Absolute Risk Screening study (CARS), tested the first community pharmacist-delivered screening model for diabetes and cardiovascular disease (CVD) in the UAE. Both PHARMASCREEN and CARS screening models successfully identified at-risk individuals despite differences in healthcare systems, infrastructure, and scope of practice. Comparing pharmacists' experiences of screening delivery in different health systems will help to understand key contextual factors that affect future implementation. OBJECTIVE: To explore and compare the views and experiences of pharmacists participating in the UAE PHARMACSCREEN trial, with those of community pharmacists who participated in the Australian CARS trial. METHODS: In-depth, face-to-face interviews were conducted with pharmacists who delivered the screening programs in Australia (n = 10) and UAE (n = 12) to explore their views and experiences. The interview guide was similar in both studies to ensure consistency and comparability of collected data. Interviews were transcribed verbatim and thematically analyzed. RESULTS: Two common themes emerged: pharmacists' experiences with the screening program, and barriers and facilitators to service delivery. Both groups held very positive views about the screening intervention, particularly referencing the professional satisfaction it generated and broad participant satisfaction with pharmacy-based screening. Despite country and health system differences, pharmacists reported many similar barriers (e.g., staffing levels, pharmacy coordination) and enablers (e.g., implementation support, adequate staffing, point-of-care tests, no cost to patient) to implementation. The context for screening delivery emerged as a key theme for UAE interviews only, where issues such as local population needs, regulatory factors, pharmacist roles and expectations, and training needs were quite prominent. CONCLUSIONS: Pharmacists' positive experiences with the screening programs is a testimony to the strong emerging evidence supporting pharmacists-delivered screening. Despite differences in health care systems, similar enablers and barriers were identified. The adaptation and successful implementation of international screening models requires a country-specific adaptation process.

Evaluation of clinical quality improvement interventions: feasibility of an integrated approach.

BACKGROUND: Cardiovascular diseases (CVD) are the largest cause of death and disability in Australia. Australian national guidelines for the primary prevention of CVD recommend that all adults without CVD and aged 45 years or more are screened for their absolute risk of CVD every 2 years. Despite the compelling evidence to address CVD risk, treatment gaps remain and evidence suggests that much of the shortcomings are attributed to the performance of primary care practices. To address this issue, a quality improvement initiative is being implemented in a large urban multidisciplinary primary care practice in the South West region of Victoria, Australia. The key outcome of this intervention will be to increase the use and acceptability of CVD risk assessment guidelines. To ensure the intervention is tracking toward its objectives, a robust monitoring and evaluation framework was established. METHOD/DESIGN: A novel framework that assimilates key traditional and theory-driven evaluation practices was developed to assess the impact of the intervention. The framework approach is termed the integrated model of evaluation (IMoE). Researchers and stakeholders convened several times to discuss and develop the evaluation protocol and align it with the quality intervention. The main objective here is to explore the feasibility of an integrated approach to evaluating clinical quality improvement interventions. The sub-objectives are to test the alignment of the IMoE to clinical quality improvement projects and its ability to derive findings to the satisfaction of stakeholders. The design and establishment of the evaluation approach is discussed in further detail in this article. DISCUSSION: The novel feature of the IMoE is its emphasis on tracking 'change' in practices that lead to quality improvement. This emphasis suits the quality improvement theme of this initiative as identification of change elements and explanation behind change is necessary to sustain and promote quality improvement. The other principle behind development of this model, which emphasises practicality in implementation, is to ensure stakeholders gain greatest value from the commissioning of program evaluation. By incorporating practical components and leaving out esoteric concepts, this approach ensures evaluation can be undertaken in realistic timeframes. ETHICS APPROVAL: The quality improvement intervention and evaluation framework received approval from the Deakin University Human Research Ethics Committee (Approval Number: 2017-313).

Pharmacy Diabetes Screening Trial: protocol for a pragmatic cluster-randomised controlled trial to compare three screening methods for undiagnosed type 2 diabetes in Australian community pharmacy.

INTRODUCTION: With the rising prevalence of type 2 diabetes in Australia, screening and earlier diagnosis is needed to provide opportunities to intervene with evidence-based lifestyle and treatment options to reduce the individual, social and economic impact of the disease. The objectives of the Pharmacy Diabetes Screening Trial are to compare the clinical effectiveness and cost-effectiveness of three screening models for type 2 diabetes in a previously undiagnosed population. METHODS AND ANALYSIS: The Pharmacy Diabetes Screening Trial is a pragmatic cluster randomised controlled trial to be conducted in 363 community pharmacies across metropolitan, regional and remote areas of Australia, randomly allocated by geographical clusters to one of three groups, each with 121 pharmacies and 10 304 screening participants. The three groups are: group A: risk assessment using a validated tool (AUSDRISK); group B: AUSDRISK assessment followed by point-of-care glycated haemoglobin testing; and group C: AUSDRISK assessment followed by point-of-care blood glucose testing. The primary clinical outcome measure is the proportion of newly diagnosed cases of type 2 diabetes. Primary outcome comparisons will be conducted using the Cochran-Mantel-Haenszel test to account for clustering. The secondary clinical outcomes measures are the proportion of those who (1) are referred to the general practitioner (GP), (2) take up referral to the GP, (3) are diagnosed with pre-diabetes, that is, impaired glucose tolerance or impaired fasting glucose and (4) are newly diagnosed with either diabetes or pre-diabetes. The economic outcome measure is the average cost (direct and indirect) per confirmed new case of diagnosed type 2 diabetes based on the incremental net trial-based costs of service delivery and the associated incremental longer term health benefits from a health funder perspective. ETHICS AND DISSEMINATION: The protocol has been approved by the Human Research Ethics Committees at University of Sydney and Deakin University. Results will be available on the Sixth Community Pharmacy Agreement website and will be published in peer reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12616001240437; Pre-results.