ABSTRACT
Introduction Prevalence of hepatitis C virus (HCV) is substantially higher among prisoners than the general population. In Australia until recently, only a small proportion of prisoners with HCV received antiviral therapy. The direct-acting antivirals (DAAs) for HCV are highly effective, with a low burden of side effects. Since 2016, DAAs are available to all Australians with HCV. However, currently in Australia, they can only be prescribed by or in consultation with experienced prescribers. This study evaluated a telementoring service to upskill doctors and nurse practitioners working in correctional facilities. Methods The telementoring service was implemented in five correctional facilities. Qualitative interviews were used to examine the perceived clinical effectiveness and organisational impacts of the service. Content analysis of the interviews was used to identify key themes. Results In the first ten months of the service, there were 16 telementoring sessions with 173 patients discussed. Sixteen staff participated in qualitative interviews. From these, three key themes were identified: access to antiviral therapy; organisational impacts (cost, increased staff knowledge and confidence, staff time, and workload); and, adaptations of the care model and future opportunities. Conclusion Telementoring is an effective method to facilitate eligible prescriber status to medical doctors and upskill other clinicians in correctional facilities to increase capacity to treat HCV.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/drug therapy , Prisons , Telemedicine/standards , Adult , Attitude of Health Personnel , Australia , Clinical Competence , Education, Medical, Continuing/methods , Female , Health Knowledge, Attitudes, Practice , Health Personnel/education , Humans , Male , Middle Aged , Qualitative Research , Self Efficacy , Treatment Outcome , WorkloadABSTRACT
OBJECTIVE: Singing group participation may benefit patients with chronic obstructive pulmonary disease (COPD). Previous studies are limited by small numbers of participants and short duration of generally hospital-based singing group intervention. This study examines the feasibility of long-term participation in a community singing group for patients with COPD who had completed pulmonary rehabilitation (PR). METHODS: This was a feasibility cohort study. Patients with COPD who had completed PR and were enrolled in a weekly community exercise group were recruited to a new community-based singing group which met weekly for over 1â year. Measurements at baseline, 4â months and 1â year comprised comprehensive pulmonary function tests including lung volumes, 6â min walk test (6MWT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and hospital admission days for acute exacerbation of COPD (AECOPD) for 1â year before and after the first singing group session. FINDINGS: There were 28 participants with chronic lung disease recruited from 140 people approached. Five withdrew in the first month. 21 participants meeting Global Initiative for Chronic Obstructive Lung Disease criteria for COPD completed 4-month and 18 completed 1-year assessments. The mean attendance was 85%. For the prespecified primary outcome measure, total HADS score, difference between baseline and 12â months was -0.9, 95% CI -3.0 to 1.2, p=0.37. Of the secondary measures, a significant reduction was observed for HADS anxiety score after 1â year of -0.9 (95% CI -1.8 to -0.1) points, p=0.038 and an increase in the 6MWT at 1â year, of 65 (95% CI 35 to 99) m compared with baseline p<0.001. CONCLUSIONS: Our findings support the feasibility of long-term participation in a community singing group for adults with COPD who have completed PR and are enrolled in a weekly community exercise group and provide evidence of improved exercise capacity and a reduction in anxiety. TRIAL REGISTRATION NUMBER: ACTRN12615000736549; Results.
Subject(s)
Pulmonary Disease, Chronic Obstructive/rehabilitation , Singing , Aged , Aged, 80 and over , Anxiety/psychology , Cohort Studies , Depression/psychology , Feasibility Studies , Female , Forced Expiratory Volume , Functional Residual Capacity , Humans , Inspiratory Capacity , Male , Middle Aged , New Zealand , Pilot Projects , Prospective Studies , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Respiratory Function Tests , Total Lung Capacity , Vital Capacity , Walk TestABSTRACT
OBJECTIVE: To explore the ways in which participation in a community singing group contributed to the health and well-being of patients with chronic obstructive pulmonary disease (COPD). DESIGN: Qualitative description, based on transcripts from individual interviews and a focus group meeting with people with COPD participating in the singing group, regarding their experience. SETTING: Urban community, Wellington, New Zealand. PARTICIPANTS: 23 people (13 women and 10 men), 51-91â years with COPD (21) or interstitial lung disease (2). RESULTS: The weekly singing group was a well-attended activity, with self-reported benefits to health and well-being. 4 key themes were identified: being in the 'right space', connection, purpose and growth, and participation in a meaningful physical activity. CONCLUSIONS: This study helps us to better understand how participation in a community singing group can benefit the health and well-being of patients with COPD. TRIAL REGISTRATION NUMBER: ACTRN12615000736549; Results.
