Experiences of telehealth in general practice in Australia: research protocol for a mixed methods study

BackgroundDue to the COVID-19 pandemic, use of telehealth has expanded rapidly. However, little is known about the impact of delivering care through telehealth on communication between clinicians and patients. At an interactional level, the ways in which clinicians establish rapport and connection with their patients in telehealth consultations is not well understood.AimThis study will explore interactional practices of general practitioners (GPs) and patients in telehealth consultations to develop evidence-based resources to improve communication.Design & settingThe study will be conducted within the Australian general practice setting.MethodConversation analysis and sociolinguistic discourse analysis of recorded telehealth consultations will provide direct evidence of specific elements contributing to successful and less successful instances of telehealth communication. This analysis will be complemented by co-design techniques such as qualitative and reflective interviews and collaborative workshops with telehealth users, including both general practitioners and patients.ConclusionEffective communication is critical for telehealth consultations and is central to achieving optimal clinical outcomes and patient satisfaction. This study will co-develop with end-users, evidence-based guidelines encompassing effective telehealth communication strategies.

Face-to-face versus telehealth consultations during COVID-19 in australian general practice: comparison of medication prescribing

BackgroundThere has been a precipitous rise telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice.Design and SettingThis multisite, retrospective observational study used de-identified routinely collected electronic health data extracted from 806 general practices in Victoria and New South Wales (NSW), Australia between April-December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data are reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) Classification System level one groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13,608,216 consultations satisfied the inclusion criteria (61% face-to-face and 39% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication– a statistically significant difference (adjusted OR 1.38; 95% CI 1.379–1.381). The prescribing rate was greater for face-to-face vs telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared to telehealth consultations in the study population.

Learning from the Implementation of a Quality Improvement Intervention in Australian General Practice: A Qualitative Analysis of a CVD Preventive Care Project

BackgroundQuality-improvement collaborative (QIC) initiatives aim to reduce gaps in clinical care provided in the healthcare system. This study provides a qualitative evaluation of a QIC project (QPulse) in Australian general practice focused on improving cardiovascular disease (CVD) assessment and management. MethodsThis qualitative-methods study explored implementing a QIC project by a Primary Health Network (PHN) in 34 general practices. Qualitative analyses examined in-depth interviews with participants and stakeholders focusing on barriers and enablers to implementation in our health system. They were analysed thematically using the Complex Systems Improvement framework (CSI), focusing on strategy, culture, structure, workforce, and technology.ResultsDespite strategic engagement with QPulse objectives across the health system, implementation barriers associated with this program were considerable for both PHN and the general practices. Adoption of the QIC process was reliant on engaged leadership, practice culture, systems for clear communication, tailored education and regular clinical audit and review. Practice ownership, culture and governance, rather than practice size and location, were related to successful implementation. Financial incentives for both the PHN and general practice were identified as prerequisites for systematised quality improvement (QI) projects in the future, along with individualised support and education provided to each practice. Technology was both an enabler and a barrier, and the PHN was seen as key to assisting the successful adoption of the available tools. ConclusionsImplementation of QI programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as individualised education and support provided via a meso-level organisation, financial incentives, and IT tools and support are crucial if the full potential of QI programs are to be realised in the Australian healthcare setting. Trial registrationACTRN12615000108516, UTN U1111-1163-7995.

629Influenza-like illness surveillance in Australia: comparison of general practice data with laboratory-confirmed influenza notifications

Background Influenza is a respiratory infection responsible for 645,000 annual deaths worldwide. Surveillance systems provide valuable data for monitoring influenza in order to detect outbreaks and guide public health responses. This study aimed to investigate the epidemiology of influenza-like illness (ILI) using two Australian general practice databases (MedicineInsight and the Australian Sentinel Practice Research Network (ASPREN)) and compare them with laboratory-confirmed influenza from the National Notifiable Diseases Surveillance System (NNDSS). Methods All patients who had a consultation in MedicineInsight general practices or ASPREN and all laboratory-confirmed influenza reported by the NNDSS between 2015-2017 were included. Weekly ILI rates per 1,000 consultations (MedicineInsight/ASPREN) were compared with influenza notifications (NNDSS). Results Data was consistent among sources, with higher cases in 2017, among women and patients aged 20-49 years. The peak rate in MedicineInsight almost doubled in 2017 compared to 2015, while in ASPREN it was less pronounced. MedicineInsight ILI curves more closely resembled NNDSS patterns (shape, the start of the season, peaks) than ASPREN, although both were highly correlated with NNDSS (r = 0.90 to 0.97 and r = 0.88 to 0.98, respectively). Conclusions MedicineInsight and ASPREN provided consistent ILI results, both resembling confirmed influenza epidemic curves, suggesting the potential use of routinely collected electronic medical records (MedicineInsight) in influenza surveillance. MedicineInsight provides comprehensive medical data, such as underlying conditions, medications prescribed and vaccination status, which could be used to improve accuracy on influenza detection. Key messages Electronic medical records could be used to monitor ILI in combination with ASPREN for effective early detection of outbreaks.

Statistical Analysis Plan for the MSK DI AF trial

The primary objective of the MSK DI AF trial is to estimate the effectiveness of audit and feedback for reducing diagnostic imaging requests for 11 musculoskeletal imaging services in high requesting GPs in Australia compared with control. It is a 5-arm partial 2 x 2 factorial cluster randomised trial testing variations in the design and delivery of audit and feedback for reducing musculoskeletal diagnostic imaging requests in Australian general practice. This statistical analysis plan pre-specifies all analyses and was prepared while blinded to the randomised allocation.