The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy

Background Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities. Methods An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward. Conclusions While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

Evaluation of a voucher scheme to increase child physical activity in participants of a school physical activity trial in the Hunter region of Australia

Background Global population data suggest that physical activity levels in children remain unacceptably low. Improved participation in organised sport has been recommended by the WHO as one strategy to improve population levels of physical activity. In 2018, in the state of New South Wales, Australia, the government introduced the Active Kids scheme, to help families meet the cost of getting children into organized sport. The aim of this study is to describe the uptake of Active Kids and assess the impact of the scheme on organized sport participation and child physical activity in a region of New South Wales. Methods A pragmatic longitudinal study was undertaken of parents/carers from primary school aged children (5–12 years) in the Hunter region of NSW, Australia. Baseline data were collected between Oct-Dec 2017, with follow-up 12 months later. A telephone survey occurred at both time points, asking questions regarding registration and redemption of an Active Kids voucher for their child, child participation in organised sports and child physical activity levels. Results Of the 974 parents/carers who consented to participate, 511 (52.5%) completed the telephone surveys at both time points. A very large proportion of children (n = 454, 89.0%) were reported by their parents/carers at baseline as meeting the minimum physical activity guideline of 60 min per day. Of participating parents/carers in this study, 407 (96.0%) reported redeeming an Active Kids voucher. Children who redeemed a voucher had three times the odds to participate in organized team sports from baseline to follow-up (p = 0.009). Sub group analyses identified that females who redeemed a voucher had four times the odds to participate in organized team sports (p = 0.012). Conclusions Given the already active nature of this sample, no significant improvements in physical activity levels were noted, but the positive contribution community sport can have on health and wellbeing amongst children is reinforced. Whilst voucher schemes can address financial burdens across all socio-economic groups, more population targeting is needed to deliver voucher schemes to the most disadvantaged and inactive segments of the population in order to increase physical activity.

The qualitative experience of telehealth access and clinical encounters in Australian health care during COVID-19: Implications for policy

BackgroundAdaptive models of health care delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential health care services during COVID-19. However there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences or specialists, based at tertiary hospital in the Hunter Region, and General Practitioners (GP) including barriers, enables and opportunities. Methods In-depth interviews explored the telehealth experiences of specialists, based at tertiary hospital in the Hunter Region of Australia, and General Practitioners (GP) including barriers, enablers and opportunities. Data were analyzed using an inductive thematic approach with constant comparison.ResultsIndividual interviews were conducted with 10 specialist and 5 GPs. Key themes were identified: (1) Transition to telehealth has been valuable but challenging; (2) Persisting telehealth process barriers need addressing; (3) Establishing when face-to-face consults are essential; (4) Changes in workload pressures and potential for double up; (5) Essential modification of work practices and (6) Exploring what is needed going forwardDiscussionWhile there is a need to rationalise and optimise health access during a pandemic, we suggest that more needs to be done improve telehealth going forward. Our results have important policy implications. Specifically, there is a specific need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

Youth mental health competencies in regional general practice

Objective: General practitioners (GPs) are key health professionals for referrals to mental health specialists. Youth mental health issues are particularly challenging, requiring a competent assessment and understanding of appropriate referral pathways. We surveyed local GPs about their understanding of youth mental health problems and needs to competently look after young patients. Methods: GPs working in the Hunter region were contacted via email, fax and post over a 6-month period in 2019. Results: Seventy-five GPs participated. They reported 577 of 1698 (34%) of young people seen 2 weeks prior to being surveyed presented with a mental health problem. Predominantly, referrals were to private practice psychologists and Headspace. Almost a third (31%) reported having limited understanding of ‘at-risk mental state’ and are ‘not always comfortable’ when facing a young person with a mental health problem. Nearly all (95%) expressed interest in attending specialised training. GPs identified treatment costs, scarce access to psychiatrists and limited patient engagement as the main obstacles to help young people. Conclusions: Effective treatment of a mental health problem relies on early identification. GPs are seeing young people on a regular basis but don’t feel well equipped for this task and are keen to up-skill, which needs to be addressed by targeted training.

Projected change in meteorological drought characteristics using regional climate model data for the Hunter region of Australia

Drought is a natural phenomenon that can have prolonged and widespread impacts on many communities and environments. The impact of climate change on drought is uncertain, which makes it challenging to quantify how future droughts will affect society. This study uses downscaled rainfall data from 4 global climate models (GCMs) and 2 time windows (1990-2009; 2060-2079) to estimate changes in the average length and intensity of single drought events, and the total number of months experiencing drought during each time window for the Hunter region of Australia. This region was chosen as it is economically important for Australia, and will be the focus of future work that examines the social and policy implications of projected climate change impacts on drought and human displacement. The changes in drought characteristics are assessed using Standardised Precipitation Index and deciles approaches, and 2 datasets: (1) downscaled GCM rainfall; and (2) historical gridded rainfall adjusted via a quantile-quantile approach conditioned on the GCM rainfall. Key findings are that the changes in drought characteristics vary spatially across the study region, and are highly dependent on the downscaled GCM rainfall used, with some regions showing opposing changes in drought characteristics between the ensemble members. Further, the change in drought characteristics between the current and future time windows tends to be greater using the downscaled GCM rainfall when compared with the GCM-adjusted historical rainfall. These results pose the question of how GCM projections should be used to develop robust but cost-effective climate adaptation strategies.