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Objective: The coronavirus disease 2019 (COVID-19) pandemic precipitated a major shift in the use of telehealth in Australia. The changes highlighted gaps in our knowledge regarding the efficacy of, and clinician attitudes to, the use of telehealth. The current study expands and deepens the available evidence as a result of being collected in unique circumstances that removed one of the major barriers (lack of Medicare rebates) and also one major enablers (willingness) of telehealth uptake. Methods: Using a semi-structured interview, we invited clinicians (N = 39) to share their perspectives, attitudes and experiences of using telehealth. Topics covered included perceptions of the strengths and challenges of telehealth, and how experience of using telehealth during the COVID-19 pandemic had influenced clinicians' views and intentions regarding their future practice. Participants included clinicians from five disciplines across public and private practice: paediatrics, neurology, immunology, rural general practice, and orthopaedics. Results: We found three key dimensions for consideration when assessing the suitability of telehealth for ongoing practice: the attributes of the patient population, the attributes of the clinical context and environment, and the risks and benefits of a telehealth approach. These findings map to the existing literature and allow us to infer that the experiences of clinicians who previously would have chosen telehealth did not differ significantly from those of our 'pandemic-conscripted' clinicians. Conclusions: Our findings map clearly to the existing literature and allow us to infer that the experiences of the clinicians who have chosen telehealth (and are already represented in the literature) did not differ significantly from those trying out telehealth under the unique circumstances of the removal of the Medicare Benefits Scheme barrier and external pressure that over-rides the 'willingness' enabling factor in uptake decisions. What is known about the topic? Clinician and patient experiences of telehealth use have already been documented in contexts where both clinician and patient have opted-in to that process. What does this paper add? The paper adds data on clinician experience across a range of specialities, from a context (pandemic public-heath measures) where the choice element was reduced for both patient and clinician. What are the implications for practitioners? The data speak to the generalisability of existing evidence, but also provide practical considerations in planning for the inclusion of telehealth for specialist health services in the Australian context. [ABSTRACT FROM AUTHOR]

Background: Despite emerging evidence of validity and reliability, speech and language therapists' (SLT) uptake of telehealth has been limited and barriers remain to the effective and confident use of this service model. The COVID‐19 pandemic has caused significant disruption to essential health services, including speech and language therapy assessment and intervention, meaning that telehealth must now be considered as part of the suite of service delivery options for all clinicians. Aims: To explore the perceived barriers and facilitators of telehealth among community paediatric SLTs before and after their use of a telehealth platform with an embedded standardised assessment tool. Methods & Procedures: Mixed‐methods questionnaires were developed for this study and completed by SLTs before and after the 3‐month trial of the telehealth platform. A total of 38 SLTs completed the pre‐trial questionnaire and training in the use of telehealth platform (Coviu), including instruction in using a standardised, norm referenced language test as an integrated tool within the Coviu platform. A total of 27 SLTs went on to use the telehealth platform, and 25 of these completed the post‐trial questionnaire on which subsequent qualitative and quantitative analysis was completed. Outcomes & Results: Prior to using the platform, perceived barriers included technology issues, limited clinician experience and concerns around parent acceptance of the service. Potential facilitators included access to appropriate platforms, tools and resources as well as increased clinician confidence with telehealth. Following the trial, barriers to telehealth use continued to include technology barriers, particularly internet stability, and client issues, including suitability for telehealth services. Facilitators for future telehealth use included access to appropriate platforms for telehealth, stable and appropriate internet connectivity, and more extensive telehealth resources for both assessment and intervention for this mode of service delivery. Conclusions & Implications: This study provides insights into the perceptions of the barriers and facilitating factors for telehealth use among community‐based SLTs. This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery beyond the pandemic. What this paper adds: What is already known on the subject: Research about telehealth has shown that it is a reliable and valid way of delivering speech pathology services, yet many clinicians have been wary of its use and uptake of telehealth prior to COVID‐19 had been limited. We wanted to know what SLTs thought about using telehealth before and after participating in a 3‐month trial of a telehealth platform with an embedded formal language assessment. What this study adds to existing knowledge: This study indicates that technology issues including internet stability are a barrier to effective telehealth services, but that appropriate telehealth platforms, resources and experience are facilitators of uptake and successful use of telehealth. What are the potential or actual clinical implications of this work?: This information will be useful in developing strategies to promote uptake and effective and confident use of telehealth as a mode of service delivery for children during and beyond the pandemic, including those isolated by geographical or transport barriers. [ABSTRACT FROM AUTHOR]

Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice. [ABSTRACT FROM AUTHOR]

This paper presents findings from the evaluation of an Australian trial of self‐managed home aged care. The self‐management model was codesigned by advocacy organisation COTA Australia, consumers and service providers. The primary aim of the evaluation was to examine whether self‐management improved consumers' perceptions of their choice, control, and wellbeing. The secondary aim was to examine whether provider prior experience with self‐managed packages significantly influenced consumers' perceptions of choice, control and wellbeing, thereby confounded trial effects. A pre‐test post‐test quasi‐experimental design and mixed‐methods design were used to collect data over nine months in 2018–2019. The pre‐trial methods and findings have been published. The post‐trial evaluation replicated the pre‐trial data collection method of an online survey (n = 60) and semi‐structured telephone interviews with consumers (n = 9), family carers (n = 13), and consumers and carers jointly (n = 2), totalling 24 interviews. Semi‐structured telephone interviews were also conducted with CEOs and senior managers from each of the seven providers (n = 14). Three providers had prior experience supporting self‐management. Parametric and non‐parametric tests examined the statistical data. Qualitative data were analysed thematically and framed according to self‐determination principles and ecological systems theory. Both datasets demonstrated that consumers reported greater choice and control at post‐trial than pre‐trial. This finding was not affected by providers' prior experience with self‐management; therefore, it was not a confounding factor. Participants reported improved wellbeing in interviews, however this was not reinforced statistically. Key desirable features of self‐management included greater autonomy and control over spending, recruiting support staff and paying lower administration fees. There was no evidence of increased risks or fraud. The research limitations included a small sample size, convenience sampling with providers recruiting interview participants, no control group and differences in trial implementation. The findings support the expansion of self‐management opportunities and more comprehensive evaluations that use mixed methods. [ABSTRACT FROM AUTHOR]

Objectives: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. Methods: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. Results: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. Conclusions: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care. [ABSTRACT FROM AUTHOR]

Aims: To map the pathway and service provision for pregnant women whose newborns require admission into the surgical neonatal intensive care unit at or soon after birth, and to examine the nature of continuity of care (COC) provided and the facilitators and barriers to woman‐ and family‐centred care from the perspective of women/parents and health professionals. Background: Limited research exists on current service and care pathways for families whose babies are diagnosed with congenital abnormality requiring surgery. Design: A mixed method sequential design adhering to EQUATOR guidelines for Good Reporting of a Mixed Methods Study. Methods: Data collection methods included: (1) a workshop with health professionals (n = 15), (2) retrospective maternal record review (n = 20), prospective maternal record review (17), (3) interviews with pregnant women given a prenatal diagnosis of congenital anomaly (n = 17) and (4) interviews with key health professionals (n = 7). Results/Findings: Participants perceived care delivered by state‐based services as problematic prior to admission into the high‐risk midwifery COC model. Once admitted to the high‐risk maternity team women described care 'like a breath of fresh air' with a 'contrast in support', where they felt supported in their decisions. Conclusion: This study highlights provision of COC, in particular relational continuity between health providers and women as essential to achieve optimal outcomes. Relevance to Clinical Practice: Provision of individualised COC offers an opportunity for perinatal services to reduce the negative consequences of pregnancy‐related stress associated with diagnosis of foetal anomaly. Patient or Public Contribution: No patient or public was involved in the design, analysis, preparation or writing of this review. [ABSTRACT FROM AUTHOR]

Background: The implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood. Aim: To explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care. Method: This study used semi‐structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio‐recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069). Results: The process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles. Conclusion: A key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy. [ABSTRACT FROM AUTHOR]

Individuals with depressive symptoms often experience changes in physical activity and lifestyle factors. Despite the benefits of exercise, mental health clinicians often do not refer for or prescribe exercise as part of traditionally accepted models of care for consumers with depression and anxiety. The aims were to investigate: (i) mental health clinicians' understanding of the relationship between exercise and mental health, (ii) if and how exercise is used by mental health clinicians in treatment for depression and anxiety, and (iii) the barriers to prescription of exercise. A descriptive qualitative method was used, and data were collected via individual semi‐structured interviews. Ten mental health clinicians with varying backgrounds participated in this study. The data driven inductive analysis of participants views identified three themes: (i) knowing and not knowing, (ii) consumer comorbidities – the risk and benefit dilemma, and (iii) protecting vulnerable consumers. Enhancing clinicians' knowledge of the beneficial role of exercise in treatment for consumers' experiencing depression and anxiety is an important step. Mental health services can support integration of exercise by implementing policies and training for staff to support exercise prescription, and the role and referral of exercise and physical activity specialists, as part of routine care to improve clinical outcomes for consumers. Additional considerations should be given to fiscal support to access exercise as an adjunct therapy. [ABSTRACT FROM AUTHOR]

Female genital mutilation/cutting (FGM/C) is a harmful cultural practice with significant health consequences for affected women and girls. Due to migration and human mobility, an increasing number of women with FGM/C are presenting to healthcare facilities of western countries (including Australia) where the practice is non-prevalent. Despite this increase in presentation, the experiences of primary healthcare providers in Australia engaging and caring for women/girls with FGM/C are yet to be explored. The aim of this research was to report on the Australian primary healthcare providers' experiences of caring for women living with FGM/C. A qualitative interpretative phenomenological approach was utilised and convenience sampling was used to recruit 19 participants. Australian primary healthcare providers were engaged in face-to-face or telephone interviews, which were transcribed verbatim and thematically analysed. Three major themes emerged, which were: exploring knowledge of FGM/C and training needs, understanding participants' experience of caring for women living with FGM/C, and mapping the best practice in working with women. The study shows that primary healthcare professionals had basic knowledge of FGM/C with little or no experience with the management, support, and care of affected women in Australia. This impacted their attitude and confidence to promote, protect, and restore the target population's overall FGM/C-related health and wellbeing issues. Hence, this study highlights the importance of primary healthcare practitioners being skilled and well-equipped with information and knowledge to care for girls and women living with FGM/C in Australia. [ABSTRACT FROM AUTHOR]

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Introduction: Collaborating with consumers in designing, delivering, and evaluating curricula is an ongoing initiative within occupational therapy tertiary courses in Australia. Within the Australian educational context, consumers are involved in on‐campus educational activities. Student occupational therapists must complete 1000 hours of practice placements as part of their education. To date, no research has explored how consumers could contribute to student occupational therapists' learning during practice placements. This study aimed to explore Australian occupational therapists' perceptions of consumers providing feedback to students during practice placements. Methods: A qualitative descriptive approach was adopted to engage with the diversity of practice contexts and gain a rich dataset from the occupational therapy profession. A qualitative questionnaire was developed and distributed using snowballing techniques. The questionnaire asked recipients to reflect on the risks, challenges, and benefits of consumers providing feedback to student occupational therapists from all stakeholders' perspectives. Demographic data were collated, and reflexive thematic analysis was used to construct themes. Findings: Responses were received from 81 participants. Most respondents identified as experienced occupational therapists from metropolitan locations across Australia. Reflective thematic analysis was used to construct three themes: Personal capability of consumers and students will enable, inhibit, and be developed by engaging in a feedback process; an educator‐controlled process to ensure safety for all stakeholders is required for time‐poor practice contexts; and us versus them: Shifting control to consumers can disempower practice educators. Conclusion: Engaging with consumers throughout all aspects of student occupational therapists' educational programme is required, including practice placements. New educational initiatives need to consider all stakeholders' concerns to ensure that authentic contribution from consumers is made within the various practice contexts. A co‐design approach that involves all stakeholders to develop a feedback process may result in high‐quality learning experiences that assist students to become safer, consumer‐centred health professionals. [ABSTRACT FROM AUTHOR]

This study used a qualitative, cross‐sectional design to address a gap in understanding the perspectives and practices of care planners and case managers in supporting consumer‐ directed care (CDC) for community dwelling people living with dementia. Semi‐structured telephone interviews were conducted with a convenience sample of n = 16 planners and managers from seven providers of the Australian home care packages (HCP) program in NSW (Australia). All interviewees described the aspirations of supporting choice within CDC as synergistic with their values and with person‐centred care. Some described new flexibilities within the more open‐ended planning conversations enabled by CDC. However, most acknowledged their capacity to enable choice for clients with dementia was limited by the capped care budgets, as well as the skills and time needed to support choice and decision‐ making. Organisational practice changes associated with the shift to a market‐based system were also perceived as limiting the capacity to support choices. Reducing centralised systems, increasing individual budgets and improving staff capacity to support decision‐making by people with dementia may help to improve this situation. However, results suggest a deeper need to re‐evaluate whether the CDC model is the most appropriate for supporting the rising numbers of people with dementia to age well in place. [ABSTRACT FROM AUTHOR]

Functional impairment in people diagnosed with depression is common, although the domain of personal hygiene and grooming has received limited attention in the scholarly literature. While issues concerning personal hygiene and grooming by those experiencing depression have been reported in personal narratives, they are rarely included in symptom lists or treatment guidelines, or as an outcome indicator in research studies. The aim of this research was to better understand how mental health practitioners assessed, understood and worked with, service users diagnosed with depression who had previously exhibited declining personal hygiene and grooming standards. In‐depth interviews (n = 16) explored the views of professionals experienced in this area of mental health practice. A qualitative descriptive methodology was utilised. Findings indicated that for some service users, personal hygiene and grooming issues were an integral aspect of their depression, which negatively impacted recovery, particularly in areas concerned with overall functioning, mood, social and vocational engagement, motivation, self‐worth and esteem, and engagement with treatment. Study results supported the benefits of a person‐centred approach to assess, engage with and intervene effectively when a decline in personal hygiene and grooming was noted. However, lack of pertinent research is a barrier to appropriately assessing specific skill or performance difficulties when declining standards are observed. This impedes the provision of interventions which might support the person to develop and maintain of personal hygiene routines, which conform to socially acceptable standards. Difficulties with personal hygiene and grooming presented both a barrier to recovery and an opportunity for timely and salient intervention. Further investigation is needed to build the research evidence needed to develop appropriate and acceptable interventions, and to inform effective treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Research capacity building enhances the abilities of individuals and is critical within health systems for quality patient care and promotes a culture of excellence within the occupational therapy profession. A research capacity building toolkit was proposed identifying strategies to support allied health professionals to undertake research. This study evaluated participant‐reported outcomes of research capacity building toolkit implementation in an occupational therapy department. Methods: An observational pre–post‐cohort study at a tertiary hospital with volunteer occupational therapists using the standardised Research Capacity in Context Tool (RCCT) and an author‐designed quality improvement (QI) survey was employed. The RCCT measures research capacity and culture at organisation, team and individual levels. Semi‐structured interviews were used to elicit reflections regarding participant experience. Results: All levels of the toolkit were implemented successfully. The response rate was 59% (n = 36) at baseline and 49.1% (n = 26) at follow‐up. Eighty‐five percent of participants held direct clinical roles. Nine clinicians participated in the interviews. There were significant improvements in the estimate mean for the organisation (6.51 [2019] compared with 8.13 [2020], p = <0.001) and the team (5.52 [2019] compared with 7.15 [2020], p = 0.001). The individual level did not significantly change with an estimate mean of 4.20 in 2019 increasing slightly to 4.84 in 2020 (p = 0.128). This was supported by the QI survey where improvements were noted in the department but not at an individual level. The qualitative findings verified the components of the toolkit including 'supporting clinicians in research', 'working together', 'valuing research for excellence' and reflected the importance of 'individual attributes'. Conclusion: The toolkit supported the implementation of specific strategies to enhance research capacity and culture. Improvements within the organisation and team were evident; however, these were not seen at an individual level. Further research about the contribution of individual‐related factors and processes to the building of research capacity is required. [ABSTRACT FROM AUTHOR]

Purpose: To explore the perceptions, use and interest to use telepractice by speech-language pathologists (SLPs) to deliver services to people with Parkinson's disease (PwPD). Method: A cross-sectional, mixed-methods online survey was conducted. Recruitment of SLPs with an active caseload of PwPD was conducted through non-probability, purposive sampling. Data were analysed using frequency distribution and thematic analysis. Result: A total of 63 SLPs responded. The majority (82.5%) were interested in telepractice, but only 23.1% provided services to PwPD online. Monitoring of motor speech function, and therapy were the primary services delivered online. Of those who did not currently offer online services to PwPD, 77.5% expressed interest to use telepractice. The development of telepractice guidelines and a comprehensive list of available software were the resources most requested to assist clinicians in offering such services. Most perceived telepractice as an appropriate delivery method for speech-language pathology services. However, views regarding the preference for face-to-face delivery were divided. Conclusion: SLPs view telepractice as a viable service delivery model for PwPD, but uptake of the model is variable. Several key barriers and resource limitations must be addressed to facilitate the implementation and sustainability of telepractice in clinical services. [ABSTRACT FROM AUTHOR]

Purpose: To determine the clinical practices of Australian speech-language pathologists in the management of communication disorders in people with Parkinson's disease (PwPD) and their perspectives on service provision. Method: A cross-sectional, mix-methods online survey was conducted. Nonprobability, purposive sampling was utilised to recruit speech-language pathologists who currently work with PwPD. Descriptive statistics and thematic analysis were employed. Result: Ninety-nine clinicians responded. Most offered services for both motor speech and cognitive-communication disorders, but a greater focus on the motor speech disorder was evident. A range of impairment and functional assessments and interventions were reported. Therapy was most commonly delivered one session a week over 4 or 6 weeks. Service, client and evidence barriers in the management of both communication disorders were identified. Most clinicians felt PwPD accessed communication services at stages later than optimal, they recognised a need to improve their services in varying degrees (92.3%), and believed not enough services exist for PwPD in Australia (78%). Cognitive-communication management was the highest requested area for further research evidence. Conclusion: This study captured the current practices of Australian speech-language pathologists in the management of communication disorders in PwPD. Findings may inform future service planning, research on service effectiveness and new management targets. [ABSTRACT FROM AUTHOR]