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In this article, we examine the role and effectiveness of the Centers for Disease Control and Prevention in the USA and Europe and consider possible lessons for future pandemic planning in Australia. We also 'map' the interjurisdictional communication pathways that have been secured since the election of the new Commonwealth government. We suggest a number of steps that could be taken to upgrade the collection, distribution, accessibility and timelines of key information required to improve pandemic management and national health outcomes. While it may be hard to contemplate a move to a fully integrated National capacity when we are only just emerging from the pandemic, we do have a unique opportunity to at least start the process of review. We should use the lessons we have learned to transform our systems, rather than 'tinker' with them and ensure we are better prepared for next time. What is known about the topic? Much has been reported on the challenges of coronavirus disease 2019 presented to everyone at a global and country level. The pandemic highlighted the often dysfunctional decision making at all levels that impacted on the responses of govenments. What does this paper add? This paper reviews in particular the responses of the Centers for Disease Control and Prevention (CDCs) and 'maps' the interjurisdictional pathways that exist or have been proposed in Australia and outlines the opportunity that the new Government has to ensure a proper process of review of these responses. It also provides some suggestions and priorities for consideration in the planning of an Australian CDC as recently canvassed in the discussion paper released by the Department of Health and Ageing. What are the implications for practitioners? An understanding of the complexities of our health 'governance' systems and the opportunity to commence a discussion on how we might transform our systems rather than work around the 'edges' to ensure we are better prepared for the next pandemic. [ABSTRACT FROM AUTHOR]

Objective: This study explored the experiences, concerns and perceptions of hospital clinical staff returning to work after parental leave during the COVID-19 pandemic. Methods: An exploratory mixed-methods study was performed. Eligible staff employed at a large metropolitan tertiary health service in Melbourne, Australia, completed an ethics-approved anonymous online cross-sectional survey and/or participated in an interview between February and June 2021. Results: Ninety-six staff completed a survey and four participated in an interview. Staff reported both positive and negative aspects of being on parental leave during the COVID-19 pandemic including disappointment their leave had not gone as planned; feeling isolated from family and friends; wanting greater communication from their health service; appreciating the increased opportunities for them and their partner to be at home and bond with their baby; and concerns about returning to work such as limited knowledge of COVID-19 workplace policies and potentially infecting their baby and family. Conclusions: The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of hospital clinical staff. The findings suggest that staff would benefit from formal return to work policies and programs including regular contact with their manager while on parental leave and workplace reorientation on their return, especially during events such as a pandemic. What is known about the topic? Healthcare workers often experience additional challenges and stressors returning to work after parental leave compared to other workers. What does this paper add? The COVID-19 pandemic had a unique impact on the parental leave and return to work experiences of healthcare workers who reported positive and negative aspects including isolation, limited workplace communication and increased opportunities for bonding with their baby. What are the implications for practitioners? Appropriate organisational initiatives may alleviate staff distress and support their return to work and could include formal return to work programs, regular managerial contact and workplace reorientation. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods: A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results: COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6%; n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2%; n = 160) planned to receive the COVID-19 vaccine; however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions: There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts. What is known about topic? People with cancer are a COVID-19 vaccine priority group, as they are at increased risk of morbidity and mortality from this disease. There is currently a dearth of information regarding COVID-19 vaccine hesitancy, acceptance, or informational needs for this population. What does this paper add? This paper has shown that although vaccine refusal rates were low in this population, feelings of hesitancy remained. Women, those in younger age categories, those with previous vaccine hesitancy and those who felt they had not received adequate information had stronger vaccine hesitancy and higher refusal rates. What are the implications for practitioners? There is a need for tailored information and open communication regarding COVID-19 vaccines and people with cancer. There is an opportunity to build upon established relationships of trust between cancer patients and their clinicians. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus disease 2019 (COVID-19) vaccination response in primary health care provides important learnings for strengthening health systems and preparing for surge response. The aim of this study was to examine the contributions of service providers to the COVID-19 vaccination program in Victoria, Australia, to gain insight into the role of primary health care during surge response and determine if this differs with rurality. Methods: A descriptive quantitative study design using existing COVID-19 vaccination data extracted from the Australian Immunisation Record via the Department of Health and Aged Care, Health Data Portal, de-identified for primary health networks, was used. Vaccination administrations were categorised by provider type for the first year of the Australian COVID-19 vaccination program in Victoria, Australia from February 2021 to December 2021. Descriptive analyses describe the total and proportional vaccinations administered by provider type and patient rurality. Results: Overall, primary care providers delivered half (50.58%) of total vaccinations for the population, and the number and proportion of vaccinations increased with patient rurality. The largest difference was observed in remote communities where 70.15% of COVID-19 vaccinations were administered by primary care providers. Primary care providers administered fewer COVID-19 vaccines in regional centres at 42.70%, compared to 46.45% administered by state government (and 10.85% administered by other). Conclusion: The contribution of primary health care to the COVID-19 vaccine program highlights the importance of rural primary care providers and settings, primarily general practice, to the delivery of population health interventions in rural communities especially during times of crisis. What is known about the topic? Research on pandemic response provides important insights for future surge planning and preparedness. What does this paper add? The contribution of primary care to the COVID-19 vaccine program highlights the importance of rural general practice to the delivery of population health interventions during times of crisis. What are the implications for practitioners? Policymakers must tailor reforms towards strengthening rural primary health care in preparation for future surge response. [ABSTRACT FROM AUTHOR]

Background: The majority of allied health services are delivered by small, private practices in the primary care setting with limited government funding. During the coronavirus disease 2019 (COVID-19) lockdowns these practices were subject to the same health orders as any other private business with only 'essential services' permitted to remain open. Research aim: We set out to understand the impact of the COVID-19 pandemic, and associated public health measures, on the financial viability of private allied health practices. Methods: Thirteen semi-structured interviews were conducted with primary care allied health practice owners and managers in Sydney. Data were analysed thematically. Findings: All of the interviewees reported experiencing the stress of balancing precarious finances caused by reduced and/or fluctuating patient demand. Patients' reluctance to seek care was compounded by ambiguity around whether allied health services were 'essential'. Manual therapies were particularly vulnerable to financial stress because their capacity to transition to telehealth and access to government funding were limited. Conversely, psychologists reported demand for their services exceeded what they could provide. Study implications: The findings are indicative of primary care allied health's peripheral status in Australia's primary care landscape. Greater priority to the funding and integration of primary care allied health is needed in primary care policy. What is known about the topic? Most allied health services in Australia are delivered by small, private practices in the primary care setting with limited government funding. What does this paper add? The findings indicate that allied health has a peripheral status in Australia's primary care landscape. What are the implications for practitioners? Greater priority to the funding and integration of allied health is needed in primary care policy. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to describe the patterns in emergency department (ED) presentations and hospital admissions in children with Ambulatory Care Sensitive Conditions (ACSCs) before and during the coronavirus disease 2019 (COVID-19) pandemic restrictions in Victoria, Australia, to assess if changes in out-of-hospital care resulted in an increase in delayed/severe presentations. Methods: This study involved secondary analysis of Victorian Emergency Minimum Dataset and Victorian Admitted Episode Dataset data. Patients (<18 years) attending EDs with a diagnosis of an ACSC were included. We compared the number and severity of ASCS presentations pre-COVID-19 (1January 2018–27 March 2020) and during COVID-19 (28 March–31 October 2020). A linear regression prediction model was built to compare the observed versus predicted presentation number in the 2020 period. Results: In total, there were 108 104 paediatric ACSC ED presentations in Victoria during the study period. Females accounted for 51 462/108 104 (47.6%) of all presentations, with a median age of 3 years. A significant decrease in ED presentations was seen in 2020 (41 319 in 2018; 44 978 in 2019; and 21 807 until October 2020), predominantly due to reductions in conditions that are typically mediated by viruses in childhood (i.e. asthma, convulsions/epilepsy and ear, nose and throat conditions). The proportion of high-urgency presentations and those requiring admission was stable in 2020. Conclusions: An overall reduction in the number of ED presentations and admissions with paediatric ACSCs was seen in Victoria in 2020, indicating that rates of delayed or more severe presentations did not occur as a result of changes in out-of-hospital care. What is known about the topic? Ambulatory Care Sensitive Conditions (ACSCs) relate to conditions or diagnoses that in the paediatric context are frequently mediated by common viral illness. What does this paper add? A reduction in the numbers of presentations and admissions with paediatric ACSCs was seen during the public health measures implemented to reduce the transmission of COVID-19 in Victoria, Australia. What are the implications for practitioners? These data can assist development of healthcare policy to allow healthcare resources to be prioritised for patients in whom viral transmission is not relevant. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of telehealth policy changes on general practitioner (GP) consultation activity in Australia, during the coronavirus disease 2019 (COVID-19) pandemic, from January 2019 to December 2021. Methods: An interrupted time-series analysis was conducted to analyse the impact of two major policy changes, introduced through the Medicare Benefits Schedule (MBS), on GP consultation (in-person, videoconference, telephone) activity. The first policy change was the introduction of additional COVID-19 telehealth funding through the MBS on 30 March 2020. The second policy change was the limitation on telephone consultation length to under 20 min on 1 July 2021. The rate of GP telehealth provision and activity was compared between pre-and post-intervention periods, separated by these MBS policy changes. Results: After the first policy change, there was a significant increase in telehealth provision, with a simultaneous decrease in in-person consultations (P < 0.0001). However, telehealth provision decreased in the months following this first policy change (P < 0.0001), while in-person activity increased. After the second policy change, the initial videoconference provision increased (P < 0.0001). However, all telehealth activity decreased afterwards. In the months following the second policy change, the decrease in monthly activity for in-person (P = 0.700), telephone (0.199) and videoconference (P = 0.178) consultations was not significant. Conclusions: The introduction of additional telehealth funding and limitations on telephone consultation length encouraged the initial provision and growth of telehealth services. However, these policy changes did not sustain the long-term upward trajectory of telehealth activity. Telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. What is known about the topic? The COVID-19 pandemic was a catalyst for increased telehealth provision by general practitioners (GPs). Since COVID-19, the Australian Government have invested in telehealth by increasing reimbursement opportunities through the Medicare Benefits Schedule (MBS) and making multiple telehealth policy changes. What does this paper add? This study examined the impact of MBS telehealth policy changes on GP consultation activity in Australia over 3 years during COVID-19. What are the implications for practitioners? Telehealth funding is necessary for service viability. However, funding alone is unlikely to encourage increased videoconference use and is unlikely to promote long-term telehealth provision. Future telehealth policies should increase opportunities for appropriate and sustainable GP telehealth services. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the experience of patients with chronic diseases regarding access to and utilisation of multidisciplinary care during COVID-19 in South Australia. Methods: Telephone interviews were conducted with 30 patients with chronic conditions attending nine general practices in metropolitan Adelaide. Supplementary data were obtained from the Medicare Benefit Schedule (MBS) to compare health services activity data provided by different health professionals before and after COVID-19 (from January 2019 to June 2020). Results: There was variation in access to different health services by patients with chronic conditions during COVID-19. The introduction of telehealth facilitated continuity of general practitioner (GP) services, with a high level of satisfaction among patients. Changes in medicines regulation, including the home delivery of medications, enabled timely access to medications for patients. The use of telehealth was less common for specialist and particularly allied health services. Dental check-ups that are important for the management of some chronic conditions were disrupted the most during COVID-19. Conclusion: The findings of this study suggest that the policy measures introduced in Australia provided an opportunity to maintain multidisciplinary care for patients with chronic diseases during COVID-19. GPs, as core members of the primary healthcare team, as well as pharmacy and pathology services, were highly accessible. Telehealth was less accessed for chronic care services provided by specialists and allied health professionals. What is known about the topic?: Access to multidisciplinary care is critical to ensure continuity and quality of care for patients with chronic health conditions. Evidence suggests disruptions in health services can occur during pandemics. To continue access to routine care, the Australian Government introduced several policy initiatives during COVID-19 to enhance access to multidisciplinary care. What does this paper add?: Telehealth policy was particularly effective in facilitating patients' access to general practice services during COVID-19 particularly those services that did not need physical examinations. This policy complemented changes in medicines regulations that enabled timely and convenient access to medications for patients with chronic conditions. Allied health services, as important elements of multidisciplinary care, were more likely to be disrupted during COVID-19. What are the implications for practitioners?: Continuation of telehealth services is likely to enhance access to general practice services. The acceptability and use of telehealth for allied health services may require more flexibility, and training for both practitioners and patients. [ABSTRACT FROM AUTHOR]

Objective. To quantify the introduction of new, temporary telehealth Medicare Benefits Schedule (MBS) items delivered by allied mental health professionals (AMHPs) through the Better Access initiative during the COVID-19 pandemic in Australia. Methods. MBS-item service data for clinical psychologists, registered psychologists, social workers, and occupational therapists were extracted for existing face-to-face, remote videoconferencing and new, temporary telehealth items for the study period April-December 2020. The total number of services in Australia were compared with the baseline period of 2019. Given the second wave of increased COVID-19 infections and prolonged lockdowns in the state of Victoria, we compared the per capita rate of services for Victoria versus other states and territories. Results. During the study period, there was an overall 11% increase in all allied mental health consultations. Telehealth use was substantial with 37% of all sessions conducted by videoconferencing or telephone consultations. The peak month was April 2020, during the first wave of increasing COVID-19 cases, when 53% of consultations were via telehealth. In terms of Victoria, there was an overall 15% increase in all consultations compared with the same period in 2019. Conclusions. Allied mental health services via MBS-subsidised telehealth items greatly increased during 2020. Telehealth is an effective, flexible option for receiving psychological care which should be made available beyond the pandemic. [ABSTRACT FROM AUTHOR]

Objective. The COVID-19 pandemic in Australia coincided with an early trend of reduced visits to the emergency department (ED), but to determine which patients presented less requires closer evaluation. Identifying which patient groups are presenting less frequently will provide a better understanding of health care utilisation behaviours during a pandemic and inform healthcare providers of the potential challenges in managing these groups. Methods. This single-centre retrospective study examined trends in presentations in 2020 to a private, mixed paediatric and adult ED in an inner city suburb within the state of Victoria that treats both COVID-19 and non-COVID-19 patients. The 2019 dataset was used as a reference baseline for comparison. All analyses were performed using baseline characteristics and triage data. Results. The total number of visits to the ED dropped from 24 775 in 2019 to 22 754 in 2020, representing an overall reduction of 8%. Significant reductions in daily presentations and admissions from the ED were observed in the months immediately following the peak of the two COVID-19 waves in the state of Victoria. Visits by those in the 0- to 17-year age group, triage categories 4 and 5 and musculoskeletal presentations were also reduced for most of 2020. Gastrointestinal/abdominal and urological/renal presentations were reduced immediately after the first COVID-19 wave, whereas infectious diseases visits were reduced during and after the second COVID-19 wave. Conclusions. These findings add to the growing body of evidence regarding emergency care underutilisation during the COVID-19 pandemic. Reduced private ED presentations were observed overall and in paediatric patients, lower acuity triage categories, musculoskeletal, abdominal/gastrointestinal and urological/renal presentations during the first wave, whereas infectious disease cases were reduced during the second wave. [ABSTRACT FROM AUTHOR]

Objective. Palliative care has played a key role in the response to the coronavirus disease 2019 (COVID-19) pandemic in Australia. This review of consecutive patients with COVID-19 referred to the palliative care consultancy service of a tertiary health service in Melbourne describes the palliative care experience with COVID-19 in Australia. Methods. The experiences of 55 patients (median age 86 years; interquartile range (IQR) 81-90 years; 55% male; median Charlson comorbidity score 6 (IQR 5-8); 85% with Australia-modified Karnofsky Performance Status ≤50; 67% from residential aged care facilities) were reviewed to collect relevant data points. Results. Most patients were referred for end-of-life care with symptoms including dyspnoea (80%) and agitation/delirium (60%). Continuous subcutaneous infusions were commenced in 71% of patients, with the most frequent medications being opioids and benzodiazepines in relatively small doses; 81% required ≤20 mg subcutaneous morphine equivalent and 64% required ≤10 mg subcutaneous midazolam over 24 h. Fifty patients (91%) died in hospital and the median time from palliative care referral to death was 3 days (IQR 1-5 days). Five patients were discharged back to residential aged care facilities. Overall, 80% of referrals were from the aged care team. Conclusion. Our patients had similar demographics, symptoms, medication needs and outcomes to patients in similar settings overseas. We found the symptom management of patients with COVID-19 to be generally straightforward. However, the psychosocial needs of patients were predominant and contributed to complexity. This study highlights the need for well-integrated relationships between the palliative care consultancy service and the diverse range of key treating teams involved in the delivery of pandemic health care. [ABSTRACT FROM AUTHOR]

Objective. This study investigated the short-term psychosocial effects of the COVID-19 pandemic on hospital clinical staff, specifically their self-reported concerns and perceived impact on their work and personal lives. Methods. Nurses, midwives, doctors and allied health staff at a large metropolitan tertiary health service in Melbourne, Australia, completed an anonymous online cross-sectional survey between 15 May and 10 June 2020. The survey assessed respondents' COVID-19 contact status, concerns related to COVID-19 and other effects of COVID-19. Space was provided for free-text comments. Results. Respondents were mostly concerned about contracting COVID-19, infecting family members and caring for patients with COVID-19. Concerns about accessing and using personal protective equipment, redeployment and their ability to provide high-quality patient care during the pandemic were also reported. Pregnant staff expressed uncertainty about the possible impact of COVID-19 on their pregnancy. Despite their concerns, few staff had considered resigning, and positive aspects of the pandemic were also described. Conclusion. The COVID-19 pandemic has had a considerable impact on the work and personal lives of hospital clinical staff. Staff, particularly those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage their work and personal lives. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to describe and evaluate the implementation of a virtual ward as a COVID-19 hospital avoidance response strategy and identify opportunities for improvement and future applicability. Methods. A mixed-method observational study was conducted of a centralised virtual ward, which operated in a large metropolitan Australian health service from 23 March to 1 June 2020. Results. In total, 238 unique patients were admitted to the virtual ward, accounting for 264 individual admission episodes and 2451 virtual bed days. Twenty (7.6%) episodes resulted in transfer to hospital and 136 patients provided responses to feedback surveys and reported their experience as very good (61.7%, n = 87) or good (34.8%, n = 49). Implementation success was high, with the model widely accepted and adopted across the health service. The service delivery model was considered to be low-cost in comparison to inpatient hospital-based care. Conclusions. Overall, as a rapidly developed and implemented low-tech model of care, the virtual ward was found to provide an effective, accessible and low-cost solution to managing low-acuity COVID-19-positive patients in the community. This model should be considered in future pandemics as a hospital-avoidance response, with the ability to minimise patient-to-healthcare worker transmission, reduce personal protective equipment use and enhance patient adherence with isolation requirements. Targeted remote telemonitoring should be considered as a future modification to improve patient care. [ABSTRACT FROM AUTHOR]