Factors that influence the uptake of virtual care solutions in Australian primary care practice: a systematic scoping review.

Introduction: Uptake of virtual care solutions in primary care settings has increased exponentially, and current evidence suggests high patient satisfaction but mixed clinician views.

Aims: This paper aimed to identify factors influencing its' implementation to support delivery to the right patient, in the right clinical context, at the right time. Further, this paper evaluates how the updated Consolidated Framework for Implementation Research (CFIR) can be used to assess these factors that contribute to the uptake of virtual care innovations.

Improving Residential Aged Care Placement from Hospital Through the Implementation of a Digital Matching Solution - A Before-After Evaluation.

Patient discharges from hospital to residential aged care facilities (RACFs) are often delayed due to inefficiencies in matching them to suitable available beds. To investigate the improvements that digital solutions can offer here, case-mix adjusted Length of Stay (LOS) of patients discharged to RACFs from a major metropolitan Victorian hospital were compared before and after the introduction of a digital solution for matching patient needs and preferences to available RACFs places. The study found that after the digital solution was implemented, the period where a patient would wait in the hospital for a RACF placement post the Aged Care Assessment Services (ACAS) assessment, the LOS reduced by 26.

Innovative Implemented Tools for Outpatient Clinic Scheduling.

Every year there are approximately three million new specialist clinic appointments at local hospital networks in Victoria. CSIRO, in collaboration with Austin Health, have developed two algorithms to assist with waitlist management in their outpatient specialist clinics. This study describes the implementation of these algorithms in software tools developed to support their use and trial in the clinical setting at Austin Health.

A novel, multidomain, primary care nurse-led and mHealth-assisted intervention for dementia risk reduction in middle-aged adults (HAPPI MIND): study protocol for a cluster randomised controlled trial.

Introduction: Middle-aged multidomain risk reduction interventions targeting modifiable risk factors for dementia may delay or prevent a third of dementia cases in later life. We describe the protocol of a cluster randomised controlled trial (cRCT), HAPPI MIND (Holistic Approach in Primary care for PreventIng Memory Impairment aNd Dementia). HAPPI MIND will evaluate the efficacy of a multidomain, nurse-led, mHealth supported intervention for assessing dementia risk and reducing associated risk factors in middle-aged adults in the Australian primary care setting.

Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study.

(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow.

Patient Perspectives on Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure (ITEC-CHF): Usability Study.

Background: Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but little is known about the usability and patients' willingness to engage with this technology.

Objective: This study aims to evaluate feedback from patients with CHF following participation in the Innovative Telemonitoring Enhanced Care program for CHF (ITEC-CHF) study.

Methods: The telemonitoring intervention consisted of three components: remote weight monitoring, structured telephone support, and nurse-led collaborative care.

Home telemonitoring for chronic disease management: Perceptions of users and factors influencing adoption.

Home telemonitoring has been used as a solution to support the care of individuals living with chronic disease. While effectiveness of telemonitoring have been widely studied, more research is needed to understand the perceptions among patients and clinicians in incorporating telemonitoring into their daily routine and practices. This paper presents an investigation of patients' and clinicians' experiences in a care augmenting telemonitoring service, their perceived impact delivered through the service, and clinicians' perceptions on how the service was introduced in their organizations.

Morphometric Changes to Corneal Dendritic Cells in Individuals With Mild Cognitive Impairment.

Purpose: There has been increasing interest in identifying non-invasive, imaging biomarkers for neurodegenerative disorders of the central nervous system (CNS). The aim of this proof-of-concept study was to investigate whether corneal sensory nerve and dendritic cell (DC) parameters, captured using confocal microscopy (IVCM), are altered in individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD).

Methods: Fifteen participants were recruited from the Australian Imaging Biomarkers and Lifestyle (AIBL) study in Melbourne, VIC, Australia.

Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis.

Background: Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes.

The Effects of Telemonitoring on Patient Compliance With Self-Management Recommendations and Outcomes of the Innovative Telemonitoring Enhanced Care Program for Chronic Heart Failure: Randomized Controlled Trial.

Background: Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied.

Objective: This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF).

Methods: We conducted a multicenter randomized controlled trial with a 6-month follow-up.

Before-after evaluation of patient length of stay in a rehabilitation context following implementation of an electronic patient journey board.

Purpose: To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients.

Methods: A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay.

Results: A reduction in case-mix adjusted length of stay of 4.

A risk stratification tool for hospitalisation in Australia using primary care data.

Predictive risk models using general practice (GP) data to predict the risk of hospitalisation have the potential to identify patients for targeted care. Effective use can help deliver significant reductions in the incidence of hospitalisation, particularly for patients with chronic conditions, the highest consumers of hospital resources. There are currently no published validated risk models for the Australian context using GP data to predict hospitalisation.

Ocular Biomarkers of Alzheimer's Disease: The Role of Anterior Eye and Potential Future Directions.

Globally, Alzheimer's disease (AD) is a growing health and economic challenge that has no effective cure. Recent clinical trials indicate that preclinical treatment may be required but a routine screening tool for AD has been elusive. Hence, a simple, yet sensitive biomarker for preclinical AD, when the disease is most likely to be amenable to treatment, is lacking.

Patient Adherence to Scheduled Vital Sign Measurements During Home Telemonitoring: Analysis of the Intervention Arm in a Before and After Trial.

Background: In a home telemonitoring trial, patient adherence with scheduled vital signs measurements is an important aspect that has not been thoroughly studied and for which data in the literature are limited. Levels of adherence have been reported as varying from approximately 40% to 90%, and in most cases, the adherence rate usually dropped off steadily over time. This drop is more evident in the first few weeks or months after the start.

What Have We Learned from the CSIRO National NBN Telehealth Trial?

The CSIRO National NBN Telehealth Trial investigated the effects of introducing at home telemonitoring of vital signs for the management of a heterogeneous group of chronically ill patients. Patients suffering from a wide range of chronic conditions who were frequently admitted to hospital, were selected from nominated hospital lists. The impact of telemonitoring was analysed using a wide range of health and wellbeing outcomes as well as numerous health economic metrics derived from Medicare Medical Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) data and Hospital Health Roundtable data.

Innovative Telemonitoring Enhanced Care Programme for Chronic Heart Failure (ITEC-CHF) to improve guideline compliance and collaborative care: protocol of a multicentre randomised controlled trial.

Introduction: Chronic heart failure (CHF) is a life-threatening chronic disease characterised by periodic exacerbations and recurrent hospitalisations. In the management of CHF, patient compliance with evidence-based clinical guidelines is essential, but remains difficult practically. The objective of this study is to examine whether an Innovative Telemonitoring Enhanced Care Programme for CHF (ITEC-CHF) improves patients' compliance, and associated health and economic outcomes.

Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis.

Background: Telemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease.

Objective: The objective of this trial was to evaluate the impact of introducing at-home telemonitoring to patients living with chronic conditions on health care expenditure, number of admissions to hospital, and length of stay (LOS).

Design of a multi-site multi-state clinical trial of home monitoring of chronic disease in the community in Australia.

Background: Telehealth services based on at-home monitoring of vital signs and the administration of clinical questionnaires are being increasingly used to manage chronic disease in the community, but few statistically robust studies are available in Australia to evaluate a wide range of health and socio-economic outcomes. The objectives of this study are to use robust statistical methods to research the impact of at home telemonitoring on health care outcomes, acceptability of telemonitoring to patients, carers and clinicians and to identify workplace cultural factors and capacity for organisational change management that will impact on large scale national deployment of telehealth services. Additionally, to develop advanced modelling and data analytics tools to risk stratify patients on a daily basis to automatically identify exacerbations of their chronic conditions.

Integrating a mobile health setup in a chronic disease management network.

Supporting self management of chronic disease in collaboration with primary healthcare has been a national priority in order to mitigate the emerging disease burden on the already strained healthcare system. However, in practice, the uptake of self-management programs and compliance with clinical guidelines remain poor. Time constraints due to work commitments and lack of efficient monitoring tools have been the major barrier to the uptake and compliance.