The unprecedented increase in telehealth due to COVID-19 has changed general practitioners’ (GP) and patients’ engagement in healthcare. Examining these changes allows opportunities to produce evidence-based guidance for optimal use of telehealth in a safe and effective way.

This presentation summarises a project that aimed to:

1. Systematically analyse interactional practices of GPs and patients in telehealth consultations to develop evidence-based resources based on interactional elements and patterns associated with desired consultation outcomes.

2. Examine how telehealth influences both GPs’ and patients’ perceptions of the clinical relationship to ensure that guidelines developed support both parties to build positive clinical relationships through this alternate mode of communication.

3. Determine the key concerns of GPs in relation to communication through telehealth to inform new evidence-based advice and resources that directly address these concerns.

The process and findings of the research will be presented, including the mixed methods approach and translation of the results from findings to co-designed best-practice principles.

The first two phases of this research involved recording telehealth consultations (n=42), conducting surveys (n=152), and qualitatively interviewing patients (n=10) and GPs (n=11). These were examined using interaction analytic methods, thematic analyses, and quantitative analysis, to create a robust, connected picture of telehealth practice and perspectives.

From these synthesised analyses, three key themes relating to communication in telehealth were identified: relationship building, conversational flow, and safety netting. These themes will be presented, with examination of similarities and differences between stakeholder perspectives and observed practice.

The process of translating the findings from the first two phases of research into best practice principles will then be presented. This process included engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. Final principles and associated resources will also be presented.

At the conclusion of our presentation attendees will take away:
1. An understanding of the connection between perspectives on and practice of telehealth.
2. Best practice principles for communication using telehealth.
3. A robust approach to understanding communication in healthcare.

Introduction
Remunerated telehealth consultations have become a permanent feature of Australian general practice (GP), with two main modalities: videoconferencing and telephone. Videoconferencing has advantages over telephone, including improved diagnostic accuracy and being able to perform a remote physical examination. However, thus far, videoconferencing uptake in Australia has been relatively low. This study aimed to establish the prevalence and associations of video versus telephone consultations in Australian GP trainees' practice.

Methods
This was a cross-sectional analysis of data from the ReCEnT (Registrars Clinical Encounters in Training) project, collected over 3 x 6-month terms from 2020 to 2021. In ReCEnT, registrars record the details of 60 consecutive in-practice consultations every 6-month term, for a total of three terms. Univariable and multivariable logistic regression were performed within the Generalised Estimating Equations framework with the outcome being video versus telephone.

Results
From 2020-2021, 102,286 consultations were recorded by 1,168 registrars, with 21.4% of consultations performed via telehealth. Of these, telephone accounted for 96.6% (95% CI: 96.3-96.8%) and videoconferencing for 3.4% (95% CI: 3.2-3.7%). Statistically significant associations of using videoconferencing, compared to telephone, included longer consultation duration (OR 1.02, 95% CI: 1.01-1.03 per minute; and mean 14.9 versus 12.8 minutes), patients aged 0-14 years old (OR 1.29, 95% CI: 1.03-1.62, compared to age 15-34), patients new to the registrar (OR 1.19, 95% CI: 1.04-1.35), part-time registrars (OR 1.84, 95% CI: 1.08-3.15), and areas of less socioeconomic disadvantage (OR 1.27, 95% CI: 1.00-1.62 per decile).

Conclusions
The majority of registrars' telehealth consultations were performed via telephone, which limits potential for remote physical examination. Further, telephone use being associated with greater socioeconomic disadvantage has implications for health equity. Future research should explore barriers to videoconferencing use and strategies to increase its uptake.

1. The majority of GP trainees' telehealth consultations were performed via telephone, which suggests barriers to video use and has implications for performing remote physical examinations
2. Telephone consultations in GP trainees' practice are shorter in duration compared to video, and further research is needed to determine how telephone-consulting affects patient outcomes
3. Telephone consultations are associated with a greater level of socioeconomic disadvantage compared to video, which has implications for health equity

The use of online and mobile internet and social media has been increasing in healthcare service delivery. This study aims to explore the use of social media in older adults with multimorbidity in Hong Kong primary care and to assess the feasibility and usage of online health services in this population, including satisfaction, preference, and problems encountered.
This was a cross-sectional study among older adults with multimorbidity conducted between November 2020 and March 2021 in a Hong Kong primary care programme. Online and face-to-face services were offered based on the needs of the participants. Demographic characteristics and health conditions were assessed at baseline. Participants using online services were invited to complete a feedback questionnaire.
The study included 752 participants, of which 66.1% use social media every day. Participants who declined to use online services were found to be significantly older, live alone, have lower income, have social security assistance, have greater cognitive decline, and be less depressed (p < 0.05). Non-responders to the online questionnaire had fewer years of education and greater cognitive decline (p < 0.05). The median satisfaction with the online services was 8 (interquartile range: 7, 9), and 14.6% of the participants preferred online more than face-to-face services. Lower education levels, fewer internet connection issues, and more self-efficacy on mobile apps were associated with a higher level of online satisfaction after adjustment (p < 0.05). Fewer internet connection issues and more self-efficacy on mobile apps were associated with participants’ preference for online services (p < 0.05).
More than half of Hong Kong older adults with multimorbidity in primary care use social media daily. . Prior use and training can be beneficial to enhance use and satisfaction in older adults.
Accepted for publication BMC Geriatrics May 2023

Background: To prepare for an ageing society, the Thai government has established a policy integrating the use of communication technology into health services (Telehealth). However, local evidence about telehealth implementation in the older population was limited.

Aims and objectives: This study aimed to identify what key factors were needed for successful telehealth implementation general and specifically in the Thai older population.

Methods: A mixed method approach including a critical literature review and qualitative interviews with six stakeholders in the Northern part of Thailand was applied. In the critical literature review part, eleven studies from four databases (Delphis, Web of Science, PubMed, and Scopus) were included. Inclusion and exclusion criteria were applied. In the qualitative part, six stakeholders were included: one policy maker, three healthcare providers, one IT worker, and one older patient. Online semi-structured interviews were conducted via Zoom or LINE VDO call. Qualitative content analysis was applied.

Results: Three categories of person-related factors, technology-related factors, and contextual factors were extracted from the literature review and interview data. Each category had effects on one another. Seven key factors were highlighted. (1) Promoting acceptance: perceived usefulness and social influence, (2) Minimising barriers: health conditions, socioeconomic issues, and technology skills, (3) Training, (4) Practical support, (5) Effective tools: consideration of older people’s conditions, ease-of-use, integration into existing infrastructure and services, (6) Security, (7) Policy and funding support.

Conclusion: A holistic approach by integrating key factors into the existing healthcare system considering older people’s specific needs and cultural context would lead to the successful implementation of telehealth in the Thai ageing population. However, policy and funding support was also needed to sustain the telehealth services.

At the conclusion of my presentation, attendees will take away
1. To implement telehealth into health services for older population, seven key factors were highlighted. (1) Promoting acceptance, (2) Minimising barriers, (3) Training, (4) Practical support, (5) Effective tools, (6) Security, and (7) Policy and funding support.
2. Key factors needed to be smoothly integrated into existing healthcare system, considering older people's specific needs and cultural contexts.
3. To sustain telehealth services, policy and funding support were important factors.

The COVID-19 pandemic stretched the limit of our healthcare system. Health care services were disrupted. This situation has greatly affected the health of the high risk population. This scenario calls for an intervention that could cater to the health needs of the communities in the midst of the implementation of community quarantine. An ideal set-up will be a setting wherein health workers and possible patients are not unnecessarily exposed to COVID-19 but still able to provide and receive appropriate and quality health services accordingly.

The primary objective is to enhance the health care service delivery to the vulnerable population. Continuity of programs and services must be ensured in order to lessen the morbidity and mortality of other cases while combating Covid-19. Telehealth was one of the proposed solution by the community members that can be utilized to ease the pressure on our health service infrastructure. It may address the need to balance between both Covd19 concerns and other health care needs of the community residents.

To implement this in community level, program acceptance, quality, access and cost effectiveness of the proposed telehealth were evaluated. Barriers were also identified such as lack of funding, lack of infrastructure, privacy issues, competing health system priorities and lack of legislation or regulations covering telehealth programs.

Government and non-government agencies were tapped. Telehealth core committee was created. Eventually, despite all the limitations, the community people was able create their own telehealth system in the community. With multi-sectoral support and collaboration, good leadership and teamwork, a thriving rural community with limited resources had successfully implemented the project in order to deliver health services to the people.

At the conclusion of my presentation attendees will take away
1. A community level telehealth system can be possible
2. It take a multi-sectoral effort to implement a project
3. The project may not be an ideal one but it serves the people

Public health experts expressed concern regarding the spread of Covid within the homeless community of Sydney (2021). Many homeless people were housed in vacant hotels in response to this crisis. This benevolent housing intervention raised another concern regarding the mental health of people in forced isolation. The Haymarket Foundation charity sought to provide welfare support for these people with daily visits from case managers. Local general practitioners were under extreme workload pressure and there was government support for telehealth options.
A project was initiated by a team of two general practitioners(GP) and two nurses to train non medical case managers who were domiciliary visitors to perform basic vital signs and conduct a Kessler 10 questionnaire. Two managers were trained to perform finger oximetry, pulse, Blood pressure, temperature, BGL and record respiratory rate. Confirmation of their technical skills were checked by an external registered nurse to confirm their skills. The case managers were not trained to interpret any signs.
A telehealth consultation with a GP was trialed on 10 consecutive patients to test the feasibility of this service.
Six of the patients were followed up with two further consultations and multidisiplinary case conferences. Three showed a high level of psychological distress.

Overall this pilot project was well received by case managers and patients.The facilitation of a telehealth consultation by trained community visitors may be an option in times of crisis with an acute shortage of health workers. The two GPs (authors) agreed that this was an efficient communication process for patient management. The Haymarket Foundation charity continues to support health initiatives for homeless people

1. Non medical case managers can be trained to perform vital signs 2. Facilitated telehealth is a viable opton when no alternative exists 3. The mental and physical health should be a consideration when relocating homeless people.