Background: The risks and benefits of COVID-19 vaccination are constantly evolving with new data and outbreaks. To facilitate informed choice, a Covid Risk Calculator (CoRiCal) tool was developed by Australian GPs and epidemiologists. People with low health literacy are less likely to understand and act on COVID-19 prevention advice, so we aimed to improve the health literacy design features of the tool.
Aim: To evaluate the effect of different risk communication formats on understanding of key messages amongst people with varying health literacy.
Methods: An online trial with n=2005 people was conducted in April 2023. Participants were randomised to see one of four information formats: 1) standard government information about the Pfizer mRNA COVID vaccine; 2) standard CoRiCal output based on bar graphs for risks vs benefits; 3) animation explaining the bar graphs in “x per million” format; 4) animation explaining the bar graphs in “1 in x” chance format. The primary outcome was knowledge about COVID-19 vaccine benefits/risks. Secondary outcomes included booster intentions, emotional response, credibility and relevance. Regression analyses controlled for age, gender, health literacy and COVID-19 vaccination doses.
Results: People with lower health literacy had lower knowledge, more negative emotional responses and lower perceived credibility across groups. Both the “x per million” and “1 in x chance” animations increased understanding of key messages about COVID-19 vaccination, compared to standard government information about the Pfizer vaccine. The “x per million” format increased booster intentions, and static bar graphs with no explanation reduced credibility. These effects were found across a sample with varying health literacy levels.
Discussion: The results show that clear explanations of complex epidemiological models can improve knowledge about COVID-19 risks and benefits across health literacy levels. The interactive website and animations can be used by GPs to help explain COVID-19 vaccination options to patients.

Context: Initial US COVID-19 strategy relied on mass vaccination campaigns and many primary care practices were also unable to reliably receive vaccination data. Objective: Test the hypothesis that between the lack of inclusion of primary care in a national vaccination strategy, and the lack of vaccine data interoperability, the primary care practices were unable to vaccinate or know patient vaccination status. Study Design: Cross-sectional analyses of COVID-19 vaccination status captured in practices from 12/01/2020-12/31/2021. Patients were aggregated by month by dates of first doses and patient counts in each month to compare cumulative counts between administration sites. We compared practice vaccination rates to vaccination rates reported by Centers for Disease Control and Prevention (CDC) for the county of practice location. Setting: We used data from the CDC and the American Family Cohort dataset (EHR data from 947 practices). Population Studied: Patients aged 5+ who visited or had immunization reported to practices. Vaccination status and administration were assessed using COVID-19 vaccine CPT, RXNorm, ICD, SNOMED CT, CVX, HCPCS, and free text. Outcome Measures: Practice vaccination rate calculated as the number of patients who received at least one dose divided by the total number of patients who had visits or had immunization recorded during the study period. Results: 539 (57%) practices gave COVID-19 vaccine or captured patient vaccination status. 1,838,936 patients visited practices and of these 435,112 (23.7%) had at least one dose of vaccine, but only 89,423 (4.9%) were vaccinated in practices. 60% of patients were vaccinated in the first quarter of 2021 or prior. The CDC reported higher vaccination rates for the same counties. Conclusions: PRIME Registry practices were generally unable to provide COVID-19 vaccine or capture vaccination status through the end of 2021 due to an absence of a primary care vaccination strategy combined with poor immunization data exchange.

Aim
This study aimed to investigate the barriers and facilitators for doctors in delivering telemedicine services post the COVID-19 pandemic.
Methods
A structured anonymous questionnaire was developed, taking into account the format of the AMA Physician Questionnaire and the current telemedicine practices in Taiwan. It encompassed demographic information, practice experiences, obstacles and challenges faced, as well as future attitudes and practices towards providing telemedicine services. The data was analyzed using ordinal logistic regression with SAS 9.4 edition.
Results
A total of 529 participants responded to the questionnaire. The majority of respondents were family medicine specialists (40.8%). Prior to the COVID-19 pandemic, only 23% had utilized telemedicine services to care for their patients, which increased to 84.6% during the pandemic. After adjusting for age and gender, it was found that a more positive attitude towards telemedicine among physicians was associated with a 9.2 times greater willingness to provide telemedicine services in the future(95% CI 6.4-13.3) . Regarding the each aspect, physicians who believed that telemedicine enabled them to provide better quality care to patients were 3.5 times more likely to have a higher willingness (95% CI 2.8-4.5). Similarly, they were 2.9 times more likely to have a higher willingness if they perceived telemedicine to promote more holistic care (95% CI 2.4-3.5), 3.3 times more likely to increase patient satisfaction (95% CI 2.6-4.1), 3.0 times more likely to enhance professional satisfaction of physicians (95% CI 2.5-3.7), 2.9 times more likely to reduce the cost of care (95% CI 2.3-3.5), and 3.3 times more likely to address the shortage of in-person outpatient visits during the COVID-19 pandemic (95% CI 2.7-4.1).

Conclusion
To encourage physicians in providing telemedicine services in the post COVID-19 era, the government should enhance the perceptions of physicians to provide the patent-centered comprehensive care with greater physicians’ achievement.

Background: The upward trend in international travel has raised concern for travel-related health problems. Existing travel health surveillance systems, such as GeoSentinel, EuroTravNet, and CanTravNet, were mainly designed for countries of origin in high-income nations, with limited travel-related disease data available for low- and middle-income countries. The aim of this study is to develop an integrated travel health surveillance and information system in Indonesia. Technical architecture, interoperability, and functionality of the Indonesian Travel Health Network (InaTravNet) web platform will be discussed.
Methods: A survey was conducted to identify and assess health and safety risks in ten major tourist destinations in Indonesia. Primary healthcare providers in those areas were recruited to build a travel health service networks. Courses were conducted to improve the competencies of network members in travel medicine. Subsequently, guidelines and procedures for reporting travel-related diseases were developed to improve the availability of surveillance data at tourist destinations.
Results: The InaTravNet web platform (https://inatravnet.org/) has been developed comprising traveler resources (health and safety risks, risks by destination), network resources (course/seminar/workshop agendas, informational materials, references), a network clinic directory, and member-only pages for monthly reporting, incidental reporting of unusual cases, stock reporting (vaccine, medication), a discussion forum, and a provider-to-provider telemedicine platform. As of April 2023, 42 primary healthcare providers have joined the network. During the introduction to travel medicine course, the mean (SD) knowledge score of the participants increased from 19.33 (2.16) to 20.96 (3.09) (p=0.015). The usability and workflow fit of the system arrangement during the first three months of implementation were described. The sequential trends in travel-related disease data in the implementation area can be assessed. This will improve and complement the current surveillance system for local diseases and enhance travel medicine services at tourist destinations.

Aims
The strategy of engaging patients and their families in patient safety has been proposed and promoted in recent decades. However, little is known about the translation of such an approach into practice, particularly in Primary Care. We aimed to estimate the effectiveness of interventions focussing on patient and family engagement for patient safety in primary care based on the published randomized controlled evidence.

Methods
This systematic review aims to synthesize available randomized controlled evidence on engaging patients and/or their families in primary care to improve patient safety. The search protocol has been registered on PROSPERO. MEDLINE, CINAHL, Embase, Web of Science Core Collection, and Cochrane Library were searched for potentially eligible studies using tailored searches focusing on three blocks: patient and family engagement, patient safety, and primary care (see the detailed search strategy on Open Science Framework: https://osf.io/sbacp/ ). EndNote 20 was used for deduplication of the records. Following piloting of the eligibility criteria, duplicate independent title/abstract screening was undertaken in Rayyan. R will be used to conduct a meta-analysis and explore the heterogeneity should sufficient articles be included. Collaboration’s tool for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework will be used to appraise the level of certainty.

Results
All databases were searched between 7-9 Feb 2023. There were 4,773 records identified, and 3,137 records remained after deduplication. Following title/abstract screening, 187 articles were retrieved for full-text screening, and it is currently ongoing. Project completion, including data synthesis, is expected by July 2023.

Conclusion
This review aims to synthesize the currently available evidence on patient safety interventions engaging patients and/or their families in primary care. Having an overview of existing approaches can inform general practitioners and policymakers, whereas gaps highlighted can pave the way for future interventions.

Introduction:
Dengue is usually self-limiting and can be managed as outpatients. Once diagnosed, patients are advised to return to clinic daily for monitoring until they recover. However, some patients can deteriorate rapidly at home in between follow-ups and fail to recognise the deterioration. The delay in seeking help can significantly impact dengue morbidity and mortality. DengueAid application was designed as a self-monitoring tool for patients to reduce delay in seeking treatment. This study aimed to assess the feasibility and acceptability of a randomised controlled trial for DengueAid application.

Methods:
Patients with dengue were recruited from a public health clinic in Malaysia and randomised to either use the DengueAid application (intervention) on top of the standard care for dengue or receive just the standard care for dengue fever (control). The primary outcomes evaluated were the measures of feasibility and acceptability of (1) recruitment and follow-up procedures; (2) data collection procedures and clinical outcome measures; and (3) dengue self-monitoring intervention. Qualitative interviews were conducted for participants in the intervention arm at the end of the trial to assess the intervention's acceptability.

Results:
37 patients were recruited with 63% refusal and 89% retention rates. The recruitment and follow-up processes were acceptable with more success using direct face-to-face recruitment than via phone recruitment. The application's built-in collection form was not helpful for collecting relevant clinical outcome data, necessitating phone calls and tracing of electronic medical records to obtain clinical outcome measures. The DengueAid application was acceptable to the participants, but preliminary clinical outcomes and qualitative data suggested that the application alone was inadequate to reduce treatment delay in dengue.

Conclusion:
This study provided important insights into improving the recruitment process of participants and data collection methods. Further refinement of the dengue self-monitoring system is needed before a full-scale randomised controlled trial can be considered.

This study compares behavioural intentions and self-reported use of telemedicine after the COVID-19 pandemic among Swedish and English General Practitioners (GPs).
GPs' data were collected using the Physician Attitudes and Intentions to use Telemedicine questionnaire (PAIT), with 7-point Likert scale items ranging from ”Strongly disagree” to ”Strongly agree”. PAIT was developed in 2019 in Sweden by the authors and is now being validated in the UK. It is based on the “Theory of Planned Behaviour” that predicts intentions to use telemedicine by examining three predictors: Attitudes, Subjective Norms, and Perceived Behavioural Control.

In this preliminary comparative study, the 53 English GPs had more working experience, with 40% having 30 years or more experience compared with 8% of 101 Swedish GPs.

Intentions to use telemedicine were lower in English GPs (English 3.7, SD 1.6) than Swedish (4.8, SD 1.7; P<0.001). Self-reported use of text communication was higher for English GPs (median 2 of a 7-point scale ranging from ”Not at all” to ”A lot” vs median 1 for Swedish GPs, P<0.01). The use of video and chronic disease monitoring was similarly low in both countries (medians 2 vs 2, 2 vs 1, respectively in both countries using an identical scale, both P-values >0.7).

Linear regression analyses showed that, for GPs in both countries, Attitudes and Perceived Behavioural Control had a statistically significant effect on Intentions to use telemedicine. Attitudes was the strongest predictor for the English GPs whilst Perceived Behavioural Control was the strongest predictor in Sweden. Subjective Norms had no statistically significant predictive effect on Intentions in either country.

These findings provide insights into the similarities and disparities between English and Swedish GPs' behavioural intentions and the self-reported use of telemedicine. These contribute to our understanding of the adoption of telemedicine in primary care.

Background: The Australian Healthcare System is experiencing an unprecedented shift in the system-level model of care used to treat people with non-life-threatening urgent conditions. In 2022, the Australian Government committed to 58 general practice (GP) based Urgent Care Clinics (UCCs) with most state governments providing additional investment in GP-based UCCs. Given the current context of emergency department (ED) overcrowding, ambulance ramping and an emerging system of urgent care, it is important to better understand how patient referrals to GPs and UCCs occur. Compared to Australia, New Zealand (NZ) has been practicing triage from Emergency ED to GPs and UCCs for a longer time. This project reviewed one service enabling triage from ED to GPs and UCCs in NZ with seven years of data. The cloud-based digital platform has transferred over 133,000 low acuity presentations from 7 EDs to 18 GPs and UCCs.

Aim: A retrospective descriptive study evaluated triage from ED to GPs and UCCs to identify demographic and presenting condition data.

Content: De-identified medical records of patient presentations triaged from EDs to 18 GPs and UCCs were evaluated. Data include independent (predictor) variable data such as time, day, month and year of presentation, type of clinic diverted to, sex, age in years, number of postcodes from the ED, general practice, and ED, and presenting symptoms. Dependant data were on-referral to ED or discharge to home.

Goals: The study offers analysis of the client group presenting to NZ EDs that can be served by GPs and UCCs. The study will inform policy and decision making for patients triaged from EDs to GPs and UCCs.