Virtual care in residential aged care and primary care settings: a systematic literature review using the SEIPS framework.

Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.

ABSTRACTIntroductionRestrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence‐based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes.MethodsThis pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi‐structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation.ConclusionThis study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care.Patient or Public ContributionA person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards.Trial RegistrationACTRN12624000044527.

Creative expression by people living with dementia and their families and carers can improve communication and relationships and strengthen relational personhood. The transition to residential aged care from living at home with dementia is a time of 'relocation stress", and a time when additional psychosocial supports like these might be particularly beneficial. This article reports on a qualitative study that explored how a co-operative filmmaking project functioned as a multifaceted psychosocial intervention, and explored its potential impacts on relocation stressors. Methods included interviews with people living with dementia who were involved in the filmmaking, and their families and close others. Staff from a local day centre and residential aged care home also took part in interviews, as did the filmmakers. The researchers also observed some of the filmmaking process. Reflexive thematic analysis techniques were used to generate three key themes in the data: Relationship building; Communicating agency, memento and heart; Being visible and inclusive. The findings reveal challenges regarding privacy and the ethics of public screenings, as well as the pragmatics of using short films as a communication tool in aged care settings. We conclude that filmmaking as a cooperative endeavour holds promise to mitigate relocation stressors by: improving family and other relationships during challenging times for family and for people living with dementia; providing opportunities for new self-narratives derived from relational subjectivities; supporting visibility and personhood; and improving communication once in residential aged care. This research has relevance for communities who are looking to support dynamic personhood and improve the care of people living with dementia.

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed.

Virtual care is increasingly used to improve access to primary care. However, the roles of primary care nurses (ie, nurse practitioners [NPs], registered nurses [RNs], licensed practical nurses [LPNs]) in virtual care delivery are not clearly defined. A better understanding of these roles can improve their integration and optimization in virtual primary care delivery and the availability and quality of virtual primary care. The purpose of this scoping review was to identify and map the international literature on nurses' roles in virtual care delivery in primary care. Following the Joanna Briggs Institute methodology, we searched academic databases for published literature and webpages for gray literature sources. We included studies that described the roles of nurses (NPs, RNs, LPNs) in providing virtual primary care. We excluded studies that focused on nurses' use of digital technologies without nurse-patient interaction. After screening potential sources, we included 34 sources from countries such as the United Kingdom, Canada, the United States, Australia, and Sweden. Most were specific to RNs (n = 12) or did not specify a regulatory designation (n = 12). Primary care nurse roles in virtual care were mostly related to care coordination, chronic disease management, and triage and assessment using various modalities (eg, telephone and video). Many factors influenced nurses' roles in virtual care, such as patient/nurse experiences, training/support, access to resources/equipment, and ethical/privacy concerns. Nurses are well-positioned to provide virtual care based on their diverse roles across primary care settings; however, their roles could be better optimized to improve primary care access and quality.

An Exploration of Pain Documentation for People Living with Dementia in Aged Care Services

IntroductionHealthcare assistants (HCAs) play a crucial role in the delivery of care and the well-being of older people living in aged residential care (ARC) facilities. In New Zealand (NZ) there are approximately 31,452 nursing support workers and personal care assistants working in nursing homes and in the community, with HCAs making up the majority of this workforce (Statistics New Zealand, 2013). Direct care in ARC is mainly provided by HCAs who are unregulated; a marginalized workforce, due to undervaluing of aged care services and low wages (McGregor, 2012). This aging, gendered and ethnically diverse workforce is expected to grow in response to the demands of the aging population (Kiata, Kerse, & Dixon, 2005; Ravenswood, Douglas, & Teo, 2014). There are concerns about recruitment and retention (Badkar, Callister, & Didham, 2009; Badkar & Manning, 2009; Grant Thornton New Zealand Limited, 2010; Ravenswood et al., 2014) but of equal concern is the landscape of care into which the HCA is recruited.Registered nurses (RNS) in aged care settings are responsible for the care delivered by HCAs and need to have an in-depth insight into the contemporary and evolving roles of HCAs, and the diverse challenges experienced by this workforce. Healthcare assistant responsibilities and workloads are expanding as they work with residents who have complex health conditions. Influential factors that shape the working environment of the NZ HCA were identified in a thorough review of the existing grey literature, current national policy, district health board (DHB) contract agreements and New Zealand Nursing Organization (NZNO) collective agreements. This article presents an overview of the role of HCAs in the current residential aged care environment. The authors argue that RNs need to be cognisant of the socio-political, economic and educational factors that influence HCA's ability to navigate the complexity of the aged care environment and the delivery of personcentred care in the New Zealand aged care context.Demand for aged caregivingThe demand for ARC is increasing, as are the associated costs for care and demands placed on the workforce. There were approximately 33,006 residents in aged care facilities for 2015-2016. This number is projected to increase to 40,619 for the period 2026-2027, and to 60,080 in 2031-2032 (Technical Advisory Services [TAS], n.d.-a). Currently there are 669 certified aged care facilities in NZ offering 38,742 beds (Ministry of Health [MOH], 2016a) with 90% overall occupancy rates for dedicated rest home beds, 88.8% occupancy for swing or dual beds which serve either rest home or hospital level care and 87.6% for specialist dementia beds (Kana, 2015). The DHB expenditure for the support of older people was $983 million with $590 million directed to ARC in 2016 (MOH, 2016b). The government weekly contribution for long term-residential care for individuals differs for each territorial district with the highest funding of $971.53 for Auckland City and the lowest $884.03 for Otorohanga, South Waikato, Buller, Grey, Waimate, Southland and Gore districts including Goods and Services Taxes (Chuach, 2016).The demand for ARC persists even with ageing-in-place initiatives aimed at reducing the need for rest home level care. The workforce that supports care in the home overlaps with the ARC workforce and shares similar issues. The 2002 Health of Older People Strategy (MOH, 2002) was created in response to ageing population projections and the need for a positive ageing strategy. Initiatives within the 2002 Health of Older People Strategy and the replacement Healthy Ageing Strategy (Associate Minister of Health, 2016) include improving community support so that older persons can stay in their homes longer and avoid costly ARC services. Care aimed to restore functional status is provided in the home or in the community by paid caregivers, delaying or preventing ARC admissions (Parsons et al. …

<h3>Context:</h3> The onset of COVID-19 and rapid response to public health restrictions prompted increased use of virtual care (VC). Prior to the pandemic there was low utilization of technology for communication and many primary care providers (PCPs) had little to no experience with VC. Thus, greater use of VC required adjustments to how health care was provided. Literature specific to VC has focused on communication modalities with lingering questions regarding how providers have been impacted. <h3>Objective:</h3> To explore virtual care (VC) adoption and use in Manitoba, Canada from the perspective of health care providers. <h3>Study Design and Analysis:</h3> Qualitative phenomenological approach using content analysis performed by two members of the team including a patient partner. <h3>Setting:</h3> Six focus group sessions conducted virtually. <h3>Population Studied:</h3> 21 primary care providers in Manitoba, Canada. <h3>Intervention/instrument:</h3> Exploration of experiences including benefits and challenges of VC, the impacts on provider workload, quality of care and clinic workflow, as well as recommendations for sustainable VC. <h3>Results:</h3> Options for VC visits were limited due to logistical and accessibility challenges faced by providers and patients. Telephone visits were most common. In some instances, VC was useful for screening and assessment; however, the lack of visual cues challenged the delivery of care. Respondents felt consults required in-depth history-taking and focused exploratory questioning, but also raised the concern of having to balance risk and ruling out more serious conditions. One provider referred to VC as “a great addition to the whole care package,” generally offering convenience and greater accessibility for some but limitations for others. Providers experienced more flexibility with their practice, which benefitted their well-being and evolved as providers developed individual strategies for the ‘right mix’ of virtual and in-person care. <h3>Conclusion:</h3> The perspectives gained from one of the key ‘user’ groups within the health care system will likely resonate with health care providers across Canada and beyond, who also were faced with implementing VC in a rapidly changing environment during the pandemic. Through the experiences of health care providers, we gain a better understanding of VC within clinical practice; where challenges need to be mitigated; and the recommendations for sustained quality VC beyond the pandemic era.

There is a clear need for food and nutrition research to lead to pragmatic and sustainable solutions to the ongoing problems in residential aged care, particularly within foodservices. The present study aimed to identify systemic challenges for residential aged care homes in Australia to participate in quality food and nutrition research, using a complexity science lens. Qualitative data from three studies in residential aged care were gathered, which included 28 participants across 21 aged care homes. Qualitative data consisted of in-depth interviews, field notes and email communications with aged care staff. Thematic analysis was undertaken using both inductive and deductive approaches. Four themes were identified: (1) complex staffing issues deter or impede participation in research; (2) external pressure on the aged care system leads to research not being a priority; (3) funding issues are variable and pose a barrier for some aged care homes; and (4) research processes and requirements can lead to biased samples. Several challenges to undertaking quality empirical research in residential aged care in Australia were identified. Research needs to be part of usual business, similar to hospitals, and operate independently of staffing and funding issues. Issues within foodservices are system issues and there is a need for quality empirical research to determine solutions.

Review question/objective The objective of this systematic review is to synthesize the best available evidence for the effectiveness of audit and feedback as a quality improvement strategy. More specifically, the objectives are to identify: 1. What characteristics contribute to an effective audit and feedback cycle in aged care. 2. Whether audit and feedback is an effective quality improvement strategy for improving health outcomes for older people in residential aged care facilities. 3. What the most effective feedback mechanisms as part of an audit and feedback cycle in implementing practice change are. Background Systematic reviews of the effectiveness of audit and feedback as a quality improvement strategy to improve practice and health care outcomes have been reported since 2000 with varying effects being identified.1 Traditionally, these reviews have examined medical practices and the acute health care sector. The most recent systematic review - conducted in 2012 - on audit and feedback outlined that this process has been widely used as a quality improvement tool and concluded that the implication for practice “generally leads to small but potentially important improvements in professional practice”.2(p.2) It also concluded that “the effectiveness of feedback seems to depend on baseline performance and how feedback is provided”.2(p.2) This review only included randomized controlled trials, the participants were healthcare professionals including physicians, pharmacists and nurses responsible for patient care and it included both inpatient and outpatient settings.2 Audit and feedback and clinical audit appear to be used interchangeably in the literature. In the United Kingdom a clinical audit was seen as one approach to improving the quality of patient care and was introduce in the 1990s. One article defined clinical audit as: ‘the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient’ or “audit is the process of reviewing the delivery of care to identify deficiencies so that they may be remedied”.1(p.24) PubMed defines clinical audit as ‘a detailed review and evaluation of selected clinical records by qualified professional personnel to improve the quality of patient care and outcome’. Interestingly there was no definition on PubMed for audit and feedback. Audit and feedback was defined in a systematic review in 2006 as “the provision of any summary of clinical performance over a specified period of time”.3 However, Pearson et al. 2007 provide a clearer description of clinical audit describing it as a tool that addresses all components of clinical effectiveness where health professionals examine their care practices against clinical guidelines or best practice statements. Pearson et al also explain that clinical effectiveness includes “best-practice activities such as systematic reviews, clinical guidelines and clinical audit”.4(p.134) The authors describe the clinical audit and feedback process as a method of promoting evidence utilization and how it can be utilized an “internal mechanism for health professionals to use for quality improvement”.4(p.138) However, an initial search of various databases indicated that the term clinical audit is not commonly used in studies involving residential aged care facilities and more often the term audit and feedback is used. Therefore this review will include both audit and feedback, and clinical audit, in its search strategy focusing on implementation of evidence-based practice. A literature review conducted in 2009, identified eight factors that might influence the implementation (utilization) of evidence-based practice in aged care in Australia.5 These included: “a receptive context for change; having a model of change to guide implementation; adequate resources; staff with the necessary skills; stakeholder engagement, participation and commitment; the nature of the change in practice; systems in place to support the use of evidence; and demonstrable benefits of the change”.5 Whilst this review did not specifically look at audit and feedback the underlying assumption was that ‘evidence-based practice is about taking something new (the evidence) from one domain (research) and implementing it in another domain (practice), which describes a process used in clinical audit.5 Ives et al also stated: “in an audit and feedback process, an individual's professional practice or performance is measured and then compared to professional standards or targets”.2(p.2) There is evidence to confirm that audit and feedback on its own or as part of a multifaceted change process can have some effect on health outcomes and practice change.1 Implementation and utilization of evidence-based practice is a challenge for researchers, educators, policy makers and health practitioners. A review that can provide evidence that the audit and feedback cycle, when used as a quality improvement strategy, can impact on clinical outcomes for a high risk population with co-morbidities, is warranted. This is supported by Masso's literature review that outlines the Encouraging Best Practice in Residential Aged Care (EBPRAC) program, funded by the Australian Government, which was introduced in 2007 to implement evidence-based practice in residential aged care facilities.5 The program involved 13 projects working with facilities in 108 locations across six states.5 The impact of this project is outlined in the Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report (2011) which states “collectively, the projects had a positive impact on residents, staff and facilities, with considerable variation between individual projects, and within each project”.6(p.97) Changes to the care received by residents were diverse. Many of the changes built on work that had been done previously in participating facilities and were relatively small scale and incremental in nature. In part this reflects the focus of the program and the available evidence. It is also indicative of the capacity of the sector to change; however this is dependent on the availability of resources, including the knowledge and skills of staff, the nature of daily work and the influence that a wide range of factors that are largely outside the control of those trying to bring about change can have e.g. turnover of facility managers which had a significant impact on some facilities and some projects.6 This report and the literature review by Masso et al. both confirm that aged care as a profession is willing to change depending on a number of variables as outlined in both papers.5,6 A total of $12,918,238 in Commonwealth funding was allocated to round one and two of this project.6 In 2010, EBPRAC was expanded to include community aged care that consequently resulted in the name being change to: ‘Encouraging Better Practice in Aged Care’ (EBPAC) program. In the 2011-2012 Australian federal budget, the EBPAC initiative was incorporated into the Aged Care Services Improvement and Healthy Ageing Grants Fund. This confirms that implementing better practice in aged care is still on the political agenda and funding is being made available. The Aged Care Standards and Accreditation Agency (previously the auditing body for aged care in Australia) has facilitated the “Better Practice” in aged care award annually. The criteria for an award were as follows: Is the program based on the findings of research/feedback? Has the program's effectiveness been measured and monitored? Is the program focused on achieving better outcomes for the residents? Does the program demonstrate evolving and improving, finding the best way of doing things? How does it link with the residential aged care home's continuous improvement system? This demonstrates that implementing better practice is being supported by funding and auditing bodies nationally in Australia. A systematic review of audit and feedback as an evidence-based quality improvement strategy is essential to provide the aged care industry (including policy makers, educators, medical professionals, allied health and nursing professionals, care staff, residents, families and consumers) with a review of the effectiveness of this process in improving health outcomes and the implementation of evidence-based practice. A study using a cross-sectional post feedback survey, conducted in Canada and published in 2013, examined unregulated care provider's perceptions of audit and feedback reports.7 This report concluded that “unregulated care providers can understand and feel positively about using audit with feedback reports to make changes to resident care”.7(p.1) This report recommended “further research should explore ways to promote fuller engagement of unregulated care providers in decision-making to improve quality of care in long-term care settings”.7(p.1) A search of the Cochrane Library identified 36 systematic reviews on audit and feedback and confirmed that only one of these related to aged care and had reviewed the prevention of the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people.8 This search also identified 63 systematic reviews on clinical audit and there were no systematic reviews relevant to residential aged care. A search of the Joanna Briggs Institute Database of Systematic Reviews and Implementation Studies also revealed no systematic reviews or protocols had been conducted on this topic. The most recent systematic review in the Cochrane Library by Ives et al confirms that audit and feedback is effective, however it will “continue to be unreliable approach to quality improvement until we learn how and when it works best”.2(p.5) The lack of literature on audit and feedback and/or clinical audit in aged care suggests that the healthcare sector needs more information on how useful this tool could be as a quality improvement strategy to improve outcomes for residents in their care. Notwithstanding this, there are studies that have used audit and feedback as a change process in aged care some of which are randomized controlled trials. A review of these studies may provide the necessary evidence to increase the uptake of audit and feedback as a quality improvement strategy that may support the implementation and utilization of evidence-based practice. This is a quantitative systematic review as it seeks to establish the effectiveness of audit and feedback as a quality improvement strategy. While it is acknowledged that qualitative data may inform this review, it is not within the proposed scope of this review. Whilst this protocol has predominately reflected on the Australian aged care sector, to obtain enough studies to be included in this review, evidence will be sought globally. It is hope that the lessons learnt internationally will be transferable to the local context as the review is focusing on evidence-based practice and not local legislative requirements.

<h3>Context:</h3> The COVID-19 pandemic spurred the rapid implementation of virtual care – which can include video visits, telephone calls, remote monitoring, and asynchronous services – within primary care settings. Little is known about how virtual care will transform primary care delivery beyond the pandemic. <h3>Objective:</h3> Characterize future roles for virtual primary care. <h3>Study Design:</h3> Qualitative study using interviews with health care administrators. <h3>Setting:</h3> National sample of health care systems and primary care practices. <h3>Population studied:</h3> Administrators at 17 diverse health care systems and primary care practices. <h3>Outcome Measures:</h3> Future plans for virtual primary care. <h3>Results:</h3> Administrators discussed three broad areas for the future of virtual primary care. <h3>Optimizing services:</h3> Administrators realized that many medical services were appropriate for virtual primary care including care of some acute and chronic conditions as well as preventive health. For example, e-visits (where patients complete questionnaires and clinicians respond electronically) enable primary care teams to address common issues, such as urinary tract infections, in ways that reduce effort for both clinicians and patients. Several administrators thought that behavioral health visits are ideal for virtual primary care. <h3>Care coordination:</h3> Administrators were considering how virtual care can enhance coordination between primary care and specialists. For example, one primary care clinician reported attending specialist visits with patients. Other administrators described use virtual care for chronic care management and follow-up processes. <h3>Engaging patients:</h3> Administrators reported that virtual care could engage new patients and sustain existing relationships. Administrators hoped that virtual care would engage younger, healthier patients in preventive care. They also considered the Medicare Annual Wellness Visit as ideal for virtual visits, in part, because they enable clinicians to assess risks within the home. <h3>Barriers:</h3> Administrators expressed concerns about virtual care reimbursement and external competition. Sustained pay parity between virtual and in-person visits is needed to ensure financial viability of virtual care. Some worried how virtual care services provided by payers and technology companies could impact their revenue. <h3>Conclusions:</h3> Administrators are actively exploring ways to improve virtual primary care services.

Objectives: This study examined knowledge of late-life depression among staff working in residential and community aged care settings, as well as their previous training in caring for older people with depression. Method: A sample of 320 aged care staff (mean age = 42 years) completed a survey questionnaire. Participants included direct care staff, registered nurses and Care Managers from nursing and residential homes and community aged care services. Results: Less than half of the participating aged care staff had received any training in depression, with particularly low rates in residential care. Although aware of the importance of engaging with depressed care recipients and demonstrating moderate knowledge of the symptoms of depression, a substantial proportion of staff members saw depression as a natural consequence of bereavement, aging or relocation to aged care. Conclusion: Experience in aged care appears to be insufficient for staff to develop high levels of knowledge of depression. Specific training in depression is recommended for staff working in aged care settings in order to improve the detection and management of late-life depression, particularly among direct carers, who demonstrated least knowledge of this common disorder.

This study aims to identify the benefits of using electronic health records (EHR) for client safety in residential aged care (RAC) homes. The aged care accreditation reports published between 27 April 2011 and 3 December 2013 were downloaded and analysed. It could be seen from these reports that only 1,031(37.45%) RAC homes in Australia had adopted an EHR system by 2013. 13 RAC homes failed one or more accreditation standards. Only one of these was using an EHR system and this one met the accreditation standards on information systems. Our study provides empirical evidence to suggest that adopting and using EHR can be one of the effective organisational mechanisms to meeting accreditation standards in RAC homes.

During the COVID-19 pandemic, primary care providers (PCPs), nurses, and integrated mental health specialists continued to collaboratively manage depression among patients using both in-person and virtual (i.e., hybrid) modalities. Few studies have characterized how hybrid services are currently delivered within interdisciplinary primary care teams. This study aimed to understand frontline PCPs' perspectives on providing hybrid virtual and in-person depression care during the pandemic. From September to November 2020, 12 semistructured individual interviews focused on depression management were conducted with PCPs in two Veterans Health Administration (VA) clinics in Los Angeles, which resumed in-person services while balancing rising COVID-19 cases. Interviews were audio-recorded, transcribed, and coded for depression management patterns. Themes were derived using a team-based constant comparative analytic approach. The pandemic and subsequent expanded use of virtual care necessitated clinic adaptations to depression assessments and procedures. PCPs perceived increased depression and anxiety among patients with existing psychiatric conditions, attributed to social distancing and isolation restrictions. They expressed acceptance of virtual care modalities for patients' depression management. PCPs did not perceive a delay in mental health care delivery in the shift to virtual care but noted the possibility of patients being lost to follow-up. During the pandemic, there has been heightened PCP concern for patients' emotional well-being and adaptations of clinic processes to meet needs for depression care. While PCPs were optimistic about new virtual care options for depression management, virtual care transfers remained poorly defined and the extent to which patient care experiences and health outcomes have been disrupted remains unknown. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The COVID-19 pandemic elucidated the importance of infection prevention and control (IPC) in residential aged care homes (RACHs), both on the health and wellbeing of its residents, and the staff and clinicians who care for them. While considerable efforts have been made in Australia to improve IPC both during and in the aftermath of the COVID-19 pandemic, many of these resources remain reliant on evidence originating from hospitals and acute healthcare settings. This research aims to establish the core minimum components that will populate standards for IPC programs and governance (Stream A) and for professional practice and competencies (Stream B) in RACHs. This research will be completed using a sequential three-phase design. In Phase 1, two integrative literature reviews will be completed to synthesise the elements of current global IPC programs and professional competencies in RACHs. In Phase 2, a qualitative analysis of IPC programs and professional practice in Australian RACHs using a combination of surveys and interviews will be completed. Finally, in Phase 3, an e-Delphi will be conducted to collate expert opinion and generate consensus on the minimum components of the IPC program and professionals who administer them in RACHs. The final standards and resources will be collaboratively designed with aged care partners, industry leaders, professional bodies and key Australian health policymakers. These standards seek to empower IPC and aged care staff, not only by ensuring that they are well-equipped with the knowledge and skills to implement effective IPC programs themselves, but also that the organisation is adequately prepared to provide the resources and governance systems.