Centaine L. Snoswell

Background: Women who experience gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy (HDP) face a significantly elevated risk of developing chronic diseases, including Type 2 diabetes and cardiovascular disease (CVD). The postpartum period of 3–6 months represents a unique opportunity for targeted risk reduction; yet engagement with follow‐up care is often low due to systemic and personal barriers. Aim: This study aimed to adapt and implement a dedicated women‐focused, cardio‐metabolic risk reduction clinic at an Australian tertiary maternity hospital, modelled on the successful Canadian MotHERS program. We also aimed to describe the initial implementation and baseline characteristics of the attending high‐risk cohort. Methods: Using a Hybrid Type 2 design to test the clinical effectiveness and evaluate implementation processes, eligible women with GDM or HDP from the Mater Mothers' Hospitals (MMH) were invited for post‐pregnancy visits (3 and 9 months) that focused on risk screening and stratification and systematic connection to primary care. We report on their attendance and baseline clinical and lifestyle characteristics. Results: The clinic achieved a high initial reach, with 126 of 178 eligible women (70.8%) attending. The cohort demonstrated a high‐risk profile; mean BMI was 29.4 (6.3) kg/m ² , mean waist circumference was 99.7 (14.8) cm, and over 50% of the cohort had a ‘high’ lifetime cardiovascular risk score. Lifestyle and health screen data also revealed significant modifiable risks Conclusion: The implementation of the 4HER clinic successfully engaged a substantial proportion of women with medically complicated pregnancies who demonstrate an elevated baseline burden of cardio‐metabolic risk.

Background: Transition of care (TOC) is a high-risk period for medication errors as patients move between multiple health care professionals, settings, and changing medication regimens. Ineffective communication systems further increase the likelihood of medication harm and hospital readmission. A TOC service with tailored, patient-specific support may help reduce these risks. Cardiovascular medicines significantly contribute to medication harm, and patients recovering from acute myocardial infarction (AMI) or cardiothoracic surgery (CS) are vulnerable due to complex regimens and frequent medication changes. Pharmacists, as medication experts embedded within cardiology teams, are well positioned to support these high-risk patients, facilitate safer transitions from hospital to home, and provide coordinated postdischarge follow-up. Objective: This study aims to evaluate the impact of a pharmacist-led interdisciplinary TOC service on reducing medication harm for cardiology patients post-AMI or CS. Methods: The study will be conducted in two phases: phase 1—intervention development will combine scoping review findings with stakeholder input to design an evidence-based, cocreated, culturally relevant intervention, underpinned by implementation science. A risk prediction model will be developed and validated to identify AMI/CS patients at high risk of medication-related unplanned readmission within 30 days. Phase 2: the RECARD (Reduce Hospital Readmissions for High-Risk Cardiology Patients) trial will use a pre-post design across 3 Australian tertiary hospitals (2 metropolitan and 1 regional) to compare a retrospective usual care patient cohort (referred to as “pre”) with a different prospective patient cohort (referred to as “post”) that includes both usual care and intervention AMI/CS patients receiving the TOC service. Only high-risk poststudy patients will receive the intervention TOC service, consisting of an individualized bundle of TOC activities to optimize medication management, while the remaining poststudy patients will receive usual care. A unique feature of the service is its capacity for hospital clinicians to conduct postdischarge home visits for patients needing additional support. The primary outcome for this study is medication-related 30-day hospital readmission. The analysis will consist of multivariable logistic regression. An economic analysis will be conducted to evaluate the costs associated with the intervention and medication-related readmissions. A comprehensive process evaluation will be conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to enable learnings from the trial to inform sustainable improvements in this field. A patient survey will be administered at the end of the trial to assess patient experience and elicit patient preferences using a discrete choice experiment. Results: The predata are currently being collected for patients discharged from the 3 hospital sites during the 12-month prestudy period. The postdata intervention began on December 10, 2025. As of May 27, 2026, a total of 343 patients have been recruited at the 3 study sites. Conclusions: The findings of this study will inform future implementation of a sustainable cardiac TOC model within the Australian health care setting.

Artificial intelligence (AI) chatbots are being increasingly used for mental health support, information, and care. They have the potential to provide accessible support to people with mental health conditions who otherwise may not be able to access traditional forms of care. However, there are risks associated with chatbot use that can put users at risk of worsening mental health and harm. This chapter discusses how AI chatbots are being used in mental health, their effectiveness as an intervention for symptoms of anxiety, depression, and loneliness, as well as the potential for harm and recommendations for safe use for those seeking to use chatbots for mental health support.

Objective: This research aimed to explore healthcare professional (HCP) students’: dementia knowledge; perceptions of older adults’ digital literacy, and perceived usefulness of digital health interventions for people living with dementia and their caregivers. Methods: Semi-structured interviews were conducted to explore HCP student perceptions of cognitive ageing and their understandings of the relationship between technology and healthcare practice. Researchers also explored student knowledge of dementia and their contemporary education experiences. Results: Findings revealed a lack of formal education regarding the use of technology in cognitive care associated with ageing populations. Students also reported limited experience with the use of technology in care. However, there was a positive response to the future possibility of introducing technologies into healthcare practice. Conclusions: Considering prevalence of dementia globally, we should increase knowledge of dementia and associated digital health support, so that future HCPs can make informed choices regarding utility and effectiveness of digital tools.

Introduction: Telehealth in Residential Aged Care Homes (RACHs) is recommended to improve access to specialist health services. Successful telehealth adoption depends on reliable technical infrastructure, a skilled workforce, and revised models of care. This study aimed to evaluate the impact of a telehealth training program on RACH staff's knowledge and skills, telehealth uptake, related challenges and how to sustain its use. Method: A quasi-experimental design study. After delivering an onsite training program, we conducted t-tests with pre- and post-surveys, analysed feedback from training consultants, and performed follow-up interviews with RACH's senior managers. Results: From August 2023 to October 2024, 41 RACHs received onsite telehealth training, primarily attended by nurses (88%). Survey results showed significant improvements in perceived telehealth knowledge, skills and confidence. A key motivator for implementing telehealth was enabling family members to attend consultations, while the major barrier was transitioning external health providers from phone to video consultations. In followup data, senior staff reported increases in telehealth activity and staff's confidence in using it, but potential for more activity. They wanted ongoing support, particularly to improve external providers' capability and willingness to use telehealth, indicating sustained telehealth adoption requires more than just access to equipment and training in RACHs. Discussion: Telehealth training can be effective in increasing knowledge, skills and confidence to use telehealth in RACHs. However, RACHs need ongoing training and support, especially given workforce challenges and staff retention issues. Engaging all stakeholders, particularly external service providers is crucial to ensure that telehealth-supported models of care are well integrated within the broader health system.

Objectives: To examine the explanatory variables for consumers’ selection of either telephone consultation or video consultation for specific health conditions, using multinomial regression analysis conducted on a national survey dataset. Methods: A cross-sectional survey was conducted involving a sample of Australian adults who had used a telehealth service in 2021. An online sampling service by Qualtrics® enabled the recruitment of consumers that represented the Australian population in terms of gender, age, location (state or territory), and place of residence (urban or remote). Data collected included demographics, recent telehealth experience, and preferences for telephone or video consultation for different scenarios including varying time lengths and reasons for seeking a general practitioner. Results: A total of 1,069 consumers completed the survey. In-person consultations at a clinic were the top preference in all clinical scenarios presented, except when needing a prescription or to receive test results. In these cases, telephone consultation was preferred. General videoconferencing experience in day-to-day life increased the likelihood of consumers choosing video consultations over in-person clinic visits for their general practitioner appointments. In addition, consumers’ preferences for telephone consultations appear to be increased by internet connection issues and needing support to access technology. Conclusions: This paper revealed that there are a variety of reasons influencing consumer preferences for health care modalities. It also demonstrated that increased exposure to videoconferencing increased consumer preferences for video consultations, particularly when seeking advice for chronic conditions, and decreased their likelihood of choosing telephone over in-person appointments, and that consumers avoid video consultations when they are experiencing technological issues or when they need support. The results of this survey give valuable insights into consumer preferences for telehealth and factors that may influence telehealth uptake within our health system.

Background: This study aims to describe the change in telerehabilitation service volume and cost that resulted from the introduction of the Medicare Benefits Schedule (MBS) item numbers in response to COVID-19 in 2020 for physiotherapy services provided in Australia from January 2017 to December 2024. Methods: MBS activity and cost data for physiotherapy services between January 2017 and September 2024 were extracted from the Services Australia statistics website. Fourteen item numbers were used for the extraction. Data were grouped by delivery mode (in-person, telephone, or videoconference), and reported according to these groups. Results: Telerehabilitation services for physiotherapy were not funded by the MBS until March 2020. Despite the pandemic and national lockdowns, telerehabilitation physiotherapy only accounted for a small percentage of MBS physiotherapy consultations, peaking at 1.84% in Q2 2020 and fluctuating between 0.36% and 0.79% per quarter after that. Telephone consultations were used about twice as often as video consultations from 2020 to 2023, but usage became similar in 2024. Medicare reimbursement costs reflected these trends, with telerehabilitation accounting for an average of 1% of the total costs, peaking during the pandemic. Physiotherapy had the lowest telerehabilitation usage compared to other specialties, such as mental health and GPs. Conclusions: Although the delivery of MBS-funded telerehabilitation physiotherapy services was initiated during the pandemic, its overall uptake was minimal and accounted for less than 2% of total MBS-eligible consultations during 2020–2024.

BACKGROUND Globally, there is a high prevalence of mental health conditions, but access to timely and appropriate care is limited by accessibility, stigma, wait times, and worker shortages. Artificial intelligence (AI) chatbots are an emerging technology offering an alternative to traditional forms of mental health support. OBJECTIVE The aim of this paper is to assess the effectiveness of AI chatbot interventions in reducing symptoms of anxiety and depression, and feelings of loneliness. METHODS PubMed, CINAHL and Embase databases were searched in April 2025 for studies published in peer-reviewed journals in English language since 2022. The search strategy included terms for mental health and AI. Eligible studies included a text-based synchronous AI chatbot as the main intervention for participant screening, diagnosis, or treating symptoms of anxiety or depression, or feelings of loneliness. Additionally, studies needed to: use a validated psychometric scale to measure effectiveness; include participants aged 16 years and over; and have a focus other than prenatal or perinatal mental health. Screening and selection were conducted by two of the authors. Eligibility disagreements were resolved by a third author. Data extraction was performed by one author and checked for data integrity by a second author. Meta-analyses of mean changes were performed for studies reporting results using the same psychometric scale, study method, and comparators. The primary outcomes were results of validated psychometric scales measuring symptoms of anxiety or depression, or feelings of loneliness. Results were compared at baseline and post-intervention. Study details and demographics were also reported. RESULTS Thirty studies met eligibility criteria and were included for review. Statistically significant improvement was found in 67% of studies measuring depression and 56% of studies measuring anxiety, but only 25% of studies measuring loneliness. There was a small mean reduction in symptoms for all conditions but these are not considered clinically significant. CONCLUSIONS When measured using psychometric scales, AI chatbots may be effective in reducing anxiety and depression symptoms in some cases, and have the potential to be used in conjunction with other forms of mental health care for these conditions. They are less effective in reducing feelings of loneliness. According to present findings, chatbots are not consistently effective enough to be recommended as a stand-alone intervention for symptoms of anxiety and depression, or feelings of loneliness. CLINICALTRIAL PROSPERO ID: CRD420250651616