The Use of Helplines and Telehealth Support in Aotearoa/New Zealand During COVID-19 Pandemic Control Measures: A Mixed-Methods Study

BACKGROUND

Early evidence suggests that the COVID-19 pandemic and associated interventions have affected mental well-being and associated health service use.

AIMS

the aim of this study was to examine the effect of the COVID-19 pandemic and associated public health measures on helpline and telehealth service demand.

METHODS

the study utilized a mixed methods research design. Segmented regression analyses were used first to identify changes in patterns of demand for Aotearoa/New Zealand national helplines (n = 11) from January 2020 until the end of March 2021. Thematic analysis of 23 in-depth interviews was used next to explore the reasons behind the quantitative findings from the perspective of various organizational stakeholders.

RESULTS

the data from 1,244,293 Aotearoa/New Zealand national helplines' contacts between January 2020 and March 2021 showed a non-significant (1.4%) upward trend for the full range of observations. Throughout this period, a peak and trough pattern was observed. Significant demand increases were observed in anticipation of containment measures (12.4% increase from January to March 2020) and significant demand decreases coincided with relaxation of restrictions (6.9% decrease from April to June 2020). There were spikes in demand during public health interventions (i.e., mental health promotion, introduction of new helpline services) and regional lockdowns, but these did not result in significant changes in trends. In general, the demand for helplines stabilized at a new higher level. Most of the contacts occurred by telephone calls. Contacts by other methods (webchat, text, email) have shown higher uptake during the periods of lockdowns. Quantitative-qualitative data triangulation showed that youth and populations who were disproportionally negatively affected by unstable economic conditions and underemployment made more frequent contacts. Providers emphasized that increased demand could be viewed positively as a successful outcome of public health messaging; however, greater capacity is needed to better serve higher demand.

CONCLUSIONS

COVID-19, related interventions, and measures of control were associated with an increase in contacts to helplines. However, the extent of the demand increases was lower than observed internationally. Moreover, in Aotearoa/New Zealand the reasons for increases in demand were often beyond the COVID-19 pandemic and measures of control.

COVID-19 related innovation in Aotearoa/New Zealand mental health helplines and telehealth providers - mapping solutions and discussing sustainability from the perspective of service providers

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic and associated interventions resulted in changes in both the demand and supply of mental health services and necessitated agile adaptation and innovation from service providers.

AIMS

The aim of this study was to explore what innovative solutions were adopted in response to COVID-19 and the pandemic control measures, what opportunities and challenges were associated with these innovations, as well as to critically reflect on the longer-term sustainability of the innovations in the context of Aotearoa/New Zealand mental healthcare.

MATERIALS AND METHODS

We used thematic analysis to analyse the data from the 23 in-depth interviews with helpline employees and general practitioners from 18 service providers that regularly engage in mental healthcare.

RESULTS

Two key themes related to COVID-19 and the pandemic control measures were identified from respondents' accounts. These were "Technological innovations" and "Process innovations" where providers noted types of innovative solutions, and opportunities and challenges associated with those. The themes culminated in a meta theme "Sustainability of changes to service delivery" that appeared consistently in each theme and asks to consider how sustainable these innovative solutions might be in the long-term. Namely, sustainability of innovation was questioned in respect to the (a) innovative solutions being the emergency solutions with little or no impact analysis, (b) "returning back to normal" due to limited future funding and innovation as a sunk cost, and (c) sporadic and inconsistent innovation between service providers that does not contribute to quality and continuity of care from the systems perspective.

CONCLUSION

COVID-19 and the measures of pandemic control were associated with an increase in innovative solutions from service providers. There were both opportunities and challenges associated with these innovative efforts and the sustainability of innovation was questioned. Future research about COVID-19 related innovation of service provision should focus on service user experiences and empirically measure the innovation safety and efficacy.

Protocol for a randomised controlled trial to evaluate the effectiveness of the diabetes community exercise and education programme (DCEP) for long-term management of diabetes

INTRODUCTION

Type 2 diabetes is common in Māori and Pacific peoples and in those living in areas of high socioeconomic deprivation in New Zealand (NZ). People with type 2 diabetes often have multimorbidity, which makes their diabetes management more complex. The Diabetes Community Exercise and Education Programme (DCEP) is an interprofessional, patient-centred, whānau (family)-supported package of care specifically developed to engage with Māori and Pacific people and those living in deprived areas. We have previously demonstrated the feasibility and acceptability of the DCEP. This study aims to determine the effectiveness and cost-effectiveness of the DCEP through a pragmatic randomised controlled trial (RCT).

METHODS AND ANALYSIS

220 adults (age ≥35 years) with type 2 diabetes will be recruited from general practices in the lower South Island of NZ (Dunedin and Invercargill) to participate in an RCT. Participants will be randomised to intervention (DCEP) and control (usual care) groups. The DCEP participants will have their exercise goals agreed on with a physiotherapist and nurse and will attend two 90 min exercise and education sessions per week for 12 weeks. The primary outcome measure is blood glucose control (glycated haemoglobin). Secondary outcome measures include quality of life assessed using the Audit of Diabetes-Dependent Quality of Life questionnaire. Data will be collected at four time points: baseline, end of the 12-week intervention (3 months), 6 months postintervention (9 months) and 12 months after the intervention ends (15 months). We will also conduct a cost-effectiveness analysis and a qualitative process evaluation.

ETHICS AND DISSEMINATION

The study has been approved by the Health and Disability Ethics Committee, Ministry of Health (HDEC17/CEN/241/AM01). A key output will be the development of an evidence-based training package to facilitate implementation of the DCEP in other NZ regions.

TRIAL REGISTRATION NUMBER

ACTRN 12617001624370 p; Pre-results.

A rapid monoclonal antibody blood theophylline assay; lack of cross-reactivity with enprofylline

We evaluated a rapid monoclonal antibody theophylline assay for two reasons: (a) to determine its specificity with respect to the possible confounding influence of a structurally related xanthine, enprofylline, and (b) to assess its accuracy relative to high-performance liquid chromatography (HPLC). Blood samples were taken from 233 patients who had been randomized in double-blind fashion to receive either oral theophylline (n = 117) or enprofylline (n = 116) for the treatment of chronic reversible obstructive airways disease. Monoclonal antibody assays (MAAs) were performed in 10 clinical sites by 10 trained paramedical technicians. Three patients, who actually received enprofylline but not theophylline, had MAA theophylline values of > or = 3.2 micrograms/ml, giving a specificity of 97%. HPLC determination of simultaneous blood samples confirmed that theophylline levels were in fact < 3.2 micrograms/ml and that theophylline was not being taken surreptitiously. Good correlation was observed between MAA and HPLC in patients taking theophylline (y = 1.07 x + 0.36; r = 0.93; standard error of the estimate (SEE) = 1.93). However, there was wide variability from technician to technician such that r values for individual sites ranged from 0.67 to 0.99. Based on the overall correlation, the prediction of an individual HPLC value from an individual MAA value had broad 95% confidence limits: when the MAA value was 10 micrograms/ml, the predicted HPLC value was 9.19 +/- 3.32; when MAA = 15 micrograms/ml; HPLC = 13.19 +/- 3.33; and when MAA = 20 micrograms/ml; HPLC = 17.19 +/- 3.36.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of protease inhibitors on skeletal muscle lysosomal enzyme activity and resting membrane potential

Inhibition of lysosomal enzyme activity by protease inhibitors in denervated muscle was studied in vitro by incubating muscle homogenates with increasing concentrations of inhibitor and determining acid protease activity. Pepstatin was the most potent inhibitor of protease activity, followed in order of inhibitor potency by chloroquine, aprotinin, and leupeptin. The in vivo uptake of chloroquine or leupeptin by denervated muscle was greater than that of innervated muscle, and repeated administration of the drug led to a decrease in muscle N-acetylglucosaminidase activity. Repeated administration of chloroquine had no effect on resting membrane potential of muscle fibers in the soleus or extensor digitorum longus measured in vivo. Chloroquine attenuated the marked decrease in the resting membrane potential of the extensor 2.5 days after denervation, but had no effect on that of the denervated soleus. Possible involvement of proteases in lowering the membrane potential of denervated muscle is discussed.

Neurotoxicity of Adriamycin and misonidazole in the mouse

The neurotoxicity of the anticancer drug adriamycin was investigated in the peripheral nerve of the mouse. Injection of adriamycin into the sciatic nerve resulted in biochemical and morphologic signs of severe axonal degeneration. The biochemical evidence was based on marked increases in lysosomal enzyme activity. Acid protease and N-acetylglucosaminidase remained elevated for more than 70 days after injecting the drug. In contrast, local injection of the radiation-sensitizing drug misonidazole into the peripheral nerve failed to increase lysosomal enzyme activity.

Toxin-induced activation of muscle hydrolases

Application of batrachotoxin, lysolecithin, tetrodotoxin, or veratridine to mouse skeletal muscle results in an increase in the activity of the following lysosomal enzymes: acid protease, acid phosphatase, and N-acetylglucosarninidase. Batrachotoxin caused the greatest increase in lysosomal enzymes while veratridine resulted in the smallest response. The increase in lysosomal enzymes was most marked within 1–2 days after toxin application and returned to normal values after 8–12 days.

Peripheral nerve autografts increase soleus muscle hydrolase activity

A peripheral nerve autograft placed on the surface of a normally innervated muscle has been shown to induce acetylcholine hypersensitivity and myofibrillar degeneration. Using a similar preparation, we determined the acid protease, alkaline protease, and N-acetylglucosaminidase activity in rat soleus muscle and the effect of protease inhibitors on these enzymes. Three days after nerve transplant, the muscle showed a significant increase in all three enzymes assayed. The protease inhibitors leupeptin and pepstatin totally prevented the nerve-induced increase in hydrolase activity. Our data suggest that muscle degeneration is secondary to an inflammatory response induced by the nerve.

Neurotoxin-induced hydrolase activity in peripheral nerve

The effect of neurotoxins which block axonal transport or impulse transmission was examined on sciatic nerve hydrolase activity. Subepineural injection of batrachotoxin (BTX) or colchicine resulted in a 4-9 fold increase in acid protease and N-acetylglucosaminidase activity with a smaller increase in acid phosphatase activity. The enzyme remained elevated for up to 48 days. Similar injections of tetrodotoxin (TTX) led to a relatively small increase in the activity of these enzymes which returned to normal values within two days. The prolonged increase in hydrolase activity produced by BTX and colchicine suggests that blockade of axonal transport may be mediated by nerve necrosis.